Decision-Support Tools

Improve outcomes with the best claims insights in the industry

At Gallagher Bassett, our people are our greatest strength. We hire the best and brightest claims professionals in the industry, and then we invest in their career growth with ongoing training, education, licensing, and certification. We also provide them with proprietary support tools that help them make the best decisions at critical points along a claim's lifecycle.

While every step in the claims process is important, our collective experience handling more than $9 billion in claims every year has taught us that certain decisions at certain times — or waypoints — along a journey can have an increased impact on a claim's outcome.

To aid our knowledgeable claims Resolution Managers in making the right decisions at the right times, our machine-learning-based decision-support tools are embedded directly into the claims handling process where we know certain key decisions, such as understanding when and how to intervene appropriately, can influence the trajectory of a claim.

One of the best ways to illustrate the benefits of Waypoint is to look at how the tools are used in higher complexity workers' compensation claims. The chart below shows at which point in the claim certain support tools are used.

Waypoint decision-support tools

Integrating AI-enabled tools and data analysis into specific points along the claims lifecycle enhances decision-making and results in better claims outcomes.

	Lifecycle Stage	Support Tools	Purpose	Benefit/Proven Results
	Intake Triage Claim assignment	Clinical Concierge Claim Prioritization Tool	After the incident, engage early with the injured worker to ensure proper care Assign cases based on the claim's complexity, urgency, and criticality	Early intervention increase of 30-50% with the most appropriate managed care Reduce litigation by 10-20% Cut lost workdays by 10-20% Claims closures increase by 5-10%
	Claims investigation	Litigation Avoidance Surveillance	Flag claims with a high likelihood of litigation Recommend litigation mitigation strategies Identify cases where investigation is helpful to support the case	Pay claims only when appropriate/limit fraud Lower attorney involvement by 18% Reduce total costs incurred by 10% Cut total paid by 8%
	Provider selection	Treatment Quality Index (TQI) Provider Guidance	Identify providers focused on evidence-based medicine and optimal clinical and claims outcomes Refer injured workers to the identified providers	Ensure injured workers receive best-in-class care Avoid medical insurance fraud Reduce disability duration Lower total claim cost
	Clinical intervention	Clinical Guidance	Flag claims with risks for delay (e.g., longer than expected disability duration or care that deviates from TQI) Intervene with care management resources	Ensure optimal assignment of care management resources (right resource to the right claim at the right time) 40% lower cost of claims* 41% reduction in claim duration*
	Reserving	Reserve Guidance	Identify and continuously update top factors influencing current reserve patterns Add context for evaluating and predicting accurate reserves	Increase the accuracy of reserves by 3 to 4 points relative to their ultimate valuation Help ensure reserve consistency
	Subrogation	Subrogation Potential	Flag claims with the highest probability of subrogation recovery Funnel claims to centralized in-house subrogation team	Maximize subrogation recovery opportunities Lower TCOR
	Litigation management Settlement	Legal Score	Analyze and score the performance of clients' outside counsel Empower clients to make informed decisions about firms used for defense or settlement	Mitigate the cost of litigated files by ensuring the use of best-in-class law firms
	Return to work (RTW)	RTW Optimization	Scan all open claims to identify roadblocks to RTW that are not clinical (e.g., lack of light-duty opportunities) Assign RTW coordinator to resolve roadblocks	Help injured workers navigate RTW policies Contain claim cost leakage associated with extended disability duration
* For claims with case management assignment within 30 days versus 180 days or more