A list of current and potential uses of AI in the workers' compensation industry

AI is revolutionizing the landscape of the workers’ compensation industry. I am particularly optimistic about the positive impact it will bring. While acknowledging that there are many challenges, I firmly believe that AI will ultimately lead to significant benefits for injured workers and substantial cost reductions within the system. As an experienced Risk Manager and GVP of Claims at insurance companies, I’ve witnessed the evolving dynamics of our industry firsthand. I am excited to present this preliminary list of potential AI applications that are poised to transform the workers’ compensation system. Knowing that this is just the beginning of the AI revolution, I would love to hear your thoughts and opinions on any additional applications which I may have missed.

Injury Prediction and Prevention:

• Safety Analytics: AI can analyze existing workplace safety data and recommend improvements to reduce accidents and injuries.
• Identifying ergonomic problems within each job function to help avoid musculoskeletal injuries.
• Creating an IoT database of all injuries (not in the current employer’s current locations) for early trend identification.
• Analyzing internal security videos to identify PPE use and compliance.
• Early Intervention: AI can identify high-risk employees and trigger early interventions to prevent injuries.
• Identifying potential efficiencies in production or distribution processes where automation can reduce injury exposure.
• Identifying problems with employee satisfaction and management leadership issues contributing to claims frequency and severity.
• Providing early warnings for outside factors contributing to claims frequency and severity (e.g., pending winter storms, severe heat conditions).
• Optimizing inspections, equipment maintenance, and safety program compliance.
• Identifying potential fatigue issues contributing to claims frequency and severity.
• Providing instant feedback on every injury cause and potential prevention process.
• Tracking safety training for all employees.
• Determining the qualifications of potential employees for open jobs.
• Identifying the best-qualified employees for specific functions or jobs.

Brokerage / Underwriting / Risk Assessment:

• Analyzing vast amounts of data, including medical records, historical claims data, and workplace safety records, for accurate risk assessment.
• Predicting future claims and helping insurers set appropriate premiums using machine learning models.
• Assisting the insured in selecting the “best” insurance broker or company for its risk.
• Determining the appropriate level of risk in a “shared risk” model.
• Helping the insured with scheduling insurance program renewals.
• Providing analysis of jurisdictional laws, rules, and regulations impacting claims outcomes.
• Improving presentations to the underwriting community.
• Indicating which accounts excel in safety programs or injury prevention.
• Assisting insurance companies in binding risk based on readily accessible information.
• Calculating administration costs and losses for each employer under risk.
• Determining payment schedules for insurance policies.
• Identifying potential payroll and exposure issues.
• Helping excess carriers determine their participation and collateral needs.

Claims Processing and Management:

• Facilitating immediate reporting of claims and detecting reporting delays due to process issues or mischief.
• Early detection of injured workers at risk for delayed recovery.
• Avoiding improper AOE/COE denials.
• Efficiently triaging claims for optimal examiner assignment.
• Triaging open claims for settlement and examiner focus to maximize reserve loss development patterns.
• Determining if there is an issue with accurate medical diagnoses.
• Accurately calculating indemnity rates for TD and PD.
• Improving reserving consistency.
• Triaging claims to the proper medical provider for maximum recovery.
• Assisting injured workers in determining if litigation is necessary and selecting an attorney.
• Identifying subrogation potential and meeting filing deadlines.
• Maximizing communication between the claims office and injured workers.
• Automatically calculating and reimbursing transportation expenses.
• Facilitating a faster return to work by providing accurate job descriptions and limitations.
• Triaging litigated claims to the optimum defense counsel.
• Providing a list of deposition questions for optimum results.
• Assigning subrosa, determining surveillance parameters, and leveraging the obtained information.
• Assessing the need to remove WCAB Judges based on biases or prejudices.
• Identifying applicable case law on open claims.
• Predicting optimal settlement amounts.
• Using AI-powered chatbots for settlement negotiations.
• Automatically reporting claims to excess carriers.
• Determining the injured worker’s personality for effective interaction.
• Facilitating medical appointments and transportation.
• Automatically paying medical treatment bills at a fee schedule.

Automation:

• Automating routine tasks like data entry, document verification, and claims routing.
• Using AI-driven chatbots for immediate customer inquiries.
• Personalized communication with injured workers.

Fraud Detection:

• Identifying suspicious claims patterns and potential fraud.
• Detecting “cookie-cutter medicine” and unusual treatment patterns.
• Monitoring claimants and providers for suspicious activities.
• Using security cameras to validate AOE/COE claims.
• Analyzing claims data for unusual patterns indicating fraud.

Medical Treatment:

• Determining the best treating doctor or treatment facility based on patient characteristics.
• Providing treatment recommendations based on medical records and evidence-based research.
• Ensuring injured workers receive appropriate care.
• Optimizing the network of healthcare providers for better outcomes and cost savings.
• Assessing injured workers’ participation in recovery.
• Facilitating referrals to specialists as needed.

Regulatory Compliance:

• Assisting in monitoring compliance with regulations and generating required reports.

Cost Containment:

• Optimizing resource allocation to reduce operational costs.