Implementing AI for Workers’ Compensation Law Firms and Insurance Companies

Artificial intelligence [AI] opens new frontiers for workers’ compensation law firms and insurance companies. Last week, Google announced new applications that will vastly expand how workers’ compensation claims can be serviced, managed, and supported.

Available Workers' Compensation Law 2023 Update

Jon Gelman’s* newly revised and updated treatise on Workers’ Compensation Law is now available from Thomson Reuters®. The treatise is the most complete and research-integrated work on NJ Workers’ Compensation law.

Order: Workers' Compensation Law 2022 Update

Jon Gelman’s* newly revised and updated treatise on Workers’ Compensation Law can now be ordered from Thomson Reuters®. The treatise is the most complete and research integrated work available on NJ Workers’ Compensation law.

Just Published - Workers' Compensation Law 2021 COVID-19 Update

Jon Gelman’s* newly revised and the updated treatise on Workers’ Compensation Law has been published by Thomson Reuters®. The treatise is the most complete and research integrated work available on NJ Workers’ Compensation law. Updated annually for over 35 years, this body of work provides practical tips, objective analysis, and academic support for the workers' compensation community.

Is the workers' compensation system ready for the COVID-19 [coronavirus] virus? Live Updates

It seems that every decade a new pandemic emerges on the world scene, and complacency continues to exist in the workers’ compensation arena to meet the emerging challenges of infectious disease.

OSHA's vague COVID-19 reporting guidance

OSHA issued a COVID-19 reporting guidance that lacks a foundation in essential epidemiology as well as legal evidentiary principles for admissibility. It is doubtful that court of law would permit the guidance to be used for the determination of causal relationship.

HHS Relaxes HIPAA Rules During COVID Pandemic

The US Department of Health and Human Services has published a “Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency,” that eases the enforcement of medical record privacy. As workers’ compensation providers increasingly employ electronic communication with their patients, these rules will have a major impact on how medical care is provided.

AI and Workers' Compensation: Who is Watching the Machine?

Artificial intelligence [AI] is the new challenging frontier in the administration of workers’ compensation benefits. While there are cost savings benefits that will be achieved through deep learning and machine intervention there are also serious ethical concerns coming to the forefront as this new technology evolves. 

Deep machine learning is complicated and it is in an ambitious goal. The result may afford a good prediction, but it lacks an explanation of "why" in many instances. 

The potential decrease costs in both administration and payment of workers’ compensation benefits have been alluded to in advertisements of software manufacturers. Already vendors are claiming reductions including: a 5% reduction in claims cost; a 50% decrease in the cost of medical-only claims; and a 25% to 60% reduction in attorney involvement. 

AI programs transfer the decision-making role onto a computer algorithm rather than a human being. In others words, the plight of the injured worker is not left to the decision making capacity of an adjuster, but rather a computer utilizing logarithms. The logarithms can be biased concerning such stereotypes as: racial, demographic, genetic, gender, economic, and/or religious. AI can be utilized to admit or deny claims, restrict temporary disability benefits and direct medical care. 

The lack of privacy in the vast amount of data flowing into machine learning programs continues unabated. Some of the data is distributed without consent and without transparency. How much of this data is used by AI programs remains unknown. The process is unexplainable. 

Computer based learning systems have available vast amounts of data, from unknown sources, that form a gold mine of information available. Insurance carriers and employers can use this data to reduce claims costs and ultimate payouts. The data grows daily from multiple sources both with in the workers’ compensation community as well as from collateral information resources. In the information world the availability of electronic information grows constantly. 

The deployment of artificial intelligence programs that involve deep machine learning raise significant issues involving questions as to the explainability of the decision making process. The Explainability of Artificial intelligence [XAI] including the algorithms employed in the decision making process is problematic. An overriding question is who is responsible for the potential harm since an individual cannot sue a computer. 

The ethical dilemma created is that it is difficult to regulate logarithms. The federal government has taken the lead on this challenging issue. The Defense Advancement Research Projects Agency [DARPA] assesses how the components of AI can be explained and applied in a responsible manner. The components include: how rich, complex and subtle information is perceived; how the machine learns the information within an environment; how the information is abstracted to create new meanings; and how artificial intelligence can reason to plan and decide. 

The integrity of workers’ compensation is being challenged by AI systems that lack explainability. The goal of employers and or insurance companies in utilizing AI for cost-claim reduction is noble. The playing field must remain balanced and the right to “due process” in workers compensation programs needs to be preserved. The oversight by governance, policy, and rules concerning XAI should be utilized to maintain the integrity of workers’ compensation programs.

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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman 1.973.696.7900jon@gelmans.com has been representing injured workers and their families who have suffered occupational accidents and illnesses.

New Opioid Prescription Regulations

Attorney General Gurbir S. Grewal and the New Jersey Division of Consumer Affairs, together with the New Jersey Coordinator for Addiction Responses and Enforcement Strategies ("NJ CARES"), today announced a series of regulatory actions that will advance the State’s battle to end the opioid epidemic, including proposed rules that will expand access to the prevention and treatment of opioid use disorder through telemedicine.

Nebraska Doctor Exposed to New Ebola Outbreak

An American providing medical assistance in the Democratic Republic of Congo recently experienced a possible exposure to the Ebola virus and is in Omaha for monitoring. This person has no Ebola symptoms but will be monitored closely. Should any symptoms develop, the Nebraska Biocontainment Unit would be activated and the person admitted.

Amnesty International USA Files a FOIA Request on Burn Pits

Amnesty International USA filed a request under the Freedom of Information Act (FOIA) to seek documents related to the use of burn pits by the U.S. military. For decades, the military has used burn pits producing toxic smoke to dispose of hazardous waste on military bases around the world. More than 100,000 veterans have reported serious health effects following exposure to burn pits, including neurological disorders, rare forms of cancer, reduced lung function and pulmonary diseases.

Safeguarding Injured Workers From Cybersecurity Breaches

Under new Federal proposals, injured workers will be protected from cybersecurity breaches. The impact will be greater responsibilities and costs for law firms and, employers and their insurance companies.

NJ Supreme Court Allows COLA Pension Freeze

LaVECCHIA, J., writing for a majority of the Court. In this appeal, the Court considers whether the 2011 suspension of State pension cost-of-living adjustments (COLAs), L. 2011, c. 78, contravened a term of the contract right granted under the earlier enacted “non-forfeitable right” statute, L. 1997, c. 113 (presently codified as N.J.S.A. 43:3C-9.5).

FL Supreme Court Rules Yet Another Part of the Work Comp Law Unconstitutional

The Florid Supreme Court today ruled yet another part of the Florida Workers' Compensation Act unconstitutional. The cut off of benefits provision was declared unconstitutional. The future of workers' compensation law in FL is now uncertain.

Privacy: Court Mandates Protective Order for Workers' Compensation Discovery

Plaintiff in mesothelioma case sought production of defendant's (Union Carbide Corp) employees' workers' compensation claim records. The corporate defendant, Union Carbide Corp) sought to restrict access and limit dissemination of the records of the workers' compensation matters sought through discovery.

Confidentiality is a two sided sword. Historically asbestos litigation had its genesis in workers' compensation claims. In this instance the Corporate Defendant sought the utilization of privacy restrictions as a defense.

Expectations Must Adapt to Change

In the "old days" the US workers' compensation system,  meet or "exceeded exceptions." Looking backward we recognize an aggressive and dedicated work ethic, that the government, private industry and labor," managed to embrace into a "Grand Bargain" called Workers' Compensation. 

Times have changed. In the past the corporate and executive workplace was a formal "tie and jacket" environment. Seasoned member always gripe how things have changed for the worse and long for a return to the comforting and familiar "good old times." 

Defense Firm Prohibited From Seeking Unfettered Medical Discovery

A defense firm, that had a “custom” of seeking unlimited medical discovery in workers’ compensation claims, was barred from utilizing that litigation tactic. The NJ Appellate Division affirmed the trial level decision of The Honorable Emille R. Cox, Supervising Judge of Compensation that prohibited requests for unlimited medical data.

Senator Patrick Leahy Calls For Greater Transparency by Asbestos Companies

Statement of Senator Patrick Leahy Ranking Member, Judiciary Committee Hearing on “The Need for Transparency in the Asbestos Trusts”

Today the Judiciary Committee meets to discuss legislation that purports to promote more transparency in asbestos trusts.  Before we get into a detailed discussion about the merits of the proposed legislation, I want to make sure we all remember why we are here today.  For decades, millions of American workers were secretly poisoned.  Men and women who worked in our Nation’s factories, shipyards, mines and construction sites, and service members in the military, unknowingly inhaled air that was laced with asbestos—a substance so harmful that an individual can become critically ill simply by breathing.

CMS to Speed-Up MSP Collection Practices

The Centers for Medicare and Medicaid Services (CMS) has announced that it intends to speed up its collections practices enforcing the Medicare Secondary Payer Act (MSP). CMS stated that such procedures are mandatory under the Digital Accountability and Transparency Act of 2014 or the DATA Act Public Law No: 113-101 (05/09/2014).

In the name of privacy...

After the massive US IRS data breach announcement this week, CMS has posted that it is establishing a more secure system for access to Medicare Secondary Payer Information. This is pretty consistent with President Obama's announcement to take Social Security Numbers off of Medicare Cards. 

The real issue is that while workers' compensation records are supposedly confidential in State systems, the Federal government has consistently neglected to insure that privacy whether be: medical records under HIPPA; by integration of  state's motor vehicle or workers' compensation records utilizing Social Security Numbers, or by Medicare Secondary Payer Act electronic data systems. 

Additionally, the Federal government will probably be mandating the reporting workers' compensation payment information, in Federal Income Returns shortly. The batting record of the IRS this week on privacy has been dismal.

Time will only tell whether workers' compensation data can actually be shielded from intruders. 

CMS announced today:

"As part of the Strengthening Medicare and Repaying Taxpayers (SMART) Act, the Centers for Medicare & Medicaid Services (CMS) will be implementing optional MFA services on the MSPRP. MFA is the use of two or more different authentication factors to verify the identity of an end user. Verified users will have access to view unmasked claim data on the Portal.

"Non debtors will still need to have a Verified Proof of Representation or Consent to Release authorization to perform actions on cases. Please note that MFA and the associated identity proofing process will be optional to portal users. Portal users may continue to use the portal without going through the MFA process but will not have the benefit of viewing un-masked data.

"MFA is scheduled to be available beginning on July 13, 2015. Updated user guides and training materials will be available on CMS.gov and within the portal upon implementation.

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• CMS Comments: "No Comment" on The Forthcoming Smart Act Regulations (workers-compensation.blogspot.com)
• CMS Posts Sample Notice To Beneficiaries Regarding Appeal Rights (workers-compensation.blogspot.com)
• On-Demand Labor - Is Workers' Compensation Ready for Flex-Time Employment? (workers-compensation.blogspot.com)
• Is The Reserve Offset Heading for Extinction? (workers-compensation.blogspot.com)
• Coordination of Benefits and Non-Group Health Plan Recovery Transition (workers-compensation.blogspot.com)