When it comes to workers’ compensation claims, time is of the essence. AI Medical Chronologies step in to streamline this timely process, ensuring claimants and insurers alike arrive at a better outcome and a positive resolution.

What is an AI Medical Chronology 

An artificial intelligence (AI) medical chronology uses the speed and power of AI to simplify medical record review. Instead of time or labour intensive paperwork, AI medical chronologies automatically sort, organize, and clean up medical records. These sorted chronologies allow the user to view medical records by date, as well as sort them by service provider, title, or category, allowing the end user to identify key points and review the entirety of the medical records in a fraction of the time. 

AI Medical Chronologies Impact  in Workers’ Compensation?

Vast medical records often pose bottlenecks that slow down the claims process as it relates to workers’ compensation claims. A patient accumulates health records as they seek medical treatment over the course of their lives; each interaction they have with a doctor, nurse, hospital, or other healthcare provider will add to the medical history. These health records will pass through multiple sets of hands during the claim. In the event of a workers’ compensation claim, these medical records are used to corroborate the facts that the claimant or their doctor provides. 

For example, under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) overseen by the U.S. Department of Labor, it’s up to employees to prove that their ailment was caused by workplace exposure to a hazardous substance. This means that the employee needs to have proof that they worked at a qualifying job, were exposed to a toxic substance, and have medical evidence to support the work-related exposure. The exposure needs to at least be a significant factor in the illness in order to qualify for the claim. 

Although this example is specific to hazardous substances, the average workers’ compensation claim is often similar. Depending on the state and insurance policy, the burden of proof is on the employee to show that their illness happened because of work.

How AI Medical Chronologies Support Workers’ Compensation Claims

Consider an employee who gets hurt at work. At the time of the incident, the employee would report the injury to their employer and provide documentation. The employee may or may not need to fill out a form about the claim, depending on the state. The employer then sends the documentation to the workers’ compensation insurance, and the employee will go to their doctor to file the medical report. Insurance companies then approve or deny the workers’ compensation claim based on the evidence and medical records presented. 

Now imagine the patient is a firefighter in their 50s. They get respiratory issues due to smoke inhalation, and file a claim for workers’ compensation. Later, the insurance company will assign a workers’ compensation case manager to the claim. The case manager requests the medical record for each health care facility that the patient has visited in their life – and by the time they are in their 50s, there are many! – as well as supporting documents from witnesses and the fire station to support the event that led to the claim.

At this point in the claim including the paperwork related to the (hypothetical) firefighter is substantial. When the case manager attached to the claim sits down to their desk, the file is likely hundreds, if not thousands,of pages long. Now the case manager might read medical records, looking for the diagnosis of smoke inhalation or a similar condition, as well as medical tests done after the incident, treatments provided, and physician’s notes. The case manager would also likely look at the employment details – how long that firefighter has worked at the fire station, and if they were working on the job or in administration. Finally, they’ll examine the evidence relating to the specific case from the witness statements or the call logs. 

Since the firefighter has issues breathing, the case manager also looks for asthma or other respiratory illnesses. If anything is inconsistent, they might order a medical examination or request more patient information. 

Streamlining Workers’ Compensation Claims with Automated Medical Chronologies 

In the process detailed above, the AI medical chronology narrows the scope of work down to the case manager’s educated decisions. How long has the firefighter worked at the station? How long have they had asthma? How much worse were their breathing problems after the event that led to the incident?

Instead of sifting through duplicates and volumes of paperwork related to the claim, the AI medical chronology helps the workers’ comp case manager quickly identify key doctor’s appointments, fire station reports, and documents with the operative word “asthma” going back over the patient’s lifetime. Case managers are able to find these documents quickly, examine them, and process the claim in a timely manner. While there still may be back and forth between the insurer and the claimant around the decision, the bulk of work for the initial claim is finished – meaning a faster decision for the insurer, a better outcome for the patient, and a more positive resolution for the claim.