Claims adjusters
Accept or deny the claim, pay indemnity benefits, set reserves and manage the file to closure.
Insurtech / Workers' Compensation
Workers' compensation insurance software
One late first report, one duplicate medical bill or one stale reserve can cost a carrier or TPA more than the claim. Agnotic Technologies builds workers' compensation claims systems that keep every state clock, bill and benefit visible to the people who own them.
EDI
First and subsequent reports
Bills
Review before payment
Reserves
Updated on every status change
Trusted by global innovators
Industry Overview
What is workers' compensation insurance software?
Workers' compensation insurance software is the claims and policy system a carrier or third-party administrator uses to report injuries to state agencies, pay indemnity benefits, review medical bills, set reserves and support payroll audits. Agnotic Technologies builds it for claims teams that answer to several state rules at once.
Who uses it
Who works a workers' compensation claim?
A single injury claim passes through several desks. Each needs its own view and its own deadlines in the same record.
State reporting coordinators
Send first and subsequent reports to each state and correct anything the state rejects.
Medical bill reviewers
Check bills against the state fee schedule and the treatment authorised, and object or pay on time.
Nurse case managers
Follow treatment and return-to-work plans and flag changes that should move the reserve.
Premium auditors
Confirm payroll by class at the end of the policy term, which feeds premium and statistical data.
Employer clients
See their own claims, costs and injury details, often through a TPA's client portal.
Industry Challenges
Why do carriers and TPAs rebuild their WC claims systems?
Workers' compensation is one line, but it behaves like fifty. These are the reasons buyers give us on the first call.
Every state has its own EDI implementation guide, and adding a state to the old system takes a release cycle.
Medical bills arrive on paper, by fax and electronically, and each route is reviewed in a different tool.
Benefit rates and waiting periods are worked out in spreadsheets outside the claim file.
A TPA serves many employers, each with its own reporting and service agreement, from one system.
Employer clients want claim data they can use, not a monthly PDF loss run.
The legacy system cannot show who changed a reserve, when and why.
Our Approach
How should a workers' compensation claims system be organised?
Three choices on the scoping call decide how well the system copes with many states.
State rules as configuration
EDI requirements, benefit rules and bill payment clocks are held per jurisdiction and dated by date of injury, so a rule change is a configuration release.
Every clock on screen
Each claim shows its open deadlines: state reports, bill objections, payments and reviews, with the owner of each one.
Data the employer can use
Injury and cost data flow to the employer client in a structured feed, not only as a loss run.
Capabilities
What do we build for workers' compensation carriers and TPAs?
Workers compensation insurance software services for the claim side of the line. Class rating and statistical reporting are part of our property and casualty work.
Injury intake and first report
Employer, phone and portal intake that captures what the state's first report needs from the start.
State EDI engine
First and subsequent reports built to IAIABC Claims Release 3.1 and each state's guide, with acknowledgments and error handling.
Indemnity benefit management
Temporary and permanent disability payments calculated by state rules for the date of injury, with every payment explained.
Medical bill review workbench
Fee schedule pricing, duplicate checks, authorisation matching and objection letters within the state's time limits.
Reserve management
Reserve changes driven by status events, each with a reason, an approver and a history.
Return-to-work tracking
Work status, restrictions and modified duty offers recorded against the claim.
Payroll audit support
Audit results checked against the policy's classes before they change premium.
Employer client portal
Claims, costs and loss runs for each employer client, with data exports.
Engineering Stack
Systems and standards behind a WC claims platform
Chosen to fit the states you report to and the bill review and payment partners you already use.
State reporting
IAIABC Claims EDI Release 3.1State EDI implementation guidesAcknowledgment and error processingTrading partner connections
Medical bills
Electronic medical bills (ASC X12 837) where states require themPaper and fax bill captureState fee schedule tablesExplanation of review output
Policy and premium
ACORD P&C XMLClass code tablesPayroll audit recordsPolicy administration interface
Platform and security
Role-based access by employer clientAudit loggingEncryption in transit and at restCloud hosting
Failure points
Where do workers' compensation systems fail?
This is the failure-point list we test an existing system against. Each row is a place we have seen claims go wrong, with the control we build to stop it.
| Failure point | What goes wrong | Control we build |
|---|---|---|
| Missed state EDI deadlines | A first or subsequent report goes late, or is rejected and never corrected, and the state flags the claim administrator | A deadline clock per claim and state from the date of knowledge, acknowledgment tracking, and rejected reports queued for correction |
| Wrong class codes on payroll audits | Audited payroll lands on the wrong class, so premium and statistical data are both wrong | Audit entries validated against the policy's classes and the state class table before premium is recalculated |
| Duplicate medical bills paid | The same service arrives on paper and electronically, or is resubmitted, and both copies are paid | A duplicate check on provider, claim, service date, procedure and amount before payment, with matches held for a reviewer |
| Bills not objected to or paid in time | A state's objection or payment window passes and penalties or interest apply | Receipt date stamped on every bill, with objection and payment clocks set by the state's rule |
| Reserves not updated after a status change | Surgery, litigation or a return to work changes the exposure, but the reserve stays where it was | Status events open a reserve review task, and every change records the reason and approver |
| Indemnity calculated by hand | The weekly benefit or waiting period is worked out outside the system and differs from the state rule | A benefit calculator with state rules versioned by date of injury, and the calculation stored on each payment |
| Injury data never reaches the employer log | The carrier knows about an injury but the employer's OSHA log does not, because the data never left the claim system | A structured injury feed to the employer client, flagged as possibly recordable, so the employer can decide |
Measured Impact
What should a workers' compensation claims team track?
Measures we put on the claims and compliance dashboards.
Acceptance
State EDI results
Reports accepted, rejected and still open, by state.
Bill clocks
Review deadlines
Bills near their objection or payment limit, by reviewer.
Reserves
Changes and reasons
Reserve movements by status event, adjuster and approver.
Return
Return to work
Claims with a work status change and an open modified duty offer.
Use Cases
Where do workers' compensation builds start?
Common first releases, each scoped to one state, one desk or one client group.
01
State EDI module
First and subsequent reports for the states with the most claims, with error queues.
02
Medical bill review
One workbench for paper, fax and electronic bills with duplicate checks.
03
Benefit calculator
Indemnity payments calculated by state rules and stored on the claim.
04
TPA client portal
Employer clients see their claims and costs in real time.
05
New state launch
A jurisdiction added through configuration rather than code.
06
MGA claims desk
Workers compensation insurance software for startups and MGAs handling their first claims.
Integrations
Which systems does a WC claims platform connect to?
The agencies, partners and systems a workers' compensation claim depends on.
Claim EDI
State workers' compensation agencies
Transmission
EDI trading partners
Electronic bills
Medical bill clearinghouses
Pricing
Fee schedule and bill review data
Coverage and classes
Policy administration
Benefits
Payment and check services
Audit data
Payroll providers
Injury data
Employer HR and safety systems
Compliance-First Development Services Backed by Global Standards
We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.
General Data Protection Regulation
Implement lawful consent flows, data minimization, and secure processing for global data privacy.
Service Organization Control 2
Verified controls for security, availability, and confidentiality of enterprise data systems.
Information Security Management
Adhering to the international gold standard for managing information security risks.
Our Edge
Why Global Leaders Choose Us
We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.
Enterprise-Grade Security
We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.
High-Performance Scaling
Our architectures are built to handle massive data loads and user bases, keeping performance steady whether you're serving ten or ten million.
Accelerated Time-to-Market
Using our suite of internal tools and proven frameworks, we cut setup work so your first release reaches users sooner.
Embedded AI Integration
Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.
Engagement Model
How does a workers' compensation engagement work?
We start with the states and desks under most pressure. Timing depends on scope; we agree a fixed first release on the scoping call.
01
Scoping call
States, claim volumes by desk, bill routes and the first failure point to fix.
02
State rule inventory
EDI guides, benefit rules and bill clocks for each state in scope, held as configuration.
03
Fixed-scope first release
One desk, such as state reporting or bill review, live for the first states.
04
Add states and desks
More jurisdictions and workflows on the same claim record.
05
Support
State guide changes and fee schedule updates under agreed change control.
Facts and sources
Which state and federal rules shape WC claims software?
Short facts we design around, each linked to its primary source. California and Minnesota are shown as state examples.
In California, each claims administrator must submit the required first report data elements to the Workers' Compensation Information System within ten business days of knowledge of the claim, by EDI as set out in the state's implementation guides.
Source: 8 CCR 9702(a) and (b), California DIRIn California, a properly documented medical bill must be paid within 45 working days of receipt (60 for a governmental employer) unless contested within 30 working days; amounts not paid or contested in time are increased by 15% and carry interest.
Source: 8 CCR 9792.5(b), California DIROn 9 February 2023 the Minnesota Department of Labor and Industry adopted the IAIABC Claims Release Standard Version 3.1.5 XML format for workers' compensation EDI, retired the ACORD XML format and required all EDI trading partners to use the IAIABC format.
Source: Minnesota Department of Labor and Industry, Work comp EDIEmployers must enter each recordable injury or illness on the OSHA 300 Log and 301 Incident Report within seven calendar days of receiving the information, and many employers use an insurance form as the equivalent of the 301.
Source: 29 CFR 1904.29(b)(3) and (b)(4) (eCFR)
Voice of success
We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
“I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly.”
Aaron Phelan
Founder, Benchmark
“Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective.”
John Pasmore
Founder, Latimer
“Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together.”
Kim Smith
Founder, My Lauren
Related pages
Related claims and safety services
This page covers the payer side of a workers' compensation claim. These pages cover the provider, employer and safety side.
Accident and injury claim software for providers
The clinic side: billing workers' compensation and auto insurers for injury care.
OSHA compliance software
Employer injury logs and the 300, 300A and 301 records.
EHS management software
Incidents, inspections and corrective actions for safety teams.
Insurance software for policy and claims administration
Policy servicing and claims across other lines of business.
Insurtech software development
Our wider insurance practice for carriers, MGAs and startups.
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Cross-Industry Reach
The Same Engineering Patterns, Across Other Industries
The technical patterns behind this platform translate naturally into adjacent verticals.
Frequently Asked Questions
Many states use the IAIABC Claims EDI Release 3.1 standard with their own implementation guide on top. Minnesota, for example, moved all trading partners to the IAIABC XML format in 2023. We build to each state's guide.
Yes. Each jurisdiction's EDI rules, benefit rules and bill clocks are configuration on the same claim record, so adding a state does not mean a new system.
Every bill is checked against earlier bills for the same provider, claim, service date, procedure and amount before payment. Likely duplicates wait for a reviewer instead of paying automatically.
No. Recordability is the employer's decision. The system sends the employer a structured injury feed and flags claims that may be recordable, so the employer's own log stays complete.
The number of states, the EDI and bill review scope, integrations with policy, payment and payroll systems, and how many open claims must be migrated. We set out these drivers on the scoping call and agree a fixed first release.
Yes. Access is scoped by employer client, so each one sees only its claims, costs and reports, while the TPA works across all of them.
Clinic software sends injury bills to insurers. This system is on the other side: it receives those bills, reviews them and pays them, alongside state reporting and benefits.
Industries