Use case Decision Support:

The value of accurate decisions

  • Decrease costs
    More accurate decisions will reduce overpayment and litigation costs.

  • Increase transparency
    Well-informed decisions are easy to motivate, and you can show how you made your decision.

  • Improve customer satisfaction
    Ensure your customers get the compensation or treatment they are entitled to.

  • Increase efficiency
    The system will help you make accurate decisions faster.

As insurers, you want to make accurate decisions and provide fair settlements where the claimant gets what their policy entitles to. If the decision is correct, well-motivated, and transparent – everyone’s a winner. But it can be hard to find a fair settlement, like figuring out what kind of long-term disability an accident may have caused. The consequence of this can be compensation that is either too large or small, and obviously, none of those options are desirable.

Problems with underpayment

Underpaying means letting your customers down when they are counting on you. It will lead to decreased customer satisfaction, lost customers, and possibly litigations that will cost time and money to process. According to KPMG, litigations are the most extensive part of the LAE, making up 55% of all costs. To better understand and reduce litigation costs could mean enormous savings for insurers.

Problems with overpayment

To avoid underpayments and reduce the claims handling time, insurers often overpay. The claimant is satisfied, and the case can be quickly closed. But that isn’t very sustainable, right? A medium-sized insurance company paid out over 600M€ in A&H claims last year. A considerable amount of money and only a reduction by some percentage points will save the insurer millions.

The Solution

Mavera DSS helps you make more accurate decisions and enhances the overall decision-making process. During a pilot evaluating Mavera DSS, one of our customers realized savings of 2% on their claims costs. 2% might not sound much, but for this customer, it meant an annual saving of several million euros

Success story #1

Decision support for health insurance

In health insurance, a big challenge is to validate the medical necessity of treatments suggested by private caregivers. Some caregivers recommend medical surgery instead of other alternatives, such as rehabilitation or physiotherapy. This leads to high costs for the insurer and could expose the patient to unnecessary risk.

To help the insurer decide on what treatments to approve, Mavera has developed an AI system that helps detect suggested treatments that may not be medically motivated. The insurer can then investigate the case further and ask for a second opinion from a medical advisor.

  • Profile 
    Large Swedish insurance company.

  • Challenge
    The customer suspected that they approved too many unmotivated medical treatments.

  • Solution
    AI-based detections of suspected not medically motivated treatments and automatic assignment to medical advisors.

  • Result
    Yearly savings of 1,9M€ and more engaged customers.

Success story #2

Investigation of long-term disability

One of the most complex tasks in personal injury claims is determining the long-term disability from an injury. Together with some of Europe’s leading insurance companies, we have developed a tailored solution supporting accurate disability decisions.

The system enables Claims Handlers to securely upload claims documentation and automatically assign it to the most suitable Medical Advisor. As the process, materials and questions are streamlined, the Medical Advisor can make his assessments efficiently and precisely.

  • Profile
    Medium sized Danish insurance company.

  • Challenge
    Streamline medical advisory and improve decision accuracy.

  • Solution
    Mavera DSS for secure and effective communication with medical advisors.

  • Result
    2% reduced claims costs meaning a yearly saving of several million euros.