CaseXpert® Data Drives Results

June 27th, 2018

Significant Cost Reductions in Injury Settlements

A great deal of attention is being paid to the potential for artificial intelligence and predictive analytics to help control costs in the property and casualty insurance industry. Every week, webinars, conferences, articles and more tout AI as the next promising technology that will lead insurance companies to a land of lowered costs and perfect knowledge. Insurance companies are investing real time and money in the hope that AI might offer a silver bullet to tackling rising costs, among other matters.

Like predictive analytics, AI requires high quality data as inputs to reliably forecast outcomes. However, in the domain of third party bodily injury claims, this is a challenge. Among other issues, much of the data collected by claims adjusters is entered in claim systems in the form of unstructured notes, which don’t lend themselves well to automated data extraction and analysis, absent significant data review and cleanup. Frequently, too, data that’s critical to understanding the value of a claim or its likely resolution are missing from the records. In the absence of readily accessible, high quality data, the cost-benefit value of AI for property and casualty insurance companies remains in question.

CaseXpert® is a cost-effective solution that solves the data problem for property and casualty insurers in the area of third party injury claims. Our software application helps insurers evaluate and resolve injury claims more accurately and for significantly less money, as the results below show.  CaseXpert® captures all information relevant to the value of an injury and its negotiated resolution in real-time and in a single location. Generally, the settlement reductions equate to a more than 10X return-on-investment. CaseXpert® also generates entirely new, highly structured data that provides incisive intelligence on group and individual employee performance in evaluating claims and negotiating their resolution, in addition to specific guidance on steps to take to improve performance.

Below is our update on customer performance using CaseXpert®, our innovative, ground-breaking software application for evaluating and resolving third party bodily injury claims. The takeaway? CaseXpert® delivers significant and sustainable expense reduction to claims organizations.

Below is a chart that shows actual settlement cost reductions achieved by eight CaseXpert® customers.

After customers started using CaseXpert®, negotiated settlement values across measured injury types dropped dramatically, ranging from 23% to 53% lower overall.  More specifically, claims adjusters successfully negotiated settlements with third party claimants (commonly represented by plaintiffs’ counsel) that resulted in submitted medical bills being significantly reduced, in the range of 13% to 45% less, and claimed pain and suffering values being reduced, in the range of 33% to 61% less.  For customers that either exclusively or additionally elect to use CaseXpert®’s shared responsibility module (commonly referred to as liability in the industry), the rate of application of comparative fault rose to as high as 46%.  While claims adjusters are expected to evaluate whether a claimant contributed to the cause of his or her claimed injury and, if found, reduce the total evaluated damages by the claimant’s share (percentage) of responsibility, in all reviews that we’ve conducted, we find that shared responsibility is infrequently or inconsistently applied.

All of the reporting and results are made possible by CaseXpert®’s data collection and reporting capabilities. Customers have never before had insights into their claims performance in the way that CaseXpert® does.  The data has enabled us to develop new metrics for evaluating performance at both the organizational and individual level.

The Casualty Equation

Often, claims organizations will seek to improve on a single facet of claims, such as controlling medical bills, only to find that expenses rise elsewhere, say, in pain and suffering.  CaseXpert® controls for this by managing and measuring all components of what we refer to as the “casualty equation” (above), that is, the statement that the value of an injury claim is equal to the sum of the damages (medical bills, pain and suffering, lost wages, etc.), multiplied by the percentage of fault of the insured.  This ensures that efforts successfully applied in one area of focus are not lost in another.

Some other observations on the above results:

Data Driven. CaseXpert® generates data that reveals how claims handlers use information from claim investigations in their evaluations and negotiations. It also provides pinpoint information to management on ways to improve performance. The quality of the data and the new metrics that CaseXpert® has enabled make CaseXpert® a next-generation tool for today’s claims organizations. CaseXpert®’s rich, highly structured data is also especially well-suited for AI and predictive analytics.

Consistent. Our customers represent a variety of insurance companies—auto, commercial, property, etc. The results shown are consistent across companies and are achievable at any organization that assesses and resolves personal injuries.

Fast. Results are measured as soon as cases are settled. There’s no need to wait for months to determine whether CaseXpert® is working.

Smarter. The results reported here are not about software alone. While CaseXpert® is intuitive and simple to use, what’s equally important is that, together with training that Casentric provides to claims handlers on how to effectively evaluate and negotiate injury claims, it forces more critical and balanced thinking on claims. CaseXpert® embodies the methodology we teach and the ongoing gathering of data that’s necessary for improvement.

Casentric is pleased to serve its customers’ needs and help improve their business of resolving bodily injury claims more accurately and for significantly less money.

Please take a look at other posts that may interest you:

Casentric’s Severity Point Index, a new measure we’ve developed to assess casualty organizations’ performance in negotiating injury settlements across a wide variety of injury types.

Our recently launched CaseXpert® Injury Support™, a new service that we offer to insurance companies to help their claims personnel evaluate medical records and other injury treatment information more accurately.

If you’re interested to learn more, we can be reached at 877.433.4141 or info@casentric.com.