Long-horizon agentic AI for workers' comp claims.
Workers' comp files develop over days and weeks — and the Layerup workers' comp claims agent stays on the file the whole time. It continuously ingests documents, monitors work status, supports compensability review, surfaces return-to-work signals, prepares examiner handoff packages, and routes exceptions — a single uninterrupted run per claim, not a one-shot pass.
One-shot agents answer. Long-horizon agents finish.
Most AI agents are one-shot: one prompt, one response, no memory, no obligation to finish. Layerup agents are long-horizon — each owns a workflow end to end and stays on it, uninterrupted, for hours or days until the work is done.
One prompt in, one output out. The run is over in seconds — whatever state the work is in.
One workflow worked continuously, for hours or days, until it is actually finished.
Stateless per call. Everything learned about the case is forgotten between steps.
Persistent working memory of the whole case — every document, finding, and decision carried forward.
Guesses or stalls when an input is incomplete. Someone has to notice and re-prompt.
Requests the missing document, follows up, waits for it to land, and resumes exactly where it left off.
Returns a response. Acting on it — updating the core system, moving the queue — is still human work.
Reads from and writes back to your systems of record throughout the run, every action logged for audit.
A label, a draft, a score — an input to someone else's work.
Finished, decision-ready work with rationale and citations attached, staged for human approval.
A one-shot agent can summarize one medical record. It can't work a comp claim that develops over months — track statutory deadlines by jurisdiction, ingest each new record as it arrives, monitor work status, surface return-to-work signals, and keep the examiner package current the entire time. The long-horizon workers' comp claims agent stays on the file as it develops.
The whole claim, worked in one continuous run.
The workers' comp claims agent does not handle a single moment in the file. Every capability below belongs to the same agent's run — it works alongside the examiner across the life of the claim, for days and weeks, ingesting, summarizing, surfacing, and preparing.
FROI intake
The agent intakes First Reports of Injury from any channel — portal, email, employer integration — and stages them for examiner review.
- Multi-channel FROI intake
- Required field validation
- Employer and policy match
- Initial routing
Employer / employee / injury data capture
The agent extracts employer, employee, employment, and injury data points across forms, statements, and incident reports.
- Employer profile match
- Employee identification
- Injury type and body part capture
- Mechanism of injury extraction
Policy verification
The agent verifies policy effective dates, classifications, endorsements, and coverage applicability against the policy admin system.
- Effective date and term verification
- Class code applicability
- Endorsement review
- Coverage determination support
Jurisdiction & statutory deadline support
The agent tracks jurisdiction-specific statutory deadlines and surfaces upcoming actions before they slip.
- Jurisdiction identification
- Statutory deadline calculation
- Action calendar preparation
- Examiner reminders
Compensability review support
The agent assembles the evidence and timeline needed for compensability decisions and prepares a recommendation packet.
- Statement and document review
- Witness and incident evidence
- Prior history reconciliation
- Compensability packet preparation
Medical record ingestion & summarization
The agent ingests medical records continuously, summarizes new findings, and surfaces clinical changes that affect claim direction.
- Provider record ingestion
- Clinical timeline construction
- Diagnosis and treatment summarization
- Causal relationship support
Work status extraction
The agent extracts work status from medical documentation — full-duty, modified-duty, off-work — and updates the file in real time.
- Work status detection
- Restriction extraction
- Status change alerts
- RTW timeline projection
Provider & bill intake
The agent intakes provider documentation and medical bills, classifies them, and stages them for adjudication.
- Provider classification
- Bill ingestion
- Service code extraction
- Adjudication preparation
Nurse case management support
The agent synthesizes file activity for nurse case managers — clinical course, RTW barriers, provider concerns, and next-step recommendations.
- Clinical course summarization
- Barrier identification
- Coordination prompts
- Care plan documentation support
Return-to-work signal detection
The agent continuously scans medical, provider, and employer documentation for early RTW indicators and routes them to the right examiner.
- RTW signal detection
- Modified-duty opportunity flags
- Employer coordination prompts
- RTW packet preparation
Indemnity workflow support
The agent prepares indemnity workflow inputs — wage data, benefit calculations, and statutory references — and stages them for review.
- Wage statement ingestion
- Benefit calculation support
- Statutory rate references
- Indemnity packet staging
Litigation / denial package support
The agent assembles litigation and denial packages — evidence, timeline, statements, and rationale — for legal and senior examiner review.
- Litigation evidence assembly
- Denial rationale documentation
- Timeline construction
- Counsel-ready packet preparation
Fraud flagging
The agent flags fraud signals across statements, providers, prior history, and documentation patterns and prepares an SIU referral packet.
- Statement consistency review
- Provider pattern detection
- History reconciliation
- SIU referral packet
Subrogation flagging
The agent identifies recoverable exposure — third-party liability, premises, products — and stages the recovery workflow.
- Third-party liability detection
- Premises and products signals
- Evidence assembly
- Recovery workflow trigger
Reserve support
The agent synthesizes file activity to support timely, evidence-based reserve adjustments and surfaces drift before it becomes a problem.
- Exposure synthesis
- Reserve recommendation support
- Change driver identification
- Drift alerts
Examiner handoff package & ongoing file development
The agent continuously maintains an examiner-ready package as the file develops over days and weeks, so every interaction starts ready.
- Always-current file summary
- Open-action checklist
- Pending document tracker
- Decision-ready packet at every touch
Put long-horizon agentic AI on every workers' comp file.
Deploy the workers' comp claims agent, prove cycle time, file readiness, and reserve accuracy improvements — then expand to other lines.