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Workers' Compensation Claims

Focused on helping people get back to health and normal activities.

Higher claim costs are typically the result of delays in an injured employee returning to work. Our claims management model is focused on getting people back to health and normal activities. 

 

We identify high-risk claims with 98.5% accuracy*.

 

  • Proprietary ID15® model helps identify the behavioral and psychosocial factors in a person’s life that may keep them from a full recovery and could escalate the cost of a claim.
  • Technology and highly skilled nurses work together to help identify the underlying issues in the claim that could lead to more pain, addiction, delays in returning to work and ultimately higher claims costs. 

 

We have claims specialists, not generalists.

 

  • Compensability team specializes in the upfront investigation of high risk claims to determine if the injury is eligible for workers’ compensation benefits.
  • Medical-Only team specializes in claims that follow a more typical trajectory.
  • Focus15 team specializes in claims at high-risk for delayed recovery and higher claims cost. Our nurses are assigned to claims where intervention is needed to facilitate a treatment plan.
  • Resolution and Long-Term Claims teams specialize in claims involving litigation, lifetime disability and catastrophic injury.

 

We're focused on getting people back to health and productivity.

 

  • Treatment plans with a purpose are focused on a person’s capabilities, rather than the disability. 
  • Transitional light duty is a key focus for our nurses and on-staff physicians. 
  • Psychosocial and behavioral factors are managed by nurses who actively listen for key indicators for delayed recovery and pain perception issues.
  • Opioids are managed proactively to help reduce the chance of a person becoming addicted.  


Learn more about our proprietary ID15® model that helps predict which workers' compensation claims could be at higher risk for delayed recovery. 

 

See our value by the numbers

Our proactive claims management process helps to lower the overall cost of claims: 

  • 90% of our injured workers who are prescribed opioids are off of their prescription opioid drugs within 30 days.
  • Employees off work for 12 weeks only have a 50% chance of returning. See the stats
  • Our nurses help injured workers get restricted duty within 12 days.
  • We help get people back to work within 7 weeks (on average).
  • For every dollar spent on a claim, the indirect cost to the employer is $4.50. (OSHA)

Source: State Auto data unless otherwise indicated.

Average Claim Costs comparing State Auto to the Industry

Average claim cost data source: 

Average cost per claim derived from data extrapolated from NAIC (National Association of Insurance Commissioners) valued December 31, 2016:

- Total Cost (by accident year):

- Schedule P, Part 1D: Column 4, Loss Payments direct and assumed plus,

- Schedule P, Part 1D, Column 13, Losses unpaid, case base, direct and assumed plus,

- Schedule P, Part 1D: Column 15, Losses unpaid, bulk & IBNR, direct and assumed

- Total Claims with a payment:

- Schedule P, Part 5D, Section 1, Column 10, cumulative claims closed with a payment plus,

- Schedule P, Part 5D, Section 2, Column 10, number of claims outstanding at year end

 
*Based on independent RTW study.