The News You Need for May 3
Ohio compliance and the latest from Sedgwick and NCCI make today's WorkersCompensation.com news
5-Year Limit in Ohio doesn’t Apply Once Claim Goes to Court
Columbus, OH (WorkersCompensation.com ) -- When a workers' compensation statute includes a time restriction on when a claim can be filed, does that restriction apply when the case is through on the administrative side and heads to court?
Ohio's top court in Caldwell v. Whirlpool Corporation, No. 2024-Ohio-1625 (Ohio 05/01/24) ruled that it does not, finding that a five-year limitation period was jurisdictional to the state's Industrial Committee, not its judicial branch.
A worker suffered a work-related injury while he was employed with Whirlpool. After a successful initial workers' compensation claim, the worker sought coverage for additional conditions a few years later. Eventually, the case wound up in court and then in appellate court, with the outcome being Whirlpool's favor. Ultimately, the appellate court ruled that the worker's claim had expired as a matter of law because an Ohio statute limited the Industrial Commission's continuing jurisdiction to five years from the date of the last payment on the worker's initial claim and that five years had passed.
The worker appealed to the Ohio Supreme Court.
Under Ohio law, in cases in which a claimant has received compensation from an initial successful claim and seeks additional compensation, any "modification, change, finding, or award shall be made within five years from the date of the last payment of compensation." Caselaw has established that when a workers' compensation claimant files a notice of appeal in a court of common pleas, jurisdiction over the claim vests in that court, and a timely notice of appeal satisfies the jurisdictional requirements under the five-year rule.
In reversing the previous decisions going against the worker, the Ohio Supreme Court held that, based on the plain language of the relevant workers' compensation statutes, when a workers' compensation claimant perfects an appeal, the subsequent expiration of the commission's five-year period of continuing jurisdiction does not cause a claim that is pending in court to expire as a matter of law.
The court noted that the statute in question was concerned solely with the commission's continuing jurisdiction over workers' compensation cases, but not court cases.
Because the worker's case was filed in court, the five-year limit did not cause his claim to expire.
"[The worker] did all that was required of him ... to have his day in court," the court wrote. "The statute that establishes the continuing jurisdiction of the commission in no way affects ... court proceedings once they have been properly initiated."
Thus, the Ohio Supreme Court sent the case back to the trial court.
NCCI’s Workplace Safety Technology pt. 3 Article out Now
WHAT:?NCCI’s latest report -?The Future of Workplace?Safety?Technology Is Now Part Three - The Employer Perspective ( ncci.com )?[ link.mediaoutreach.meltwater.com ]
For this third and final installment, NCCI interviewed three employers that have adopted innovative?safety?technology including wearables and video AI/Computer Vision.?
KEY INSIGHTS:?
WHY IT MATTERS:?There’s a growing buzz in workers compensation that technology, the workplace, and the role of the worker are changing more dramatically today and at a faster pace than ever before. Along with shifting jobs and evolving workplaces come new and changing exposures to worker injuries. Questions continue to arise about the status and evolution of?safety?technologies.?
领英推荐
WHO:?the report is authored by:?
WHAT ELSE:?NCCI’s?Annual Insights Symposium 2024?will feature a session dedicated to workplace?safety?technology and how these game changers may impact the future of workers compensation. Check out?ncci.com ?[ link.mediaoutreach.meltwater.com ] ?to learn more.?
ACCESS THE FULL REPORT: The Future of Workplace?Safety?Technology Is Now Part Three - The Employer Perspective ( ncci.com )?[ link.mediaoutreach.meltwater.com ]
Sponsored: Sedgwick Enters Next Phase of AI Technology Development to Transform the Claims Industry
Industry leader announces slate of technology innovations and updates
MEMPHIS, Tenn., May 2, 2024 — Sedgwick , a leading global provider of claims management, loss adjusting and technology-enabled business solutions, announced today ahead of the upcoming RISKWORLD 2024, the annual conference of RIMS, several new updates to its artificial intelligence-powered (AI) technology program. Building on a half-century of claims handling excellence and a robust data science program, Sedgwick remains at the vanguard of technological innovation in the industry with its pioneering generative AI technologies and claims management applications.
The latest enhancements are significant milestones on Sedgwick's journey of technology evolution and have been supported by dedicated research and development in predictive modeling, machine learning and now, generative AI. This work has been propelled by the company's vast global dataset and expert in-house data science and technology teams. Their goal is to expedite the claims process by predicting, addressing, and automating steps in the claim lifecycle, thereby enhancing consumer experiences, and streamlining claim resolutions. Claim resolution times are expected to decrease, early adopters will swiftly benefit from the technological advancements, and the overall experience for Sedgwick’s consumers and clients will be significantly elevated.
Sedgwick’s technology stack is built around several AI-enhanced tools that comprise a scalable, rapidly deployable platform. Recent enhancements to Sedgwick technologies include:
Sidekick+: In April, Sedgwick achieved integration of generative AI tools into its proprietary technology program with a best-in-class claims workflow.?New updates to Sidekick+, an industry-first application that integrates Microsoft/OpenAI's ChatGPT technology with Sedgwick’s established claims management tools, leverage API integration so that claim professionals automatically receive medical document summarizations directly into their claim files. Sidekick+ has processed 50,000 documents in the initial pilot with greater than 98% accuracy in its summarizations. Sidekick is bundled with Sedgwick's digital intelligence suite, including predictive models and decision engines, so that AI can prescribe optimal workflows, leading to genuine process transformation. Sedgwick was named by Foundry’s CIO as a 2024 CIO 100 Award winner for Sidekick+, which is a first-of-its-kind application developed by the company’s technology team. Foundry’s CIO 100 award recognizes enterprise excellence and innovation in IT.
AI care guidance: Sedgwick has expanded its offerings with the launch of an AI-powered care guidance application to identify claims on workers’ compensation programs with integrated managed care whose progression could benefit from early clinical intervention. The proprietary model uses modern AI, machine learning and natural language processing to rapidly review unstructured data — such as claim notes, correspondence, medical bills, and clinical documentation — and collect meaningful, actionable information for review. By identifying subtle patterns that might otherwise be overlooked, AI care guidance detects the warning signs of claim severity early in the process and facilitates prompt referrals to appropriate clinical resources.
mySedgwick: With an eye toward continued innovation addressing communication gaps in the claims process, mySedgwick — Sedgwick’s customer-centric self-service tool and virtual guide through the claims journey — has been refreshed with a simplified, mobile- first user experience for U.S. casualty and workforce absence clients and their employees/customers. Today, nearly 70% of claimants use mobile devices to check on their claims and ask questions — up from 30% just three years ago. AI-backed chat capabilities can address many claims questions in real time or direct claimants to their assigned examiners for more complex queries. This update simplifies the claims experience and meets claimants where they are in the digital realm.
“Our work in bringing together GenAI, data science and 50 years of experience, knowledge and data has empowered Sedgwick to make the claims model more intelligent, more consumer- and customer-centric, and more situation-specific than ever before,” said Leah Cooper,
Sedgwick’s Global Chief Digital Officer. “We have the tools, the experience and a wealth of data in meaningful insurance categories to be able to develop solutions that, when married with meaningful human engagement and decision-making, can shape the claims resolution in a more advanced way.”
With 2,000 dedicated IT and data science colleagues, Sedgwick continues to deliver exceptional technology-enabled solutions that support many of the world’s premier employers and
insurers. For more on Sedgwick’s technology offerings, see sedgwick.com/solutions/technology .
About Sedgwick
Sedgwick is a leading global provider of claims management, loss adjusting and technology- enabled business solutions. The company provides a broad range of resources tailored to
clients’ specific needs in casualty, property, marine, benefits, brand protection and other lines. At Sedgwick, caring counts; through the dedication and expertise of 33,000 colleagues across 80 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact performance. Sedgwick’s majority shareholder is The Carlyle Group; Stone Point Capital LLC, Caisse de dép?t et placement du Québec (CDPQ), Onex and other management investors are minority shareholders. For more, see sedgwick.com .