How Big Data can Drive Better Outcomes for Worker's Compensation

HR Tech Outlook | Tuesday, January 28, 2020

Big data can assist wounded employees in getting the correct support at the right time and by identifying their resource needs as they recover.

Fremont, CA: Growing healthcare and prescription medication expenditures and expanding treatment alternatives drive up workers' compensation costs. Fortunately, most firms and insurers have enough big data to operate with. When paired with new artificial intelligence and machine learning technologies, data analytics can be a powerful tool for taming the growing flood of workers' compensation medical expenditures. Claims generating such expenses can be identified and intervened on using data analytics.

When a worker is hurt, the goal is to bring them back to work as soon as possible. Big data assist firms and insurers in providing improved claim results for injured workers. However, to make effective use of the data acquired, a model must be developed that will assist decision-makers in understanding the issues that drive costs and developing methods that will make the information provided actionable. An effective analytical model must have three parts to help firms effectively control workers' compensation expenses.

1. Compensability

Worker's compensation payments are not available for all workplace injuries. Big data may get used to assess the likelihood of a claim getting paid. It is in everyone's best interest to identify ineligible instances as soon as possible. A sophisticated algorithm may examine each circumstance using data analytics, flagging allegations for further inquiry.

2. Return-to-Work Efforts

The majority of workers' compensation cases are simple and don't require extra attention. However, a small minority of cases need recommendations or case management assistance. Complex situations must get distinguished from straightforward claims enough so medical expertise may be enlisted sooner rather than later, lowering total claim expenses and speeding up a worker's return to work.

3. High-Cost Claims

Along with detecting invalid claims, an escalation warning model may get created to identify high-cost claims earlier on, allowing employees to respond sooner. Co-morbidities (the existence of two or more health concerns) that may impact a worker's recovery timetable, and any other additional resources and assistance that may be necessary, should be identified using this sort of model.

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