“We are coming closer to the point where not only cashiers but surgeons might be at least partially replaced by A.I.,” said former Federal Reserve Chairman Ben Bernanke in a recent interview.
The rapid integration of automation in all industries is undeniable. The surprising news is that there are many jobs that have traditionally required an expert—a highly trained human professional—that can be better performed by robots, at least in part.
Workers’ compensation is no exception. As the sun sets on the age of the expert and rises on the age of the machine, workman’s comp is a critical example of a field that will benefit from automation.
Why Does Work Comp Need Automation?
Treating, evaluating, and ultimately assigning a price to a workplace injury should not be a guessing game. The lives and livelihood of injured workers’ are at stake.
If a doctor says that an injured worker’s whole person impairment rating is 6%, how much can you trust that number? The report might be missing important data, such as unanswered questions about activities of daily living or incorrectly obtained measurements of the injured body part’s range of motion.
Inaccurate impairment ratings are widespread. In 2012 Work Comp Central estimated that 40% of impairment ratings received by insurers are incorrect. Flawed impairment ratings cause wasted time, litigation, and unfair outcomes for the stakeholders. The resulting rift in communications between the expert (the physician) and insurance carriers only adds insult to injury for the affected worker.
Problems in workers’ compensation claims often boil down to incomplete or incorrect information about the patient’s condition.
Automated systems can ensure that injured employees get the treatment they need without dispute and that workers’ compensation claims are resolved quickly.
All stakeholders—from providers to insurance carriers—can benefit from automation and tools to settle these disagreements and ensure that the patient’s injury is assessed correctly.
How Automation Helps Medical Providers
Automation already takes care of many administrative tasks associated with workers’ compensation in a medical clinic—for example, automatically formatting Doctor’s First, PR-2 and PR-4 reports.
But formatting documents only scratches the surface of how automation benefits providers.
A medical practice with multiple physicians and midlevels will produce inconsistent reports. Each type of provider examines the patient according to their individual experience and exam-style.
The physician, responsible for determining the impairment rating for a work injury, will do so based on their understanding of the AMA Guides—an understanding that is likely to be incorrect or incomplete, especially for physicians who do not specialize in workers’ comp.
As a result, the workers’ compensation reports that the medical practice sends to insurance carriers will be inconsistent. This makes it easy for insurance carriers to deny RFAs or dispute an impairment rating.
An automated approach to workers’ compensation can solve these problems.
When using a standardized, automated approach to workers’ compensation exams, all providers will examine the patient the same way. This ensures that the necessary data about the injury is gathered, which produces a strong report and makes clear which treatments are working and which are not.
When providers use an automated impairment rating system, the data in PR-4 Permanent & Stationary reports (and other impairment reports) is calculated using algorithms derived from the logic of the AMA Guides. The result is an impairment rating based on objective data about the patient, and determined by an impartial calculator—or, as we like to call them, impairment rating engines.
The bottom line: when using automation technology, there is no variance in report quality or impairment rating accuracy, even among providers who do not know the AMA Guides well—or who didn’t get enough coffee on that particular morning.
How Automation Helps Insurance Carriers
When you’re a claims adjuster and you receive a report from a medical provider, how do you know if the report contains complete exam information, or if the report has a correct impairment rating? How do you know if the treatment requests that the provider ordered in the report are truly justified based on the history of the claim?
When it comes to determining the accuracy of impairment ratings, you can go off of your personal experience. It’s common to reject an impairment rating by saying, “This whole person impairment is too high for a simple case of carpal tunnel syndrome,” but intuition is no substitute for data.
However, you probably do not have the time to crawl through the AMA Guides to find out of the rating really is too high.
The fact of the matter is you have a huge stack of reports related to other claims on your desk, and you can’t go through every single report that a provider sends you. You don’t have the resources to ensure that providers are sending you complete products.
Now, imagine that you had a robot that was an expert in AMA Guides, that could perform the boring and repetitive task of going through every single physician’s report you receive for every single workers’ compensation claim. The robot would automatically check the completion of the exam, and validate the accuracy of the impairment rating.
How Automation Helps Attorneys
The medical provider’s decisions are at the heart of any workers’ compensation legal case. Half of the battle is determining whether the provider gave a complete examination and accurate impairment rating.
Attorneys—whether they advocate for injured workers’ or defend insurance carriers—can benefit from automation.
Attorneys don’t need to spend hours combing through a patient’s chart and the claim documentation. Instead, they can hand it off to their workers’ comp robot, who will examine every physician’s report related to the claim. Similar to the tools that should be used by claims adjuster’s, the robot can automatically check the completion of the exam, and validate the accuracy of the impairment rating.
Even attorneys who have a deep understanding of the AMA Guides don’t necessarily have the time or desire to apply that understanding to every new case. Robots can take care of the boring, easy to automate work—checking the medical provider’s work for completeness—freeing up the attorneys time to focus on the other aspects of the case that require their more-nuanced, human attention.
The Big Picture
We’ve just explored how automation might impact an individual workers’ claim from the perspective of several stakeholders. But how would automation change workers’ compensation as a whole?
Imagine if the exam data gathered during all workers’ compensation examinations were collected in a single shared database.
Medical providers who routinely perform examinations incorrectly could be identified, and could be educated and held accountable.
Patterns about particular industries and patient demographics would soon emerge. With enough data, jobs could be accurately rated for how risky they are, and what types of injuries employees are likely to develop when working for certain amounts of time and under particular conditions. With this kind of information, precautions could be adopted throughout industries, injuries could be prevented.
Legal disputes would move forward quickly. Claims with incomplete data could be identified in a snap. Injuries that received highly irregular treatments or unlikely outcomes could easily undergo necessary scrutiny.
With a fact-based idea of what a “normal” injury is like, the likelihood of human error—for example, in the form of incorrectly taking a measurement or entering some information incorrectly—becomes smaller and smaller.
As doctors implement automated rating systems into their medical practices, the barrier that separates experts (physicians) and stakeholders will dissolve. Injured workers and their employers will be able to understand their injuries as easily as specialist attorneys, claims adjusters, and QMEs.
Conclusion
A workers’ compensation process assisted by automation technology, or robots, leaves little room for interpretation. It minimizes guesswork and increases the speed of the entire claim.
Where the process of writing reports for a workers’ comp claims is rife with the potential for error, automation can bring consistency, accuracy, and speed to the process—to the benefit of all involved.