Will Watson Replace WC Professionals?

Artificial intelligence should never threaten workers’ comp if more pragmatic, technology-based strategies are implemented now.

The Japanese firm Fukokui Mutual Life Insurance has replaced more than 30 office workers with artificial intelligence (AI), in this case the famed IBM Watson. Watson, or one of its doubles, is in fact affecting nearly all industries in multiple ways. Eliminating workers is a major goal. But could Watson replace workers in workers’ comp? AI has been around for decades, but now with advanced technology it has fully caught on, and its applications are widely varied. AI is what drives driverless vehicles and operates machinery sans human involvement. More practically, AI enhances worker productivity, accuracy and efficiency. But AI should never reach workers’ comp if more pragmatic, technology-based strategies are implemented now. Replacing workers’ comp professionals with Watson is not feasible at this point or, I hope, ever. Yet, it is a wake-up call to the industry. See also: 10 Questions That Reveal AI’s Limits   Imagine injured workers navigating the workers’ comp system without claims adjusters and medical case managers. Picture Watson managing claims. It could make payments without difficulty and even review the bills effectively. Watson could also determine which claims are the most challenging and refer them to medical case management. Stop there! Envisioning Watson as medical case manager is a real stretch. Human interaction is central to effective medical case management. Likewise, Watson delivering claim management services without dialogue with the claimant would be spotty and unpleasant at best. Accuracy and efficiency under Watson management could be nearly perfect, but claim adjusting relies heavily on human interaction. Injured workers managed by Watson would feel victimized in a heartless system. The only recourse would be to litigate. Watson might have trouble with that. While replacing professionals with technology like Watson is going too far, it should prompt workers’ comp payers to engage current technology to improve processes and outcomes—just to keep up. Clearly, the momentum in every industry is more technology to gain efficiency, and workers’ comp cannot afford to lag. To stay in the game, technology designed to assist workers with task-relevant knowledge and decision support that makes them more accurate, more efficient and, yes, smarter is crucial. Watson will replace health insurance industry administrative workers fairly easily. Essentially, bills are paid if they match the benefit plan and the treating doctor is in the PPO. However, the workers’ comp industry is very different from general health and much more complex. The question is how can the workers’ comp industry optimize efficiency and productivity without discarding its professionals and alienating injured workers? The answer is to apply currently available predictive analytics technology to make WC professionals smarter, more accurate and highly efficient. Of course, that also spells profitability for the organization. Apply predictive analytics to understand historic data and the cost drivers inherent in it. Monitor the data continuously to identify risk conditions as they occur. Create apps that inform claims reps of conditions and events in claims that need attention in real time so action is taken early. Assist claims reps by providing information for decision support such as the probable ultimate medical reserve amount for a claim. Time and effort are saved, while accuracy and efficiency are gained. Rather than labor with decisions such as adjusting reserves, you can present a timely and accurate projection, optimizing efficiency. See also: Next Big Thing: Robotic Process Automation   Similarly, relevant information should be available for medical case managers so they can avoid searching for claim information and status. Timely alerts and shared information promote collaboration and integration of efforts between claims and case management decision-makers in the organization. Watson is thwarted.

Karen Wolfe

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Karen Wolfe

Karen Wolfe is founder, president and CEO of MedMetrics. She has been working in software design, development, data management and analysis specifically for the workers' compensation industry for nearly 25 years. Wolfe's background in healthcare, combined with her business and technology acumen, has resulted in unique expertise.


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