What The Simon Companies does

The Simon Companies is a privately held, family-owned holding company headquartered in Modesto, California, founded in 1994 by Ray Simon after his tenure as President and owner of Freese and Gianelli. It operates four wholly-owned operating subsidiaries — Pegasus Risk Management (third-party workers' compensation claims administration), Status Medical Management (utilization review and nurse case management), Status Bill Review (medical bill review integrated with the proprietary Status Preferred Provider Network), and Status Investigative Group (workers' compensation and general liability fraud and surveillance investigations) — plus an acquired, brand-retained general liability claims operation under the Freese and Gianelli name.

The platform combines claims administration, UR, bill review, PPO network access and investigations under a unified architecture. Notable technology components include the proprietary Status PPO Network (average 15% discounts below the official California medical fee schedule), the ManageWare CareWare UR platform (an extended partnership integration that feeds utilization review decisions directly into bill review), a three-tiered utilization review process developed by the Medical Director and Status Medical Management, and the Status Core Bill Review system with key-from-image technology and rules-based checks for duplicates, upcoding and unbundling. URAC accreditation in Workers' Compensation Utilization Management was achieved by Status Medical Management effective March 1, 2024.

Revenue is generated through quote-based, multi-year contracts with self-insured government entities, joint powers authorities (JPAs), pooled programs, captives, and private companies throughout California. The revenue mix spans recurring claims administration fees, managed care service fees for UR and nurse case management, and transaction-fee bill review and investigative services. Sales are enterprise field-sales led with direct engagement to claims teams, HR directors and executive leadership; no pricing is publicly disclosed and bundled programs are tailored per client with individual accountability preserved across services.

Name

The Simon Companies

Legal name

The Simon Companies

Website

https://simon-companies.com

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

101–250 employees

Short description

The Simon Companies is a family-owned, Modesto, California holding company operating four subsidiaries that deliver workers' compensation and general liability claims administration, utilization review, medical bill review with a proprietary PPO network, and investigations to self-insured government entities, JPAs and private companies throughout California.

Ownership category

akta.pro rank

Headquarters

HQ city

Modesto

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Claims Administration Services: Third-party administration fees for workers' compensation and general liability claims management services provided to self-insured entities, government agencies, and private companies throughout California.
2. Medical Management Services: Utilization review and nurse case management services providing clinical oversight of medical treatment for workers' compensation claims, generating revenue through managed care cost containment.
3. Bill Review Services: Medical bill review services integrated with PPO network access, providing fee schedule analysis, usual and customary review, and network management for cost containment programs.
4. Investigative Services: Workers' compensation and general liability investigation services including surveillance, background checks, SIU investigations, and AOE/COE investigations billed per assignment.

Pricing tiers

Go-to-market motion2 records

Distribution channels2 records

Marketing channels4 records

Core offering

The Simon Companies is a family-owned holding company that provides customized workers' compensation and general liability claims management services through four wholly-owned subsidiaries: Pegasus Risk Management (third-party claims administration), Status Medical Management (utilization review and nurse case management), Status Bill Review (medical bill review with proprietary PPO network), and Status Investigative Group (workers' compensation and fraud investigations). Services are delivered as bundled programs with individual accountability to self-insured government entities, public agencies, JPAs, captives, and private companies throughout California.

Product overview

The Simon Companies operates as a holding company comprising four distinct subsidiaries offering bundled but individually accountable claims management solutions for workers' compensation and general liability. The portfolio includes Pegasus Risk Management (third-party claims administration), Status Medical Management (utilization review and case management), Status Bill Review (medical bill review with integrated PPO network), and Status Investigative Group (insurance fraud and workers' compensation investigations). These services are designed to work together as an integrated ecosystem while maintaining separate accountability, allowing clients to use combined services or those addressing specific organizational needs.

Differentiator

Problem solved

Functional benefit

Brands

• Pegasus Risk Management: Third Party Workers' Compensation Claims Administrator serving self-insured government entities and companies in California.
• Status Medical Management
• Status Bill Review
• Status Investigative Group

Products and services

• Pegasus Risk Management Third-party workers' compensation claims administration for self-insured government entities and private companies in California, providing customized claims management programs and cost containment for labor code 4850, salary continuation, and presumptive injury scenarios.
• Status Medical Management Case management and utilization review services for workers' compensation throughout California, delivered via telephonic and field case management for public and private entities, with three-tiered UR processes and URAC-accredited utilization management.
• Status Bill Review Medical bill review services for workers' compensation and general liability, integrated with the Status Preferred Provider Network. Provides fee schedule analysis, usual and customary review, PPO discounts, network management, and ancillary vendor services for medical cost containment.
• Status Investigative Group Workers' compensation and general liability investigations including surveillance, field investigations, SIU anti-fraud investigations, AOE/COE investigations, and background checks, staffed by former law enforcement officers and licensed private investigators.
• Status PPO Network Proprietary preferred provider organization network integrated with Status Bill Review, offering an average 15% discount below California's official medical fee schedule across occupational medicine, urgent care, physical therapy, orthopedics, chiropractic, acupuncture, and pain management specialties.
• Medical Provider Network (MPN) Customizable Medical Provider Networks for employer clients, allowing injured workers to search for providers by name, specialty, city, or zip code. Status was the first company in California to create an approved MPN.

Quantifiable outcome

• 70% average savings on bill review when combined with Status PPO Network
• +2 more outcomes

Named customers2 records

Segments5 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature5 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• ManageWare, LLCcoreTechnology or IntegrationPegasus Risk Management extended partnership with ManageWare, LLC to implement the ManageWare CareWare UR platform. This integration fully connects Pegasus's internal managed care process with bill review in a proprietary single platform. The partnership enables automated coordination of utilization review decisions into the bill review process, optimizing medical cost savings for clients.
• Association of Claims ProfessionalsminorOthersIndustry membership organization alignment to stay current with claims management laws and regulations.
• California Association of Self-Insured Public Entities (CAJPA)minorOthersIndustry association membership for self-insured public entities to maintain regulatory compliance and best practices.
• California Workers' Compensation Institute (CWCI)minorOthersIndustry research and education organization membership supporting workers' compensation best practices.
• Council of Self Insured Public Agencies (COSIPA)minorOthersAssociation membership for self-insured public agencies in California.
• National Association of Insurance Commissioners (NAIC)minorOthersRegulatory body membership for insurance compliance.
• RIMS (Risk and Insurance Management Society)minorOthersProfessional society membership for risk and insurance management professionals.
• American Bar Association Workers' Compensation & Employers' Liability Law CommitteeminorOthersProfessional legal association membership for workers' compensation practice.

Scale indicators6 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• TRISTAR Insurance Group: Multi-line claims administrator and managed care provider with workers' compensation TPA capabilities. Competes with Simon for self-insured public entity and JPA business, with a comparable focus on bundled claims and medical management services.
• CorVel Corporation: National managed care company that, like Simon, integrates workers' compensation claims administration, utilization review, bill review, and PPO network services. CorVel's proprietary CareMC platform competes directly with Simon's Status/ManageWare stack for the same self-insured and JPA buyer segments.
• Genex Services: Provider of workers' compensation managed care services including utilization review, case management, and bill review. Closely comparable to Status Medical Management and Status Bill Review within Simon's portfolio, serving similar insurer and self-insured clients.
• Gallagher Bassett Services: Large third-party claims administrator serving self-insured employers, public entities, and JPAs across multiple states, including California. Competes with Pegasus Risk Management for the same large workers' comp accounts and offers similarly bundled managed-care services.
• Cannon Cochran Management Services (CCMSI): Third-party claims administrator serving self-insured employers, municipalities, schools, and JPA pools with a service model very similar to Pegasus Risk Management. Direct comparable on target segment and bundled service approach.
• PMA Companies: Workers' compensation-focused managed care and claims administration provider with a strong footprint in public entity and large employer accounts. Competes directly with Simon's Pegasus Risk Management on TPA services and medical cost containment.
• Keenan & Associates: California-headquartered insurance brokerage and managed care services firm serving public agencies, schools, and healthcare systems in the same verticals as Simon. Directly comparable in target customer (CA self-insured public entities and JPA pools) and service mix.

Emerging players

• Rising Medical Solutions: Technology-forward workers' comp medical cost containment and bill review vendor. Competes with Status Bill Review on enterprise accounts and represents the kind of tech-led challenger that could pressure Simon's cost-containment economics over time.

Broad incumbents

• York Risk Services Group: National third-party claims and managed care services provider covering workers' compensation, liability, and property claims. A broader incumbent competing for the same JPA, captive, and large self-insured accounts Simon targets in California.
• Sedgwick: One of the largest North American claims administrators serving employers, insurers, and public entities across all P&C and workers' comp lines. A broader incumbent competitor to Simon's Pegasus Risk Management, with deeper technology investment and multi-state reach that Simon lacks.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Subsidiaries5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about The Simon Companies