WORKERS COMPENSATION CLAIMS MANAGEMENT SOFTWARE || BUILD OR BUY in 2021?

Updated: May 19

It is a fact that out of the entire data that is present in this world, about 90% of it has been produced in the last 2-3 years. And we have had digital data since the 20th Century. What it indicates is an exponential rise in the production of data in the last few years.

It implies that we now heavily rely on the internet to access that data. The Internet is where Cloud comes in and on cloud is where all great organizations and businesses thrive nowadays.

The insurance industry is no exception. As a result, it now uses software that helps it run its operations online with large amounts of data. And this brings us to our topic for today.

Where does software fit in the context of Workers’ Compensation? But before we get to discuss the workers compensation claims management software, we need to check some boxes.


Table of Contents

  1. - Introduction

  2. - Workers’ Compensation

  3. - Workers’ Compensation Claims

  4. - Workers’ Compensation Claims Adjuster

  5. - Workers’ Compensation Insurance

  6. - Workers’ Compensation Insurance, Florida

  7. - L&I

  8. - ISO

  9. - Claims Management Software

  10. - What Is Claims Management Software?

  11. - Buy or Build?

  12. - Workers Compensation Claims Management Software

  13. - Workers Compensation Claims Management Software, Pennsylvania

  14. - Feature of Workers Comp Claims Management Software

  15. -Tracking

  16. -Documentation

  17. -Management of Medical Things

  18. -Automation

  19. -Increase Productivity

  20. -Cost Management

  21. - List of Workers Comp Claims Management Software

  22. -Free Workers Comp Claims Management Software

  23. - FAQs

Introduction



Workers’ Compensation


The term, Workers’ Compensation, in itself, is enough to dish the dirt on its meaning. It is suggesting that there is some sort of compensation for the workers.

But what workers? And what compensation?

Both these words- workers and compensation- can be used in different contexts and as a result, they could mean something open to interpretation. But in this article, the term Workers’ Compensation, means something a lot more specific.

So, let us establish the context in which the two constituting terms have been used. Workers mean people who are employees on a payroll for a certain employer and Compensation means the replacement wages that they will receive.

But replacement wages for what?

The worker will get replacement wages for the time during which he is unable to come to work. And why he is unable to come to work will bring us to the Workers’ Compensation Claim.


Workers’ Compensation Claims


Let us consider a scenario in which the said worker has been severely injured or picked up an illness while he was at his workplace or during his duty hours. And this injury or illness is physically keeping him from coming to work anymore.

Under normal circumstances, if an employee is not coming to work then the employer has every right to deduct a portion of his wages but in this case, the employee is protected by his right to file a Workers’ Compensation Claim.

If an employee sustains an affliction while carrying out his employment duties and he is unable to come to his workplace anymore then he can still avail his wages by filing for a Workers’ Compensation Claim.

The workers’ compensation covers everything from wages and the cost of medical bills to disability and death benefits.


Workers’ Compensation Claims adjuster


He is the person who decides how much money a workers’ compensation claimant will receive as compensation for his liabilities due to his misfortunes while carrying out his employment duties or if he will receive it at all. He tries to put the best interests of the insurance company, the employer, and of course the employee in alignment.


Workers’ Compensation Insurance


Workers’ Compensation Insurance is the insurance that needs to be purchased by employers who run or operate a business with employees on their payroll. In most states, employers are obligated legally to purchase this insurance.

Workers’ Compensation Insurance is purchased so that the employer can cover the expenses that will occur when any Workers’ Compensation Claim gets filed. A Workers’ Compensation settlement can be very expensive for insurers and employers.


Workers’ Compensation Insurance, Florida

Florida is one of those states that requires most employers to purchase Workers’ Compensation Insurance. This gives the employees the ability to work with fearlessness and the employers, the immunity from any lawsuits from their injured employees.


L&I

The Washington State Department of Labor and Industries is an insurance for the employees working in Washington state that covers for their workplace injuries and occupational illness. It covers replacement wages, medical bills, any type of disability, rehabilitation, travel expenses, death benefits, loss of earning power, etc.

It can be individually purchased or your employer can have it purchased and a worker can file for L&I compensation in case he gets injured at work.

The most important difference is that, if someone is a worker in Washington state, then he is automatically covered by L&I, with some minor exceptions. You do not necessarily need to pay for this insurance. That is not the case with Workers’ Compensation. You or your employer needs to have a Workers’ Compensation Insurance to file for a Workers’ Compensation Claim.


Insurance Services Office (ISO)


The reason why Insurance Services Offices exist is so that they can collect and analyze data of insurance companies to provide them with an ISO report.

What is the need for an ISO report and why do insurance companies need it?

And the answer is quite simple – to avoid unnecessary financial losses.

The data in these ISO reports is an analysis of the raw data that they received from insurance companies. The data can include things like records of all the entities -individuals and organizations - that have purchased insurance from them, the financial statements of all the people that have claimed any insurance money from them, the reason for claiming the insurance money and of course the details of those people.

This data is further refined to produce results that help these insurance companies take effective cost control measures. The interpretation of this data helps them drive the costs associated with Workers’ Compensation Claims



Let’s say a person gets injured at his workplace and becomes involved in a Workers’ Compensation Claim. In this case, all the details about this person’s Workers’ Compensation Claims will be provided to an ISO. This data can then be used in the future by that insurance company if something similar happens again.

The ISO reports that the Insurance Services Offices provide to the insurance company is very important in cases of false Workers’ Compensation Claims. There have been instances in the past where people have committed multiple Workers’ Compensation Claims fraud multiple times and for years.

Now it has become a standard practice to take into consideration a claimant’s past Workers’ Compensation Claim record and detect and prevent these frauds. And you guessed it. The ISOs are the ones keeping track of the injury records of the injured workers.


Workers' Compensation Claims Management Software



As we know, the Insurance Security Offices collect the data from insurance companies and then they use that data to generate an ISO report. A pen and paper were all that was needed to collect and store data in the old days but in the last few years, things have changed exponentially.

Large amounts of data are generated each day and this data includes the data of the insurance companies as well. Pen and paper just aren’t enough anymore. Although we moved on to spreadsheets with the release of Microsoft Excel at the beginning of the millennium, even excel is considered outdated now.

In this day and age, we have software that can not only store and manipulate data but can also run that data through complex statistical algorithms and help us visualize this data. Today the focus is on time and space. Less time to get the results and low space to store the data. We simply cannot achieve that with electronic spreadsheets with these large amounts of data.

We can also not deny the importance of cloud storage. Data that was traditionally stored in physical hard drives are now being stored on cloud platforms. And most traditional software doesn’t even have the features to work with Cloud. Today the software itself is integrated with a feature to access cloud storage.


Buy or Build? What should you do?

The biggest dilemma that companies face after deciding to start using a claims management system software is whether they should buy an already existing software or whether they should build their claims management system software

And the answer is quite simple. The capital.

Claims management software can be really expensive and buying software will take a big chunk out of the company’s capital. The option of buying is not exactly budget-friendly in the beginning but it is a one-time investment and it pays off in the long run.

On the other hand, companies can build their software. That does not mean building one from scratch. It means replacing their existing claims management system over time and optimizing it according to the needs and the requirements. This method is more economical but it is not a very productive one as it involves constant change.


Workers’ Compensation Case Management Software

Case Management in Workers’ Compensation involves two things basically – Medical treatment and return-to-work. Workers’ Compensation Case Management software is the one that is specifically built for handling these two things.

This can involve managing all the hospital bills and medical reports of the injured person and tracking his recovery and progress to help him return to work as soon as possible.


If you have decided to buy one, you can watch a free demo of KlearClaims - Workers' Comp Claims Management Software with native AI


Workers’ Compensation Claims Management Software Pennsylvania

Pennsylvania has its software for managing everything associated with Workers’ Compensation. In 2013, Workers’ Compensation Automation and Integration System, WCAIS was launched for the convenience of employers and workers in Pennsylvania.

In 2012, they also established the Workers’ Compensation Appeal Board (WCAB) and Bureau of Workers’ Compensation (BWC) helpline. These helplines were in 2013 integrated into the WCAIS making it very convenient for the people working in Pennsylvania to file claims, upload documents and resolve their queries simply using their mobile devices.

“The Department of Labor & Industry strives to establish a common ground where both workers and employers thrive in Pennsylvania's economy. This is our mission statement, and it is passionately pursued daily by each department employee. Many pillars support this mission, including a strong and effective workers' compensation system.”

- DLI, an official Pennsylvania government website


Features of Worker' comp Claims Management Software


Tracking

This is perhaps the most important feature that any company can expect from a claim’s management software. They keep the user updated with every new development that occurs in the Workers’ Compensation Claim process.


Documentation

In the absence of a claim’s management software, one would be required to provide hard copies of documents and be physically present while submitting them. The software makes it convenient to work with scanned copies and this can be done virtually.


Management of Medical Things

The most important aspect of any Workers’ Compensation is the medical aspect. It is what decides eventually the money that will be paid as compensation. The claims management software is medical claims software. AdvancedMD, NextGen, and DrChrono are some of the most commonly used medical billing software.

Things like reports of medical diagnosis, doctor appointments, and medical bills are easily managed in one single place by these healthcare claims management software which simplifies the entire medical care process.

Adjudication is a process in the medical workflow where the benefits of the claim are carried over to the claimant. Being a healthcare claims adjudication software, this process is also taken care of.


Automation

This software act as auto claim management software that automates the process. Medical bills get automatically added to the Workers’ Compensation Reserves, notifications and alerts are triggered automatically. The workflow, in general, becomes automated.

In the context of Workers’ Compensation, underwriting is the evaluation of risk evaluation. By performing underwriting, the features of a Workers’ Compensation Claim management and underwriting software are included in this software.


Increases Productivity

With all the time and travel hassles that the software saves and due to all the above features, the overall productivity increases significantly.


Cost Management

The constant tracking and monitoring provide a bird’s eye view of the expenditure landscape and hence one can easily decide how to spend and save money.


List of Workers' Comp Claims Management Software

Here is a list of some of the best software that improves workflow, helps service providers collaborate and perform revenue management at reasonable monthly prices

  1. - Waystar ($100 per month)

  2. - Kareo ($110 per month)

  3. - Optum360 ($103.45 per month)

  4. - CareCloud ($349 per month)

  5. - RXNT Practice Management ($65 per month)

  6. - QuickPractice ($599 per month)

Free Claims Management Software

This software provides a free version. There is always a paid version with premium features.

- iSALUS Billing and Scheduling

- athenaCollector

- Availity

- EZ Claim

- Therapy Notes


FAQs about workers' comp claims management software