Use case
From file intake to a signed-off recommendation
Follow step by step how Omnilex reviews a claims file: from the intake of the dossier to a recommendation signed off by lawyers.
01 — The starting point
More cases than can be seriously reviewed
Your dossiers typically run to 500 to 1,500 pages, delivered in a different form depending on the canton and the source. A serious review takes hours per file. New cases arrive continuously, and the deadlines keep running.
Decisions are therefore often made on an incomplete picture. That has a price: rejections without sound reasoning do not withstand review, unjustified payments go unnoticed, recourse claims quietly become time-barred.
02 — The examination questions
Five questions that decide every file
Behind every benefit decision stands the same examination. Five questions recur in every file, and each has its price when answered sloppily.
Competence and coverage. When did the incapacity for work occur, and which insurer or institution was liable for benefits at that point? If the onset is dated wrongly, the wrong carrier pays.
Causation. Is there a natural and adequate causal link between the insured event and the health impairment? A rejection that does not properly examine adequacy will not hold up in court.
Connection in invalidity cases. Is there a material and temporal connection between the original incapacity for work and the later invalidity? For instance when a burnout is followed years later by an invalidity on other grounds. This determines which pension institution has to pay.
Benefit assessment and coordination. At what amount are benefits due, and does the interplay of several insurers lead to overcompensation? Without coordination, benefits are paid twice or reduced wrongly.
Recourse. Is there a right of recourse against liable third parties, and is it asserted? Recourse never asserted is money lost, and the limitation periods keep running.
At the end of every file stands the decision: pay benefits or not, and at what amount.
03 — Where this applies
One review, six segments
This review carries wherever your benefit decisions rest on extensive medical dossiers.
Accident insurance (UVG)
The core question is the natural and adequate causal link between the accident and the health impairment. Contested causation, at high volume.
Daily sickness benefits (KTG)
Incapacity for work, exclusions, overcompensation. High volume, small case value, little time per case.
Legal expenses insurance
Assessing the prospects of success. One legal question, a thousand times over, under time pressure.
Liability & motor insurance
Personal injury dossiers, causation, recourse. Extensive files, long histories, high case values.
Recourse & subrogation
Recovery from liable third parties, before the limitation periods run out. What is never asserted is lost, and nobody notices.
Disability insurance offices & compensation funds
They keep the disability insurance file themselves. The review starts at the most direct source.
04 — How Omnilex case handling works
Every file in full, in hours
A case arrives
A dossier comes in for review: several hundred to over a thousand pages, in a different format depending on the canton.
The file is structured
The dossier is broken down into its original documents and ordered: medical reports, official rulings, history.
The facts of the case are established
From the ordered documents, the facts of the case take shape: a complete chronology of the incapacity for work.
Analyzed in parallel
Many documents are reviewed at the same time: against the applicable law (ATSG, UVG, VVG, BVG) and against the insurer's policy & general terms.
The examination questions are answered
Omnilex's legal analysis engine answers the five examination questions: from competence through causation and the connection in invalidity cases to coordination and recourse. It flags contradictions and formulates a recommendation.
Signed off & delivered
An experienced Omnilex lawyer signs off the recommendation. The result goes back to you: pay benefits or not, and at what amount.
05 — The outcome
Every case reviewed in full
Every file is reviewed in full and reasoned consistently, in hours instead of weeks. Every recommendation is signed off by experienced lawyers. The decision stays with you; Omnilex delivers the basis for it.
