Over-treatment, not the injury
Workers' comp economics live and die on return-to-work timing, MMI determination and PT-utilization against state guidelines (MTUS, ODG). Owl reads the FROI, the ER intake, the payroll register, every progress note and the IME on intake, and matches treatment to state cohorts and provider patterns.
38 visits, wk 24
PT at 4.1× MTUS guideline cohort
$761/wk
TTD rate, §4453 AWW, leave excluded
Subro: 87%
Forklift-vendor product-liability path
Three AI agents on a WC loss. Reading. Cross-referencing. Answering.
One loss: a forklift strain, 38 PT visits, an MSA the state hasn’t seen yet.
Anonymized composite: warehouse forklift incident, L4-L5 strain, claimant 24 weeks post-DOL, PT utilization at 4.1× cohort, subrogation path on equipment vendor.
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.
38 PT visits across 24 weeks against MTUS guideline of 6-10 visits for L4-L5 strain. Provider NPI 1xxxxx5821 shows 247 prior WC matters with avg 32 visits per claim, 3.8× the cohort. CMS billing-graph flags this provider on a top-decile over-utilization list within the state.
Forklift Hyster H50FT serial #H187xx2231 last service 2024-09; OEM-required interval is 2,500 hours, equipment hour-meter shows 3,840hr at DOL (1,340hr overdue). Hyster service bulletin SB-2024-114 covers lift-cylinder seal failure on this serial range. Maintenance vendor is third-party. Product-liability + maintenance-negligence subrogation: ~87% recovery probability on the indemnity portion.
Employer OSHA 300 log shows 2 prior forklift-related lost-time incidents at this facility in last 36 months. Most recent OSHA inspection 2024-06 cited 1910.178(l)(4)(i) (operator training) with abatement filed 2024-08. No equipment-related citation. Subrogation does not implicate the employer.
HL7 records exchange returns prior PT episode 2022-03 (12 visits) for L5-S1 strain on a separate non-occupational matter. Apportionment opportunity on the PPD rating; does not extinguish compensability under AOE/COE for the current L4-L5 episode but will compress final PD award by ~18%.
IME 2025-09 (orthopedic) finds claimant at MMI with 8% WPI lumbar rating per AMA Guides 5th ed. Treating physician progress note 2025-08 declares MMI but continues PT through 2025-11 (12 additional visits post-MMI). Post-MMI utilization is non-compensable under §9792.6: recovery opportunity on $4,200 of paid PT.
Reserve revisable down by 50%. Current reserve of $184K reflects continued PT utilization, an open MMI determination and no subrogation credit. With IME-confirmed MMI 2025-09 at 8% WPI, post-MMI PT non-compensable under §9792.6, and the forklift-maintenance subrogation path at 87% probability, recommended reserve is $92,500. Indemnity floor $68K (8% PD + closed TTD), ceiling $128K (if MSA over-funds). Subrogation recovery target $42K-$58K against the equipment-maintenance vendor under the OEM bulletin SB-2024-114 product-liability theory. Open MSA work now via CMS WCMSAP submission with $32K-$40K projected.
AWW = $1,142.18, TTD = $761.45/wk. Gross wages 52-week lookback per payroll register: $59,393.36 across 52 weeks gross. §4453 requires exclusion of weeks with zero qualifying earnings, and the claimant had 2 unpaid leave weeks (2024-12 and 2025-02 per HR record). Adjusted divisor is 50 weeks. AWW = $59,393.36 / 50 = $1,187.87, then reduced by §4453(b)(1) statutory minimum/maximum to $1,142.18 (state SAWW cap). TTD rate at 66.67% × AWW = $761.45/wk. Capped at $1,651.39/wk SAWW maximum (not binding here). 24 weeks paid to date = $18,275; remaining authority before MMI cap = $0 (claimant at MMI 2025-09).
What the world says about your Workers’ Comp 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 Workers’ Comp.
CMS NPI billing graphs, OIG LEIE sanctions, state WC Board provider sanctions, MTUS / ODG guideline-deviation analysis. Identifies the providers driving over-utilization across cohorts.
OEM service bulletins, equipment maintenance graphs, third-party vendor contracts, NHTSA / CPSC recall registries. Surfaces product-liability and maintenance-negligence subro paths your file doesn’t flag.
OSHA inspection records, 300 log filings, BLS injury rates by NAICS, EPA / state-OSHA citations. Establishes the safety record and proximate-cause picture for compensability and subrogation.
External EHR pulls and HL7 exchanges that surface prior PT episodes, imaging, pharmacy fills and diagnoses. Drives apportionment under AMA Guides for the PPD rating.
IRS 4506-T income reconstruction, state UI wage records, employer payroll filings, 1099 reconciliation. Substantiates AWW against §4453 and overtime/bonus inclusion rules.
CMS WCMSAP submission graph, prior MSA approvals by region, prescription cost projection, life-expectancy tables. Right-sizes MSA so settlements close instead of stalling for 18 months.
Numbers from P&C carriers running Owl on Workers’ Comp in production.
Built for the regulatory shape of Workers’ Comp.
Lives where your Workers’ Comp files live.
Claim systems
Guidewire ClaimCenter, Origami, Ventiv, Riskonnect, in-house
Bill review / UR
Mitchell, Mitchell SmartAdvisor, Coventry, myMatrixx, Optum
Records exchanges
Datavant, MRO, Verisma, Ciox, HL7 partners
Industry data
NCCI, WCIO, CMS NPI, OIG LEIE, OSHA inspection feeds
Document intake
Box, OnBase, Documentum, ImageRight, Kofax
Identity & SSO
Okta, Azure AD, PingFederate, SAML, SCIM provisioning
Bring us a closed WC file. We’ll show you the over-utilization, the subro path and the MSA you under-funded.
Two-week pilot. Your records, your tenant, your bill-review partners. We measure cycle time, RTW timing, subrogation catch and indemnity leakage against your own ground truth.