December 4, 2025
When a major U.S. transit authority faced rising costs and inefficiencies in its self-insured workers’ compensation program, it turned to Sedgwick for a data-driven solution. This case study reveals how advanced analytics, transparent dashboards and disciplined strategies helped the agency close more claims in three months than in the previous decade — and set the stage for millions in projected savings. Discover how actionable metrics and expert partnership can transform claims management, improve outcomes and deliver measurable value from day one.
Challenge
A transit authority for a large U.S. city was struggling with rising expenses associated with its self-insured workers’ compensation program. After administering WC claims in-house for decades, they sought new ways to bring greater discipline and efficiency to the program and reduce their total cost of risk (TCOR) — without sacrificing the quality of employee care.
Solution
The transit authority decided to explore opportunities to outsource claims handling to an expert partner. After an extensive 15-month proposal process, they selected Sedgwick to administer WC and managed care on their behalf. The client cited our track record of improving outcomes and managing medical costs, as well as our deep public entity expertise and transition management experience. Sedgwick’s data-driven technology and spirit of innovation were also deciding factors.
As part of the program implementation, our data science specialists conducted a thorough analysis of key metrics to identify areas ripe for improvement. Using our industry-leading tech stack, data visualization tools and WC expertise, we pinpointed six critical factors to meaningfully reduce the client’s TCOR:
- Reducing claim open/reopen rates
- Improving first-year closing ratios
- Lowering indemnity-to-medical-only ratios
- Controlling average incurred costs
- Shortening claim durations
- Reducing litigation rates
Based on these data insights, we partnered with the transit authority to design a comprehensive WC and managed care program that aims to control costs and meet the complex needs of the workforce. We implemented best-practice strategies to address each key metric, with an eye toward improving both financial performance and health and productivity outcomes. These include:
- Introducing early intervention programs, such as on-site medical evaluations, to prevent injury complications from developing
- Using data analytics to identify hearing delays and other bottlenecks
- Enhancing safety training and modified duty opportunities to reduce lost time
- Ensuring medical treatments follow jurisdictional fee schedules and negotiating lump-sum settlements where appropriate
- Assigning dedicated adjusters to prioritize timely medical approvals and return to work
- Improving initial claim investigations and documentation to minimize disputes
Outcomes
With disciplined strategies and informed decision-making, the transit authority closed more unresolved claims in three months than it had in the previous five years. Reserving accuracy also improved significantly.
By continuing to operate a data-driven program with the support of an expert outsourced partner, the agency is projected to save nearly $25 million on WC claim costs within the next two years.
To learn more about how our data-driven insights can transform your claims program, visit sedgwick.com/technology or contact us via our website.
