At Mavera, we talk to lots of European insurance companies. Most of them have one thing in common: They lack a structured way to get medical assessments for personal injury claims.
Medical assessments are essential for claims management, but it's a complex matter and isn't all that simple to get right.
In this article, I will briefly discuss the challenges we've seen with our customers and show you how Mavera's solution can help improve your claims accuracy and save time.
(Backstory: We've managed a network with hundreds of medical advisors for more than ten years. That's an essential part of our history, and with that experience, we've built what has now become a system for investigating and decision-making for personal injury claims).
Just for context: What are medical assessments?
When evaluating a personal injury claim, the claims handler needs to understand the injury. It can be to understand the correlation between an accident and the damages. Or what long-term disability the injury has caused.
It's a complex and time-consuming task, where any mistake is costly for the insurer and the claimant.
That's where the value of medical assessments comes in: Accurate decisions in accidents and health claims.
Somewhat simplified: The claims handler asks a doctor to look at the claim and write an assessment, which helps make accurate decisions. The assessment is then shared with the claimant to motivate the decision transparently.
It's a critical step in the claims process.
And it's even mandatory to have every claim assessed by a doctor in some markets and insurance companies. Others let the claims handler decide on certain compensation levels based on experience. Either way, the process for medical assessments is crucial for their claims management.
The challenge with medical assessments
There's no argument that medical assessments are essential for claims management.
But to make accurate decisions and give the claimants fair evaluations, you need an extensive network of medical advisors.
Just the fact that you need to cover every medical discipline. That's around 50 specialists. Some insurers use general practitioners to cover cases from different fields.
But that'll lower the quality of the assessment and lead to overpayments or unfair underpayments.
Now, we know that the number of doctors varies a lot between insurance companies. And that not all insurance companies feel they have the luxury of an extensive network.
We believe a bigger network produces better decisions.
So let's continue with the rundown.
To add, you'll need at least one extra doctor per discipline to handle second opinions, battle biases, and reduce dependency.
You may also need extra capacity with additional doctors in the most common disciplines like orthopedics. All this adds to 100-150 doctors. Larger insurers need even larger capacity and can easily double this amount, so 100-150 is a minimum.
With that size, you can make accurate decisions.
But maintaining it?
It isn't that simple to manage 150 contractors, including recruiting, onboarding, evaluation, time-reporting, and managing payments.
And you can expect that everyone wants to increase their compensation yearly. Also, what about keeping track of everyone's vacation during the summer period to ensure you always have specialists available?
Typically, a coordinator role manages the operations of a provider network, keeping track of everything with an extensive Excel file or a contact management system not made for that specific purpose.
I'm not exaggerating. This is an example from a customer.
The reality is that it's error-prone, adds unnecessary complexity, and makes it harder to collaborate efficiently.
These are some of the challenges Mavera's Decisions Support System (DSS) solves in the claims management process.
The rewards for solving the network challenge
Let me explain how Mavera's Decision Support System helps the coordinator role to gain control of the medical advisor network, free up time, and identify high-performing advisors.
How can you get more control of the medical advisor network?
Medical advisors can log in and update their details by themselves. They can easily change their personal information, add their competencies, and limit how many cases they can handle simultaneously.
And if a medical advisor needs to take a couple of weeks off or wants to assess more claims during a period, they can simply make updates themselves.
This self-management process removes manual administration while giving the person responsible for managing the medical network a complete overview.
The built-in time reporting function is another way to free up even more time. That's a way to systematically associate the cost with the correct claim and guarantee every medical advisor gets the right compensation.
How do you monitor and evaluate a medical advisor's performance?
Mavera provides insights if a medical advisor often has to clarify their assessments, frequently misses deadlines, or takes a long time to evaluate. Simply having this information structured and available enables greater efficiency in the medical network manager's workflow.
Now, let's talk about how Mavera enables claims handlers and medical advisors to communicate in a more organized and secure way.
Overcoming the communication barriers
Security is a fundamental aspect to consider when working with medical specialists.
But the challenge here isn't your internal security level, which we know is impeccable, but that the medical specialists you work with are often not part of your company's IT security structure.
So the solution is often to send the case by post.
While it's compliant, it's not efficient and an enjoyable experience to print all the documentation, send it by post and then scan the response when you receive it.
And while we can trust our postal service, mail does get lost and isn't trackable.
Trying to understand the handwriting of a doctor is unfortunately also something that too many claims handlers still spend much time on, and what if they misinterpreted the text?
Mavera's DSS solves this and enables digital, transparent, trackable, and structured communication between claims handlers and medical advisors. You can see when and who handled the case.
With your organization handling thousands of cases yearly, the potential for efficiency gains is high.
You can automate many repetitive, multi-step tasks to shift workload from human to technology.
The claims handler won't have to write requests themselves, and when the medical advisor opens the case, they must first answer if they're biased. If that's true, the system will give it to another doctor in the same specialist area.
That's a straightforward and efficient way to avoid biased assessments.
Greater customer experience
Helping claimants get the correct compensation is in everyone's interest.
But with a high volume of cases and often too little time to give full attention to every case, it's hard to do quality work with each one.
The result is often overpayments because there's not enough time to do the work thoroughly.
When a claims handler doesn't have to repeatably get back to a claim and read up on it multiple times on different occasions, it's much easier for them to focus on the details with higher quality.
Plowing through medical journals in an unstructured way hinders quality, accuracy, and effectiveness.
Ease of communication leads to superior customer experience and better insurance outcomes.
Now, let's touch on how you can simplify the process.
The anatomy of a streamlined process
Medical advisors share their expertise in every case they assess, but a lot of the value is lost when the expertise doesn't get collected in a structured way.
Structured data is the basis for more accurate claims decisions and a streamlined process.
With Mavera DSS, you get a structured approach to requesting medical assessments with pre-defined questions and injury-specific templates.
Templates don't only help you streamline the process.
Approaching this in a standardized manner creates consistency in decision-making and helps you identify extremities and unnecessary treatment.
And we've seen claims assessed 30% faster. That's huge.
A large part of this gain is with the help of Mavera's smart assistance function. It's an AI feature supporting claim handlers to re-order which claims to investigate while removing many manual tasks.
It's also a way easier way for the entire team of claims handlers to read up on any case, collaborate on them and easily assign it to other colleagues — reducing the dependability of the individual claims handler.
With Mavera's process automation features you get support for common workflows when communicating with medical advisors, which includes:
- Biased verification
- Second opinions
- Requests for clarification
- Additional motivation in an assessment.
And all the documentation is encrypted and protected, blocking the medical advisor from downloading or printing the information.
Wait, what does even AI mean in this context?
It's fair to say that AI is a buzzworthy, fancy slap-on word.
But it's not just a word.
Mavera's AI gives you better insights and lets your team make fairer, quicker decisions by collecting structured claims data.
Here are two things the data collection and machine learning enables:
Visualizations. Claims data is visualized on dashboards to empower claims managers to identify bottlenecks and optimize the claims process.
Automations. Structured data train's the AI-powered smart assistance feature. For example, the system reviews treatment proposals from private caregivers and highlights those that might not be medically motivated. They're then automatically assigned to a relevant medical advisor for an extra review.
Lacking a structured way to get medical assessments for personal injury claims adds unnecessary complexity to an already challenging process.
But when you collect claims data in a structured way and empower it with technology specifically made for personal injury claims, it helps you make more accurate decisions and give claimants fairer evaluations.
Mavera's platform enables claims handlers to focus on the customer by giving a clear overview of everything that happens with a claim.
Streamlined. Structured. Secure.
We'd love to show you how it all works and share our experience of how other insurance companies work.
When you're ready, our specialists are here to give a demo anytime.