AI in Work Comp: A 60-Second Seminar in Workers’ Compensation Claims Handling

There can be little doubt that the future of Artificial Intelligence (AI) will impact many industries for years to come, including the realm of workers’ compensation.  In fact, AI is already being used today in work comp but to a limited extent.  Some work comp law offices are using AI in place of paralegals, while a few medical bill review companies use it to keep physicians and providers up to date on submitted invoices.  For the most part, the limited use of AI in workers’ compensation to date has been a stunning success.

Does the success of AI mean claims adjusters and attorneys will be soon be replaced by a computer?  Are careers in jeopardy?  At this time, we don’t believe adjusters and attorneys are in danger because for the most part the success of AI has been limited to menial tasks.  We therefore predict that AI will be used in the future to assist, rather than replace, claims professionals in the performance of their job duties.

Allow us to provide a few examples where artificial intelligence would receive a warm welcome by a claims department.  Imagine a claims administrator never having to pick up a phone to discuss the status of a lien.  Nor would the administrator need to speak to a medical office or vendor who phones to check on the status of an RFA or billing invoice.  AI would be able to handle these tasks without adjuster involvement.  The amount of time saved from researching and responding to various requests could be quite substantial.

AI has already infiltrated the world of workers’ compensation medical bill review, where AI determines amounts to be paid after applying our state’s official medical fee schedule and other discounts.  AI is also being used to supplement utilization review (UR) to authorize requested medical procedures.  However, AI is not allowed to deny or modify requested services as only a licensed physician may perform these tasks.

Interestingly enough AI is being used in a test case by a medical management firm out of Florida to streamline medical care for injured workers.  Of particular interest, the actual advertisement touting this company’s prowess on the use of AI in workers’ compensation was authored by artificial intelligence.

We will leave you today with a warning about certain health insurers who use AI to identify and file liens in workers’ compensation claims.  If you receive a work comp lien from a health insurance company, be sure to review it carefully. A major health insurer is using AI to file work comp liens.  However, its accuracy is questionable.  In one situation involving a very expensive non-industrial cervical surgery, the health carrier filed a comp lien even though the work accident only involved a low back injury.  AI refused to withdraw the lien even though their services were for a body part unrelated to the industrial injury.

We at Friedman + Bartoumian are carefully monitoring the development of AI and its influence on the world of workers’ compensation. It’s quite possible that one day this blog may actually be written by AI leaving everyone to wonder whatever happened to this author.