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.

Protecting workers from electronic monitoring, tracking, and management

Automated technological tools are being deployed to monitor, surveil, manage workers, and defend workers’ compensation claims. The Biden Administration has focused on this issue and requested information to create an advanced understanding of these tools' design, deployment, prevalence, and impacts.

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.

New Jersey Cannabis Regulatory Commission issues guidance for workplaces

The New Jersey Cannabis Regulatory Commission has issued guidance for workplaces as a first step toward formulating and approving standards for Workplace Impairment Recognition Expert certifications.

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.

Is It Your Employer’s Business if You Are Vaccinated?

Privacy issues have arisen as employers throughout the U.S. are mandating and/or encouraging COVID vaccinations. The U.S. Department of Health and Human Services [H.S.S.] recently issued guidance on workplace vaccinations and the Health Insurance Portability and Accountability Act (H.I.P.P.A.), 42 U.S.C.A. § 201 et seq. 

NJ Department of Health App Provides Consumers Access to Personal, Family COVID-19 Vaccination Record

In an effort to expand consumer access to immunization records, a new app from the New Jersey Department of Health (NJDOH) makes it easier for individuals and families vaccinated in the state to access their COVID-19 vaccination record. The mobile phone app will also be proof of vaccination as employers ramp up the return of employees to work and the COVID-19 variants, ie. Delta variant spread like wildfire.

Cybersecurity Must be a Shared Responsibility

Cybersecurity security is becoming even more acute of an issue for law firms. The recent pandemic increased the reliance upon remote technology as lawyers and supporting staff have worked from home and participated in virtual meetings and hearings. The recent ransomware attacks on major utilities have created heightened concerns. 

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.

NJ & NY Launch Apps to Help Prevent the Spread of Covid-19

Governor Phil Murphy and New York Governor Andrew M. Cuomo today announced the launch of COVID-19 exposure notification mobile apps in their respective states that will serve as crucial tools to supplement the effort to trace and contact individuals subject to a COVID exposure. 

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.