The U.S. Bureau of Labor recently revealed that in 2022, employers reported over 2.8 million workplace injuries, 5,486 of which were fatal. Additionally, the net premiums written value of the workers’ compensation (WC) insurance industry reached a staggering $47.5 billion, presenting an alarming 10.5% increase from the previous year. These statistics showcase the tremendous scale of workplace injuries in the nation and call for an immediate and effective solution that targets many arising issues.
When an individual gets injured outside of their workplace, they are allowed to claim recompensation through their own initiatives and means. However, workplace medical insurance doesn’t offer that course of action, forcing employees to follow set recommendations within that process. Workers’ compensation is a closed circle, and every occurrence stays within the system. This poses a major challenge for many people, obliging injured employees to be compliant. Not following the rules ends in losing work benefits or wage replacements and significantly burdens employees hurt during work.
“With everything being within the system, workers are bound by the data that the system offers. Unfortunately, there is no single source of truth that supplies that information, and requirements vary between each state,” explains Jamie LaPaglia, founder of Claim Clarity, a tech solutions provider for the healthcare industry.
As noted by LaPaglia, there are over 10,000 different evidence-based guidelines that approach various cases and medical treatments. Additionally, there are 16 different sources that the information is coming from, and it’s difficult to find appropriate and useful data. Fourteen of these sources are state-based, and two are commercially available products, such as ODG by MCG. The lack of an optimized and efficient system that filters through tens of thousands of pages of information is stupefying and makes the economic aspect of recovery much more difficult.
Most states lack the resources to create evidence-based guidelines, leaving many injured employees seeking alternative solutions. While commercial options can provide some assistance, the overwhelming amount of information available presents a significant challenge. Even when guidelines address the same procedures, varying naming conventions and formatting can make it difficult for employees to navigate the available documents.
“People need to know which state they’re doing the review for because that will dictate which guideline to use. Every guideline has different medical criteria and requirements that injured workers have to meet to receive medical reimbursement, salary replacement, and other benefits. What it’s all about is being able to find the right evidence-based guideline, and seeing if an employee fits the criteria. Unfortunately, analyzing the heaps of information available is a long and laborious task,” added LaPaglia.
Although systems that are in place require immediate attention and effective resolutions, there has been some hesitation around renovating and upgrading how guidelines work. The running apparatus is built on an antiquated infrastructure, presenting a daunting challenge for many healthcare companies. Adding to the grimness of this issue, most stakeholders have highly specialized custom-built systems. Updating those legacy systems would not only be heavily cost-excessive but also incredibly time-consuming.
The workers’ compensation industry is in dire need of improvement, but most evidence-based companies want to maintain the foundations and software of their guidelines. Eliminating the common concern of a complete system turnaround, Claim Clarity introduced a solution that can be plugged in on top of any existing systems, allowing companies to access updates and accurate information without losing their antiquated structure.
The healthcare industry is one of the most critical sectors worldwide, and the issues it faces in this day and age are scarily tangible for many people. An overwhelming excess of information leads to unclear paths for injured employees to take. That causes not only massive delays but may also lead to patients receiving the wrong treatment, prompting a threat to someone’s life.
Claim Clarity’s mission is to create a single, easily accessible source of truth, enabling stakeholders to access the overflowing information more easily. This end-to-end, automated support solution for workers’ compensation empowers stakeholders to make informed decisions and automates the difficult claim process. By implementing developed prompts and useful AI insights, Claim Clarity enables employees to authorize treatments and accurately define injuries in a simple and time-efficient manner.
“This situation is a serious crisis that can explode, and it’s crucial to take appropriate steps urgently. Claim Clarity isn’t just a business for the sake of being a business. We’re talking about human lives and people living with disabilities for the rest of time. Every step of the insurance claim process requires a learning curve, and there’s a pressing need for high-tech solutions that make this task easier,” LaPaglia expresses.
