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 private through their specialist knowledge in risk management, loss control, claims management andeconomic scale. 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. claims, litigation exposure and changes to the nature of work increasing the modernizationchallenge for insurers. 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 rates pharmaceutical, and insurance industries. This gives them a unique opportunity to leverageadvances across multiple industries to improve injured worker outcomes, boost insurer 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 to 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’ compensation 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. 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. Changing litigation trends have resulted in higher “nuclear verdicts” and large class action litigation, increasing the unmodeled loss exposure for insurers. 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 a 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 the 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 improved 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 these 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 and 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 both Voice of the Workers’ Compensation Carrier Insights from a 2025 Guidewire Survey onAI in Workers’ Compensation Markets What are the top challenges to workers’ compensation carriersin the next five years? SURVEYSAYS… of respondents believe anaging workforcewill shiftthe risk profile and loss experience of the industry of respondents believemedical cost inflationwillhave the greatest impact to their performance 87%State of AI strategy among workers’ compensation carriers out theirAI platforms 60%of insurers have adefined AI strategyat theenterprise or business unit level56% or moreAI models in pilot or production 53% while ~30% have yet to achieve their benefit goals Hopes & Fears In discussions with Guidewire’s workers’ compensation user groups, business advisory councils,and carrier role observations, insurers expressed overall optimism toward the benefits of GenAI,with improvements in handling large and complex volumes of documentation a key benefit. The Next Frontier for Workers’ Compensation Generative AI Impacts to theWorkers’ Compensation Market While much of the current discussion around GenAI in the insurance industry focuseson process automation and cost savings, these conversations often overlook moretransformative, long-term implications. Case in point: 100% of the respondents in our We believe 5 GenAI Forces will have an impact on workers’ compensation consumersand insurers through 2030: 5 GenAI FORCES OF CHANGE Shift to Worker