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Accident benefits · Ontario SABS

Your adjusters decide entitlement.
They shouldn’t be assembling the requirement set.

The Schedule sets prescribed forms and prescribed periods for each of them.
Before judgement begins, someone must establish which provisions this claim engages — and check whether the file answers each one.

Outcomer prepares the claim for them.
Your adjuster opens a Case Orientation Report, not a raw file.

What your adjuster opens

A Case Orientation Report instead of a raw claim file.

Every provision the claim engages — the Statutory Accident Benefits Schedule, the prescribed forms and their response periods, the FSRA conduct requirements, and your own handling standards — identified for consideration, with the evidence on the file set against each one. It states the position on each requirement. It never reaches the entitlement decision.

One requirement, as it appears in the reportIllustrative
A response to the treatment and assessment plan was provided within the prescribed period, approving, partially approving or denying it.
Statutory Accident Benefits Schedule · treatment plan response period · version in force at date of accident
Not evidenced
The plan is on file with its date of receipt. No response appears on the file within the period, and nothing records that one was sent. Named before the adjuster decides — and the consequence of missing this period is prescribed.
Requirements are prepared this way across eligibility, each benefit head, form receipt and response, examination referrals, and your own handling standards.

Two rails, clearly separated. The statutory and regulatory requirements for the jurisdictions you write in, and your own handling standards alongside them. Your adjuster can see at a glance which findings carry regulatory exposure and which are your house rules.

It reports the file, not the adjuster. It states what the record shows and what it does not — never what anyone did or decided.

It can be run at the beginning, and again whenever the claim is updated, to orientate the adjuster. Requirements that did not exist at intake appear with their own deadlines, and evidence that was absent becomes present.


What it returns to the desk

Less manual preparation. More time for the decision.

Outcomer removes the manual work your adjuster does before judgement can begin — establishing which provisions and benefit heads the claim engages, tracking which forms have been received and which remain unanswered, and checking the file against each requirement. That time returns to the decision you employ them to make. Judgement minutes are unchanged; every minute saved is preparation.

An estimated 44% less time on each claim —
around 79% more capacity from the same team.

Estimated from a task-level decomposition of a contested accident benefits claim at the point of an entitlement decision, taking the conservative end of each range and including the time to run and read the report. Judgement minutes are unchanged — the saving is all preparation. These are our figures, not measurements on your claims; we go through the working against your own case timings in the demo.


Configured to your work

Configured to your rule book, and signed off before anything runs.

Two sets of requirements govern an accident benefits claim, and the report names both. Your standards sit in your own configuration only. Nothing derived from them enters the shared regulatory corpus, and no other client’s configuration can draw on them.

The statutory matrix

The Statutory Accident Benefits Schedule — each benefit head, each prescribed form, and the period that attaches to it, with the version in force at the date of accident. Public, identical for every insurer, built once. You review the whole set and sign it off.

Your internal matrix

Your contact standards, authority limits, examination referral criteria and documentation standards, set alongside the Schedule rather than merged with it. You confirm the rendering represents your manual.

Maintenance is agreed at the same time — we monitor the instruments, decompose any change, you sign it off, and it applies from the effective date. Requirements are date-gated, so a claim from 2021 is examined against the rules as they stood in 2021.


What changes for the desk

Six things your claims manager sees.

  1. Fewer prescribed periods missed.Every response period the claim engages is identified before the clock runs, not after.
  2. More claims closed per adjuster without adding desks.The capacity comes out of preparation, not out of the time spent deciding.
  3. A new joiner works to the same standard as your most experienced adjuster.The same provisions, in the same order, on every claim.
  4. Fewer benefit heads overlooked.An entitlement nobody identified was never in the file, and never in the reserve.
  5. Fewer files back on a supervisor’s desk.The position on each requirement is complete and recorded the first time.
  6. When a decision is disputed, what was considered is already in the file.A dated record on every claim, not reconstructed afterwards.

How it runs

In your estate, against the requirements in force at the time.

An orientation layer that sits alongside your claims administration system. Outcomer does not replace or write to it. It reads the file and states the position; your adjusters decide and update the record. No migration, no change to how claims are administered.

Outcomer deploys as a container inside your own environment. The software and the model run in your estate, and nothing about the claim leaves your tenancy.

Built to fit your claims workflow. Outcomer can operate as a standalone workflow during evaluation, or integrate with your existing claims-management environment so the Case Orientation Report becomes another part of the adjuster’s existing workflow.

Schedule a 20-minute demo and see how it matches your desk’s work.

We will show you a Case Orientation Report, walk through how the matrix is configured and signed off, and go through the capacity estimate against your own case timings.