AdjudiCLAIMS covers the complete regulatory lifecycle of a California workers' compensation claim. From first notice of injury through closure — with statutory citations at every step.
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Guided decision workflows with statutory authority at every step
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Simultaneous deadline clocks tracked from Day 0
12 tabs
Claim detail view covering every aspect of a CA WC claim
3 roles
RBAC: Claims Examiner, Supervisor, Admin — each with appropriate access
Platform Features
15-day acknowledgment (10 CCR 2695.5(b)), 14-day first TD payment (LC 4650), 40-day accept/deny (10 CCR 2695.7(b)), 90-day presumption (LC 5402(b)), 30-day delay notification cycle (10 CCR 2695.7(c)). Every deadline tracked from the correct source date.
AWE from 52-week wage records, 2/3 statutory rate, injury-year min/max bounds. LC 4652 3-day waiting period and LC 4652.5 retroactive compensation. Every calculation cites its statute. 10% self-imposed penalty calculator for late payments (LC 4650(c)).
QME/AME report analysis: diagnoses, WPI ratings per body part, work restrictions, treatment history, causation opinions — all extracted with citations to specific pages. 5–10 minutes vs. 2–4 hours.
2024 MTUS treatment guidelines matched against treatment requests for UR decisions. ACOEM evidence basis cited for every determination. Prospective, concurrent, and retrospective UR supported. UR decision grounded in evidence — not examiner assumption.
Per-body-part AOE/COE (Arising Out of Employment / Course of Employment) determination tracking. Acceptance, delay, and denial status per injury site. Factual indicators organized — legal complexity flagged for defense counsel routing.
Aggregate medical financials: total billed, allowed, paid, and outstanding by body part and provider. Medical lien tracking. OMFS fee schedule cross-reference. Complete financial picture of the medical side of every claim.
Conversational AI over all claim documents. GREEN zone: factual answers with citations. YELLOW zone: statistical context with mandatory disclaimer. RED zone: blocked with attorney referral. Three enforcement layers. 517 test fixtures verifying compliance.
Three-point contact checklist (injured worker, employer, treating physician), outstanding documentation inventory, SIU referral trigger evaluation. The investigation record is the audit record — gaps identified before determination.
Org-wide compliance view for supervisors: deadline violations across the portfolio, examiner performance metrics, audit readiness indicators. Claims with approaching or missed deadlines surfaced proactively.
Two-tier progressive education: Tier 1 dismissable basics (term definitions new examiners learn once), Tier 2 always-present statutory authority (LC citations and consequences that never disappear). The product IS the training program.
Carrier/TPA-level data isolation. Role-based permissions (Claims Examiner, Supervisor, Admin). BAA available. Zero data retention for AI training. 7-year immutable audit log. DSAR export and right-to-deletion support (CCPA/CPRA).