Hard hit by claims from Sept. 11 and lower returns on investments, U.S. workers’ compensation carriers are registering a 135 percent combined loss ratio (for every dollar they receive in premium, $1.35 is paid). However, industry analysts estimate that insurance companies could save billions of dollars each year by improving efficiencies in claims processing.

When a claim is filed, HNC Decision Manager can automatically raise issues concerning medical factors, return to work issues and risks, litigation merits, strategies and costs so adjusters can act on the most critical issues and risk factors. The system also can recommend a course of action in real-time, and continues bringing this recommendation to the attention of adjusters until the claims process is complete. The technology enables beginning adjusters to have the same body of knowledge and best practices available to them as their more experienced counterparts, resulting in a "best practices" approach throughout the organization.

"Workers compensation carriers, third-party administrators and self-administered/self-insured funds and companies must automate claims decisioning and processing to survive," explained John D’Alusio, senior vice president of strategic business development. "With HNC Decision Manager for Claims, companies can receive immediate ROI as they automatically deliver the right decision at the right time. This revolutionary new software also enables executives to learn more about claim trends from both macro and micro levels, ensuring continuous improvement and the best possible claim outcomes are consistently achieved."

"Claims processes will be radically changed by emerging technologies that offer greater workflow and intelligence," stated Kimberly Harris, research director with Gartner Inc. "The use of these technologies will allow insurers to support exception-based processing, reduce subjectivity and inconsistencies, and identify problems that will ultimately help the organization transform their claims processes."

HNC’s medical bill review software for workers’ compensation is the market leader, reviewing more than 30 percent of the nation’s workers’ compensation bills. HNC Decision Manager for Claims combines HNC’s proven technology with its in-depth expertise in workers compensation, incorporating best practices and extensive knowledge in predictive modeling to enable the most efficient claims investigation process possible.

With the software, cases are instantly re-analyzed and new actions recommended when information changes. Consistent application of rules and policies improves consistency, regulatory compliance and adherence to special account instructions. HNC Decision Manager also reduces risk exposure through identification of fraud, subrogation opportunities, reserving and the need for case management. Business users can easily modify the system to employ new rules and business policies without having to use scarce IT resources.

In addition to these efficiencies, the system also helps to reduce litigation by speedy and accurate responses, and manages permanent disability and lifetime medical treatment awards.

The development of Decision Manager for Claims further demonstrates HNC’s execution of one of its corporate growth strategies — leveraging core technology and domain expertise to expand its product offering. HNC Decision Manager will be incorporated into HNC’s Critical Action Technology Platform, which provides a common architecture for HNC’s suite of business applications. Designed to support modern enterprise architecture, HNC’s Critical Action Platform leverages HNC’s years of experience solving real-world, real-time decisioning problems.

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Cautions About Forward-Looking Statements. This press release contains forward-looking statements about events and circumstances that have not yet occurred. For example, statements regarding potential cost-savings that may be obtained through the use of HNC Decision Manager for Claims, and words such as "will," "expects," "believes" or other statements in the future tense are forward-looking statements. Actual outcomes and results may significantly differ from expectations in this press release due to a number of risks and uncertainties about the future.

HNC Software

1.858.799.8370

Heidi Flannery

Fi.Comm

1.503.203.8808, x111