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PokemonGo-wikipediaIs Pokémon Go a new technique to promote exercise in the fight against anxiety and depression?

It is common knowledge that exercise is a great way to improve not only physical health, but mental health as well. Depression and anxiety often improve with regular exercise, but the difficulty in prescribing exercise has always been how to motivate and sustain this aspect of wellness improvement – especially for those who may suffer from social anxiety or are not prone to exercise in the first place.

There is a new motivator on the rise called Pokémon Go, and it is taking the nation (and world) by storm. Despite the negative stories warning of potential liability risks, the augmented reality game is motivating many people to start moving.

When you have depression and/or anxiety, exercise may be the last thing you would consider doing. But once motivated, exercise can make a big difference in how you feel.  And for many who suffer from social or other forms of anxiety, finding the strength to motivate yourself may seem nearly impossible.

On the Pokémon Go website, the creators state:

“Get Up, Get Out, and Explore! Get on your feet and step outside to find and catch wild Pokémon. Explore cities and towns where you live—and even around the globe—to capture as many Pokémon as you can. As you walk through the real world, your smartphone will vibrate to let you know you’re near a Pokémon.”

For many of us who may not be gamers, this phenomenon – that literally took hold over night – was quite surprising. I have seen scores of people (not just kids and millennials) walking and interacting in parks and in town where it was virtually vacant days before. Even at work there seem to be more individuals and groups walking together at lunch time glancing at their phones.

On almost every social platform people are expressing a newfound interest in walking, even those who may not have made exercise their first priority in a long time. Concurrently, I am also seeing interest arise in the ideas around gamification from the wellness industry since the release of Pokémon Go.

Perhaps this is just another fad, but maybe Pokémon Go is the start of a new era where corporate-sponsored wellness programs include gamification to entice more people to become engaged.  From my vantage point, it seems we are at the dawn of something new – where gamification will be taken seriously as an engagement and exercise tool in the fight against anxiety, depression and obesity, as well as having an impact on overall wellness.

For years, employers have been promoting competitive or game-oriented challenges within their corporate wellness programs such as walking contests using old school pedometers or new age fitness devices to track steps and provide rewards. These can be successful for those motivated by fitness challenges.  However, building an exercise component into your wellness program by using gaming techniques that are founded in both the virtual and real worlds could be the additional aspect you need to motivate a larger community of employees to participate.

It will be interesting to see how gamification can be used to improve many aspects of both mental and physical health. Could Pokémon Go or some other augmented reality game be an asset to your employee mental health and wellness initiatives?

Kimberly George, SVP, Corporate Development, M&A, and Healthcare

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DavidDePaolo-trailblazer-In any industry, there are people who work in it and people who pass through it, and fortunately there are people who care for it. David DePaolo cared for us and for injured workers across America. Within a moment of meeting him at an industry conference years ago, I instantly knew he had a vision and passion for transforming workers’ compensation into a system from which all stakeholders could benefit.

Regrettably, David died this weekend at the age of 56 while riding his beloved motorcycle in the Malibu Hills. In his far-too-short life, he left an indelible mark on the workers’ compensation community. A workers’ comp attorney by profession, David worked tirelessly to elevate the discussion on industry issues through his popular blog, DePaolo’s World. He also founded WorkCompCentral, a respected news and educational service, and the Comp Laude Awards, a recognition program designed to showcase how much good emanates from the workers’ compensation profession. David was well-known for his regular speaking engagements at industry conferences and events, where he candidly shared his views and advocated for industry improvements.

Last time I spoke to David, he shared his vision for creating a program at Pepperdine University (where he earned his law degree) to train the next generation of claims professionals. Perhaps that vision can become a reality as a tribute to his outstanding legacy.

David made the pursuit of improving the workers’ compensation system his life’s work, and we are all better for it. All of us at Sedgwick send our sympathy to his family and many friends. We will miss his wisdom.

Dave North, President and CEO

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Geo-fencing-vehicle“It is a very sad thing that nowadays there is so little useless information.” – Oscar Wilde                                                            

The world is a growing resource. No disrespect to Oscar Wilde, but yesterday’s useless information is essential data today, and that is by no means a sad thing.

When it comes to collecting useful information, the “Internet of Things” (IoT) has eradicated nearly all of the limitations previously posed by geographic and political barriers. First coined by British entrepreneur Kevin Ashton in 1999, the IoT is a network of physical devices such as smartphones, vehicles, buildings, homes and other items embedded with electronics, software and sensors that enable the collection and exchange of data. We are now worldwide consumers seeking products, employment, entertainment and information through personal devices and applications that easily integrate the physical world into a giant network of connected “things.” Some experts estimate that the IoT will consist of 50-75 billion objects by 2020.

Today, the IoT is widely used as a marketing platform. Businesses connect with consumers by creatively exploiting information made available by the IoT and using geo-fencing techniques. Geo-fencing is technology that uses GPS to define a virtual boundary, or “fence,” to be put around any location or combination of locations. By setting alerts to track social media activity for specific keywords in user comments or postings, businesses can identify you – the consumer, what you consume, and where you consume it. Data extrapolated and aggregated from your past purchases can be used to sell you new products.

Conceptually, this sounds a lot like what George Orwell warned us against back in 1949 with the publication of his seminal work, “1984.” However, even Orwell couldn’t fathom a communications platform as vast, convenient and embraced as our internet.

Marketing advantages aside, this vast network of information has become an invaluable tool for law enforcement and national defense agencies. Data obtained from these networks can be used to identify and evaluate actions and behavior patterns within crime-ridden neighborhoods and global areas of conflict, allowing for the implementation of proactive solutions to resolve situations before they escalate.

Geo-fencing technology has now found its way into the realm of insurance investigations. With more ease than ever, special investigation teams can utilize this technology as a tool to aggregate location-based intelligence data for analysis to assist in claims investigation and resolution.

Unlike telephone conversations, social media posts are an example of “open source” communications. As such, this information is public and can be tracked. Existing historical posts can be collected. Alerts can be set up to send a notice when a person of interest is actively posting or communicating. Upon review of these public communications, investigation strategies can be more narrowly focused with significantly less uncertainty.

Image recognition technology is also making its way into the special investigation toolbox. This technology utilizes artificial intelligence and machine learning to understand the properties of images.  These complex recognition programs can detect and identify an object or feature within a digital image or video.

Hotels and casinos have employed facial recognition software for years. You might recall that impressive concierge who remembered your name a year after your previous visit. Sorry, but you may not have been as memorable as you were led to believe. Wish you had that $10 tip back now?

The power of combining image recognition algorithms with geolocation are exemplified in movies like “The Bourne Identity” where a fractional portion of a facial image is used to locate a target on the other side of the globe.

Image recognition techniques are not just limited to the identification and location of faces. Aggregated data files also include landmarks, buildings, terrain, sounds, voices and vehicles – all stored in information “warehouses” for immediate and future use.

One such information warehouse is particularly useful in claims investigations. License plate recognition technology, known as Vehicle Sightings, utilizes a national system of fixed and mobile camera units to capture license plate images. The images are compiled in a database and integrated with online mapping tools to provide documented vehicle sightings, which confirm the vehicle’s identity, time and date of the sighting, and the geolocation. The database contains billions of vehicle plate images and can be an effective tool for auto claim investigations. It can also be used in conjunction with skip traces, and may be useful in identifying potential employment and activity trends.

There are already several billion image files readily accessible today and tens of millions more are being added daily. By comparison, after decades of accumulation, fingerprints on file worldwide only number about 100 million. Accessing the database and employing social media and recognition applications adds an entirely new dimension to investigative services such as witness identification, skip traces and surveillance operations. Accident scenes are now on center stage. Actionable intelligence is being gathered and distributed by unwitting collaborators. Smartphones just need to be aimed. Who can resist taking a few quick pics of an unfortunate event to share with the world? Vacation pictures and videos are now being used to determine causation and liability.

While this may all seem alarming as it relates to privacy, everything described here is a matter of public record. For those committing criminal and fraudulent activities, geolocation and data recognition techniques can likely leave clues to their misdeeds. It should be mentioned that criminals in turn are capable of taking public information that you may be sharing and use it against you, so please take appropriate steps to protect your own data.

Those who commit insurance fraud cost businesses and consumers billions of dollars every year. Utilizing the technology and data available today can contribute to cost savings in the long term. Sedgwick’s special investigation unit (SIU) works diligently to use the resources and tools at our disposal to address insurance fraud matters through prevention, detection, investigation and mitigation while always adhering to established laws and federal and state guidelines.

I welcome your comments and thoughts on how these and other emerging technologies might benefit claim investigations.

Michael Anderson, Director of Claims, SIU Operations, Sedgwick

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dispense-as-writtenI am a complex pharmacy nurse for Sedgwick which means my mission in life is to restore injured workers’ lives. I work collaboratively with doctors to change prescribing practices and follow best practices based on national guidelines and the individual patient’s needs. Sometimes my job requires me to be a detective and sometimes I uncover things that even surprise the prescriber.

Recently I connected with a doctor who had been treating an injured worker for many years. For the most part all was going well. We were working collaboratively to lower the prescription opioid dosage the injured worker was taking. I was thrilled with the results achieved except for one issue that remained unresolved. I had asked the doctor multiple times to prescribe generic instead of brand medication; the physician was frustrated because he insisted that he was not prescribing brand medication. Yet after another costly refill of brand medication came in, I followed up again and asked to speak with the doctor’s office manager; she supported the physician’s stance that brand medication was not being prescribed to the patient in question.

So here’s where I put on my detective hat. I called the pharmacy to see if they could pull the image of the prescriptions. I asked the pharmacist on duty if perhaps the prescriptions had “dispense as written” (DAW) documented. At that point I wondered if perhaps the patient wrote a DAW note on the prescription themselves; this can be a tactic of an opioid abuser. The pharmacist who was speaking with me pulled several months of the prescriptions and saw that one of the other pharmacists had written a note on the script that said “patient called and wants brand name medication only.” The pharmacist indicated that he had called the doctor’s office and gotten approval from an individual there and provided me with a name. I now had something to go on; I called the doctor’s office manager and told her what I had uncovered. She relayed that the staff member noted in the pharmacist’s record had not worked there in over a year.

Just like in a good Law and Order episode, diligent detective work solved the case. After further investigation, we found that the pharmacist, in an effort to make the patient happy, wrote “DAW approved” on the prescriptions. Alongside, he provided the name of the person previously employed with the physician because, at some point, he had spoken to her in that office. You may imagine my surprise – and that of the doctor’s office and the pharmacy – at this discovery. The pharmacy agreed to reimburse the difference in cost for all of the prescriptions filled.

It took some digging, but tracking down the underlying cause of this prescription’s inconsistency paid off in multiple ways. Not only was I successful in saving a significant amount of money for my client, I also more importantly was successful in lowering the morphine equivalent dose and helping to restore this injured worker’s life. I get excited about my job every day because I know what I do is making a huge difference for injured workers and their employers! At Sedgwick, caring counts℠ is part of what we do every day when we come to work. This is exactly the kind of outcome we strive for when supporting the people who count on us in a time of need. Do you have similar stories to share? How have you turned a simple request into an impactful result?

Jamie Waits, RN, Complex Pharmacy Nurse

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firework-safetyWho doesn’t love July 4th, Independence Day, a celebration of our nation’s independence and traditionally a day filled with food, family and good fun? Unfortunately, July 4th is also a holiday that can bring danger and great potential for property and casualty losses due to the negligent use of fireworks if the proper safety measures are not followed.

Unified Investigations & Sciences’ professional fire investigation experts nationwide most often find that fires resulting from negligent use of consumer fireworks involve the use of bottle rockets. A bottle rocket is a skyrocket (about two inches in length) that is attached to a stabilizing stick. They are often placed into, lit, and shot from bottles (hence the name bottle rocket). As the fuse ignites the propulsion component, the bottle rocket shoots into the air and eventually a secondary charge explodes, giving off an illuminated display and an audible “bang.” Bottle rockets are just one of many different types of fireworks, but they pose a special risk as they cannot be controlled and often fly into unintended areas such as mulched flower beds, trash piles and into woods that are dry due to the summer heat. Depending on the available fuel where the bottle rocket lands, the potential for an unintended fire is present. More times than not, these fires are not noticed immediately and grow in size before being discovered and reported.

Insurance claims professionals should be aware of the subrogation opportunities associated with the negligent use of fireworks. There may be a number of such opportunities depending on the circumstances involved. A check of local and state laws in the area where the incident occurred may find that the use of bottle rockets, and perhaps even all fireworks, is prohibited. An illegal act on the part of a third party could easily provide a liability matter that should be explored. Many states and local communities do prohibit the consumer’s use of fireworks and encourage instead that citizens view commercial events often sponsored by municipal governments or commercial businesses such as shopping malls or theme parks.

A second possibility for subrogation lies in taking a look at the actions of the person(s) using the fireworks. Perhaps they were doing so in a manner not intended. One Unified fire investigator reported that an investigation of a fire in Florida found teenagers were shooting bottle rockets at each other, more horizontally than the usual vertical manner bottle rockets are intended to be used. This led to a bottle rocket landing in an exterior trash container, which caused the container’s contents to catch fire. A thorough investigation with interviews of neighbors revealed these details and led to a liability claim against the homeowners liability coverage for one of the participant’s parents.

A third incident with a different theory of liability occurred in Missouri when a bottle rocket landed in a flower bed where recycled rubber had recently been used as mulch. In our fire investigator’s testing, a bag of the same mulch product was purchased from a home supply store and revealed that an exploding bottle rocket can ignite the rubber mulch material. The bag that the product is sold in fails to warn the consumer about this hazard, thus providing a theory of liability against the manufacturer.

If fireworks are part of your personal celebrations this July 4th, consider ground use fireworks as a much safer alternative. With proper safety procedures and use of more predictable materials, everyone should be able to have a fun-filled and safe July 4th holiday.

Michael Reynolds, IAAI-CFI, FCLS   |   Director of Total Performance
Unified Investigations & Sciences, Inc., a Sedgwick company

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keywestfl-2399852-hurricane-blog$1.9 billon. That is the estimated dollar amount the recent historic floods in Houston Texas will cost to return life and business back to normal according to the Houston Business Journal. Now almost every major weather service is reporting that, due to weather-related pattern shifts such as La Niña, the 2016 hurricane season may be more active than any over the past three years. Experts at AccuWeather warn that those living along the Atlantic coast should be vigilant, as tropical storms Bonnie and Colin have already appeared early in the Atlantic hurricane season, which typically spans from June through November. Historically, seasons which have tropical storm activity during the months of May, June and July have a higher likelihood of becoming normal or above-normal throughout the season. The National Oceanic and Atmospheric Administration (NOAA) predicts a 70% likelihood of 10 to 16 named storms, of which 4 to 8 could become hurricanes.

It only takes one storm to create a disaster for your business, regardless of whether storm activity levels are high or low. Businesses in coastal and near-coastal regions should prepare and take several precautions every hurricane season. Here are a few considerations:

  1. Building damage related to tropical storms can be caused by high wind, debris, wind-driven heavy rain, storm surges and flooding. Determining the initial cause of damage to the property can be critical during the post-damage assessment period. Fire, arson and looting are unfortunately not uncommon after hurricanes when properties are most vulnerable.
  2. Marine equipment and offshore operations are common to coastal industries and damage to barges, cargo and offshore structures can be extensive in the aftermath of a major tropical storm. Adjusters skilled in marine operations, including surveying and adjusting to recovery and loss control, are vital to ensure that damages are accurately captured to begin the process of recovery.
  3. After a hurricane, assessing the immense scope of loss to business and personal contents within a structure can be overwhelming to both the insured and the adjuster. Personal property and business property losses require the same attention to detail as a building claim, especially when events such as looting are involved. An accurate inventory protects businesses against loss, while also avoiding potential inflation of loss. The level of thoroughness needed for content adjusting is a different skillset than that required for building adjusting.
  4. The Atlantic hurricane season not only wreaks havoc in U.S. coastal cities, but also those of islands in the Caribbean, as well as in Mexico. Of note, NOAA also predicts a normal or above-normal forecast for the eastern Pacific and central Pacific regions. Widespread damage throughout a multi-national region requires not only a fast, experienced response – it also requires professionals who have a complete understanding and expertise in local markets and conditions which may differ from those in the mainland U.S.

Catastrophe team adjusters are experts in assessing and handling all types of disasters, whether they are natural or man-made, with the goal of making everything right and stable again. While we still can’t prevent storms or know for sure what Mother Nature has in store for 2016, you can take action now to be prepared should your business or property be impacted by a hurricane or other major weather event this year. Benjamin Franklin said it simple and best, “By failing to prepare, you are preparing to fail.”

Please feel free to share your ideas and questions with us; the Vericlaim Catastrophe Response Team is available to help meet the needs of your organization.

John Hinz, AIC, Vice President
Vericlaim, a Sedgwick company

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TOneOrlandohe recent tragic events in Orlando, Florida—where 49 people lost their lives and dozens more were wounded in the deadliest mass shooting in U.S. history—weigh heavily on our hearts and minds. For Sedgwick’s 450-plus colleagues in the greater Orlando area, the impact of the attack hits much closer to home.

As we all struggle to comprehend the scope of the losses for everyone affected, it has been inspiring to see the outpouring of support from around the world for the city of Orlando and the lesbian, gay, bisexual and transgender (LGBT) community, with which many of the victims identified.

During this difficult time, I have thought a lot about Sedgwick’s commitment to taking care of people because caring counts. At the heart of our business, we intervene in people’s lives when the unexpected occurs and do our best to make things right. While we cannot bring the 49 fallen victims of the Pulse nightclub shooting home, we can support their loved ones and help those injured in the attack to rebuild their lives. To that end, Sedgwick is honored to donate $25,000 to the OneOrlando Fund.

Given our industry’s rich history of charitable giving, it’s no surprise how many Sedgwick colleagues, customers and friends have raised their hands and opened their hearts to help those affected by this tragedy. I encourage anyone still looking for a meaningful way to get involved to join Sedgwick in supporting the OneOrlando Fund.

Shortly after I announced our gift to Sedgwick’s 13,000 colleagues earlier today, I received a heartfelt note from one of our claims representatives in California. He wrote:

“I was almost in tears reading about this charitable donation. The entire LGBT community has been affected by this tragedy. I am so proud to be a part of a company that stands by our community under these horrific circumstances. Thank you so much for helping these families; it is generosity like this from our allies that will help us get through this and give us strength to not cower in fear, but instead stand and be proud of who we are. I have never been happier to work for Sedgwick and hope for a long career with the company.”

Sedgwick has never been prouder to lend a helping hand. It is colleagues like these who, day in and day out, help us demonstrate how caring counts.

Dave North, president and CEO, Sedgwick

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CHS_SBN_web-sponsor-thumbnail_050216Many within the workers’ compensation industry know that Ohio’s system is unique. In fact, even here at Sedgwick, we frequently hear, “that’s a state of Ohio situation.” The good news is that Sedgwick’s Ohio team of nearly 400 colleagues within the CompManagement Partner Companies fully understands the unique nuances within the Ohio market.

First off, it’s a monopolistic state where the Ohio Bureau of Workers’ Compensation (BWC) is the insurance carrier for more than 225,000 employers in the state fund. About two-thirds of Ohio’s workforce is covered by BWC and the remainder is covered through self-insured programs administered by large employers.

It is also unique in that managed care services are provided directly by 15 different managed care organizations (MCOs) where 100,000 new injuries and 2.5 million bills are processed each year; and 300,000 active claims are being managed at any point in time.

While employers in Ohio contract individually and directly with third party administrators for workers’ compensation claims administration, a managed care organization (MCO) has just one contract, which is with BWC. MCOs focus on providing return-to-work and managed care services to help injured employees get back on the job as quickly and safely as possible.

Perhaps the most distinctive aspect for Ohio employers is the MCO selection process. They can only change MCOs during a short, four-week period during the month of May every other year. The most recent open enrollment period took place last month and the transition for employers that selected a new MCO will occur in early July.

For the 2016 open enrollment period, we are proud to say that our Ohio MCO, CompManagement Health Systems (CHS), led the industry in both the net premium increase and the number of new claims:

  • Gained more than $19 million in net premium (more than 70% better than our nearest competitor)
  • Added over 7,000 new claims

MCOs that provide medical management with a return-to-work focus can help ensure timely and cost-effective claim resolution. They can also offer additional advantages for employers and injured employees by consistently examining treatment trends and scrutinizing medical expenses.

With 19 years of experience, CHS has the expertise to help clients handle the complex medical issues involved in Ohio workers’ compensation claims. We help our customers reduce lost time and medical costs – and ultimately gain more control over their premiums.

We would like to hear from you and answer any questions you might have regarding the nuances of the workers’ compensation and managed care process for state fund employers in Ohio. Please feel free to leave your questions or comments here.

 

Quinn Guist, President, CH

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A_Scandal_in_Bohemia-10The scientific method is a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge (1).  Its origin is thought to be over 1000 years old and it is still used today to solve problems.

Forensic experts servicing the insurance industry are required to utilize a reliable methodology to discover the cause of claim. Many experts use the scientific method, which is regularly broken down into the following seven-step process:

  1. Recognize the need: In this initial step of the scientific method, the problem is identified. Generally speaking, a property or casualty event has occurred, and its root cause needs to be determined so responsibility can be established and similar incidents can be prevented.
  2. Define the problem: This second step is where an action plan is developed to remedy the problem. Simply put, an investigation commences with planned steps needed to solve the established problem.
  3. Collect data: In the third step, data is collected. It is critical here that all available data be collected prior to the data analyzation and hypothesis development.  Any premature analyzation and hypothesis development could bias the end result. As described by Sherlock Holmes in A Scandal in Bohemia,”It is a capital mistake to theorize before one has data.  Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.”  This is why securing expert forensics is important for your needs. Experience and commitment to exploring all the facts will result in better outcomes in the long run.
  4. Analyze the data: Once all the available data has been collected, the fourth step can begin. During this step the collected data is cognitively analyzed using the education, training, experience and expertise of the team doing the analyzation. Having competent experts in the required field who can understand the value of the collected data prior to forming hypotheses is crucial. It is important that during this critical step of the scientific method that only facts and evidence are considered and that no presumptions or speculation be included.
  5. Develop a hypothesis: During the fifth step, the known facts and evidence are considered to develop potential hypotheses. It is not uncommon for multiple hypotheses to be considered initially, each with their own measure of possibility.  At this point, having all of the data available is critical for all options to be established for consideration.
  6. Test the hypotheses: In the sixth step, the hypotheses developed each have to be considered against all of the known facts and evidence. Physical testing can also be done to gain additional data for consideration to support or exclude development of one or more hypotheses.  Sometimes this testing can be as simple as setting fire to a material to confirm that it is combustible and will support propagation of a fire.  Any hypothesis that cannot be supported by the known facts and evidence is invalid and must be discarded.
  7. Select the final hypothesis: The seventh and final step occurs when all hypotheses have been evaluated and tested. Often only a single hypothesis remains and is identified as the root cause of an event.  There are occasions, however, when two or more hypotheses cannot be completely excluded.  When this occurs, a measure of probability is required to establish if any of the remaining hypotheses are more likely to be the cause than the others.

Forensic experts are tasked with recreating events and answering questions about why they occurred.  The team at Unified has in depth experience providing fire and forensic engineering investigation services and understands the value that the scientific method brings to the overall process.

Please feel free to share your examples of how using, or possibly not using, the above steps resulted in the success or failure of an investigation.

Unified provides forensic investigation services to insurance carriers, corporations and public entities. What questions can we help you with regarding forensic investigations for your organization?

Michael Reynolds, IAAI-CFI, FCLS   |   Director of Total Performance
Unified Investigations & Sciences, Inc., a Sedgwick company

  1. Goldhaber & Martin, “Photon and garaviton mass limits”
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tech-and-wcNew technology is reshaping the world in which we live. It takes the form of self-driving cars, virtual reality and 3-dimensional (3D) printers. Once thought to be cold and impersonal, technology is redefining our expectations and how we view a quality customer experience. It is no surprise that new technologies are also reshaping workers’ compensation as we know it. Soon, it will be difficult to remember a time when mobile apps, telemedicine and artificial intelligence were not part of the workers’ compensation claims process. And, it’s not hard to imagine there are many more advancements to come.

The technology currently being used and the prototypes soon to hit the market are remarkable. As an example, technology is a dominant component underlying the advocacy movement in the claims world. As service providers work diligently to improve an injured worker’s experience and alleviate much of the accompanying uncertainty, technology is being used to provide information to injured workers more quickly and conveniently.

What technologies are making an impact on workers’ compensation – today and tomorrow?

Smart technology
Today
: Smartphones, tablets and mobile devices allow injured workers to be more empowered in the claims process than ever, capable of checking claim status and payment information in real time, corresponding and meeting virtually with examiners and nurse case managers, submitting important documents and photos, even reporting their own claims – all according to their own preferences using tools like mobile applications, messaging and chat platforms.
Tomorrow: Gamification of the claims experience through self-service applications will encourage and empower employees to take a more active role in their recovery and return to work. With the rise in wearable devices and connected health initiatives, application programming interfaces (APIs) will begin to be integrated into mobile self-service tools to support injured workers within the workers’ compensation system. First fill pharmacy cards will become part of a person’s digital wallet, thereby increasing convenience and satisfaction for workers’ compensation patients needing prescription drugs.

Automated correspondence
Today
: Automated correspondence and rules engines can be engaged by employers and claims administrators to direct workflow and send real-time notifications via text or email when triggered by specific claim events. The efficiencies achieved allow organizations to direct additional resources where they will have the most impact – supporting the injured worker – while having the added benefit of potentially lowering costs, improving productivity and achieving higher levels of employee satisfaction.
Tomorrow: Techniques such as automated empathy have the opportunity to automate the experience by motivating the employee through familiar, text-like interaction. These technologies will be driven by artificial intelligence rooted in behavioral patterns and can also reduce the workload of busy claims professionals.

Paperless solutions
Today
: Electronic signatures eliminate stacks of paper forms and support faster settlements and claim acknowledgements. Injured workers can sign up for direct deposit through mobile applications. Biometric authentication that simplifies the way employees sign up for and interact with self-service tools is becoming more refined; consider, for example, secure thumbprint recognition features integrated with the latest smartphones. These technologies foster more customized and immediate access for injured workers during what can be an unsettling and stressful time.
Tomorrow: Paper and electronic correspondence containing lengthy, written explanations will be replaced by online video platforms where claim concepts can be clearly demonstrated and explained. Personal avatars, virtual assistants and chat capabilities will also increase in popularity and support more holistically the advocacy of the person.

Telepresence and videoconferencing
Today: For claim reviews, meetings and discussions among employers, claims professionals, case nurses, attorneys and others in remote office locations, today’s technologies are making communication easier. With the explosion of social media, similar newsfeed-style interactions are being developed in the claim process allowing real-time and interactive exchange between all involved parties.
Tomorrow: Telephonic advocacy outreach will be replaced with video telepresence and allow for more personable and empathetic interactions. Telehealth solutions will more comprehensively support nurse case management and clinical triage, adding more efficiency to the system.

Analytics
Today
: In recent years, the industry has progressed from the application of descriptive to predictive and now to prescriptive analytics. In addition to common claim variables, predictive analysis can leverage text-mining techniques in examiner notes and loss descriptions. This enables claims professionals to identify higher-cost claims by surfacing details such as comorbidities, opioid usage or other significant elements not readily documented in a field.
Tomorrow: Prescriptive analytics allow companies to further harness the power of big data, providing greater insight into actions needed to produce the best result for an injured worker, and then actually prescribing the intervention required. For example, new technologies allow the use of machine or deep learning techniques to prescribe actionable measures in response to the data analyzed, as we can see illustrated by the example of self-driving cars.

As we look toward the future, emerging technology advancements could create even more dramatic shifts in the workers’ compensation landscape. Imagine widespread use of wearable tech, with sensors embedded into everyday items such as clothing, shoes and hats, designed to support and track injury recovery. For injured employees requiring surgery for knee, hip or possibly even skin replacement, 3D scanners and printers could provide a more personalized approach and a faster recovery process than current practices. Safety programs could captivate the attention of workers as they are delivered using virtual, augmented or mixed reality techniques.

Now is an exciting time for the industry. Both employers and employees are capitalizing on the wave of technological change with an eye toward improving the efficiency of the entire system. However, at the center of these tech advancements remains one constant – the injured employee. Those technologies making a lasting impact will be those designed to improve and enhance the overall employee experience associated with the unanticipated and unfortunate workplace event.

Jarrod Magan, VP Client Technology Services

For an expanded look at the impact of technology on workers’ compensation today and tomorrow, read these additional articles from Jarrod Magan, originally published in WorkCompWire’s Leaders Speak series: