Revolutionizing Claims Handling in Workers’ Comp with Proven AI Solutions

The amaise agenticAI Platform is transforming the complexities of workers' compensation claim management in the United States. Tailored for the insurance industry, our platform delivers measurable improvements in speed, accuracy, and cost-effectiveness:

84%

Increase in Efficiency

Boost productivity with AI-powered workflows and automated responses.

Enhanced Understanding

Empower claims adjusters and claim managers with precise insights into medical and legal claim aspects.

10%

Reduction in Claim Payouts

Optimize settlements, saving substantial costs while maintaining fairness.

The Challenges of Workers' Compensation Claim Management

Handling workers' compensation claims is resource-intensive, requiring significant expertise to navigate complex and dynamic processes:

Vast Document Volumes

Claims involve extensive paperwork filled with intricate medical and legal terminology.

Unstructured Data in Various Formats

Managing inconsistent data from handwritten notes, scanned documents, and diverse file types.

State-by-State Regulatory Variations

Each state has unique workers' compensation laws, complicating compliance.

Complex Claim Histories

Deep analysis is required to evaluate medical conditions, workplace incidents, and compliance with regulations.

Multidisciplinary Collaboration

Claims adjusters, legal professionals, medical experts, and vocational rehabilitation specialists must work together seamlessly.

Expertise-Dependent Outcomes

Settlement amounts, claim durations, and risk evaluations are highly dependent on the knowledge and experience of professionals.

In a nutshell

Workers’ compensation provides medical benefits and wage replacement to employees injured in the workplace—removing the need to pursue legal action for negligence.

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While plans vary by jurisdiction, typical benefits include wage replacement, reimbursement of medical expenses, compensation for economic loss, and support for dependents in fatal cases. Pain and suffering or punitive damages are generally excluded, and most claims are evaluated by administrative law judges, not based on negligence.

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As in personal injury claims, the review of medical records and other unstructured documents is crucial. Every detail must clearly establish the work-related nature of the injury, and consistency across providers is essential.

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Following treatment, an independent medical examiner (IME) may determine the extent of any lasting impairment. This assessment depends on a thorough review of all medical documentation.

our solution

The amaise agenticAI Platform and Product Suite

The amaise agenticAI Platform addresses these challenges with a comprehensive, AI-driven approach to workers' compensation claim management:

Automatic Document Organization

Effortlessly organizes all claim-related files for quick access and retrieval, while eliminating duplicate documents to streamline workflows.

Key Fact Extraction

Highlights critical information within claim documents, such as injury details, medical diagnoses, treatment plans, and compliance risks.

AI-Powered Insights and Recommendations

Provides actionable insights for decision-making, including risk assessments and settlement recommendations. Offers multiple perspectives—pro-insurance, pro-claimant, and neutral—to ensure balanced evaluations.

Preconfigured Question Sets

Customizable templates allow organizations to define specific questions, ensuring consistency and comprehensiveness in every claim evaluation.

Key Benefits

Optimized Claim Settlements

Validated by leading European insurers and currently being tested by major U.S. insurance companies, amaise delivers consistent, measurable results. Ensures accurate and fair compensation while reducing the risk of overpayments or underpayments. Proven to achieve a 10% reduction in claim payouts for European insurers, with similar outcomes expected for U.S. insurers.

Accelerated Claims Processing

Improved Risk Management

Litigation Risk Reduction

Why Choose amaise?

Proven Performance

Trusted by leading European insurers and currently being tested by major U.S. insurance companies, the platform consistently delivers measurable results.

Modern Tools

Secure Collaboration

Effortless Implementation