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Claims Management for Lower Costs, Better Outcomes

Detailed investigations, claims team collaboration, and appropriate use of external resources help adjusters take a holistic view of each claim ensuring appropriate treatment and a swift return to work which drives down Workers’ Compensation premiums.

Gain the Benefits of Our Coordinated Claims Approach

Proactive claims handling with a focus on cost containment is critical in client satisfaction, acceptable loss ratios and building and maintaining long-lasting relationships. Prescient National’s winning strategies in loss reduction breeds results that surpass the industry year-over-year in claims costs. Our average claims cost is 52% lower than our competition. We achieve this through several fundamental programs.

Prescient National Explore

Prescient National’s staff of highly experienced claims representatives analyze the accident, injury and outside factors that could affect the outcome of the claim. This analysis helps to determine the compensability of the claim and create a plan of action that is unique to the injured worker’s characteristics which ensures a positive outcome.

Employer Engagement

Employers enjoy the relationship they build with their dedicated adjuster who are focused on establishing a true understanding of the client’s business. Adjusters promote collaborative thinking with the employer on each claim for excellent results.The employer’s dedicated Risk Manager will utilize data harvested by the adjuster to identify trends in the employer’s claim and help the employer improve their Workers’ Compensation program.

Adjusters work in small teams to encourage creativity and provide back-up for the dedicated adjuster, as needed. Additionally, in-person claims reviews are always available.

Prescient Protect

Nursing Analyst Program

Various health trends are driving the severity and costs of Workers’ Compensation claims, including the impact of “comorbidity” conditions in a society that is increasingly becoming unhealthier. Comorbidities include diabetes, hypertension, obesity, depression and anxiety, etc., and they play a significant role in the longer treatment times and increased costs seen in work-related injuries or illnesses.

Our Nurse Analyst program is designed to help claims adjusters who typically don’t have a medical background with the medical portion of the claims process. A Nurse Analyst is skilled at identifying comorbidities and other conditions that can impact the injured employee’s recovery, and help adjusters with the following:

Assisting with understanding complicated medical procedures and conditions and providing injury expertise
Completing Independent Medical Examination (IME) letters to assess the validity of the injury and relatedness to the incident
Drafting letters to physicians regarding overuse of therapies including medications and physical therapy
Aiding with physician selection
Forecasting likely complications and treatment

Opioid Abuse Program

Studies show that long-term use of high doses of opioids usually isn’t the best treatment for chronic pain, unless the patient is terminal. Using these drugs long term can actually increase a patient’s sensitivity to pain, requiring higher doses for the same level of pain relief. This escalating dosage pattern can contribute to opioid addiction, which can impact workplace safety and increase Workers’ Compensation costs. When injured workers are prescribed opioids, their total claim costs can be four to eight times those of similar claims where no opioids were prescribed, according to studies published by the NCCI. Using these medications can also delay return-to-work due to safety issues and drowsiness, which results in higher wage-loss benefits.

Our Nurse Analyst reviews all opioid prescriptions and works with treating physicians to limit the use before addiction becomes a problem.