VOL. 01  ·  PROTOTYPE  ·  CONFIDENTIAL
PREPARED FOR
Isaac Muller · Highview National

An AI layer that sits on top of Spear,
not instead of it.

Your adjusters keep doing the judgment work: reserve moves, settlement strategy, compensability calls. We take everything else — document chasing, note writing, medical review, status updates — off their desk. Below is what a single lost-time claim looks like running through Hypermodel.

SAMPLE CLAIM Nursing Home · Back Injury · NY HIGHVIEW BOOK PROFILE Healthcare WC · ~$30–60M GWP est. STACK POSITION Layer on Spear Claims GOAL Cut LAE · compress cycle time · stop leakage
§ 01

The claim

A realistic healthcare WC file
Insured
Maple Ridge Nursing & Rehab125-bed SNF · Rockland County, NY
Claim No.
HV-2026-0412Reported Apr 13
Injured Worker
CNA, age 447 yrs tenure
Type
Lost-TimeLumbar strain

Certified nursing assistant injured her lower back transferring a 220-lb resident from bed to wheelchair without a second assist. Reported to supervisor same shift. ER visit that evening. MRI scheduled. The kind of claim that either closes in 6 weeks with proper early intervention — or drifts into twelve months of physical therapy, an attorney retainer, and a $180K reserve.

§ 02

Adjuster copilot

Click through the tabs
What Hypermodel does for this claim

Structured FNOL — in under a minute

Voice intake from the supervisor · transcribed · parsed · fielded
Hypermodel extracted from supervisor call
Injured worker: Maria D., CNA · Date of injury: April 13, 2026, 14:20 · Mechanism: Patient transfer without second assist · Body part: Lumbar spine · Witnessed: Yes — co-worker on duty · Prior history: None on file · Treatment sought: Good Samaritan ER, same day · Compensability: Clear — occurred in course of employment
Severity flags for adjuster
✓ Classic lift injury mechanism — typical duration 4–12 weeks if managed actively
✓ No red flags for fraud (immediate report, witnessed, consistent story)
⚠ Healthcare worker with physical job — return-to-work plan needed by Day 7 or duration risk climbs sharply
Before Hypermodel
42 min
Adjuster fields call, types notes, sets up file
With Hypermodel
3 min
Adjuster reviews and approves

Every document, read and indexed

ER record · MRI report · wage statement · provider letters
Pulled from ER record (Good Samaritan, 04/13)
Diagnosis: Acute lumbar strain, no radiculopathy. ICD-10: M54.50. Prescribed: ibuprofen 800mg, cyclobenzaprine 10mg. Released with 3-day work restriction. Follow-up with PCP in 5 days.
Flagged for adjuster attention
Provider letter dated 04/22 extends disability another 6 weeks with no objective findings beyond self-reported pain. MRI not yet obtained. This is the exact pattern that drifts into litigation if we don't intervene. Recommend IME referral and peer-to-peer call with treating provider this week.
Duplicate billing detected
Physical therapy provider billed CPT 97110 + 97530 on same visit — bundling violation per NY fee schedule. Flagged 4 instances across April billing. Estimated overpayment: $840.

Medical bills, reviewed in seconds

Fee schedule validation · CPT bundling · medical necessity
Bill review summary — 11 bills processed
Total billed: $18,430 · Fee-schedule allowed: $11,290 · Bundling/duplicate reductions: $840 · Unrelated-to-injury flags: $620 (lab work for thyroid panel — not compensable)
Net to pay
$9,830 — a 47% reduction from billed. Every line is auditable, cited to the NY fee schedule, and ready for your examiner to approve or override.
Subrogation watch
Resident being transferred has history of combative episodes per facility incident log. If restraint protocol was not followed, there may be a third-party recovery angle worth $15–30K. Flagged for your subro specialist.

Reserve set on comparable closed claims

Not a guess — benchmarked against your own historical book
Comparable-claims analysis
Searched Highview closed claims, 2021–2025: 127 comparable files (healthcare WC, lumbar strain, age 40–50, NY, no surgical pathway). Average ultimate: $24,400. Median duration: 58 days. 14% litigated. 71% closed within 90 days.
Industry default reserve
$65,000
Conservative — ties up capital
Hypermodel recommendation
$28,500
Your book · your history · auditable
Why this matters
Reserves set on industry averages rather than your actual book lock up surplus and distort your loss ratio. Across a typical month of new claims, right-sized reserves free $200K–$400K in deployable capital for Highview.

Notes and status, written for you

Every file stays current without adjusters typing
Draft claim note — ready for adjuster approval
04/22/26 — Follow-up w/ treating provider obtained. Work status extended 6 wks, no objective findings beyond subjective pain. MRI still not scheduled. Recommend: (1) IME referral, (2) peer-to-peer w/ treating, (3) transitional duty offer to employer. Reserves reviewed — holding at $28.5K pending IME. Employer contact: Denise, HR Director, confirmed light-duty available. RTW target: 05/15.
Broker status update — drafted, awaiting send
"Gerald — quick update on the Maple Ridge claim (HV-2026-0412). Treatment is progressing but we're watching the duration carefully. I've ordered an IME and we have light duty lined up at the facility. Targeting RTW by mid-May. Reserves are holding at $28.5K. Let me know if Maple Ridge has any questions — I'll have Denise on a call with us if helpful."

Return-to-work, actively managed

Your differentiator — operationalized inside the claim file
RTW intervention queue
Day 1: Employer contact log — confirm light duty available ✓
Day 7: Transitional duty job description sent to provider ✓
Day 14: Progress check w/ HR ✓
Day 21: Peer-to-peer call scheduled w/ treating physician
Day 30: IME if not back to modified duty
Outcome on comparable files
Highview files where RTW protocol ran end-to-end closed 31 days faster on average and avoided litigation in 92% of cases, vs. 74% for files without active RTW management. This is the thing you already talk about publicly — we just make sure it happens on every file, not just the ones an adjuster remembers to chase.
§ 03

End to end — same claim, start to finish

Red dots = AI · Black dots = adjuster judgment
DAY 014:20
Hypermodel · 90 seconds
FNOL voice intake from supervisor
Call transcribed, fielded into Spear, severity flagged, file opened, broker notified. No adjuster touched it yet.
DAY 014:25
Adjuster · 3 minutes
Reviews & approves the file setup
Reads the AI summary, confirms compensability, accepts recommended initial reserve. Done in the time it takes to drink coffee.
DAY 1AM
Hypermodel · background
Employer contact, RTW plan initiated
Email to HR confirming light duty available. Transitional job description pulled from prior Maple Ridge files.
DAY 7
Hypermodel · background
Provider records pulled, bills reviewed
ER record indexed. First PT bills run through fee schedule. Bundling violations flagged. Notes drafted.
DAY 9
Adjuster · 10 minutes
Approves bill payments, reviews drafted notes
Scrolls AI-prepared bill review, one-click approves. Adjusts one note. Moves on.
DAY 22
Hypermodel · alert
Escalates — duration drift detected
Provider extended disability with no objective findings. AI compares to 127 similar files and recommends IME + peer-to-peer. Broker update drafted.
DAY 22
Adjuster · judgment call
Decides on IME, makes peer-to-peer call
This is what your examiner should be doing — using experience to move the claim, not typing notes about it.
DAY 58
Hypermodel · closing
Closing package prepared
Worker back to full duty. Final bills reconciled. Subrogation memo drafted. File ready for close-out approval.
DAY 58
Adjuster · 5 minutes
Reviews and closes
Total adjuster time on this file: ~1.5 hours. Industry average on a comparable file: 8–12 hours. Same outcome for the injured worker, same payment to providers, a fraction of the LAE.
§ 04

Leakage audit

Hypothetical run on 500 closed files

The pitch you actually care about, Isaac. We take a batch of your closed claims, run them through the audit, and show you — in dollars — what leaked. No commitment. Just a diagnostic. These are illustrative numbers on a hypothetical 500-file sample from a healthcare WC book your size.

01 · Medical overpayment

Bills paid above the fee schedule

Duplicate CPT codes, unbundled procedures, and billing after MMI. Typical carriers overpay 3–6% of medical spend on WC books without real-time bill review.

$187,400
Recoverable · sample book
02 · Missed subrogation

Third-party recoveries never pursued

Premises liability, auto, product defect, resident-caused injuries. Most WC carriers recover on less than half of eligible files — the rest never gets flagged.

$312,000
Recoverable · sample book
03 · Over-reserved claims

Capital locked up unnecessarily

Files reserved on industry defaults rather than your own comparable closed claims. Right-sizing frees surplus without changing a single outcome.

$840,000
Surplus freed · sample book
04 · Duration drift

Claims that should have closed earlier

Files where the treating provider extended disability without objective findings and nobody caught it. Each extra week of indemnity on a lost-time file costs real money.

$245,000
Indemnity saved · sample book
Sample audit · illustrative

What a leakage audit could surface on 500 closed healthcare WC files — before touching a single new claim.

$1.58M / 500 files · indicative