在人工智能时代重新构想工伤赔偿

The workers’ compensation market plays a critical role in bridgingpublic and private sector healthcare systems and privateenterprise employers with their workers. through their specialist knowledge in risk management, loss control, claims management andeconomic scale.Historically a challenging market, workers’ compensation has posted positive combined ratios since the early 2010s through improved risk management, lower loss frequency, and technology thatbetter connects claims management with clinical care and sustained support for injured workers.However, challenges remain with current trends in medical cost inflation, increased mental health claims, litigation exposure and changes to the nature of work increasing the modernizationchallenge for insurers. Generative AI & Workers’ CompensationIn this joint paper from Guidewire and PwC, we examine these macro trends alongside advances in the subset of Artificial Intelligence known as Generative AI, or GenAI. Broadly adopted in thecommercial sphere since 2023, GenAI-based products have seen one of the fastest adoption ratesof any new technology in history.Workers’ compensation insurers are uniquely positioned at the intersection of the healthcare, pharmaceutical, and insurance industries. This gives them a unique opportunity to leverageadvances across multiple industries to improve injured worker outcomes, boost insurerperformance, and deliver on the promise of a safer work environment. The Intersection of Generative AIand Workers’ Compensation The Case for Change Workers’ compensation insurers across the globe continue to navigate common issues related tothe changing nature of work, increases in modeled and non-modeled loss exposures and changes toregulatory environments. We see five key trends accelerating the case for change within this market: Rising Medical CostsSince 1982 medical cost inflation in the US and other developed nations has significantly outpaced the baseline rate of inflation, resulting in higher claims recovery costs for workers’ compensationinsurers in private-market healthcare systems. The impending retirement of seasoned underwriters and claims adjusters presents a critical talent gap for the insurance industry—especially in workers’ compensation, as decades’ worth ofinstitutional knowledge exits the workforce.Increased Mental Health Claims Mental health claims in workers’ compensation are rising sharply, with stress, anxiety, and burnout driving a growing share of total claims. This trend is accelerating post-pandemic, signaling a majorshift in risk profiles for employers and insurers.Increased Litigation Exposure Changing litigation trends have resulted in higher “nuclear verdicts” and large class action litigation, increasing the unmodeled loss exposure for insurers.Complex Market Regulation The transition from monopolistic state-based markets to open competitive environments in the US has increased both the addressable market and competition for insurers. In most countries,workers’ compensation boards still manage the market at a state/province level—resulting in acomplex mix of local regulatory bodies and environments.U.S. Bureau of Labor Statistics, Consumer Price Index for All Urban Consumers: Medical Care in U.S. City Average [CPIMEDNS], Innovation in the Workers’ Compensation Market Advances in medical technologies, improved historical datasets and AIare creating a convergence of innovation in the workers’ compensationmarket, with leading insurers embedding capabilities throughout theinsurance life cycle. Over half of the respondents in a 2025 Guidewiresurvey of workers’ compensation carriers reported that they are beginningto see benefits from AI investments. LOSS CONTROLGuidewire Customer in the US:A West-Coast regional carrier is combining on-site video monitoring with AI vision to identify hazardsor unsafe activities, leading to targeted training and improvedfactory layouts. Initial results show lower claims frequency fromparticipating insureds. MEDICAL BILL REVIEWGuidewire Customer in the US:A workers’ compensation customer used a Guidewire predictive analytics and AI partner to analyze medical bills and treatmentdetails and identify providers who overprescribed opioids. By removing theseproviders, the carrier significantly reduced costs and improved claims outcomes,demonstrating AI’s power to detect patterns of abuse in medical practices. Guidewire Customer in Canada:A workers’ compensation board implemented an AI-driven predictive model directly into ClaimCenterthat automatically identifies high-risk No Lost Time claims for earlyintervention, leading to significant cost savings within the first year andpreventing hundreds of claims from becoming Lost Time claims. Guidewire Customer in Canada:A single-state workers’ compensation carrier improved their return-to-work (RTW) performance with a solutionthat directly integrates to Guidewire ClaimCenter and provides bothrecommended activities as well