ISO poll highlights "most likely" reason for incorrect claims payment

ISO Poll of Insurers Shows Lack of Historical Databases Is "Most Likely" Reason for Incorrect Claim Payments

• Forty-six per cent identify lack of historical databases as primary cause of incorrect injury claim payments
• Twenty per cent identify lack of medical knowledge as the second most probable reason for incorrect claim payments

Insurance Services Office (ISO) Ltd. has announced 46 per cent of US insurance organisations identified the lack of historical databases as a major cause of poor claims management, according to a recent customer poll conducted by ISO. This follows an earlier ISO poll in which 78 per cent of insurance organisations said reducing the rising cost of claims handling is their single most important goal for 2004.

The poll asked insurance organisations to identify the most likely reason for paying injury claims incorrectly. Of the five options, just under half (46 per cent) identified a lack of historical databases as a major cause and 20 per cent cited lack of medical knowledge as the second most probable reason. Sixteen per cent said inadequate negotiation skills, while 13 per cent cited claims handlers’ inexperience.

"Empowering claims handlers with more information about similar claims and injuries is the most important step insurers can take to achieve accurate claims assessments," said Lee Fogle, ISO vice president of Claims Services. "A powerful relational database that incorporates a medical encyclopaedia, based on the International Classification of Diseases (ICD), provides claims handlers and managers with a complete claims history audit trail at their fingertips. Such a tool also provides more efficient management reporting practices, improves claims handlers’ medical knowledge and increases their negotiation skills.

"Combining best practices with professional knowledge is critical to establishing high claims-handling standards. For example, when one international client implemented the ISO Claims Outcome Advisor™ (COA™) claims management solution, the company reduced its personal injury claims costs by 14 per cent within the first six months of deployment," Fogle said.

About ISO Claims Outcome Advisor™ (COA™)
ISO Claims Outcome Advisor™ (COA™), supplied by its wholly owned subsidiary, ISO Claims Services, Inc., is the industry’s first personal injury claims management solution that manages the multiple dimensions of insurance companies’ personal injury claims portfolios. COA understands the severity and recovery implications of over 18,000 medical conditions — including injuries, treatments, complications and preexisting conditions — and 14,000 occupations. COA helps claims handlers, managers and actuaries manage the unique and complex medical, legal and occupational issues presented by personal injury claims and helps ensure appropriate financial arrangements are agreed upon and implemented. Claims handlers can manage all aspects of a case from first notice of loss to return-to-work plans, rehabilitation and damages.

About ISO
ISO is a leading provider of products and services that help measure, manage and reduce risk. ISO provides data, analytics and decision-support solutions to professionals in many fields, including insurance, finance, real estate, health services, government and human resources. Professionals use ISO’s databases and services to classify and evaluate a variety of risks and detect potential fraud. In the US and around the world, ISO’s services help customers protect people, property and financial assets.

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