Automated Workers Compensation Claim Analysis System
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Solution Overview
Problem
Managing workers' compensation claims is complex and costly for insurance companies and self-insured employers due to the need to sort through numerous documents and track deadlines, while also considering legal issues.
Innovation Solution
A system and method for automatically analyzing workers' compensation claim information using a server computer with programming for text extraction, natural language processing, and decision modeling to generate a case analysis report, enabling licensed users to upload documents and receive a recommended plan of action.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If manual analysis and management of workers' compensation claims is performed, then thorough analysis can be achieved, but the process is complex and costly with significant time investment
Solution Approach 1:
The patent replaces manual mechanical analysis with an automated computer-based system that uses optical character recognition (OCR) to extract text from documents, natural language processing to analyze content, and decision data models to generate recommendations. This substitution of human cognitive labor with automated processing systems achieves thorough analysis while dramatically reducing cycle time and costs.
2Reliability
If comprehensive document review and legal analysis are conducted, then successful defense strategy can be achieved, but expenses increase significantly
Solution Approach 1:
The system enables self-service automated analysis where the computer system independently processes documents, extracts relevant information, identifies legal issues, and generates defense strategies without requiring extensive human intervention. This automation maintains reliable defense strategy effectiveness while significantly reducing the cost and resource investment required.
Solution Approach 2:
The patent introduces an intermediary automated processing layer between raw claim documents and human analysts. This intermediary system uses OCR technology, natural language processing, and decision models to pre-analyze documents and generate initial assessments, reducing the burden on human experts while maintaining comprehensive analysis quality.
3Loss of information
If multiple documents and deadlines are tracked manually, then complete claim management can be achieved, but the process becomes complex and error-prone
Solution Approach 1:
The patent merges multiple separate tracking functions (document management, deadline tracking, analysis, and recommendation generation) into a single integrated automated system. The computer system consolidates these functions, using centralized data structures and unified processing workflows, which reduces process complexity while maintaining complete information tracking.
Data Source
AI summary
A system and method for automatically analyzing information related to a workers' compensation claim and for providing a corresponding case analysis report. A licensed user computer is programmed to upload via a computer network documents and data related to a workers' compensation claim and then to receive a downloaded case analysis report comprising analysis and a recommended plan of action regarding the workers' compensation claim. A server computer is programmed to receive the documents and data related to the workers' compensation claim. The server computer includes programming for a pdf/image text extractor, a checklist data provider, an information identifier, a natural language processor, an issue identifier, an issue analyzer, and a decision data model. The server computer is programmed to generate the case analysis report and to download the report to the licensed user computer.