American Association of State Compensation insurance Fund
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member fund.

CopperPoint Mutual Insurance Company
Phone: (602) 631-2000
Address: 3030 North Third Street
Phoenix, AZ   85012

State Compensation Insurance Fund
Address: 333 Bush Street
Suite 800
San Francisco, CA   94104

Pinnacol Assurance
Phone: (303) 361-4000
Address: 7501 East Lowry Boulevard
Suite 800
Denver, CO   80230-7006

Hawaii Employers' Mutual Insurance Co. Inc.
Phone: (808) 524-3642
Address: 1100 Alakea Street
Suite 1400
Honolulu, HI   96813

Idaho State Insurance Fund
Phone: (208) 332-2100
Address: 1215 West State Street
P.O. Box 83720
Boise, ID   83720-0044

Kentucky Employers Mutual Insurance
Phone: (859) 425-7800
Address: 250 West Main Street Suite 900
P.O. Box 83720
Lexington, KY   40507-1724

Louisiana Workers' Compensation Corporation
Phone: (225) 924-7788
Address: 2237 South Acadian Thruway
P.O. Box 83720
Baton Rouge, LA   70808

Maine Employers Mutual Insurance Company (MEMIC)
Phone: (207) 791-3300
Address: 261 Commercial Street
P.O. Box 11409
Portland, ME   04104

Chesapeake Employers’ Insurance Company
Phone: (410) 494-2000
Address: 8722 Loch Raven Boulevard
P.O. Box 11409
Towson, MD   21286-2235

SFM Mutual Insurance Company
Phone: (952) 838-4200
Address: 3500 American Boulevard West Suite 700
P.O. Box 11409
Bloomington, MN   55431-4434

Missouri Employers Mutual Insurance
Phone: (800) 442-0590
Address: 101 N Keene St
P.O. Box 11409
Columbia, MO   65201

Montana State Fund
Phone: (406) 495-5015
Address: 855 Front Street
P.O. Box 4759
Helena, MT   59604-4759

New Mexico Mutual Group
Phone: (505) 345-7260
Address: 3900 Singer Boulevard NE
P.O. Box 4759
Albuquerque, NM   87109

New York State Insurance Fund
Phone: (212) 312-7001
Address: 199 Church Street
P.O. Box 4759
New York, NY   10007

Workforce Safety and Insurance
Phone: (701) 328-3800
Address: 1600 East Century Avenue Suite 1
P.O. Box 4759
Bismarck, ND   58506-5585

Ohio Bureau of Workers Compensation
Phone: (800) 644-6292
Address: 30 West Spring Street
P.O. Box 4759
Columbus, OH   43215-2256

CompSource Mutual Insurance Company
Phone: (405) 232-7663
Address: 1901 North Walnut Ave.
P.O. Box 53505
Oklahoma City, OK   73152-3505

State Accident Insurance Fund (SAIF)
Phone: (503) 373-8000
Address: 400 High Street SE
P.O. Box 53505
Salem, OR   97312-1000

Pennsylvania State Workers Insurance Fund
Phone: (570) 963-4635
Address: 100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA   18505-5100

Beacon Mutual Insurance Company
Phone: (401) 825-2667
Address: One Beacon Centre
P.O. Box 5100
Warwick, RI   02886-1378

South Carolina State Accident Fund
Phone: (803) 896-5800
Address: P.O. Box 102100
P.O. Box 5100
Columbia, SC   29221-5000

Texas Mutual Insurance Company
Phone: (800) 859-5995
Address: 6210 East Highway 290
P.O. Box 5100
Austin, TX   78723-1098

Workers Compensation Fund
Phone: (800) 446-2667
Address: 100 West Towne Ridge Parkway
P.O. Box 2227
Sandy, UT   84070

Washington Department of Labor and Industries
Phone: (360) 902-5800
Address: P.O. Box 44001
P.O. Box 2227
Olympia, WA   98504-4001

Wyoming Division of Workers Safety & Compensation
Phone: (307) 777-7159
Address: Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, WY   82002

Workers Compensation Board - Alberta
Phone: (780) 498-3999
Address: 9925-107 Street
P.O. Box 2415
Edmonton, AB   T5J 2S5

Workers Compensation Board of British Columbia (WORKSAFEBC)
Phone: (604) 273-2266
Address: P.O. Box 5350 Station Terminal
P.O. Box 2415
Vancouver, BC   V6B 5L5

Manitoba Workers Compensation Board
Phone: (204) 954-4321
Address: 333 Broadway
P.O. Box 2415
Winnipeg, MB   R3C 4W3

Phone: (506) 632-2200
Address: 1 Portland Street
P.O. Box 160
Saint John, NB   E2L 3X9

Workers Compensation Board of Nova Scotia
Phone: (902) 491-8999
Address: 5668 South Street
P.O. Box 1150
Halifax, NS   B3J 2Y2

Prince Edward Island Workers Compensation Board
Phone: (902) 368-5680
Address: 14 Weymouth Street
P.O. Box 1150
Charlottetown, PE   C1A 7L7

Saskatchewan Workers Compensation Board
Phone: (306) 787-4370
Address: 200 - 1881 Scarth Street
P.O. Box 1150
Regina, SK   S4P 4L1

Puerto Rico State Insurance Fund Corporation
Phone: (787) 793-5959
Address: G.P.O. Box 365028
P.O. Box 1150
San Juan, PR   00936-5028
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AASCIF Newsletter

Lessons Learned from Our Implementation of a Claims Predictive Model

By Tim Michels, COO, Chesapeake Employers’ Insurance Company, 2014 Claims and Rehab Committee

If you are considering the purchase of a claims-based predictive model, you are probably intrigued by the vendor’s marketing that proposes to use your own claims history to build a model to help you more quickly identify the potential for a serious exposure and help you better allocate your finite Special Investigation Unit (SIU), Nurse Case Management (NCM) and adjuster resources.

These are worthy goals, indeed, and were in fact ours at Chesapeake Employers as we started this process a number of years ago. However, is this what your organization needs? Before you sign on the dotted line, there are a large number of issues to consider, including what is most important to your company and your claims operation, and how willing you are to change or reinvent your established practices?

To take full advantage of a claims predictive model means rethinking your current processes and approach to claims handling and claims assignment. For us, same day initial contact and dedicated assignments of adjusters to agents and policyholders has become an integral approach to our claims handling. So, we were set on maintaining that as a priority in implementing a claims predictive model. 

We also realized that we had a homegrown program in place that used data elements from the First Report of Injury to determine if the claim could be set up as an unassigned medical-only claim or as a claim that needed to be assigned to an adjuster. Through all of the years of its use, we didn’t understand that the program was an initial “predictive model” in effectively identifying claims requiring an adjuster to manage them.

Additionally, we were reluctant to loosen many of the adjuster’s protocols for initial contact and investigation, partly because of the customer service benefits we reaped from developing these relationships as well as the improved claims handling our policyholders experienced as a result. In this vein we limited our reliance on a predictive modeling score. So, our hope to realign resources was a slower proposition.

Another important consideration is workflow management. We use automated journals/diaries in many cases to alert adjusters and supervisors to pending tasks on specific claims. The workflow initially built was done before implementation using our “best guess” of how we thought it would work once the model went live. Keeping the workflow reasonably simple for the implementation, with the thought that a more complex workflow would be built once we were several months into the implementation, was a positive outcome for us. 

Once our predictive model went live, we experienced some unanticipated anomalies, primarily relating to the larger-than-expected distribution of higher scoring claims. While this slowed our overall acceptance of the model, working with our vendor to identify the source of those anomalies has been positive. We are currently engaged in discussions with our vendor to determine how to optimize the use of a predictive model in our claims department. This will require determining new goals beyond those of resource allocation and early identification of high exposure.

So, lessons learned? 

  1. Predictive models are not inexpensive under any circumstances. 
  2. Setting reasonable goals and objectives for expected results is key. 
  3. Knowing and understanding your own processes and what you are willing to change based on your own overall claim success factors is paramount. 

While our model and workflow are still being tweaked, we have learned so much more about our mix of claims throughout this process. We look forward to growing results using this valuable tool. 




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