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Start with your operating model
A claims platform that suits one buyer may not suit another. A carrier administering claims for policyholders, a public fund, a third-party administrator (TPA) serving multiple clients, and a self-insured employer can differ in their workflows, regulatory responsibilities, reporting duties, user populations, and scale.
Before reviewing products, document the scope the system must support:
- Your organization type, claim volumes, lines of business, jurisdictions, and claim complexity.
- Internal and external users, including adjusters, supervisors, medical staff, clients, providers, and finance or compliance teams.
- Whether the system must support only claims, or also policy, billing, safety, compliance, or broader risk-management work.
- Required services and connections, such as medical bill review, pharmacy benefit management, case management, or financial systems.
These decisions determine which products are relevant and which apparent differences matter. For example, Sapiens presents its workers’ compensation offerings to insurers, funds, TPAs, and other organizations; that positioning does not establish that a particular configuration covers every buyer’s requirements.
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Map the claim lifecycle you need to support
Write down how a claim moves through your organization, from first report of injury to closure, reopening, or recovery. Include the handoffs between roles and systems—not just the adjuster’s main screen.
- Injury report intake, policy and claimant matching, required-field checks, and assignment.
- Triage, investigation, communications, and escalation of medical, severity, or litigation concerns.
- Medical coordination, treatment visibility, and return-to-work planning.
- Reserve setting and changes, indemnity and expense payments, approvals, and reconciliation.
- Regulatory and client reporting, closure, reopening, recovery, or subrogation where relevant.
For each step, ask the vendor to identify whether it is supported by a standard feature, configuration, custom development, or a third-party product. Guidewire describes workers’ compensation intake, medical management, reserve management and payments, analytics, and reporting. Its descriptions are a starting point for questions, not proof that a proposed deployment supports your exact process.
Evaluate workers’ compensation and jurisdictional depth
General claims functionality does not by itself establish that a product can support workers’ compensation rules in the states or provinces where you operate. Have adjusters and compliance staff identify the relevant benefits, forms, deadlines, statutory changes, exceptions, and client-specific procedures.
Ask each vendor to demonstrate representative requirements in your jurisdictions. Establish who maintains rules and forms, how updates are tested and approved, how exceptions are handled, and what audit history is available. Ask which requirements are included in the proposed configuration and which depend on a partner, customization, or manual process.
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Rank #2
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Guidewire, Sapiens, and Origami Risk describe workers’ compensation products, but the product materials do not independently establish complete legal, regulatory, or reporting coverage for every jurisdiction. Validate the requirements that apply to your organization against current official rules and vendor documentation.
Check medical coordination and return-to-work workflows
Medical activity and return-to-work coordination can involve multiple people and external services. Assess whether the platform gives the right users timely, usable information and makes handoffs visible.
- Can users find provider and network information and see relevant treatment activity?
- How does the system connect to medical bill review, pharmacy benefit management, utilization review, or case management?
- Can staff record or track treatment plans, communications, work restrictions, and return-to-work actions?
- Which capabilities are part of the proposed product, and which rely on a separate vendor or integration?
- How are exceptions, delays, and changes in a worker’s status handled?
Guidewire describes medical management and return-to-work strategies. Origami Risk’s workers’ compensation materials describe integration with medical bill review, pharmacy benefit management, predictive models, and other tools. Confirm availability, scope, data flow, and responsibility for support in the specific proposal.
Test reserves, benefits, and financial controls
Ask adjusters and finance staff to work through realistic financial scenarios rather than relying on a feature list. A demonstration should show how the platform handles reserve setup and changes, jurisdictional indemnity calculations, medical and expense payments, approvals, payment controls, reconciliation, and financial reporting.
Rank #3
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Follow a change all the way through: who can make it, who must approve it, what appears in the audit trail, and what record reaches downstream financial systems. Guidewire describes reserve worksheets and payment support; that description does not establish that its calculations or controls match your jurisdictional and internal requirements. NCCI’s Detailed Claim Information resources describe sampled indemnity-claim data that includes wages, benefits, claimant impairment, attorney involvement, and lump-sum payments. These fields illustrate the kinds of information some claims reporting may involve; applicable reporting duties depend on role and jurisdiction.
Make reporting and data quality part of the selection
Reporting fit depends on more than whether the software can produce a dashboard. Identify the data your organization must create, validate, submit, correct, retain, and extract, and assign an owner to each task.
- List source systems, required fields, data owners, validation rules, and submission cadence.
- Ask how users see submission status, acknowledgements, errors, and correction history.
- Test how a user traces a bad value to its source, corrects it, and extracts the corrected record.
- Confirm retention, audit evidence, and how data is exported if you change systems.
- Ask how report definitions, refresh timing, and filters are documented so users interpret results consistently.
NCCI’s “Medical data tools and resources” page, posted August 27, 2021, describes medical data as bill detail from medical services and includes tools for submission status and quality or completeness review. Its “Detailed Claim Information data tools and resources” page, also posted August 27, 2021, describes sampled indemnity-claim data, including wages, benefits, impairment, attorney involvement, and lump-sum payments.
NCCI’s “View Your Claim Linking With Data Manager Dashboard,” posted April 16, 2021, describes a dashboard that compares certain claim reports with unit statistical data. NCCI says the view is informational and advises contacting data validators before making significant changes based on it. Check current reporting rules and the dashboard’s present availability before relying on it for an operational decision.
Rank #4
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Decide how much platform you need
Some buyers want claims software alone; others want claims within a policy-and-billing core or a wider risk-management platform. Compare the proposed scope rather than assuming products with similar labels are direct equivalents.
| Example | Vendor-described scope | Questions for the proposed deployment |
|---|---|---|
| Guidewire | Its workers’ compensation page describes claims intake and management, medical management, reserves and payments, analytics, and reporting. | Which capabilities are included in the proposed configuration? Which require other modules, partners, or integrations? How will the system meet your jurisdiction-specific needs? |
| Sapiens | Its workers’ compensation materials describe CoreSuite and GO offerings; its platform materials describe modular policy, billing, and claims capabilities. | Which modules are in scope? What are the implementation assumptions, integration requirements, and upgrade responsibilities? |
| Origami Risk | Its workers’ compensation materials describe a cloud-native platform spanning claims, policy, billing, bureau data, and regulatory reporting; its solution sheet describes external integrations and a starter-kit approach. | How does the proposed deployment address reporting, data conversion, security, and third-party services? What is included in the stated implementation approach? |
These are vendor-described capabilities, not an independent comparison, ranking, or endorsement. Confirm current products, regional availability, and included features directly with each vendor. For every required workflow, record whether it is native, configured, custom-built, or handled through a third party. Request API and data-model documentation, then test critical integrations with representative data.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Review security, access, and auditability
Claims systems handle sensitive personal, medical, and financial information. Have security and privacy reviewers assess the proposed service using your organization’s requirements rather than relying on general product statements.
- Request current assurance reports and details on encryption, identity integration, and role-based access.
- Test whether client, provider, and internal users can be separated appropriately and whether external users can see or change only permitted records.
- Review audit trails, incident response, subcontractors, data retention, and data export or deletion procedures.
- Establish backup and recovery objectives and ask how they are demonstrated and contractually addressed.
Sapiens describes role-based security and external-user access; Guidewire describes security and privacy as platform priorities. These are vendor statements, not independent security validation. Obtain current evidence and test permissions and audit history in the configuration being proposed.
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Assess implementation, support, and total cost
Request a written plan that covers discovery, configuration, any customization, data conversion, integrations, migration reconciliation, testing, training, cutover, support, and upgrades. Ask vendors to state their assumptions about customer staffing, decision owners, dependencies, and what must be ready before each stage can proceed.
For comparable proposals, request timeline ranges, costs, exclusions, and responsibilities in writing. Ask what ongoing support and upgrade work is included and what is charged separately. Sapiens presents configuration and modular deployment as product attributes; Origami Risk describes a starter kit and implementation support in its solution sheet. Neither description establishes the effort, price, or schedule for your organization.
Check references whose operating model and scope resemble yours. Ask what was in the original deployment, what required change, how data migration and integrations were handled, and what the customer would include in acceptance criteria if selecting again. There is no independent, comparable implementation-duration, cost, uptime, customer-satisfaction, or outcome figure established here, so require evidence tied to the proposed deployment rather than relying on promotional performance claims.
Run the same demonstration for every finalist
Use a common scenario pack and ask each vendor to work through it in the proposed product configuration. Include the people who will perform the work and those who own reporting, finance, compliance, and IT. Record what was shown, what was asserted but not shown, and what remains dependent on another system or a future change.
- Receive an injury report, find or create the policy and claimant, check required fields, and route the file.
- Triage a claim with a medical or severity concern; show the assignment rationale, applicable rules, and human review.
- Coordinate treatment and a return-to-work plan, including a handoff to an external service.
- Adjust 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 the change is configured, tested, approved, and released.
- Correct a data-quality issue, trace its source, show reporting status and acknowledgements, and extract the corrected record.
- Restrict access for an external client or provider, then show the audit trail and exactly what that user can see and change.
- Produce a management report on cycle time, open inventory, severity, medical activity, or return-to-work status; explain the definitions and refresh timing.
When a vendor cannot demonstrate a scenario, record the gap precisely: unavailable, not included, requires configuration, requires custom work, relies on a partner, or not yet confirmed. Do not score an unshown capability as though it had been verified.
Use a scorecard and make the decision auditable
Agree on scoring criteria and their relative importance before demonstrations begin. Score written evidence and demonstrated performance, not presentation polish. A practical scorecard can include:
- Functional fit and workers’ compensation or jurisdictional depth.
- User experience for each role and the clarity of handoffs.
- Medical and return-to-work support.
- Reporting, data quality, and correction controls.
- Integration and configurability.
- Security, access, and auditability.
- Implementation risk and customer staffing burden.
- Total cost over the contract term.
- Vendor support and product roadmap.
For each score, attach a demonstration note, document, reference, or explicit unresolved question. Separate mandatory requirements from preferences, and define acceptance tests for the important workflows before signing. NCCI’s May 14, 2025 panel summary, “Data and Technology: Transforming Claims Management,” emphasizes that data speed and quality matter for timely analytics and that human oversight remains a priority when using or considering technology and AI. Treat those statements as panel takeaways, not formal standards or comparative performance findings. For any automation or AI feature, ask what decision it affects, which data it uses, what validation evidence exists, how it is monitored, and how a person reviews, overrides, or handles a failure.
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