How workers’ compensation is evolving for the modern workforce

An emerging fraud concern is the potential for criminals to deploy advanced artificial intelligence (AI) technologies that could make carrying out fraud even more profitable. Identity theft is also increasing in fraud committed in the automobile and construction sectors, where individuals have been caught trying to use false identification to secure employment as a fake employee “plant” to file fraudulent claims.

A growing overlap between medical providers and legal actors implicated in both auto and workers’ compensation fraud is illustrated by recent New York RICO action brought by ride-sharing giant Uber Technologies Inc. The lawsuit claims a group of law firms, doctors and pain-management clinics staged fake car accidents and performed unnecessary surgeries to take advantage of New York’s lucrative no-fault insurance policies.¹³

But AI and machine learning may place a new weapon in the anti-fraud arsenals of claims professionals, enabling the processing of vast amounts of claims data to identify patterns and anomalies. By leveraging predictive modeling, insurers can detect potential fraud even before it occurs rather than relying on traditional red flags visible only after the fact. AI-powered systems will enhance the process of claims triage by assigning risk scores to cases, helping insurers allocate investigative resources more effectively. Utilizing AI tools for routine tasks will also reduce human error and enable insurers to focus on high-risk claims while streamlining legitimate ones, strengthening fraud detection, reducing financial losses and improving customer experience.¹⁴

Statistically, construction workers are known to have higher suicide rates than workers in other fields. By one estimate, about 5,000 construction workers die by suicide annually.¹⁵ Additionally, the construction industry continues to see high rates of drug use, contributing to the highest overdose deaths by occupation, according to the Centers for Disease Control and Prevention (CDC). Nearly half of construction workers report symptoms of anxiety and depression, but fewer than 5% seek professional help, compared to 22% of the general U.S. population.¹⁶

The combination of high-hazard work environments, long hours, family separations due to often far-flung jobsites, and the job insecurity that often goes with the territory for construction workers makes them particularly vulnerable. According to the Associated General Contractors of America (AGC), breaking the stigma about seeking help for mental

health issues, encouraging workers dealing with stress and trauma to seek help, and training supervisors to more effectively recognize when intervention may be needed should all be part of normalizing conversations about mental health in the construction industry.¹⁷

Comprehensive workplace policies are essential in addressing one of the key indicators of stress, trauma and pain management issues among construction workers – the aforementioned crisis of opioid abuse. Drug-free workplace protocols, employee assistance programs, and peer support networks can be vital in prevention and recovery. Education for both employees and employers on the risks of opioids as well as alternative pain management approaches can help to address any problems that may exist in a given workplace and help mitigate impacts on workers’ compensation programs.¹⁸

One construction industry trend showing no signs of slowing is the goal of reducing workplace injuries and illnesses through increasing investments in innovative worker safety technologies by employers. While some of the following are already in wide use, or should be, innovations in the technology development pipeline will continue to help reduce the risks of the modern construction jobsite:¹⁹

• Wearables – Smart helmets, vests and glasses equipped with sensors and communication devices help monitor the vital signs of workers and detect hazardous conditions, providing real-time information to wearers and supervisors.
• Drones – Drones enhance safety in a variety of roles, such as providing aerial surveys, monitoring work progress and assessing a site from a bird’s eye view. Drones can also inspect hard-to-reach areas that might otherwise place a worker at risk.
• Internet of Things (IoT) – Connectivity through the IoT can allow individual pieces of equipment to function as parts of a collaborative whole. IoT-enabled sensors can also monitor the condition of machinery, the structural integrity of the project at various stages, and even track environmental conditions.
• Building Information Modeling (BIM) – BIM technology enables the creation of realistic, digital 3D models of a project, providing comprehensive views of the entire construction process, allowing better planning to reduce dangerous situations.
• Autonomous & remote-controlled machinery – Similar to benefits of drones, autonomous and remote-controlled construction machinery can handle tasks in high-risk situations.
• Augmented reality & virtual reality – AR and VR technologies can provide training and simulate dangerous scenarios, providing workers with virtual safety training before stepping into the project

Manufacturing

The integration of advanced robotics and AI-enhanced automation is reshaping the manufacturing industry across the entire spectrum of industrial and consumer products. As in the construction field, robots are being called upon to perform in an expanding range of high-risk, repetitive and dangerous tasks with the potential to place human workers at risk.²⁰

But while robots are freeing workers from potentially hazardous tasks, manufacturers need to ensure that they understand any new risks that may arise when humans are working alongside robots on production lines or on the factory or warehouse floor. Have steps been taken to ensure that robots are “smart” enough to avoid injuries to humans if they get in the way? Have workers received the appropriate training to ensure their personal safety when working with or around robots?

Another trend impacting manufacturing is the integration of AI-powered predictive maintenance of production equipment. It is not uncommon for key pieces of equipment to fail at the worst possible times, potentially causing injuries to employees operating the equipment. AI-enabled monitoring of production equipment can predict failures before they occur, helping to avoid a catastrophic event.

As in construction, another innovation gaining adherents in manufacturing is the application of virtual reality (VR) and augmented reality (AR) technologies that allow employees to engage in realistic workplace scenarios without physical risks, simulating hands-on learning for operating complex machinery and emergency procedures.²¹

• Monitor developing regulatory actions related to workplace safety proposed in every state where the business may have employees. Specific regulations can and do vary from state to state.
• Continue to allocate resources to investigate, acquire and implement enhanced workplace safety technologies available to help prevent workplace accidents.
• Make sure the organization has a range of return-to-work alternatives designed to respond to variations in the restrictions recovering employees may face based on the nature of their injuries.
• Train and continuously update supervisors and managers about emerging workplace regulations and workers’ compensation trends.
• Conduct annual reviews of the workers’ compensation program to ensure that it is meeting the organization’s changing requirements and evolving regulations.

Most importantly, immediately report and thoroughly document any workplace incident to the insurance carrier or state program, even if immediate emergency medical intervention was not required. A fall, sprain or strain while lifting a heavy object could result in a potential claim at a later date. And delays in reporting can complicate a claim by making it more difficult to verify all the facts of a case as well as potentially opening the door to fraud.