The Role of AI in Managing Workers’ Compensation Claims

by | Published on Nov 15, 2019 | Workers Compensation

Artificial intelligence (AI) is being widely used in all industries including medical, legal and educational sectors. This innovative technology is helping those in the legal profession to get rid of tedious, arduous tasks and it allows lawyers to save the time for their core tasks. Along with the services provided by medical record review companies, AI is also supporting law firms to complete their cases in an efficient way.

How AI Helps in Detecting Workers’ Compensation Fraud

Detecting fraud manually is no doubt a time-consuming task.An article in Business Insurance discusses AI as an effective tool to detect workers’ compensation fraud.

Hope you have read our blog on identifying and preventing fraudulent claims.

This is how AI tools help in detecting such fraudulent claims –

  • Workers who are injured can talk with insurance companies over voice instead of filling out forms. Chatbot, an artificial intelligence (AI) software can be used by insurers to transcribe such conversations and error-free transcripts allow claims organizations as well as risk managers to obtain detailed information. Speaking allows getting more information than filling a form with restricted space. This AI technology also has the ability to identify verbal indications such as long pauses that may point to possible fraud.
  • AI makes data gathering easy from vast data sets. Any necessary information can be collected easily in the form of graphs, charts and tables for fast access. Advanced analytics models are available to present critical information necessary for fraud detection.
  • AI-powered fraud detection software provides easy access and highlights any errors in biller and provider data. For instance, if the provider has created billing errors such as upcoding or overbilling, the software will include these red flags graphically in the provider data. Any suspicious activities can be viewed easily and in advance and can prevent it from causing further damage. Instant data of billers provided by this software also includes excessive visits, double billing, denied claims, unbundling, other warning signs, treatment not rendered and provider licensure issues.
  • Along with faster data gathering, users can get the data they seek in the required form. A proven AI fraud detection system creates instant reports from various data sources. The software is set in such a way as to respond to the user’s data attribute preferences and it gathers the required information into ready-to-use reports that you can export or save – all in a matter of minutes.

Without advanced analytics software, manual data collection will be hectic and can take even a couple of weeks, which would delay the fraud detection process as well. Fraud detection investigation and IT units can also save their valuable time with machine learning-powered software.

Workers’ Compensation Lawyers Can Use AI

Not only fraud detection masters, attorneys dealing with Workers’ Compensation claims can also use AI in managing diverse tasks, such as –

  • To ease the discovery process -AI eliminates the need of assigning a big team to find evidence from paperwork. With AI-integrated predictive coding, data can be quickly organized, prioritized, and categorized. Lawyers can thus reduce the cost of discovery as well.
  • For legal investigation – AI powered software can perform legal research for legal practices. Workers’ comp cases often involve a huge amount of research. AI will save the time it takes for the team to find what you are looking for.
  • To stay organized –Many law firms dealing with workers’ comp are considering automation through AI to stay organized and always get the most accurate and up to date information possible. This software also provides option to store data about the injured worker’s employer, the injury, and insurance details.
  • To benefit from AI predictions –AI technology can also analyze data and make even a prediction about the conclusion of the case. In short, AI can assist clients in making educated, well informed decisions at a higher level than a human.

AI can also help calculate the value of a settlement. It has been reported that most of the AI software comes with workflows to create productive, efficient settlement and litigation practices. With the support of medical chart reviews and analysis and with assistance from such advanced technologies, workers’ compensation claims will be less hectic for insurance companies and lawyers.

Discover our medical record review solutions and partner with us for your next case.

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