Sedgwick was recognized for its innovation in how it flags and handles workers' compensation claims through its decision optimization platform.

Sedgwick created and implemented a business model that uses its data to identify workers' compensation claims that could exceed $50,000 in total incurred costs, allowing the claims team to focus on specific areas or apply the resources necessary to ensure the best experience for an employee.

The company also generated a model to identify claims that could reach the $100,000 mark, giving the claims unit time to triage complex claims before the impact to outcome becomes severe. In addition, Sedgwick utilizes nurse resources in workers' compensation claims to significantly impact an injured employee's overall outcome. The results have been impressive for clients and claimants alike.

"Using our decision optimization platform, Sedgwick is able to do more than just reveal meaningful trends in claims data," Sedgwick Group President Bob Peterson explained. "We use our data to offer industry perspective and guidance, prescribe and automate the next steps to be taken on a claim and direct resources appropriately for exceptional care and service." The Impact of Technology on Claims

Technology is influencing the insurance industry from mobile applications that allow policyholders to report and follow claims to the information insurers can provide when a catastrophe arises. For workers' compensation claims, mobile technology provides a conduit for communicating with injured employees to ensure they are receiving the best care and critical information as they need it.

"With the ubiquity of smartphones, tablets and mobile devices, injured workers are now empowered in the claims process," Peterson commented. "They have the ability to check the status of their claim and payment information in real time using self-service applications and can even report their own claims."

Peterson added that injured workers can also use their mobile devices to receive medication or physician appointment reminders, schedule appointments, receive text messages with critical information or even chat with claims examiners and nurse case managers. "Injured employees can also send important documents and photos to their claims professionals … and can sign up for direct deposit through mobile applications. These technologies foster a more customized and immediate access experience for injured workers during what can be an unsettling and stressful time." Meeting Workers Where They Are

As any employer knows, employees are critical to their organization's success and getting injured workers the care they need as soon as possible is in everyone's best interest. In addition, returning employees to the workforce reduces claims costs for insurers and employers, and has a positive effect in the healing process for the injured worker. Sedgwick has made a number of advancements in this area that are having a significant impact on how claims are resolved.

While treatment is important, pain management after an injury is also a consideration, especially given the addiction issues associated with opioids, narcotics and other strong prescription medications. "We are working with employers to explore alternatives to pain management and employing such tools as physician-patient contracts, pain management coaching partnerships, increased use of behavioral specialists or physical therapy," Peterson reported.

Many factors affect claims costs, but complex claims can have long-ranging effects for the employee and drive up costs significantly. Recognizing these factors, Sedgwick sees the value of creating plans that provide assistance to those impacted. "Communication should answer questions and provide reassurance. Pain management plans should be structured to meet employee needs without unnecessary or long-term reliance on opioids … an optimal recovery plan demands a holistic approach."

Balancing Act

For vendors working with insurers and their policyholders, the challenge arises in satisfying the different goals and wishes of each party. Peterson is proud of how the company balances the policyholder's needs against the realities of the policy while meeting the insurer's objectives.

"Every year, more than 15,000 Sedgwick colleagues take care of the needs of more than 2.6 million people who had something unexpected happen," Peterson said.

Not content to rest on their proverbial laurels, Sedgwick has set an aggressive agenda for 2018 with a focus on several areas including compounding global risks and ways to improve the customer experience through technology.