Sandy Shtab, Healthesystems VP of Industry and State Affairs, comments on regulatory activity across the country.
Workers’ comp has long been a system shaped by legal requirements, facts, claim and injury data, and a fair share of storytelling. While perceptions matter, data helps us identify emerging trends, evaluate outcomes, measure costs, and determine whether regulatory policy changes are solving the problems they were intended to solve. But as anyone who has spent time in regulatory hearings, stakeholder meetings, or legislative committees knows, data is often not what moves legislators or policymakers to act.
Sometimes the most impactful argument is not the data in a spreadsheet, but the story. A single example of a delayed or denied authorization, a provider’s complaint about state forms, or how a claim that became unnecessarily complicated can quickly become the lens through which policymakers view the entire system.
These stories are real, and once told, they are repeated over and over. Even when refuted by data, they can become accepted as fact. A single story may be only a tiny sliver of the bigger picture, but stories linger, take on power, and sometimes become fact despite data to the contrary.
Remember, positive experiences often go unshared. How often does an injured worker, physician, or employer rave about how well their claim was handled? But those with complaints share their stories at every opportunity. If the era of social media has taught us anything, it is this: negative stories are powerful. They keep us engaged and sometimes enraged, especially when they are simple and relatable.
For those of us who work in this ecosystem every day, storytelling is both a big opportunity and a responsibility. Credible data can and should inform the conversation, but we also need to explain what the data means in plain language and make clear why those impacted should care. Too often we fail to connect the data to the experiences of injured workers, employers, providers, and claims professionals. If we can’t easily explain why the data matters, someone else will tell their story, and it may not be the whole story.
For years, much of the technology discussion in workers’ comp focused on what carriers and their connected partners could build into their own systems. Web portals, texting, mobile apps, automated reminders, clinical decision support, and workflow tools all continue to play an important role in improving communication and reducing friction. These tools can help injured workers understand next steps, keep appointments, receive medications more efficiently, and stay engaged in their recovery.
But another shift is happening outside the payer’s system entirely. Injured workers now have free access to technology that can help them research their injury, understand medical terms, prepare questions for their physician, and navigate the administrative process. Some patients are using AI tools to ask what a diagnosis means, what their treatment might be, how long they will be off work, or what they should do if something goes awry in their claim.
Technology can help an injured worker feel more informed and better prepared to participate in the process, but it can also create confusion, unrealistic expectations, or new disputes when their research does not match the reality of their claim.
This is a new challenge for our industry. Technology is not only leveraged by claims organizations, but also by injured workers, and it’s changing the dynamic between injured workers and their employers, physicians, and even regulators.
A more informed injured worker is ultimately a good thing. It means they are asking better questions, understanding their care plan, and communicating more clearly. All of these elements can support better claim and medical outcomes. But it can also mean claims professionals, medical providers, and dispute resolution systems may be responding to potentially irrelevant information, more questions, and sometimes more unnecessary paperwork than ever before.
Artificial intelligence is a perfect example. AI can make the workers’ comp system more efficient and more responsive. It summarizes medical records, identifies missing information, supports earlier claim triage, and identifies red flags. All of this helps the claims professional find information faster. In a system facing workforce shortages, rising complexity, and growing administrative demand, these are positive gains.
At the same time, AI can also add to the workload.
When injured workers use AI to generate a formal-looking complaint, appeal, or request for review, someone has to read it, respond to it, and determine what it means under the applicable state rules. If a medical record summary is generated by a tool, someone still has to validate it. If a model flags a claim as high risk, someone still has to apply judgment to decide if it is or is not. The promise of AI is not that it removes the need for human expertise. The promise is that it can help people spend more time using their expertise and less time searching, sifting through records, and retyping information.
This matters a lot more than it did in the past, and claims professionals and regulators are starting to feel the impact AI has on claims when it is used by injured workers.
Access to AI is no longer just a claims or operational issue. It is becoming a regulatory issue, a compliance issue, and a trust issue. States continue to consider guardrails around automated medical or legal decision-making and other claim handling factors. Recently, some regulators have reported seeing an increasing number of unrepresented injured workers filing legal disputes, often throwing everything and the kitchen sink into a complaint, even when the issues raised may be unwarranted or inappropriate.
These complaints enter the judicial system, and some workers’ comp judges have raised concerns about these types of pro se filings clogging already backlogged calendars. Guardrails for responsible use by insurers are expected, but what about use by injured workers? Claims professionals need to respond to all legal pleadings in a timely manner, no matter how unsupported they may appear; failure to do so could potentially be considered a waiver of defenses.
The question and challenge for workers’ comp is this: where does technology add value, where does it require oversight, and where does human judgment belong? The answer, of course, is at the center of it all.
Responsible use of AI should improve access to information, reduce unnecessary friction, support earlier intervention, and help claims professionals make better, faster decisions. It cannot and should not replace clinical judgment, eliminate accountability, or create obstacles for injured workers trying to access the benefits they are entitled to receive.
This is how data and storytelling can work together. Data can show whether claim duration is increasing, whether treatment delays are happening, or when medications or other types of services are driving higher costs. It can also help explain whether a new process or regulation is working as intended. These kinds of data help explain the stories being shared in public forums, and the best policy discussions incorporate both data and storytelling. They acknowledge the individual experience without losing sight of the bigger system impact.
As an industry, we should be prepared to tell the complete story, not just the parts that serve one side or the other. Workers’ comp is designed around timely treatment, medical management, and return to work, and it delivers value to many injured workers and their employers. But we also need to be real about the parts of the system that are too complicated, too slow, or too dependent on manual work. Technology can help us, but only if it is implemented thoughtfully, measured honestly, and governed in a way that builds trust AND supports innovation.
The pace of change in our industry is achingly slow and lightning fast at the same time. Sometimes it can feel like we are all running before walking, especially when it comes to technology. Injured workers are adopting new tools. Claims organizations are scaling AI. Regulators are trying to understand and govern these technologies, and the technology itself is changing faster than traditional rulemaking can keep up. Providers are navigating their own administrative burdens. Payers are trying to manage cost, access, compliance, and service expectations across more than fifty different systems.
The path forward is not to slow down all this innovation, or to let technology outrun accountability. The best path forward is to be deliberate in our progress.
This means educating policymakers as they seek to implement governance standards. It means continued engagement from people who understand how workers’ comp actually works. It also means telling our own stories, stories grounded in evidence, shaped by practical experience, and focused on what matters: helping injured workers receive appropriate care and return to work safely.
If we get our stories right, technology will not only make the system more effective, but it will increase our capacity to help the humans who need it to feel cared for and feel more connected.
And that will benefit us all.
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