Why Flat-Rate Billing Makes Sense in Workers’ Compensation Claims
When it comes to managing workers’ compensation claims, the way services are billed isn’t just a financial detail.
It actually shapes behavior, incentives, and ultimately the outcome of a claim. At Prism Group, we’ve taken a different approach: instead of the industry norm of hourly billing with add-ons and unpredictable fees, we offer a transparent flat-rate pricing model with just two price points:
one for resolved claims and one for unresolved claims.
This structure not only creates predictability, but it also aligns our incentives with those of the employers and insurers footing the bill.
1. Hourly Billing vs. Flat-Rate: Aligning Incentives with Outcomes
Traditional billing structures often charge by the hour. In theory this seems fair, but in practice it unintentionally rewards time spent over problems solved. When every hour generates revenue, there’s no financial incentive for a provider to close a claim quickly or efficiently.
Fixed or flat pricing flips this dynamic: with just two prices — resolved and unresolved — an organized mediation process aims for closure precisely because that’s when the value is delivered. We don’t accrue fees by stretching out discussions or sessions. Instead, our success (and your cost-efficiency) depends on whether the claim resolves, not how long it takes.
This structure gives employers and insurers three practical advantages:
Predictable budgeting — no surprise bills or unplanned hours.
Aligned goals — everyone benefits when claims close quickly and fairly.
No incentive to prolong disputes or sessions beyond what’s necessary.
2. The Real Cost of Other Claims Tools
Some people initially balk at our flat-rate pricing, thinking it’s “too high.” But when you step back and look at the real cost drivers in typical claims management, flat-rate mediation is not just competitive, but it can be lower overall than other tools in many cases.
For instance:
Independent Medical Exams (IMEs), a common component of claims evaluation, often cost several thousand dollars each. A 2024 survey reported average IME fees around $2,890, plus potential no-show charges of almost $1,000.
Second Medical Opinions (SMOs) and other specialty assessments can likewise rack up costs on top of medical record reviews, attorney time, and scheduling fees.
With hourly or layered billing, these costs add up quickly, and they don’t guarantee resolution. An IME or SMO might clarify a medical issue, but it doesn’t settle the claim. Mediation, in contrast, is the only claims management tool that actually closes a claim, preventing the ongoing administrative and legal costs that mount when a case stays open.
Even if other tools seem cheaper in isolation, they often prolong the life of a claim, and that extended timeline is a real cost to employers and carriers.
3. Flat Pricing Means No Hidden Fees
With our flat pricing model:
There are no hourly fees.
There are no surprise charges for time spent.
The only variables are whether the claim is ultimately resolved or unresolved.
This means:
Employers can forecast reserve needs with confidence.
Insurers can evaluate claim expenses without worrying about unexpected billing.
Adjusters and risk teams can focus on outcomes not timecards.
This level of transparency fosters trust and helps payors better model and manage overall claim costs.
4. Mediation Offers Unique Closure Value
One of the key reasons flat-rate mediation is such a high-value tool is its ability to end a claim, not just move it forward. While traditional tools like IMEs or SMOs serve important technical functions, they are not settlement tools. A mediation, by design, brings all parties together to finalize the claim.
Closing a claim early:
Reduces litigation risk.
Prevents ongoing administrative and medical costs.
Relieves the insurer and employer from reserving funds indefinitely.
Helps injured workers get closure and return to their lives faster.
5. A Smarter Way to Budget and Resolve Claims
At the end of the day, employers and insurers are in the business of managing risk, both financial and operational. Billing structures that reward time spent are antiquated in a world that demands efficiency and accountability.
Flat-rate pricing reflects that reality. It:
Encourages productive, outcome-oriented service.
Makes financial planning easier.
Aligns the mediators’ success with the payor’s goals.
Offers a true final cost — because mediation doesn’t just help move a case along; it can close it.
In short: flat-rate mediation isn’t more expensive — it’s smarter.
And when you compare the total cost and value against hourly tools that never bring closure, the flat pricing model proves its worth not just in transparency, but in results.
Ready to see how a results-based billing approach changes your workers’ comp strategy? Contact Prism Group to learn more or schedule a mediation today.