Use Case 9: Severity Escalation Alerts

Overview: Identifies early signs of severity inflation driven by injury, treatment, and behavioral patterns.

Claims showing indicators like serious bodily injuries, hospital admissions, surgeries, or major property damage often carry high financial exposure long before the full picture is documented. These early severity signals—often hidden in notes, medical descriptions, or initial reports—help adjusters recognize cases that may escalate rapidly. Identifying high-severity potential early enables smarter reserving, faster escalation to supervisors, and more thoughtful claimant engagement before costs surge.

The Goal

To give adjusters early visibility into claims that may escalate into high-cost, high-complexity losses—even before reserves, medical records, or liability facts fully mature. By picking up severity signals early, insurers can set more accurate reserves, intervene sooner, and prevent claims from spiralling into large-loss territory.

Role

Claims Adjuster

Trigger

Medical utilization changes, narrative shifts

Opportunity

Control large-loss development

Before Charlee

Late-stage severity surprises

With Charlee

Predictive severity alerts at the claim level

Product Used: 4SeeCharlee

Value Proposition

• Charlee’s intelligence platform picks clues and alerts even before adjusters can. This includes early indicators of major financial exposure and other factors indicating potential high severity.
• Flagging claims with early indicators of major exposure — ER transport, hospitalization, head injuries, orthopedic surgery, delayed injury reporting, or high-impact accidents.
• Strengthens reserve adequacy by identifying high-dollar risks early, preventing surprises during audits or management reviews.
• Directs senior adjusters and supervisors toward cases requiring elevated attention, ensuring catastrophic exposures aren’t handled like routine claims.
• Improves loss ratio control by enabling earlier negotiations, better medical management, and intervention before costs escalate.
• Recommendations & Strategies: Compare prior strategies across customers’ claims or across Charlee’ repository for similar claims and outcomes.
• Enhances regulatory and executive readiness through more accurate severity recognition, supporting compliant reporting and reliable financial forecasting.

Financial Impact

• Loss Ratio Impact: 2-4 pt reduction on high-severity cohort
• Leakage Avoided: $20K+ per large loss mitigated
• Reserve Accuracy: 10-20% reserve accuracy improvement