Bridging the gap to faster, more accurate workers’ compensation outcomes

With decades of experience working in P&C insurance, I am acutely aware of the challenges carriers face in optimizing claims workflows. For example, medical data analysis imposes a significant administrative burden on claim professionals, detracting from the time they could invest in evaluating and negotiating claims. This is a common concern I hear from carriers and is a target for improvement. Gathering all relevant information about a case is a critical step. But while reviewing thousands of pages of documents, it’s all too easy to overlook crucial information. Designing efficient and accurate claims process flows has never been more challenging.

Adding to this, experienced claim professionals are leaving the industry, creating a growing skill and competency gap. Workers’ compensation carriers urgently need to address these gaps. Also, the rise in advertising spend from a highly organized plaintiff’s bar intensifies the pressure on carriers. The impact of this industry losing valuable expertise, and the constant threat of litigation or fines from delayed actions, underscores the need for advanced capabilities to analyze the vast amount of medical data carriers must sift through.

This is where artificial intelligence (AI) comes into play. AI solutions, like those offered by DigitalOwl, can reduce medical analysis time by up to 72%. This addresses the industry imperative of reducing administrative burden on claim professionals, creating capacity for more complex or expertise-based actions. An AI-powered medical analysis solution standardizes and structures information, translates complex terminology into layman’s terms, and reduces the variance from personal bias, training, or opinion. Soon, claim professionals may even be able to automate Utilization Review for greater impact.

Quick access to accurate and evidence-based medical insights facilitates more informed evaluations and decisions. Detailed analysis of the injury, treatment, and recovery enables claim professionals to promptly assess and determine if additional resources or case management are required to achieve optimal recovery. This proactive approach helps remove disputes, reducing the risk of litigation expense. Furthermore, a comprehensive analysis of medical records ensures that claim professionals can take necessary actions within required timelines, significantly reducing the risk of fines.  With the integration of expert-level medical data analysis, workers' compensation insurers can significantly enhance the speed, accuracy, and quality of their evaluations and decisions

Knowing this, it's no wonder that the number of P&C insurance professionals using AI has skyrocketed. According to a survey of 250 P&C insurance professionals by the Ethical AI in Insurance Consortium, 66% of carriers plan to use AI in 2024. This is a significant increase from the 14% of carriers using AI today. But despite the surge of interest in AI solutions, trust remains one of the primary concerns for carriers considering adopting AI in workers’ compensation claims. This is a valid concern, and it’s crucial that carriers select AI service providers committed to the responsible use of AI with fully transparent solutions.

Visit digitalowl.com/trust to discover why leading carriers trust DigitalOwl to keep their data safe. For more insights, check out our white paper, "Navigating Evolving AI Regulation in the Insurance Industry," at digitalowl.com/ai-regulation.