In a recent conversation with a seasoned workers’ compensation insurance adjuster, I was struck by the deep-seated reluctance to embrace modern technology, particularly artificial intelligence (AI), in generating impairment reports. This adjuster, with over 20 years of experience, firmly believed that all impairment reports should be manually calculated and entirely authored by doctors without any technological assistance.
During our discussion, I posed several questions that challenged this adjuster’s traditional viewpoint. Is it fair for a doctor to use pen and paper or a desktop calculator? What about using tools like the AMA Guides CD-ROM Calculator (circa 2005)? Or, ultimately, should they employ AI systems that are trained on highly-structured and accurate databases? This line of questioning seemed to highlight the central emotional struggle many face, including insurance adjusters: Are we willing to transition to higher technology for more accurate reports, fairer settlements, and faster benefit delivery?
Upon further probing, it became clear that this adjuster’s reluctance was rooted in a deeper uncertainty about technology’s role in our daily lives. Should we revert to longhand division, manually balancing our checkbooks, or even relearn cursive writing? While these questions were posed humorously, they underscored a significant point: How much are we willing to let go of, and how can we put our faith in a higher technology system that many of us may not fully understand?
AI Can Scale Like No Adjuster Can
Artificial intelligence is neither a magic wand nor a silver bullet. Instead, it represents an opportunity to scale labor and concepts far beyond what one person or even hundreds of people could achieve manually. AI can deliver results and insights into workers’ compensation injuries that are currently beyond our reach due to the limitations of manual work. Do we really want our doctors spending time on longhand division, trying to determine where the decimal point goes when translating a thumb digit impairment to a whole-person impairment across multiple body parts? The answer is a resounding no.
This adjuster’s resistance highlights a broader issue: the changing of the guard. Technology will continue to advance, regardless of our willingness or reluctance to accept it. The key to harnessing AI’s potential in impairment rating and other aspects of workers’ compensation lies in our ability to understand the algorithms, and then we can structure the instructions effectively.
AI’s possibilities are vast in terms of its potential to pare down the time and complexity in resolving workers’ compensation claims. It is unrealistic to expect qualified medical evaluators (QMEs) to search the country for past cases with nearly identical injuries, symptoms, and external variables to get a sense of how much they have generally settled for. QMEs also are not always in a position to identify anomalies in subjective pain-scale scores reported by patients. Similarly, workers’ comp adjusters will not necessarily identify key trends across thousands of claims—for example, parts of the current AMA guidelines that appear to overrate the presence of a surgery in a patient’s medical history (i.e., the surgery does not significantly impact the treatment or ability to get back to work).
But AI can do this by synthesizing hundreds of thousands of past claims and medical reports. Think about how much more quickly claims would settle with significantly more objective, comprehensive impairment evaluations. Litigation and infighting between employees and employers over subjective medical evaluations would diminish by a wide margin. Instead of trying to reconcile conflicting AMA Guides charts and tables, we would be able to determine the truly pertinent variables that can help steer us to fairer settlements.
Empowering Humans, Not Replacing Them
The struggle within ourselves, especially for those like this adjuster who has dedicated decades to the profession, is understandable. Change is difficult, and the fear of the unknown can be paralyzing. We have seen technology make many jobs obsolete in other industries, from bank tellers to elevator operators to travel agents, to name a few.
However, historically technology has enhanced individuals’ ability to do their jobs in as many or more instances. Social media did not put marketers out of work, it helped them target their buyers and audiences better. Workflow automation has not left DMV employees at the unemployment line, it has reduced the amount of “busywork” and red tape (e.g., data entry, collating, filing, etc.), enabling them to concentrate on exceptions and complex cases.
AI will have a similar effect in workers’ comp. Embracing AI will not mean abandoning the expertise and judgment that seasoned professionals bring to the table. Instead, it will augment their capabilities with tools that enhance accuracy and efficiency. If utilized properly, AI will make it easier for claims adjusters and medical evaluators to carry out their duties and do their jobs even better.
As we navigate this transition, it is crucial to provide education and support to those hesitant to adopt new technologies. By demonstrating AI’s tangible benefits and addressing concerns transparently, we can bridge the gap between traditional methods and innovative solutions. The ultimate goal is to improve outcomes for injured workers, streamline processes, and ensure that benefits are delivered promptly and accurately.
The acceptance of AI in workers’ compensation is not about replacing human expertise, but empowering it. By embracing higher technology, we can achieve more accurate reports, fairer settlements, and faster delivery of benefits. The future of workers’ compensation lies in our ability to adapt and evolve, leveraging AI to create a more efficient and effective system for all.
About the Author:
John Alchemy is founder and CEO of Rate-Fast. john@johnalchemymd.com