Workers' compensation claims management that keeps every lost-time claim moving, and on every state deadline
Lost-time claims kept on every state deadline while the adjuster decides.
See one case, screen by screen ↓Software that runs a workers' comp claim from the first report of injury to closure: the medical, the benefits, the state filings, the payments and the return to work, each on its deadline. Workers' Compensation Claims Management adds six agents that read every document on a lost-time claim and draft the next step, while the adjuster decides, pays and signs.
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A lost-time claim is a dozen moving parts, each on its own clock. In Georgia the first installment is due within 21 days of the employer's knowledge, every installment after it is weekly, and 15% is added to one more than 14 days late. The WC-1, WC-6, WC-2 and WC-240 each have their own trigger, and the modified-duty offer must carry a job description the authorized treating physician has approved and reach the worker at least 10 days before the start date.
The medical lives in PDFs: the ER note, urgent care, the ortho consult, the MRI, the operative report, PT notes and work-status slips, with restrictions that change every few weeks. An adjuster with more than a hundred open claims keeps the dates by diary, and diaries do not read documents. So an offer goes out that says kneel when the note says no kneeling, the doctor rejects it, and another week of TTD is paid for a worker who could have been back.
Estimated split for one lost-time claim handled by hand, and with the solution. The agents' part takes seconds; what is left is the adjuster's reading of what they found, the decisions and the signatures.
Six agents read every note, offer and wage statement, keep the medical picture, benefits and state forms current; the adjuster decides.
Dwayne Holloway, a maintenance technician at Tallgrass Cold Storage, twisted his left knee on a wet loading-dock ramp on 18 Aug. It is Monday 12 Oct, day 55. Here is the day, screen by screen, in the working solution.
Tanya opens WC-26-04417 and sees one thing first: 4 of 7 steps done, and one step blocking. Injured 18 Aug, off work from 19 Aug, surgery 22 Sep, released to light duty 5 Oct. Then the job offer of 8 Oct, in red: the job says kneel. Beside it, the body diagram marks the left knee amber: no kneeling, review 19 Oct, 7 days.
“Blocking: the offered job breaks two of Dr. Raman’s restrictions”
The intake reader filed two new documents since Friday: Tallgrass's modified-duty offer and the PT progress note of 9 Oct. The medical summariser updated the knee, the restriction tracker checked the 5 Oct restrictions, the benefit calculator scheduled installment 7, and the state filing drafter drafted the WC-240 and is holding it. “Run again” replays every step in view.
“Return-to-work coordinator tested the offer: 2 of 6 tasks conflict”
Complex tear, posterior horn of the medial meniscus. Arthroscopic partial medial meniscectomy, 22 Sep, uncomplicated. No kneeling, squatting or ladders; lift up to 20 lb; stand 30 min in each hour. Each line carries a number, and a click opens Dr. Raman's work-status note of 5 Oct with the sentence highlighted.
Every note on the claim in date order, from the Southside Memorial ER note on day 0 to the PT progress note on day 52. Highlighted sentences are the ones the summary and the restrictions rest on, and the margin says where each one went: the restrictions and the review date to the left knee, the wrist to “not yet decided”.
“It cites; it never adds a diagnosis the note does not state.”
The PT note of 2 Oct records right wrist pain with crutch use since about 25 Sep. Dr. Raman found mild radial tenderness, a negative x-ray, and wrote “likely related to crutch use”; the crutches were prescribed for the knee surgery. The agents mark the wrist violet, not yet decided. Tanya can accept it, deny it, or ask Dr. Raman at Friday's visit.
“Accept as part of this claim, deny, or ask Dr. Raman to say more at the 16 Oct visit. Splint $86 waiting on the decision.”
Inventory control clerk, cold-dock office, 40 hours at $24.50. Six tasks against four restrictions: kneeling to scan bottom-rack labels about 10 times a shift breaks “no kneeling”, and restocking printers from the mezzanine up the fixed ladder breaks “no ladders”. The revised job uses Tallgrass's own pole-mounted scanner and has the dock lead bring the stock down. Same job, hours, pay and start date; the request to Dr. Raman is drafted, through Elena Voss, RN.
“Sends nothing — the adjuster or RTW coordinator does.”
Thirteen weeks of gross wages, $14,497.52, divided by 13 is an average weekly wage of $1,115.19; two thirds is a TTD rate of $743.46. Seven weeks paid, $5,204.22, each installment on or before its due date. Installment 7 is due Thu 15 Oct, waiting for Tanya's approval. The what-if shows modified duty at $980 a week: TPD of $90.13, $653.33 a week less than TTD.
“Nothing is paid until you approve it.”
The WC-1 first report, the WC-6 wage statement and the WC-1 first payment notice are filed, the last one 5 days early. The WC-240 offer of suitable employment is drafted and held, because the job is not yet approved by the authorized treating physician. The WC-2 and the EDI subsequent report for the change from TTD to TPD are planned for 26 Oct.
“A start on Mon 26 Oct means sending by Fri 16 Oct.”
Tanya sends the revised job to Dr. Raman's office through the nurse case manager. Coastal Orthopaedic Group faxes the answer back the same day, ahead of Friday's visit, and Elena records it. The path changes colour: on track to return 26 Oct.
“☑ Approved. Employee may perform this job within the restrictions of 5 Oct.”
To Dwayne Holloway by mail and email, a copy to the State Board and Tallgrass, the approved job attached, start Mon 26 Oct at 07:00, 10 days' notice. If he starts that day, five weeks of modified duty to the expected full-duty release save about $3,267 of indemnity, and he is back at work five weeks sooner.
“The agent drafted it; you are the sender.”
The same claim, seen by the four people who work it — what their week looked like, and what it looks like now.
Six agents read every note, offer and wage statement, keep the medical picture, benefits and state forms current; the adjuster decides.
Reads the first report, the employer statement, the wage statement and every new document on a claim, and files each one to the claim it belongs to.
Reads every medical record and keeps a summary per body part, diagnosis, procedures and progress, with a citation for every sentence; keeps the body diagram current.
Extracts each work-status note's restrictions with start and review dates, and watches appointments and expiries.
Works out the average weekly wage, TTD and TPD with the working shown, and schedules each installment against the state clock.
Drafts each state form and electronic report with its due date under that state's rules.
Tests each modified-duty offer task by task against the current restrictions, drafts revised job descriptions and the request to the treating physician.
Decides, pays and signs. The agents propose; a named person decides.
Ask about any claim, body part, payment or form, or have it draft the next step. Every answer cites the note it rests on.
What is blocking Dwayne’s return to work?
The modified-duty offer. Tallgrass’s job of 8 Oct asks him to kneel at the bottom racks about 10 times a shift and restock from the mezzanine; Dr. Raman’s note of 5 Oct says no kneeling, squatting or ladders until the 19 Oct review. She cannot approve that job, so the WC-240 cannot go. A revised job is drafted: pole-mounted scanner, stock brought down by the dock lead. If you send it now she can sign it at the Fri 16 Oct visit, the latest send date for a Mon 26 Oct start.
Is the right wrist part of this claim?
Not yet decided; that is your call. The PT note of 2 Oct records right wrist pain with crutch use since about 25 Sep. Dr. Raman found mild radial tenderness, a negative x-ray, and wrote “likely related to crutch use”. The crutches were prescribed after the knee surgery. The only cost waiting is a splint, $86. You can accept, deny, or ask Dr. Raman to say more on Friday.
What do we owe this week, and when is it late?
Installment 7: $743.46 for 7 – 13 Oct, due Thu 15 Oct. If it were more than 14 days late, after Thu 29 Oct, Georgia adds 15%, $111.52. All six installments so far were paid on or before their due dates; the first on 3 Sep against a due date of 8 Sep.
What does fixing the offer save?
At $980 a week in the modified job, TPD is two thirds of the $135.19 gap: $90.13 a week instead of $743.46, or $653.33 a week less. Full duty is expected in late November, so from Mon 26 Oct to 30 Nov that is five weeks, about $3,266.65 of indemnity, and Dwayne back at work five weeks sooner.
13 screens from the working solution, on its sample data. Pick one to see it large.
How claims are watched and who decides are settings. Changes are versioned and on the audit trail.
| Setting | Default | Choose from |
|---|---|---|
| Alert lead time | 5 days | Business days before a form or payment is due that the draft is ready and the adjuster is told; 1 to 10 |
| Penalty guard | On | Never hold an installment within 3 days of its late date without a named reason |
| States in scope | Georgia · South Carolina · Tennessee · Alabama | Forms, clocks and benefit rules applied per state |
| Restriction review warning | 10 days | Mark a body part amber when its restriction review is this close: 7, 10 or 14 days |
| Check every offer | On | Test each modified-duty offer against the current restrictions before it reaches the doctor |
| Revised job descriptions | Adjuster · RTW coordinator | Drafted by the agents; sent only by the adjuster or the return-to-work coordinator |
| Worker contact | Never by an agent | Through the adjuster, and through the attorney when the worker is represented |
| Reserve change | $25,000 | Refer to the unit manager when a reserve moves by more than $10,000, $25,000 or $50,000 |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample claim data · “target” = the design goal, measured in the live solution · “estimated” = our estimate · “typical” = published figures (NCCI State of the Line 2026, via Business Insurance and Insurance Journal, May 2026 — medical and indemnity severity each up 4% in 2025, accident-year combined ratio 102; O.C.G.A. § 34-9-221 — Georgia adds 15% to an installment more than 14 days late). People, employers, providers, the insurer and claims named on this page are fictional — characters and sample data in the working solution.
Software that runs a workers' comp claim from the first report of injury to closure: the medical, the benefits, the state filings, the payments and the return to work, each on its deadline. Workers' Compensation Claims Management adds six agents that read every document on a lost-time claim and draft the next step, while the adjuster decides, pays and signs.
The benefit calculator works from the wage statement under the state's rule and shows every step. On the example Georgia claim, 13 weeks of gross wages of $14,497.52 give an AWW of $1,115.19 and a TTD rate of two thirds, $743.46 a week, with the state weekly maximum checked and the waiting week scheduled. It never issues a payment; the adjuster approves each installment.
It drafts them. The state filing drafter fills each form and EDI report from the claim and sets its due date from the state rule, such as the WC-1, WC-6, WC-2 and WC-240 in Georgia. It holds a form whose preconditions are not met, and nothing is filed without the adjuster's signature.
The return-to-work coordinator splits the employer's offer into tasks and tests each one against every current restriction. When a task conflicts, it drafts a revised job description using the employer's own equipment and staffing, and a request to the treating physician. The adjuster or the return-to-work coordinator decides what is sent.
No. Compensability and body parts are the adjuster's decisions. The medical summariser marks a new body part “not yet decided” and puts the notes that bear on it side by side; it never adds a diagnosis the record does not state.
The working solution applies the forms, clocks and benefit rules of Georgia, South Carolina, Tennessee and Alabama. States in scope are a setting, each with its own rule set.
Medical records are visible to the claim team and the nurse case manager; the employer's contact sees work status and restrictions, never diagnoses. No agent contacts the worker: contact goes through the adjuster, and through the attorney when the worker is represented.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your states, forms, approval limits and a sample of your lost-time claim files — and it goes live once every quality gate has passed. We will walk you through it on your own claims first.
Thousand-page demands read in full and answered before the deadline.
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1-min demoWe’ll run Workers' Compensation Claims Management on a sample of your own lost-time claim files.