The Tool Desk
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Start with your organization’s operating model
A carrier administering claims for policyholders, a public fund, a third-party administrator (TPA), and a self-insured employer may need different workflows, access controls, reporting, and scale. Before approaching vendors, document:
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- Your organization type, jurisdictions, lines of business, claim volumes, and claim complexity.
- Who will use the system: adjusters, supervisors, medical-management staff, finance, compliance, external clients, providers, or other partners.
- Whether you need claims administration alone or a broader system for policy, billing, safety, compliance, or risk management.
- Which existing applications and outside services must exchange data with the new platform.
- Who is accountable for jurisdictional rules, reporting submissions, data quality, and system administration.
These details define the requirements that a demo and proposal must address. They also keep a broad platform from appearing to be a fit merely because it offers more modules than you need.
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Write down the work from first report of injury through closure, including exceptions and reopened claims. A useful map may include intake, assignment and triage, investigation, medical coordination, indemnity and expense payments, reserves, litigation, return to work, communications, closure, reopening, and recovery or subrogation where relevant.
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For each step, record the responsible role, information needed, decision or approval, deadline, handoff, and resulting record. Ask vendors to classify each requirement as standard functionality, configurable workflow, custom development, or a third-party integration. That distinction affects cost, change control, and long-term maintenance.
Check workers’ compensation and jurisdictional depth
Ask how the proposed system supports the states or provinces where you operate, including applicable benefits, forms, statutory changes, deadlines, and client-specific processes. Establish who maintains rules and forms, how updates are tested and approved, how they are deployed, and how exceptions are audited.
Public product descriptions establish vendor positioning, not complete coverage of every jurisdiction or buyer configuration. Have vendors demonstrate your actual requirements and provide documentation showing how each is met. Confirm applicable legal and reporting obligations with the relevant authorities or qualified advisers.
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Follow a realistic medical case through the system rather than accepting a general statement that it supports medical management. Examine provider and network data, bill review and pharmacy connections, utilization review or case-management workflows, treatment-plan visibility, communication with injured workers and employers, and return-to-work coordination.
Ask what is included in the proposed product, what depends on another module or vendor, and what data passes across each handoff. Guidewire describes medical management and return-to-work strategies among its workers’ compensation capabilities; Origami Risk describes integrations with medical bill review, pharmacy benefit management, predictive models, and other tools. These are vendor-described features, so confirm availability and scope in the proposed deployment.
Test reserves, benefits, payments, and financial controls
Have an adjuster and finance representative work through a claim with an initial reserve, a reserve change, a payment, and the necessary approvals. Inspect how the system records calculations, authority limits, payment controls, reconciliation, changes, and the downstream financial record.
Ask how jurisdictional benefit calculations are maintained and what happens when a rule or exception applies. Guidewire describes reserve worksheets and payment support. NCCI’s Detailed Claim Information resources describe sampled indemnity-claim data that includes wages, benefits, impairment, attorney involvement, and lump-sum payments. Those descriptions can inform questions about data and workflow, but they do not establish that a particular product meets your controls or jurisdictional requirements.
Make reporting and data quality part of the selection
Reporting is an operational responsibility, not just a dashboard feature. Create an inventory of required reports and submissions, source systems, fields, data owners, validation rules, cadence, acknowledgements, corrections, retention, extracts, and audit evidence. Confirm which duties apply to your role and jurisdictions against current official requirements.
NCCI describes Medical data as bill detail from medical services, with tools for reviewing submission status and data quality or completeness. Its Detailed Claim Information resources cover sampled indemnity claims and fields such as wages, benefits, claimant impairment, attorney involvement, and lump-sum payments. NCCI also describes a dashboard comparing certain claim reports with unit statistical data; it says the view is informational and advises contacting data validators before making significant changes based on it.
In each finalist, test whether a user can trace a reported value to its source, identify who owns a correction, investigate a validation error, see submission status and acknowledgements, and extract the corrected record. Ask how data definitions and report refresh timing are documented so managers do not mistake a stale or differently defined metric for a like-for-like comparison.
Choose the right platform scope and integration approach
Decide whether you want claims-only software, a broader policy-billing-claims core, or a risk-management platform that brings claims together with safety, compliance, or related work. The following are examples to investigate, not a ranking or a complete market list:
| Vendor example | Scope described in official materials | Questions to resolve |
|---|---|---|
| Guidewire | Workers’ compensation claims capabilities include intake and management, medical management, reserve management and payments, analytics, and reporting. Its ClaimCenter materials describe broader claims-lifecycle capabilities. | Which proposed modules, integrations, or partners cover each required workflow and jurisdiction? |
| Sapiens | Workers’ compensation materials describe CoreSuite and GO offerings for insurers, funds, TPAs, and other organizations. Its platform materials describe modular policy, billing, and claims capabilities. | Which modules are in scope, and what are the upgrade, configuration, and integration responsibilities? |
| Origami Risk | Workers’ compensation materials describe a cloud-native platform spanning claims, policy, billing, bureau data, and regulatory reporting. Its solution sheet describes external integrations and an implementation starter-kit approach. | How will the proposed deployment meet your security, reporting, conversion, and third-party service needs? |
Product descriptions are vendor claims, not independent comparative evaluations. Ask each vendor to map every required workflow to a native module, configuration, custom development, or outside connection. Request API and data-model documentation, then test the integrations your operation depends on instead of relying on general connectivity claims.
Review security, access, and auditability
Claims systems handle sensitive personal, medical, and financial information. Have security and privacy reviewers assess current evidence for the proposed service and deployment. Ask about:
- Current assurance reports, encryption, identity integration, and role-based permissions.
- Separation among clients and limits on external-user access.
- Audit trails, incident response, subcontractors, and data retention.
- Backup and recovery objectives, plus procedures for data export and deletion.
Sapiens describes role-based security and external-user access, and Guidewire describes security and privacy as platform priorities. Treat these as vendor statements until reviewers assess current documentation and the specific service configuration.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Assess implementation, upgrades, and support
Request a written plan covering discovery, configuration, customization, data conversion, integration, migration reconciliation, testing, training, cutover, support, and upgrade management. The proposal should identify customer staffing, decision owners, dependencies, assumptions, acceptance criteria, timeline ranges, and costs.
Sapiens presents configuration and modular deployment as product attributes; Origami Risk describes a starter kit and implementation support. Those descriptions do not establish how long or easily your organization will implement the system. Compare proposals on the same scope and assumptions, and ask references about data migration, change requests, training, support responsiveness, and upgrades in deployments resembling yours.
Test usability, analytics, and automation
Have representatives from adjusting, supervision, medical management, reporting, finance, compliance, and IT complete the same tasks in each finalist. Observe navigation, handoffs, exception handling, error correction, and whether dashboards answer operational questions. For each report, ask for the metric definition, data source, filters, and refresh timing.
For automation or AI, ask what decision it supports, what data it uses, how it was validated, how its output can be explained, how performance is monitored, and how staff can review or override it. NCCI’s May 14, 2025 panel summary highlighted the importance of data speed and quality for timely analytics and human oversight when using or considering technology and AI. Treat those points as panel takeaways, not formal standards or comparative performance findings.
Run a common demonstration and scorecard
Send every finalist the same scenario pack and ask them to use your terminology and representative data. For each task, record what worked, what required configuration or a partner, what evidence was shown, and any unresolved question.
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- Receive an injury report, find or create the policy and claimant, validate required fields, and route the file.
- Triage a claim with a medical or severity concern; show the rules, assignment rationale, and human review.
- Coordinate treatment and a return-to-work plan, including a handoff to an external service.
- Change a reserve, authorize a payment, and show calculations, approvals, audit history, and the downstream financial record.
- Handle a jurisdictional exception or rule change; show how configuration is tested, approved, and released.
- Correct a data-quality issue, trace its source, show reporting status and acknowledgements, and extract the corrected record.
- Restrict an external client’s or provider’s access, then show the audit trail and what that user can see and change.
- Produce a management report on cycle time, open inventory, severity, medical activity, or return-to-work status, and explain metric definitions and refresh timing.
Set scorecard weights before demonstrations. Score functional fit; workers’ compensation and jurisdiction depth; user experience; medical and return-to-work support; reporting and data controls; integration and configurability; security and auditability; implementation risk; total cost over the contract term; and vendor support and product roadmap. Record evidence and gaps rather than relying on impressions alone.
Verify the decision before contracting
Use scripted demonstrations to narrow the field, then confirm important claims through written proposal assumptions, current security evidence, references, and contractual commitments. Where feasible, define a pilot or acceptance process with measurable criteria for workflows, data conversion, integrations, reporting, and user access. No comparable implementation duration, pricing, uptime, customer outcomes, or market-share figures are established by the cited product materials, so do not treat unsupported performance promises as evidence of fit.
Quick Recap
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