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Scan for outdated or missing drivers - takes under a minuteDriver Scan →Repair Windows errors before they cause bigger problemsFix Now →An employer’s AI policy for workers’ compensation claims should say which tools and tasks are covered, what data those tools may use, and which decisions require qualified human review. It should also set privacy, fairness, validation, documentation, vendor, and escalation controls—and require review against the laws that apply to the employer’s state and role in the claims process. There is no single federal checklist that covers every employer and claims arrangement.
What should the policy cover?
Start with an inventory, not a broad statement that employees must use AI responsibly. The policy should identify the systems in use, the people who may use them, the claims workflows they support, and the purposes for which each is approved. Include employer-operated tools as well as vendor systems, analytics, automated decision tools, and generative AI.
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- Covered work: List claims intake, document handling, summarization, communications, medical review, work restrictions, accommodation, eligibility or benefit recommendations, and return-to-work support where applicable.
- Approved purpose: State what each tool may do and what it may not do. For example, a tool approved to summarize a file is not thereby approved to recommend a benefit decision.
- Prohibited inputs and uses: Bar workers from entering identifiable claim or medical information into unapproved public AI services. Prohibit uses outside the approved claims purpose, including attempts to infer unrelated health conditions.
- Accountability: Name a policy owner and identify who approves tools, workflows, access, and material changes. Claims, HR, risk, privacy, security, and IT teams may have distinct responsibilities.
Distinguish administrative assistance from tools whose output could influence a person’s claim or work status. That distinction determines the level of review, documentation, and escalation the policy needs.
Which AI uses need human review?
Label each use as administrative support, recommendation, or decision support, and set review requirements accordingly. A reviewer should validate material AI output before it affects claim handling, benefits, medical review, work restrictions, accommodation, or return-to-work decisions. The policy should make clear that an AI-generated score, summary, or recommendation is not itself the decision.
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| Use category | Examples | Policy control |
|---|---|---|
| Administrative support | Sorting documents, routing files, or drafting a routine summary | Specify permitted tasks, data access, and how staff check for errors before relying on the output. |
| Recommendation | Flagging a file for review or suggesting a next step | Require a qualified person to check the relevant source material and record whether the suggestion was accepted or rejected. |
| Claim- or work-affecting support | Output that could affect eligibility, benefits, medical review, accommodation, restrictions, or return to work | Require documented human review before action, a reasoned decision, and a route to escalate or dispute material output. |
Define who counts as a qualified reviewer for each workflow and what information they must check. Require the reviewer to correct errors in source data where possible rather than simply overriding a result without addressing its cause. Give workers a way to question or correct material information or output, and specify who handles the request and how it is escalated.
How should the policy handle disability, injury, and accommodation?
Workers’ compensation administration and ADA obligations operate together. EEOC guidance on workers’ compensation and the ADA says that an occupational injury does not automatically establish an ADA disability. It also limits injury-related medical questions and examinations to what is necessary to assess the specific injury and its work impact or workers’ compensation liability; a claim is not permission to ask unrelated or excessive medical questions. The guidance dates to September 3, 1996, before the ADA Amendments Act of 2008, so employers should check current law when applying it.
AI use does not remove disability-discrimination or accommodation obligations. In 2022, the EEOC and Department of Justice identified risks from algorithmic employment tools, including screening out people with disabilities, failure to accommodate, and tools that prompt prohibited disability-related inquiries or medical examinations. Their technical assistance addresses employment tools broadly, rather than workers’ compensation claim systems specifically. A policy should therefore require an accommodation process when relevant, consider disability-related impacts, and offer an accessible non-automated route where needed.
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What privacy and security rules should the policy set?
Workers’ compensation files may include sensitive medical information. EEOC guidance says claim-related medical information must be kept separately from ordinary personnel records and confidential, subject to recognized circumstances for disclosure. Build controls into the workflow rather than relying only on employee discretion.
- Limit collection and use to the approved claims purpose; minimize the information sent to a tool.
- Restrict access by role, secure storage and transfers, and set retention and deletion schedules.
- Require vendors to protect the data, limit reuse, and disclose whether information may be used for model training.
- Set procedures for incident reporting and for handling applicable access or correction requests.
- Document the legal basis for each data use and disclosure under relevant state workers’ compensation law and, where applicable, HIPAA.
Do not assume HIPAA either always applies or never applies to claims data. HHS explains that HIPAA’s Privacy Rule generally does not apply to employers, workers’ compensation insurers, or administrative agencies unless they are otherwise covered entities. Covered health care providers may disclose protected health information for workers’ compensation purposes as authorized by state or other law and subject to applicable limits. HHS’s minimum-necessary FAQ explains that the workers’ compensation provision may allow disclosure to the full extent authorized by law, with exceptions including disclosures required by law or made under the individual’s authorization. The applicable entity, law, and disclosure matter.
How should employers validate and monitor AI tools?
Require evidence that a system is fit for its approved purpose before deployment and while it remains in use. WCRI’s 2025 report on AI in workers’ compensation discusses oversight, validation for bias and faulty outcomes, documentation, monitoring, transparency, privacy, and security. Those themes translate into a record the employer can inspect and act on.
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- Record the intended purpose, data sources, system or model version, validation method, known limitations, and performance thresholds.
- Assess error patterns and potential unfair bias before use and periodically afterward, including possible disability-related effects.
- Track reviewer actions, incidents, complaints, corrections, and remediation.
- Reassess when the vendor, model, data, or workflow changes; suspend use if material accuracy, safety, privacy, or fairness concerns arise.
The policy should say who reviews the evidence, how often monitoring occurs, and who can pause a system. The source materials do not establish a general adoption rate, error rate, or savings figure for workers’ compensation AI, so employers should not substitute unsupported industry averages for validation of their own use.
What should employers require from vendors?
A third-party tool does not transfer the employer’s responsibility to govern its use. Contracts and operating procedures should require vendors and system administrators to provide documentation needed to understand the tool, support validation and audits, protect claim data, disclose material changes, and cooperate with incident response. Set approval gates for new features or changed uses; a vendor update should not silently expand a tool from administrative support into consequential decision support.
How should the policy account for state and entity-specific rules?
Maintain a state-by-state review process that considers workers’ compensation rules, insurance unfair-claims and unfair-discrimination requirements, privacy and security duties, ADA obligations, recordkeeping rules, and relevant AI laws or guidance. The rules may depend on whether the employer self-administers claims, uses a third-party administrator, or acts in another capacity.
For example, Texas Department of Insurance Commissioner’s Bulletin B-0003-26, dated June 12, 2026, addresses regulated entities and their agents and representatives, including third parties working with regulated entities. It says decisions or actions affecting consumers that are made or supported by AI must comply with applicable insurance laws, including unfair trade practices and unfair discrimination rules; it also describes governance expectations and the regulator’s ability to request information during an investigation or examination. This is Texas insurance guidance with a defined regulated-entity scope, not a universal rule for every employer.
WCRI’s 2025 report said its authors were not aware of laws specific to AI in workers’ compensation at the time of their research, while noting broader insurance oversight and NAIC principles and model guidance. That is a dated finding, not a definitive legal conclusion for 2026. Employers should have counsel or another qualified adviser check current state and role-specific requirements rather than infer that no relevant law applies.
How can an employer put the policy into practice?
- Inventory tools and workflows: Identify every AI-enabled system, vendor, user group, data type, and claims task, including tools embedded in other software.
- Classify each use: Mark it as administrative support, recommendation, or claim- or work-affecting support; specify approved purposes and prohibited uses.
- Set controls before launch: Define reviewer qualifications, data permissions, validation evidence, escalation routes, vendor terms, and state-specific legal review.
- Train the people involved: Explain what staff may enter, how they verify outputs, how to document decisions, and how to report errors or incidents.
- Monitor and govern changes: Review performance and complaints on a defined schedule, reassess after material changes, and pause use when the policy’s safety or compliance conditions are not met.
These controls are practical policy recommendations, not a single government checklist. Tailor them to the employer’s state, business structure, claims-administration arrangement, and intended use of AI.
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