ISO calls for closer integration between insurers and healthcare providers

• Adopting ICD standards will improve consistency and accuracy of personal injury claims management
• Current methods often ‘dumb down’ the information provided by medical experts within the NHS and the healthcare industry

Lee Fogle, Head of ISO’s Claims Outcome Advisor division, has called for the insurance industry to use the International Classification of Diseases (ICD) injury classification standards used by the NHS and healthcare industry to improve the consistency and accuracy of personal injury claims management.

"According to the Actuarial Profession’s latest research, the growing compensation culture in the UK is now costing about £10 billion a year - or one per cent of GDP," says Lee Fogle. "Personal injury claims now represent a large proportion of costs to the insurance industry and one of the most important parts of managing these claims is the medical information.

"When a claimant is examined by a medical professional they provide insurers with a level of detail in line with the World Health Organisation’s ICD standards. By using in-house systems or some IT solutions on the market, insurers are often ‘dumbing down’ the information received on a medical report to fit into their own system. If we are serious about improving the way we manage personal injury claims, we should be using the same level of detail that is provided by medical professionals. We shouldn’t expect claims handlers to be experts in interpreting medical reports when they are not medical professionals themselves. And, why should we create our own proprietary systems when the data is already provided by the healthcare industry?

"Adopting the ICD standards would mean that insurers would be talking the same ‘language’ as the medical industry, which would help standardise settlements and improve consistency in claims management. Not only are ICD standards used by the NHS in the UK, they are already widely used by healthcare insurers in the US and healthcare providers around the world. Our own research shows that insurers adopting these common medical standards would be able to speed up data collection and make claims more accurate by making the right offer first time, helping to avoid protracted legal disputes or issues over paying claimants.

"Our own solution, Claims Outcome Advisor, helps claims managers manage the multiple dimensions on their personal injury claims and already works using the ICD code format. If the whole industry adopted the ICD standards then insurers could share information about the value of claims and make consistent and fair offers to claimants. This could pave the way for large-scale sharing of information between insurers and third parties to deliver a range of benefits such as spotting trends in new injuries and tackling fraud."

About ICD standards
The International Classification of Diseases and Related Health Problems (ICD) is a statistical classification of diseases and surgical procedures and is devised and managed by the World Health Organisation. It allows the logical translation of clinical statements into codes in a way that facilitates the retrieval of data in a consistent manner and comparative analysis of aggregated data-sets compiled from multiple sources. The ICD standard is designed for statistical analysis of data to study the incidence of disease and treatment, and to support and assist in the management of healthcare services at international, national and local levels.

About Claims Outcome Advisor™ (COA)
ISO’s Claims Outcome Advisor™ (COA) is the industry’s first personal injury claims management solution that manages the multiple dimensions of insurance companies’ personal injury claims portfolios. Using internationally recognised ICD medical codes, COA understands the severity and recovery implications of over 20,000 medical conditions, including injuries, treatments, complications and pre-existing 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 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
Insurance Services Office Limited (ISO) is the UK subsidiary of Insurance Services Office, Inc. – the premier source of information, products and services related to property and liability risk. For a broad spectrum of commercial and personal lines of insurance, ISO provides statistical, actuarial, underwriting and claims information and analyses; consulting and technical services; policy language; information about specific locations; fraud-identification tools; and data processing. Around the world, ISO serves insurers, reinsurers, agents, brokers, self-insureds, risk managers, insurance regulators and other government agencies. ISO customers in the UK include the Admiral Group, Axa, Chaucer Insurance, Highway Insurance and Zurich Financial Services. For more information on ISO products, contact ISO at Info.uk@iso.com, or visit ISO at www.iso.com.

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