Claims Analysis

How Claims Analysis Strengthens Litigation Prevention & Case Strategy in NYS Workers’ Compensation

Claims analysis is a critical tool in preventing litigation and building strong case strategies in New York State Workers’ Compensation. By identifying risks early, ensuring compliance, and using data-driven insights, claim analysis helps resolve disputes efficiently and avoid unnecessary legal battles.

1. Early Identification of Disputes
   • Detects inconsistencies in medical reports and claimant statements that may lead to litigation.
   • Flags pre-existing conditions or non-work-related factors that could challenge compensability.
2. Proactive Case Strategy Development
   • Provides data-driven insights to assess the strengths and weaknesses of a claim.
   • Supports early settlement negotiations by comparing similar past cases and outcomes.
   • Helps insurers and employers determine when to contest or accept a claim.
3. Fraud Detection & Defense Preparation
   • Identifies potential misrepresentation, exaggeration, or undisclosed employment through surveillance and background checks.
   • Strengthens defense strategies by gathering critical evidence before a claim escalates to litigation.
4. Medical & Compliance Oversight
   • Ensures medical treatment follows New York’s Medical Treatment Guidelines (MTGs), preventing unnecessary procedures that could prolong disputes.
   • Verifies whether recommended treatments and disability classifications align with objective medical evidence.
5. Cost Containment & Risk Mitigation
   • Helps control legal expenses by resolving disputes before they require costly hearings or appeals.
   • Improves claims reserving accuracy, ensuring financial preparedness for contested cases.
6. Improved Return-to-Work & Settlement Planning
   • Provides insight into alternative work accommodations or vocational rehabilitation options that can reduce litigation over disability status.
   • Guides strategic settlement offers to resolve claims efficiently while minimizing legal risks.

By prioritizing litigation prevention and case strategy, insurers, employers, and attorneys can reduce legal costs, streamline claims handling, and achieve more favorable outcomes in NYS Workers’ Compensation cases.

From the employer's perspective, our approach to workers' compensation claims centers on a rigorous investigation and strategic analysis to protect the company's interests and ensure compliance with NYS regulations. Investigation is an integral part of claims analysis beginning with documentation of the mechanism of the accident, including:

• Scene preservation: Securing the accident site to prevent alterations and facilitate accurate reconstruction.
• Witness interviews: Conducting detailed interviews with all witnesses to gather firsthand accounts of the incident.
• Equipment inspection: Examining any machinery or equipment involved to identify potential malfunctions or safety violations.
• Documentation review: Scrutinizing relevant documents, such as safety protocols, training records, and maintenance logs.
• Photographic and video evidence: Capturing visual documentation of the accident scene and any contributing factors.
• Establishing the timeline: Creating a precise timeline of events leading up to and during the incident.
• Determining if the injury occurred within the scope of employment: Establishing that the employee was performing their assigned duties at the time of the accident.

Claims analysis focuses on:

• Determining if the accident occurred within the scope of employment.
• Assessing the validity of the employee's account of the incident.
• Identifying any potential discrepancies or inconsistencies in the evidence.
• Evaluating the employee's compliance with safety protocols and company policies.
• Analyzing the reporting of the injury and the timeliness of the reporting.
• Determining if the injury was caused by the reported accident.

Robust Legal Strategy Development:

• We collaborate closely with legal counsel specializing in NYS workers' compensation law.
• This involves developing a proactive legal strategy to address potential challenges and disputes.
• We will review all video and photographic evidence to see if it proves or disproves the employee’s version of events.
• We strategically analyze the employee’s initial reporting of the accident, to look for any inconsistencies that can be used to mitigate liability.
• We will analyze if there are any subrogation possibilities, to recoup any costs associated with the incident.
• We will discuss the potential for third party actors that may have contributed to the accident.
• We will confer with risk management regarding company policies and training programs.

Our aim is to help protect the company from fraudulent claims and analyze claims handling for efficiency and fairness within the boundaries of the law. We are committed to a fact-based approach, prioritizing accurate documentation and thorough investigation to mitigate potential liabilities.

Let Asch Workers’ Compensation Strategies help your company streamline your process by analyzing your current strategies and recommending enhanced cost-cutting strategies.