Applications of AI in Workers' Comp

AI tools address long-standing challenges, improving injury care assessments, predicting recovery timelines, accurately pricing settlements and tracking patient progress

An artist’s illustration of artificial intelligence

With the advent of artificial intelligence (AI), there is a significant opportunity to enhance the efficiency and accuracy of workers' compensation processes. This is particularly true for injury care assessment and predictive outcomes, determining time to maximal medical improvement, settlement pricing and tracking patient clinical recovery.

Predictive Outcomes in Injury Care Assessment 

The assessment of injury care in workers' compensation has traditionally been fraught with subjectivity and variability. Different medical practitioners may provide varying diagnoses and treatment plans for similar injuries, leading to inconsistencies. Additionally, delays in obtaining appropriate care and treatment authorizations can hinder recovery and prolong the workers' compensation process.

AI-driven solutions offer a way to overcome these challenges. Machine learning algorithms can analyze vast amounts of patient data, identifying patterns and trends that may not be apparent to human evaluators. Predictive analytics can forecast injury outcomes and recovery paths based on historical data and individual patient characteristics gleaned from hundreds of thousands of patient exams and workers’ compensation claims.

For example, AI systems can assess the severity of an injury and suggest the most effective treatment plans based on numerous cases involving injuries of a similar nature to the body part in question, thereby improving the accuracy and consistency of assessments. Real-world implementations have shown that AI can significantly enhance the speed and precision of injury evaluations, leading to better patient outcomes. One doctor assembling one assessment may or may not produce an evaluation that all parties can agree on, However, “averaging out” the outcomes of several dozen adjacent cases give all parties a better chance at arriving at a logical, sensible and fair conclusion. 

The benefits then cascade to all stakeholders from there. Insurers and employers achieve more accurate and consistent injury evaluations, reducing the risk of disputes and litigation. Healthcare providers can develop more effective treatment plans, improving patient recovery times and satisfaction. Ultimately, injured workers receive quicker and more effective care, facilitating their return to work.

See also: How AI Could Set Premiums in Real Time

Arriving at MMI Using AI

The time to reach maximal medical improvement (MMI) varies widely based on several factors, including the body system affected, geographic location and job duties. These variations present significant challenges in setting realistic and achievable recovery goals. Additionally, recovery rates can differ based on the quality and availability of medical care in different regions. 

Again, the odds of one physician nailing the appropriate time to MMI are smaller than a report that removes the subjectivity of a single individual by synthesizing the results of thousands of like cases.  AI can analyze data from historical cases and identify key factors influencing recovery timelines. Custom algorithms can consider geographic and occupational variables to provide more accurate predictions.

For instance, AI tools can analyze data from previous similar injuries to predict how long it might take for a worker to reach MMI, factoring in their specific job duties and location. This information can help in setting target recovery goals that are both realistic and achievable.

Armed with this data analysis, employers and insurers can develop more personalized and efficient recovery plans, ensuring that resources are allocated appropriately. Healthcare providers can set more realistic expectations for patients, leading to better planning and care delivery. Overall, the efficiency in reaching MMI improves, benefitting all parties involved.

The (Settlement) Price Is Right

Settlement pricing in workers' compensation involves determining the financial value of an injury claim, which can include stipulations for future care and compromise and release agreements. Accurately pricing settlements is challenging due to the variability in injury severity and long-term care needs.

AI can significantly enhance the accuracy of settlement pricing by evaluating historical settlement data and using predictive models to forecast future care costs. These models can analyze various factors, such as the type of injury, the affected body system and historical treatment costs, to provide more precise pricing. 

For example, AI tools can generate predictions for future medical expenses based on current trends and past data, ensuring that settlements reflect the true cost of care. Thus, we may already be able to determine from similar previous cases the associated costs of surgically repairing and rehabbing an MCL tear in the elbow that results from repetitive heavy lifting of boxes. This leads to more equitable and fair settlements for all parties involved.

AI-driven settlement pricing benefits stakeholders by providing more accurate and equitable financial evaluations. This reduces the likelihood of disputes and facilitates quicker resolution times. Insurers and employers benefit from increased transparency and trust in the settlement process, while injured workers receive fair compensation reflecting their future care needs.

AI  Paves the Road to Clinical Recovery

Continuous monitoring of patient recovery is crucial in workers' compensation to ensure that injured workers receive the appropriate care and support throughout their recovery journey. Traditional methods of tracking patient progress often fall short in providing real-time insights and comprehensive evaluations.

AI can revolutionize the tracking and interviewing process by offering real-time return on investment (ROI) analysis in treatment care. Voice packet sampling, an advanced AI technique, can classify a patient's recovery momentum, gauge their opinion of care and assess their satisfaction with the recovery process.

For instance, AI can analyze voice recordings of patient interviews to detect nuances in their tone and language, providing insights into their emotional state and recovery satisfaction. This data can help healthcare providers tailor their approaches to better meet patient needs.

AI-driven tracking tools can also predict the likelihood of litigation or long-term complications by analyzing patient data and recovery patterns. This information is valuable for determining future care needs and supporting decisions regarding return-to-work expectations or alternative job placements.

The benefits of AI-enhanced tracking and interviewing methods are substantial for all stakeholders. Once again, employers and insurers can anticipate and manage potential complications and reduce litigation risks. Healthcare providers gain real-time insights into patient progress, enabling more responsive and effective care. Patients benefit from personalized attention and improved satisfaction with their recovery journey.

See also: How to Enhance Workers' Comp Outcomes

Conclusion: AI Improves the Workers’ Comp Lifecycle From End to End

The integration of AI into workers' compensation processes holds tremendous potential to enhance outcomes and efficiencies for all stakeholders. From improving injury care assessments and predicting recovery timelines to accurately pricing settlements and tracking patient progress, AI offers tools and solutions that address long-standing challenges in the workers' compensation system. By leveraging AI technologies, insurers, employers, healthcare providers and injured workers can achieve better results, reduced costs and improved satisfaction across the board. The future of workers' compensation is undoubtedly brighter with AI at its helm, promising a more efficient, fair and patient-centered approach to managing workplace injuries.


John Alchemy

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John Alchemy

Dr. John Alchemy is founder and CEO of Impairment Rating Specialists

He has been practicing occupational and family medicine since 1997 and is a diplomate of the American Board of Family Practice. Dr. Alchemy has performed and reviewed over 10,000 cases (and counting).

Dr. Alchemy has certificates of education from the American Board of Independent Medical Examiners (ABIME) and the American Association of Medical Review Officers (AAMRO) and is a California Qualified Medical Examiner (QME).

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