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Early Insights of Injury Causation

Insurers don’t typically get a full understanding of a 1st or 3rd party injury until further along in the claim lifecycle. When insurers don’t have the information they need to set appropriate reserves and understand suitable treatment, it can lead to delays in claim approvals and inefficiencies in the claim lifecycle.

At Talem, we’re focused on getting insurers the injury insights they need at the start of a claim to make better decisions upfront.

Biomechanical Review

Talem’s AI-enabled injury analysis platform provides insurers with possible occupant injuries to gauge severity and determine an accurate diagnosis, an effective treatment plan, and recovery model.

At first notice of loss, with basic claimant information and car crash photos, Talem analyzes the forensic data to determine delta-V; or the severity of the accident. Using 9/10 ICD coding, Talem compares the reported injuries to their proprietary forensic rules engine to determine how likely the injuries reported are based on occupant motion and force exposure.

Incident Analysis

Understand the severity of the incident with speed estimates (Delta-V), occupant movement, and likelihood of contact with objects.

Recovery Timeline

Gain a clear outlook with a realistic timeline for recovery of injuries based on the likely injuries, the persons age, and the physicality of their job.

Injury Review

Get a detailed overview of the likely and unlikely injuries caused by the accident based on a massive amount of historical crash data and our forensic rules engine.

Actions & Recommendations

Using key features of the crash and characteristics of recovery, Talem supports you with the most important injury-related data to make decisions immediately.

Benefits

  • Clear understanding of caused injury
  • Decrease medical upcoding
  • Understand recovery timeline
  • Streamline assignment process
  • Improve reserving accuracy
  • Fast approval of medical care
  • Improve outcome and client satisfaction

When to Use

  • First notice of loss onward
  • First or third party claims
  • Prior to medical bill audit
  • Prior to negotiation or settlement
Electronic Medical Review

Professional Experience Meets Data Intelligence

Healthcare providers are often incentivised to determine injuries are a higher severity to enable more frequent or costly billing on the claim.

Within the initial phase of the claim you must ensure appropriate billing and medical necessity. Talem pairs the Biomechanical review of injury causation with a medical expert to review the medical file to date.

Electronic Medical Review

Biomechanical Review

Understand the incident, the likelihood of injuries involved and recovery trajectory.

Medical Review

Get a detailed breakdown the providers assessment; understand the valuable and missing information, treatment summary, quality and overall causation evaluation.

Expense Review

Understand the appropriateness of current billing. Talem reviews medical billing and compares with injury causation, gold standard geographical frequency and cost comparisons to ensure you reduce excessive and fraudulent billing. 

Expert Insight

Balance advanced technical forensics with the experience of a professional. Talem's platform leverages a network of medical professionals to build on early insights and analyze complex claim situations.

Benefits

  • Medical billing linked to caused injury
  • Reduce excessive billing
  • Reduce fraudulent billing
  • Ensure value-based care
  • Provider performance

When to Use

  • Typically first party claims.
  • 1 – 4 months following date of loss.
  • Questioning legitimacy of injury/billing.
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Data-Enhanced Medical Review

Not all claim cycles are straightforward. That’s why we’ve partnered with a custom network of medical professionals to offer our customers a direct link to the experts.

Blend expertise with technology by requesting an Independent Medical Examination or File Review enhanced by our biomechanical review. Medical professionals are given the data they need to make better informed conclusions on injury causation, clinical plateau, and medical necessity.

This data-enhanced service ensures better customer outcomes through accurate diagnosis and an accelerated claim lifecycle.

File Review and Independent Medical Examination

Talem Health Analytics understands the complexities that surround bodily injury claims, ultimately claims exist requiring intervention of human medical expertise. Our network of file review and Independent medical exam doctors evaluate the Biomechanical review, medical file and the claimant to develop a comprehensive review of the injuries and medical necessity.

Biomechanical Review

Understand the incident, the likelihood of injuries involved and recovery trajectory.

Medical File Review

Medical specialist evaluates the file to date, to provide expert opinion on medical necessity, clinical presentation, clinical plateau, treatment cessation or recommendation.

Benefits

  • Medical specialists empowered with AI creates most effective decision making.
  • Expert review of treatment necessity.
  • Reduction of total number of independent medical examinations.
  • Clear recommendations of causation, medical necessity and continuation of treatment.
  • Reduction of no value-added work.
  • Linking caused injury to level of medical impairment.

When to Use

  • Mid to late phase of claim.
  • Entering negotiation or settlement.
  • When there is a discrepancy in recovery expectations and current timeline.
  • When there is a discrepancy in injury expectation and current diagnosis on file.
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Seamlessly request an IME or File Review enhanced by Talem’s biomechanical analysis directly from Guidewire.

Learn More

Claims Management Services

Timely and appropriate claims information enable insurers to proactively manage and provide a clear path to improved claim outcomes. Talems’ end to end injury causation services provides the right injury and medical necessity information at the right time. Contact us now to start your first notice of loss with a Biomechanical review or consult with an industry expert to determine which services best suit your needs.