Workers' Compensation · Carriers & TPAs

Faster claims resolution starts with better clinical insight

Claims professionals are not clinicians. SecondLook translates every complex medical record into a clear clinical story your adjusters and medical directors can act on in minutes, so reserves are accurate and adverse development stops surprising you.

Claims ExecsAdjustersMedical DirectorsState Funds
app.secondlookhealth.ai
Claim #WC-4821 · clinical brief
Reserve signalseverity trending upUnderstated
Treatment14-day gap in careMonitor
Mechanismonset inconsistent with injuryFlag
HIPAA CompliantHIPAA Compliant
SOC 2SOC 2 Type II Certified
AIClosed-System AI
The challenge

Reserves, compensability, and cycle time all hinge on the chart

Medical drives most of the cost on a complex claim, and it's decided in records no adjuster has time to read. So reserves lag the clinical reality, compensability calls get made on an incomplete picture, and cycle times stretch, while the claims that develop adversely were knowable all along.

What you get

A clinical story your team can act on

The capability set behind every complex claim, framed for the decisions your adjusters and medical directors own.

Accurate reserves, less adverse development

Rapid clinical comprehension for non-clinical staff: a clear read on severity, trajectory, and exposure the moment records arrive, so reserves reflect the clinical reality and adverse development stops surprising you.

Earlier intervention

Real-time flags on over-utilization, delayed care, and return-to-work risk, with the clinical reasoning your team needs to act before costs escalate.

Less external review spend

Claims you currently send out for medical review at roughly $443 an hour resolve internally once the clinical narrative is clear, cutting a major line of spend.

Fraud and inconsistency detection

Contradictions, undisclosed history, and treatment that doesn’t fit the mechanism of injury surfaced automatically, each tied to its exact source page.

Across the claim

Clinical insight at every decision point

1

Intake

Records read and structured the moment they land.

2

Triage

Claims scored by clinical risk and exposure.

3

Reserve

Severity and trajectory inform accurate reserves.

4

Manage

Red flags and return-to-work tracked over time.

5

Resolve

Cleaner narratives speed settlement.

99%

Accuracy, third-party validated

70–90%

Reduction in review time

$7–9

Returned per $1 on labor

500–20k+

Pages per case, routinely

The track record

MSA results you can audit

87%
of MSAs submitted to CMS approved as submitted, on first review
1,180+
MSAs prepared since 2011, predominantly workers' compensation
$708,730
in CMS over-allocations reversed on appeal: money that stayed in the settlement instead of the set-aside
25+ years
of MSA practice leadership
Career record of Leta Sharkey-Laugle, MSCC, who leads SecondLook's MSA practice
Leta Sharkey-Laugle, MSCC
Leta Sharkey-Laugle, MS, NCC, CRP, MSCC, CLCP
Leads SecondLook's MSA practice. 25+ years in workers' compensation and settlement services; former chair, ICHCC Medicare Set-Aside; wrote the utilization review framework adopted by the State of California.
Related use cases

More from the same engine

Put a clinical second look on every complex claim

Accurate reserves, earlier intervention, and less external review spend, delivered as SaaS or API straight into your claims system.

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