Recently there has been significant progress in understanding the reasons why people become disabled after an injury or illness, as well as the predictors of return to work from disability. Dr Marc Milot commented “Human behavior is now understood beyond the narrowly defined and deterministic biomedical model focused on the physical and pathophysiological aspects of […]

Fraud seems to be a hot topic at the moment and is a great area to apply advanced analytics to assist in the process of identifying potentially fraudulent claimants. We use a number of techniques to spot these claims. We can analyze the profile of previously identified fraudulent claims, and look for new claims with […]

There seems to be a big difference in approach to managing disability claims between Canada and the US. Yes that’s obvious, I hear you say, and the social health care system in Canada plays a major part in this variation. However, dare I suggest, maybe US claims managers can learn a few tricks here! In […]

So how do you determine whether an intervention actually works? You cannot run the same claim twice! No two claims are the same, so you cannot apply rehab to one claim then not to another  and measure the difference! However, data analytics can help… we can model how a claim behaves without an intervention and […]

The industry of providing medical guidelines has been around for many years, and it’s an important part of the claims management process to understand the depth of the medical issue that is diagnosed on a claim. However, there are a couple of reasons why this approach is flawed. Recovery rates are influenced by many other […]