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Technology Transformation in Workers’ Compensation

Originally published in PC360 | October 26, 2023

Whether you are a risk manager, physician, attorney, claims manager, payer, or service provider, the evolution of technology modernization in workers’ compensation affects everyone. Now is the time to invest in technology tools, data science and other tech specialists to drive your business forward, avoid repetitive duplicative tasks and allow your experts to focus their attention on meaningful work.

The latest “Out Front Ideas with Kimberly and Mark” webinar included expert guests discussing what is happening now and what they envision for the future, including digital solutions that expedite policy verification, eligibility, claims intake and reporting, document validation, rules-based decisions, and automation of straightforward, low-dollar claims. Our guests included:

  • Vincent Foderingham, CEO of Partners Risk Strategies.
  • Julie Layton, risk management segment leader, Marsh.
  •  Scott Rogers, chief client officer for Sedgwick.

Process Impedes Progress

As technology rolls out faster than ever, workers’ compensation remains one of the slowest adopters, but why? Considering how long ago the industry began, it is important to acknowledge it was born out of a process and continues to be rooted in tradition. The longevity of this industry bears a legacy claims system with a large volume of data, and any changes made will be costly and challenging. Carriers who are publicly traded may need to focus more on their profitability as their shareholders may be more concerned with reducing present costs rather than how major technology investments will provide cost savings five years from now.

Workers’ compensation is the most highly regulated insurance industry, which can severely inhibit change. Everything from what, when and how you pay an injured worker to the layout of a form is regulated. Several states still mandate that paper checks be mailed, preventing even the most uncomplicated innovations from occurring, like direct deposit or alternative payment forms.

Additionally, every innovative idea needs a trailblazer willing to take a risk, but the fear of failure is intimidating. Many organizations wait for their peers to vet it, so they are not on the cutting edge. It is about risk management, not risk aversion. Change is hard, but we will be left behind unless we learn to ask questions, discover, and adopt.

Adopting New Technology

Before investing in any new technology, it should enhance three areas, including:

1. Efficiency: For example, when automating parts of the claims process, does it allow your adjusters and claims professionals to work on more important items?

2. Effectiveness: Does it drive down the total cost of risk?

3. Experience: What is it like for the injured worker using it? Is it compatible with goals pertaining to care and connection?

After recognizing that it meets these criteria, how will it be executed in your organization? Technologies such as artificial intelligence allow employees to focus on more niche tasks without eliminating the human touch necessary to drive claims forward. For example, when reviewing medical-only claims that require a light touch, simplifying that transaction would give adjusters more time to focus on lost-time claims. As connectivity and machine learning become more refined and simulate a better experience, there will be a stronger willingness to adopt.

It is not just about learning a process, though; it is about understanding the journey. Digital roadmaps can provide insight into technology’s influence on your customer base, employee and injured worker experiences, and even regulators and attorneys. Unstructured data can be transformed through innovations like natural language processing, which can assist in determining the best decisions for claims relating to utilization reviews, medical and return to work.

The Fifth Industrial Revolution

The Fourth Industrial Revolution centered on bringing together technology to improve processes and automate systems. The next one will focus on how humans and technology work together to become more efficient. There are three components in establishing higher efficiency, including:

1. Trust: Do we have confidence in applications like ChatGPT? How do you create more refinement in this learning capability so that it is more reliable?

2. Training: Do we know how to use it to its full intent? This does not mean understanding coding but simply grasping the mechanisms required for it to create efficiencies.

3. Together with technology: Working in tandem with these advancements means knowing the possibilities, which makes its impact more significant.

Finding the right place to start implementing new processes can be one of the most challenging aspects of innovating. And with five generations in the workforce, communicating changes from the right approach can become tricky. Ideally, more methods must be available, whether communicating with an employee or injured worker.

Opportunities for Advancement

Injured workers seek transparency, eliminating frustrations throughout the claims process. Phone applications could provide immediate resolutions to problems that typically require endless phone calls. Considering why injured workers seek attorneys in the first place, technology has the potential to reduce litigation.

Employers need to discover methods to handle the large volume of workers’ compensation claims efficiently. Many claims adjusters are new to the industry, spending significantly more time per claim. Using AI and predictive modeling, all within the construct of a decision-making model can help move things along faster, providing employees with little to no claims background the ability to learn until they are more comfortable handling claims efficiently. Yes or no decision-based models can answer questions based on characteristics of what occurred.

All organizations could benefit from being more technology-curious, assessing risk appetite and aversion, and resetting with their team and partners. Additionally, understanding the priority of investments will help drive business goals forward. Learn how to be more intentional with technology, and always advocate for injured workers to best help them on their journey to recovery.

The archive of the complete webinar can be found here.