Solutions, Life & Health, Group STD

Not every STD claim is alike

STD volume is the real problem. Owl reads every intake on arrival, plots it against an evidence-based recovery curve (ODG, MD Guidelines, Reed Group), auto-routes the clean ones, and reserves examiner time for the files where something genuinely does not fit. Coordination and ties surfaced in seconds.

Recovery curve, CPT 47562, laparoscopic cholecystectomy, age 410 → 90 days
This file, day 41P50 RTW, day 32

58%

Intakes auto-route to pay on day 1

± 3 days

RTW prediction accuracy

CA EDD

State DI overlap on 11% of intakes

03A real claim, walked end to end

One file: 4 documents, 6 minutes, one decision.

Anonymized composite. Claimant J.R., 41, post-laparoscopic cholecystectomy 2025-09-04. The file arrives at intake. We watch Owl run.

Claim #
STD-2025-0904-J
LOB
Group STD, 13-week max
Procedure
CPT 47562
DOA
2025-09-04
State
CA (EDD applicable)
OwlVision
What it read
Attending physician statement
8 pp
Read, Indexed, Cited
Hospital discharge summary
16 pp
Read, Indexed, Cited
Job description (employer)
4 pp
Read, Indexed, Cited
APS update (week 6)
6 pp
Read, Indexed, Cited
Structured extraction
Surgical date 2025-09-04. CPT 47562. No documented complications. ODG/Reed Group RTW window 28–42 days. APS clears restrictions effective 2025-10-21 (day 47, within band)
OwlSignal
What the world said about the claimant

External data only. None of this lives in your CMS. Owl gathered it from public records, professional networks, registries and the open web, then resolved it to this claimant.

CLM-02
Open state DI claim, CA EDD

CA EDD eligibility check confirms an active SDI claim opened 2025-09-08 for the same disability period. Coordinate to avoid overpayment; California’s integrated benefit calculation applies.

CA EDD eligibility checkerSame DOL, 0.99 match
INC-04
No off-duty employment detected

Professional networks and corporate registries show no new role or filing in the disability window. Auto-route does not flag this dimension.

LinkedInCA SOS: negative
ACT-13
Activity consistent with recovery curve

Open-web activity matches a typical post-surgical recovery: low public posting volume, no athletic activity logged in the impairment window. No examiner action required.

Public web postsAthletic platforms: negative
OwlAssist
What it answered
Examiner asked
When is the earliest medically supported RTW date, and what is the basis?
Owl answered in 0.7s

Earliest medically supported RTW is 2025-10-21 (day 47). The discharge summary cleared restrictions effective that date. CPT 47562 has a typical recovery of 28–42 days under ODG and 4–6 weeks under MD Guidelines. The week-6 APS confirms “no restrictions.” The file is at the upper end of the evidence-based band but inside it.

Discharge summary p.2APS 2025-10-19 p.1CPT 47562 ODG, MDG
Examiner asked
What does the CA EDD overlap mean for our payment?
Owl answered in 0.5s

California requires integration of state SDI with employer-sponsored STD. CA EDD has approved $1,540/wk; the plan benefit is $1,000/wk. Under the plan’s integration clause (§3.4), Owl recommends coordinated payment with state-primary, employer-supplemental: net employer pay $0/wk while EDD is open. Confirm with payroll before adjudication.

CA EDD eligibility 2025-09-08Plan §3.4 integrationPayroll record p.1
04OwlSignal external data

What the world says about your Group STD claimants, none of which lives in your CMS.

Internal claim data is half the picture: it tells you what the claimant told you. OwlSignal continuously gathers external data (public records, professional and corporate registries, court dockets, social and open web) and matches it back to the claimant. These are the families that move the needle on Group STD.

CLMClaim Violations: Multi-source overlap

On STD, the leakage hides in overlap: state DI awards, prior open STD claims with another carrier, and short-cycle re-opens that look new but aren’t. Owl matches against external claim networks, not just your CMS.

State DI databases (CA EDD, NY, NJ, RI, HI)ISO ClaimSearchCross-carrier claim ties
INCUnreported Income: Off-duty work

New jobs, new businesses, gig roles or contract work that started during the disability period, sourced from professional networks and corporate registries, not from anything the claimant filed with you.

Professional networks (LinkedIn, Indeed)Secretary of State filingsGig platform mentions
ACTIrregular Activities

Open-web activity tested against the stated impairment window. We surface the contradictions and we surface the absence of contradiction: both useful at intake triage.

Public social postsAthletic platformsPublic news mentions
STATChanges in Status

Address moves, job terminations, employer changes during the disability period, relevant for STD eligibility at the boundary of the integrated calendar.

USPS NCOAEmployer separation filings (state UI)Public payroll mentions
Refreshed daily, matched by identity-resolution, every observation cited to its source.
05What changes

Numbers from L&H carriers running Owl on Group STD in production.

MetricWithout OwlWith Owl
Auto-pay eligible at intake11%58%
Examiner touches per claim4.21.6
RTW date accuracy (vs. actual)± 11 days± 3 days
State DI overlap captured54%97%
STD-to-LTD transition cycle11 days2 days
Cost per claim$94$31
Source: rolling 12-month average across 6 L&H carriers, Group STD only, n = 84,300 claims.

Built for the regulatory shape of Group STD.

HIPAABAA executed before any PHI is processed. Minimum-necessary by default. PHI never leaves your tenant.
ERISA §503Reasoned determinations with full claim file documentation. Adverse-benefit-determination ready.
NAIC Model #672Unfair Claims Settlement Practices: every Owl-assisted decision cited and auditable.
State paid-leave lawsCA, NY, NJ, RI, HI, MA, CT, CO, OR, WA, integrated with each state’s rules.
SOC 2 Type IIAnnual audit. Continuous controls monitoring. Report available under NDA.
Reg AI / NYDFSBias testing on auto-routing. Human-in-the-loop on every adverse decision.
External data lawful basisOwlSignal sources are public-records or publicly-available. FCRA-aware sourcing flag on every observation.
Records retentionConfigurable per state, per LOB, per carrier policy.
07Integrations

Lives where your Group STD files live.

Claim systems

FINEOS, Guidewire ClaimCenter, DCS, DXC

Document intake

Box, OnBase, Documentum, ImageRight, Kofax

Payroll & HRIS

Workday, ADP, UKG, Paylocity, Paychex

EHR / records

Epic, Cerner, MRO, Verisma, Ciox/Datavant

State DI

CA EDD, NY DBL/PFL, NJ TDB, RI TDI, HI TDI

Identity & SSO

Okta, Azure AD, PingFederate, SAML, SCIM

08Get started

Bring us a month of STD intakes. We’ll show you which would have auto-paid.

Two-week pilot. Your records, your tenant, your plan integration rules. We measure auto-route rate, RTW accuracy and overpayment prevention against your own ground truth.