Workers' Compensation Integrity
Premium fraud, claim fraud, and provider fraud on one CREB.
Workers' compensation is the intersection of three JIL verticals already in build - healthcare (provider fraud and medical billing integrity), P&C (claim adjudication and SIU), and H1B labor (employer wage and classification compliance). Approximately 90% of architecture is reuse from these three sources.
JIL is not a claims management system, not a TPA, not a medical bill review service, not a recovery vendor. It is a payment-integrity layer covering both the premium side (employer underpayment of premiums through misclassification) and the claim side (claimant, provider, and attorney fraud). Premium fraud is a category most fraud-detection products do not address.
Workers' Compensation Integrity at a glance.
Where the integrity layer sits, what it produces, and how the sealed CREB flows back to the buyer's existing systems.
Where this product earns its place.
The strategic case for Workers' Comp as a JIL line of business - what makes the wedge defensible, what makes it economically meaningful, and how it compounds with the rest of the platform.
~90% architecture transfers
Healthcare provider-fraud detection (chiropractic mills, opioid prescribers, IME shopping) transfers nearly intact. P&C claim adjudication and SIU evidence framework transfers nearly intact. H1B classification logic informs premium fraud.
Buyer base parallels Medicaid agencies
Texas Mutual, California SCIF, NYSIF, Pinnacol, Ohio BWC have procurement structures comparable to state Medicaid agencies. The 50-state expansion playbook from healthcare maps directly.
Federal compression via OWCP
DOL Office of Workers' Compensation Programs administers four federal WC programs (FECA, EEOICPA, BLBA, LHWCA). Federal partner channel (Accenture / Leidos / Peraton) compresses procurement timeline from 18-24 months to 60-120 days.
Underserved category leadership
Most WC fraud detection focuses on the claim side. Premium fraud (employer misclassifying workers, underreporting payroll, misrepresenting business operations) is comparable in dollar magnitude (25%-40% of total) but underserved by tooling. JIL leads the category.
Net-new checks, sealed evidence.
A representative slice of the Workers' Comp-specific check pack. Each one runs in the same five-stage pipeline as the rest of the platform - intake, profile load, parallel checks, verdict, sealed CREB - and ships with a 14-of-20 BFT signature, a CourtChain L1 anchor, and a reproducibility manifest pinning the exact check-logic version.
NCCI Class Code Misclassification
Cross-references declared NCCI class code against actual operations - job descriptions, payroll, OSHA logs, NAICS code. Identifies higher-rated classes. NCCI Scopes Manual lookup.
Payroll Reconciliation
Reconciles premium-audit-declared payroll against W-2, IRS 941, and state UI filings. Flags underreporting. Accounts for legitimate exclusions (overtime premium portion, certain bonuses).
Independent Contractor Misclassification
Applies state-specific worker-classification test (ABC test in CA/MA/NJ, common-law test elsewhere). Flags 1099 relationships indicative of employee status.
Experience Modification Manipulation
Detects entity-name-change patterns indicative of experience-mod evasion. Detects policy churn timed to avoid loss reporting. Cross-references owner and officer continuity.
Functional Capacity vs Disability
Cross-references claimed disability against publicly observable activity (DMV, real estate transactions, social media) inconsistent with that disability level. Asset-intelligence integration.
IME Selection Pattern
Detects IME providers with statistically anomalous opinion patterns (95% disability-supporting when claimant-referred, 95% disability-denying when carrier-referred).
Capper and Runner Detection
Detects illegal client solicitation through third parties. Cross-references state bar disciplinary records. CA Insurance Code 1871.7 and equivalents.
OSHA-WC Reconciliation
Reconciles employer OSHA 300/300A logs against WC claim filings. Flags OSHA-recordable injuries not appearing in WC system, indicative of claim suppression.
Who runs this in production.
The buyer pattern for Workers' Comp - who carries the budget, who carries the regulatory exposure, and how the engagement starts. Most first engagements are a Retroactive Proof Audit on a defined lookback window; Pre-Settlement integration follows once the check pack is calibrated to the customer's profile.
Texas Mutual ($2B+ premium, largest US WC carrier), California SCIF, NYSIF, Pinnacol Assurance, Ohio BWC (state monopoly), Washington L&I (state monopoly), North Dakota WSI, Wyoming WCD. Aggressive fraud-fighting mandates.
Travelers, Hartford, Liberty Mutual, AmTrust, Berkshire Hathaway Specialty, Zurich, Chubb, AIG, Old Republic. Specialty: Employers Holdings, Amerisafe, ICW Group. TPAs: Sedgwick, Gallagher Bassett, Crawford, ESIS, Broadspire.
DOL Office of Workers' Compensation Programs (FECA $2.5B+ annual, EEOICPA, BLBA, LHWCA). DOL OIG. VA OIG. DOE (EEOICPA). DOL MSHA. Federal partner channel via Accenture / Leidos / Peraton.
Large self-insured employers in high-risk industries - construction (D.R. Horton, Lennar, Bechtel, Fluor, Turner), energy (ExxonMobil, Chevron, ConocoPhillips, Halliburton), large manufacturing, logistics (UPS, FedEx, Walmart, Amazon).
Four-SKU model. No percentage. No contingency.
Pricing carries over from the canonical four-SKU model unchanged - Retroactive Scan (flat fee), Retroactive Proof Audit (with credit-back against the next subscription tier), Pre-Settlement Subscription (tiered annual), and per-case CREB bundles (Tier 3 court-ready evidence). Asset Intelligence is the standard fifth SKU where the vertical needs it.
No percentage of recovery. No contingency. No success fees. JIL is detection and proof, not recovery. Recovery sits with the customer or its existing partners (subrogation counsel, recovery vendors, regulators). The structure is what allows JIL to operate as neutral integrity infrastructure across plaintiffs and defendants, payers and payees, regulators and the regulated, on the same case.
Ready to scope a Workers' Comp engagement?
Initial briefings are 60 minutes. Retroactive Proof Audit lookback windows, check-pack profile design, and integration runbook are available under NDA. We start where the buyer's procurement gate is shortest.