The Claims Metric Risk Professionals May Be Overlooking

By: | November 9, 2026

Lara Heal is the Vice President of Specialty Network Services at CorVel Corporation, where she oversees the company’s CareIQ, Pharmacy, and IME service lines. She brings more than 25 years of experience in the healthcare industry, including a decade of leadership in case management and vocational rehabilitation services. A registered nurse (RN), certified case manager (CCM), and certified Workers’ Compensation Professional (WCP®), she has deep expertise in workers’ compensation, disability management, managed care, and clinical operations. Heal is recognized for her clinical expertise, operational leadership, and extensive industry knowledge. She holds a bachelor’s degree in nursing from the University of Southern Maine.

As A.I. becomes more integrated into claims management, much of the conversation about its value centers on efficiency and administrative time savings. Those improvements matter, but there’s another measure that deserves attention: how quickly we’re helping injured workers get the care they need.

Risk professionals track claim length, medical costs, and return-to-work outcomes to assess their workers’ comp programs. Those numbers tell you what’s happened, but not necessarily where delays occurred or how they affected the outcome.

A claim may stay open longer because a treatment referral took too long, an authorization was delayed, or a clinical issue wasn’t caught early. By the time it appears in a report, the opportunity to act may have passed.

In care management, time affects recovery and cost. A few days’ delay can disrupt treatment, frustrate the injured worker, and prolong a claim. Knowing where delays occur tells you a lot about your claims program.

Where Is Time Being Lost?

Consider an injured worker who needs physical therapy. A provider recommends it, but the referral takes several days to process. Scheduling the first appointment adds another delay. The treatment may be exactly what the worker needs, yet they still have to wait.

These delays don’t always show up in standard claims reporting.

One way to view these gaps is through the three Cs of effective care management:

Communication: Timely communication helps injured workers, employers, and providers understand treatment plans, address concerns, and avoid delays. An early conversation can clarify next steps before a misunderstanding slows things down.

Coordination: The time between identifying a need and arranging the next step can reveal where referrals, authorizations, or other clinical services get held up. Understanding why can help teams address delays before they affect treatment.

Collaboration: Sharing information early among claims professionals, clinicians, providers, and employers helps teams make informed decisions and plan for return to work. When everyone has only part of the picture, even straightforward decisions can take longer.

Together, these areas can reveal problems that claim duration and cost figures alone may not explain.

Technology Can Help, but Someone Still Has to Act

A.I. and predictive analytics help us spot issues, summarize claim information, and bring relevant details to claims and clinical professionals.

That’s especially useful when a claim involves extensive documentation and several people coordinating care. But identifying an issue doesn’t solve it. A nurse, adjuster, or other care team member still needs to review what’s happening and decide what to do.

When evaluating technology, administrative time savings are only one measure of its value. It can also help claims teams spot issues earlier, make decisions sooner, and spend more time with injured workers. Those benefits may be harder to quantify than hours saved, but can have a greater impact on recovery.

A Different Way to Look at Claim Duration

Claim duration, medical costs, and return-to-work outcomes will always matter. So does understanding what happens between major claim milestones, where delays may otherwise go unnoticed.

Technology can help us find those answers, but what claims and clinical professionals do with that information matters. Risk professionals should look beyond how long a claim stayed open and examine where time was lost. Some of the best opportunities to improve recovery may be found in those delays. &

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