From Intake to Resolution: A Seamless WC Claims Experience

In the world of workers’ compensation (WC), the claims process can often feel like a maze—complex, fragmented, and slow-moving. But it doesn’t have to be. At Davies, we believe that a seamless WC claims experience isn’t just possible—it’s essential. 

From the moment a claim is reported to its final resolution, every step in the process should be designed to support the injured worker, reduce administrative burden, and drive better outcomes for employers. Here’s how we make that happen.  

1. A Strong Start: Intake That Sets the Tone

Intake isn’t just about collecting data anymore—it’s about creating momentum. The way a claim starts often sets the tone for how it ends. 

At Davies, we’ve modernized the process. Our intake uses: 

• Smart forms with auto-fill based on employee and location data 

• Real-time claim creation directly into the claims system 

• Triggers that launch immediate triage and nurse engagement 

It’s more than “streamlined”—it’s automated, intelligent, and built to surface red flags early. That way, our adjusters don’t just react—they’re already moving. 

2. Early Intervention and Nurse Case Management 

A lot of TPAs talk about early intervention—but for us, it actually starts early. The moment a claim is reported, we use built-in triggers to launch nurse triage within hours—not days. 

Here’s how it works: 

• Intake flags the claim based on type, severity, and jurisdiction 

• A Nurse Case Manager (NCM) is auto-assigned based on experience and case type 

• The NCM contacts the worker and maps out a care plan right away 

This isn’t “nurse case management when needed”—this is proactive care coordination, baked into our process from day one. 

The result: 

• Less unnecessary treatment 

• Faster return-to-work 

• Fewer escalations and litigated claims 

And for high-risk or presumption claims, we match the file with NCMs who specialize in that space—so the right expertise is on the file before complications start.  

3. Data-Driven Decision Making 

Intelligence That Drives the Claim Forward 

Data should do more than sit on a dashboard. At Davies, we use analytics to drive decisions while the claim is still unfolding—not just to explain what already happened. 

We combine industry tools like Power BI and ODG by MCG with our own real-time insights to surface: 

• Lagging and leading indicators across claim lifecycle 

• Provider performance and treatment patterns 

• Return-to-work forecasts and cost drivers by location, injury type, and more 

What sets us apart?
We don’t just show the data—we use it. Our teams get alerts on outliers, stalled progress, or missed milestones as they happen. And our clients have full visibility to spot trends, adjust strategy, and stay ahead of the curve. 

It’s not just transparency—it’s intelligence with purpose.  

4. Seamless Communication and Collaboration 

Smart Tech, Real People, Zero Runaround 

Great claims handling isn’t just about having the right tools—it’s about having the right team, accessible when it counts. At Davies, we combine real-time communication tools with high-touch support to keep everyone in sync. 

Here’s what that looks like: 

• Direct access to the full claims team—no layers, no bottlenecks 

• Adjusters, account managers, and leadership who actually show up for meetings and collaborate in real time 

• Dynamic stewardship reporting tailored to your goals, not just standard metrics 

• A digital injured worker portal that gives employees instant access to claim updates, appointments, and return-to-work planning 

We use technology to keep things moving—but it’s the people behind it that make the experience seamless. You won’t find call center scripts or ticketing queues here. You’ll get real names, real accountability, and real-time answers.  

5. Closing the Loop—With Intent and Impact

Closing a claim shouldn’t just mean checking a box. At Davies, resolution means the injured worker got what they needed, the employer’s risk was managed, and the process held up under scrutiny. 

We track resolution the same way we track the rest of the claim—through measurable outcomes. Our closure ratio consistently exceeds 100%, and our clients see real results: 

• Lower indemnity claim rates 

• Reduced average incurred costs 

• Higher return-to-work success 

We focus on getting it right from the start, so resolution isn’t dragged out or reactive—it’s earned through strategy, communication, and follow-through. 

“A good claims experience doesn’t just ‘end’—it lands right. That’s what our teams aim for every day.”
— Kara Sepúlveda, President, Workers’ Compensation – North America, Davies 

Let’s Talk  

If your workers’ comp program feels more complicated than it needs to be—or just isn’t delivering the results you expect—we can help. Let’s have a conversation about what’s working, what’s not, and how Davies can do it better. Contact us to learn more.