Artificial intelligence is making waves in many different industries, and there’s no reason to think it won’t have an impact on the world of injury claims. In fact, many adjusters are already leaning on AI to assist with some daily tasks and obligations. In today’s blog, we take a closer look at how adjusters are already using AI, how it may be used in the future, and what it should never replace when it comes to the injury compensation process.
AI And Injury Claims
Even though AI programs are still in their infancy, many claims adjusters already rely on them for a number of different daily tasks. In many instances, initial claims reports and injury information are all being compiled and analyzed through AI systems. During the early stages of a claim, information can come in through a variety of channels – from the employer, from a medical professional or from the employee themselves – and all of this information can be gathered and analyzed by an AI model. The AI program can then review all the information, not to decide whether or not to approve the claim, but whether or not certain issues exist that could warrant additional attention.
For example, AI programs could compile all the information and, without human review, could analyze forms for missed signatures, obvious inaccuracies and incomplete information and flag them for immediate review. This can speed up much of the process and free up human hours for more important tasks, like reviewing claims for validity and getting approval letters back to claimants sooner. AI shouldn’t be relied on for the actual determination of whether a claim is approved or denied, but it can help speed up some compliance aspects and allow actual adjusters to process claims more quickly.
Another way that AI could be helpful in theory is when it comes to medical information that is submitted. Similar to above, sometimes medical information comes in from different sources. You may have your primary care physician send over some information, your physical therapist may send over a care plan, and another medical center may be responsible for relaying imaging results. AI could help by reviewing all this information and compiling it in a simple, easy to read report for both the adjuster and for a claimant’s copy. One concise recap of a doctor’s evaluation, a physical therapist’s notes and relevant imaging can make it easier to review, process and understand treatment expectations for all involved parties.
Finally, perhaps the most effective way that AI could be implemented in regards to injury claims is through the creation of an automated triage system. Similar to a hospital triage that establishes a priority of care based on which patient’s needs are more emergent, AI could help create a similar claim processing triage. Currently, claims are generally processed in the order that they come in, and while that makes sense, it’s certainly not the most effective way to do it.
Imagine, instead, that AI could review claims as they come in and flag certain claims for immediate human review. Certain injuries respond better to specific treatments or earlier intervention, and AI may give us the ability to approve these claims quicker or get a patient approved for the right care faster. Getting the patient to the right treatment plan sooner in the process can speed up recovery times, effectively saving insurance companies money and helping injured workers get back to work sooner. Whoever can implement an AI model that saves insurance companies money by allowing claims to be triaged and processed based on risk and needs will reinvent the claims process for the better. That’s the future we’re most excited about when it comes to AI and injury claims.
As it stands, you’re still going to need a lawyer by your side if you’re going to be attempting to win an injury claim, so reach out to the team at Hey Workers for assistance. For more information, or for help with a specific aspect of your injury claim, reach out to Hey Workers today at (844) 439-9675.
