Age of Technology – Managing Workers Compensation Claims and Litigation Today

Technology has become ingrained in our daily lives, both at home and work. The workers’ compensation claims management process can benefit from the advent of wearable devices and social media, but careful consideration should be given to issues and perspectives of the employer, administrator, insurer and injured worker. In this session at the 2020 CLM Workers’ Compensation and Retail, Restaurant & Hospitality Conference, panelists discussed ways in which technology can be used to monitor employee performance and safety, enhance post-injury care and create additional opportunities for employees to return to work.

Speakers included:

• Jeff Heaser, Vice President Workers’ Compensation Claims at Astrus Insurance Solutions
• Jennifer Jones, Attorney at Cranfill Sumner & Hartzog LLP
• Caryn Siebert, VP-Carrier Practice at Gallagher Bassett Services, Inc.
• Dorothy Riviere, Chief Clinical Officer at Bardavon Health Innovations, LLC

Healthcare costs in the United States continue to rise, including $70 billion spent on workers’ compensation each year. The value of this healthcare, however, is not increasing. Only 8% of people complete their recommended preventative care and 23% skip recommended follow-up treatments. Technologies like telemedicine are not new, but the COVID-19 pandemic has greatly accelerated adoption in the workers’ compensation setting. Use of new technologies can increase efficiency and provide additional data for better analysis, but adapting to new technologies must not replace the human experience of healthcare.

Post-Injury Care and Return-to-Work Programs

Our industry typically uses claims data to analyze and predict outcomes, but clinical data could be a valuable resource as well. Clinical data can identify patients’ comorbidities, illuminate the focus of provider efforts, provide assessments and review goals accomplished. In short, clinical data is where “outcomes” live. The combination of claims data and clinical data provides a clearer picture of the patient’s injury, recovery and potential to return to work.

Claims Reporting and Adjusting

Machine learning is relatively new, but can be used to make adjusting more efficient in medical-only claims. Chat bots, often used on consumer websites, can answer questions and resolve a multitude of simple issues. This technology will not replace claims personnel, but could make processes more efficient and allow more time to focus on strategic initiatives and issues that require more advanced analytics.

Workers’ Compensation and Personal Injury Litigation

Wearable devices (Fitbit, Apple watch, health apps, etc.) and social media accounts can provide helpful data and information that can be utilized in personal injury litigation. One consideration when using this information is court admissibility. In order for the information to be considered admissible in court, it must be relevant, authentic and reliable. Reasonable expectation of privacy should also be taken into account.