From Then to Now: An Industry View of Technology in Workers' Compensation

CorVel celebrated its 30^th anniversary as a public company this year. From its roots in rehabilitation, CorVel has been part of an industry that has experienced dramatic change during the past three decades. Throughout its history, the company’s development has tracked along two major themes: the evolving yet dramatic changes in technology along with an ever-increasing focus on patient-centered medical care for injured workers. Michael Combs, President and CEO at CorVel, looks at the significant changes in the workers’ compensation industry during the past 30 years.

CorVel is known as a technology leader within the workers’ compensation industry. How has claims processing technology changed since the company went public in 1992?

Looking back, claims processing in the industry was primarily manual and paper-based, and until recently, hadn’t changed much since the 1980s. When digitizing claim files began, it was replicating the paper processes, which did nothing to streamline workflow. Today, our focus is on changing the process and taking it to the next level.

Years ago, a claim review began when the reviewer printed out reams of paper associated with the claim file. Then they would sit down in a room and go through each stack of papers file by file to identify key issues within the claim. With that feedback, the reviewer might adjust reserves, add some notes, and then pass the review back to an adjuster, who would enter that information into multiple systems.

Modern systems that leverage advanced technology offer adjusters improved organization and the ability to automate manual, repetitive, time-consuming tasks. Platforms that utilize machine learning and artificial intelligence have the ability to review specific criteria based on historical data, automatically select the claims that need to be reviewed, and then conduct that review electronically. In addition, some systems can recommend actions to streamline the claims process and improve outcomes. We can then make immediate adjustments, saving significant time and boosting consistency and efficiency.

How have automation and machine learning changed the role of the adjuster?

A major change we’re seeing is that the adjuster won't need to be an expert in the platform itself. Systems are becoming sufficiently intuitive so that the role of the adjuster is more analytical and patient-focused. By using the right tools, adjusters are quickly becoming even more adept and effective with the claims management process. As a result, they can more clearly see potential pitfalls in a claim, make decisions based on actionable information, and communicate claim information in real time with all of the stakeholders.

Advanced technology also gives adjusters more time to focus on the injured worker—the human part of their role. This aligns with an overall shift in the industry to a more patient-centered care model. We’ve seen that increased human connection during the claim process is consistently providing better outcomes for everyone—the injured worker, the employer, and the adjuster.

The increased complexity of the workers’ compensation claims process means that claims management systems must improve, and that’s exactly what we’re beginning to see. With intuitive technology, the claims professional’s job becomes more enjoyable, easier to navigate, and more impactful. Integrated, interactive, intuitive platforms are modernizing the claims management process from beginning to end.

What other impacts will advanced technology have on the workers in our industry?

We see human interaction as essential to the successful resolution of the claim; the human component is critically important. But for those tasks that don't require higher-level expertise, automation will become more common.

Over time there will be downward pressure on pricing. Technology is not inexpensive—it’s a significant investment to implement automation—but it’s an investment that will deliver a return. If you’re not keeping up with automation, the application of machine learning and advanced analytics, then you won't have a seat at the table. I believe this will happen quickly, in the next three to five years.

Are customers receptive to the changes and advancements in technology?

Generally, our customers embrace change and select us because we are a partner who challenges the status quo and pushes to make things more efficient and intuitive. There are certainly those in the industry who are skeptical about change. However, they often come around when they see the impact that technology can have on the claims process and overall outcomes.

How can we use technology to go even farther?

Modern systems are moving beyond automation that replicates historical processes and reimagining what’s possible on a more granular level. Using machine learning, data analytics, and optimized workflows, advanced systems are leveraging historical data to track patterns, automatically identify potential issues, and provide actionable information.

Innovative systems consider a variety of parameters and data points in vast amounts of data that can alert us to claims that have potential to become problematic. Today, we're able to look within the data and understand what’s happening. With this information, we can guide decision-making to achieve better results.

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