This means employers, in one way or another, foot the bill for the medical services that now account for 60% of the costs in the average workers’ compensation case. Medical record delays play more of a role than many people think. In order for a medical examiner’s report to count as evidence to support the claim, there must be facts, examinations and notes supporting the medical history. This evidence typically takes the form of medical records, unstructured documents that can number into the hundreds, or even thousands, of pages.
WHY DO MEDICAL DOCUMENTS TAKE SO LONG TO PROCESS?
Imagine a 54-year-old patient who gets hurt at work while driving to make a delivery. The insurance company (and later, the medical examiner) requests the medical records for each health care facility the patient visited in relation to the case. Since the patient has a fractured vertebrae in their neck, the insurance carrier decides to look for previous neck injuries. They also request records leading up to the claim, covering the patient’s entire lifetime.
The medical file for the patient is now thousands of pages. If the patient’s records have been transferred from one facility to another, there will also be hundreds, if not thousands, of duplicate pages!
Rather than eliminating human brain power, though, AI-assisted claims free up time for legal management professionals to work on higher value tasks — which can also contribute to the success of the claim.
Processing all of this paperwork is responsible for at least some of the $89,152 it costs to handle a motor vehicle injury-related claim. While the analysis of these pages can (and should) be left to the medical examiner and human expert, AI tools can be trusted to handle the processing: organizing, indexing and collating these documents into a file the expert can access.
Automating this process using AI can make processes far more effective. AI tools can operate 24/7, at a speed far greater than the human worker. Rather than eliminating human brain power, though, AI-assisted claims free up time for legal management professionals to work on higher value tasks — which can also contribute to the success of the claim.
AI-DRIVEN CLAIMS AUTOMATION REDUCES PAPERWORK: INCREASING BENEFITS TO WORKERS
While claims processing time has a major impact on the ability of a worker to return to the job, there’s also a direct impact from paperwork itself. Since most people aren’t familiar with the process behind workplace injuries, there is usually some apprehension related to the claim — in addition to the impact of the accident itself. The feelings of uncertainty combine with the physical impact of the claim, as well as the stress of being off work.
A recent Risk and Insurance article from John C. Peters, PhD, calls this impact the “cognitive load” of the injury or impairment. All of these documents, plus the stress of dealing with a paperwork-laden and often uncertain timeline, can further hurt the patient’s ability to recover. Using the appropriate technology can substantially reduce this uncertainty.
Consider the 54-year-old patient in the example above. Imagine if claims adjusters, insurance company professionals or medical experts related to this scenario were using automation in the claim. A birds-eye-view look at the patient file could be generated through an AI summary of the case. This roadmap would tell insurance professionals which documents to look out for, allowing for a smoother interview with the patient. The interview is automatically transcribed and stored in the insurance adjuster’s portal, along with organized medical records. With the time saved on administration, the adjuster working for the insurance carrier even has time to answer the patient’s questions and deliver human-focused care.
In this example, the patient now has a better idea of the timeline of the claim and expectations going forward while navigating this uncertain time. The insurance company has an organized and cost-effective workflow, and the employer foots a smaller bill. When professionals reduce the costs and impacts of repetitive tasks, everybody wins — which is why AI-assisted automation can improve the speed of processing and help legal organizations save money and time.
