Artificial Intelligence (AI) is impacting many aspects of our lives, and it is no surprise that many businesses are evaluating ways in which AI can streamline processes and reduce expenses. AI has the potential to significantly impact the workers’ compensation industry, including by reducing costs, simplifying processes, and predicting outcomes.

Utilizing AI for efficient processing of workers’ compensation claims

Traditionally, claims examiners are charged with tasks such as classifying claims, entering diagnosis and billing codes, and processing payments.  AI may be used to sift through data to do so more quickly and reduce redundant efforts, freeing claims examiners up to perform additional duties, such as personally communicating with injured employees. Predictive models may be used to evaluate providers and examiners, and eventually reduce claim costs. Ultimately, having a fast way to manage the large volume of data involved in workers’ compensation claims will be an asset.

Accelerating claims review and streamlining communication through AI

AI may also accelerate the claims review process by eliminating some manual review of information, which will hopefully also eliminate some clerical errors. The system will benefit from a reduction in processing times and administrative costs. In addition, automated messages or AI-powered chatbots may facilitate communication between injured employees, employers, medical providers, insurance companies, and other parties involved with the claim. By streamlining processes, the system will run smoother, with greater impact and benefit to all parties.

Leveraging AI for enhanced claim outcome predictions

AI may be used to analyze claim data and more accurately make a prediction about the outcome of a claim, its claim value, and/or the likelihood of litigation. AI may be used to determine when cost containment methods such as when involving a nurse case manager would be appropriate.  In addition, AI algorithms may improve the accuracy of claims assessments. By identifying claims trends, employers may be able to implement prevention strategies which improve the safety of employees.

Routinely, utilization reviews have been relied upon to evaluate appropriateness of treatment modalities and potential costs involved with treatment.  AI may be used to determine if a course of treatment or the cost of treatment correlates with the allowed conditions in the claim. Eventually, after years of data is entered in the AI system, AI may be used to identify which treatment procedures and prescription medication are best suited for particular medical conditions. This may help to improve the quality of care provided to employees and may also help reduce the time an employee spends off work, thereby reducing costs for employers.

Going forward

As AI becomes more prevalent in the workers’ compensation industry, it will remain important to ensure the data being used is accurate, that the information contained in AI technology is kept confidential, and that bias and discriminatory practices are avoided. Given the sensitive nature of a person’s medical treatment, it will be critical to ensure the injured employee’s information remains protected. Further, and not least importantly, users of AI will need to institute checks and balances to ensure the data being used by AI is accurate.