ODG for Auto Injury Incorporates Commercial Claims Data
January 27, 2023 | Categories: ODG by MCG
Reliable data is critical for auto insurance carriers to accurately forecast claim costs and durations. Using such data from the Property & Casualty (P&C) side (i.e., auto or workers’ compensation claims) is incredibly helpful for this, however, we know that such claims are impacted by policy limits, liability, and litigation. It’s important to have access to data benchmarks that are not affected by those external factors; data that represents true medical necessity as might be delivered under our nation’s health plans. This is where commercial claims data can be an effective tool for auto insurance carriers. The ability to see differences in duration and cost from one type of claim to another is incredibly insightful, and it can prove useful when supporting claim decisions.
In some instances, there can be large differences in cost or duration depending on if the injury occurred in a workers’ compensation or auto loss versus at home and through a commercial health policy. These differences can help explain why some cases tend to stay open much longer (or cost much more) than anticipated. Having a “commercial data reference point” helps to anchor claim expectations and provides negotiation points to bridge gaps in difficult cases.
Case in Point: Differences in Recovery Time
As an example, let’s look at a case study of a 65-year-old with:
- a herniated disc in the lumbar spine
- preexisting obesity
Based on current ODG data, this individual will take 3 months longer to recover after a workers’ comp or auto injury than they would if the injury occurred at home. At the 75th percentile, the claim and treatment duration is double that of a commercial healthcare episode, one year vs six months. . In terms of cost, the differences can be highly impactful as well. Using a similar example as above – but looking at a simple whiplash injury – the cost for care is 35% less in a commercial healthcare case than in an auto or workers’ comp claim.
Access to Comparison Data
Having access to this type of information can help insurers, clinicians, and claims management professionals set proper expectations, streamline negotiations, and guide appropriate claim decisions, including automation to flag claims and bills outside expectations. ODG for Auto Injury provides this data in all our auto dashboard graphics as a default view. Switching between the Commercial and P&C data sets is as easy as changing the drop-down in the top right menu (see image below).
Interested in seeing a demo? Request one here.
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