Why Artificial Intelligence Is Like Fast Food

Much has been written about applying artificial intelligence tools in the workers’ compensation industry.

Injury prevention is one area that AI shows great promise. Researchers recently used machine learning to auto code over 1 million workers’ compensation claims and “taught” a computer to answer “What caused this injury.” The results assisted industry groups in their injury research and prevention efforts — an excellent thing for all concerned.

The claims management industry is utilizing AI to make underwriting more accurate and identify and manage claims more efficiently. Clearly, there is room for improvement – in 2019, the California State Auditors Office determined that over the last five years, 82% of denied claims have been reversed, which resulted in a 55% INCREASE in frictional costs to insurers and employers.

More recently, the insurance industry has been exploring the use of AI to “manage” injured workers’ perceptions of the process, reducing costs, and thereby increasing their profits. This “management” deploys AI tools to head off the injured worker’s frustration with the process so they won’t seek attorney representation. Why? Because some insurance industry experts estimate that injured workers can recover up to 400% more in benefits when an attorney represents them.

I suppose I could argue that “managing” injured workers with AI so they don’t retain an attorney is immoral. But I have a more simple point – most injured workers are smart.

Using AI to simulate empathy, sympathy, or caring won’t serve as a substitute for actually providing quality medical treatment, giving the worker adequate time to recuperate, and documenting the full extent of permanent restrictions. Those are the realities that injured workers face, and the more injured they are, the more interested they are in obtaining REAL HELP – not “feel good” phrases.

Defense attorneys often ask me, “why were you retained on this case”? The answer is usually, ” because my client knew they weren’t being treated fairly.”

Injured workers know the difference between words and actions, just like we know the difference between fast food and mom’s home-cooked meal.

AI isn’t going to change that. In fact, it may make things worse.