Workers' Comp - live proof

NAICS injury-rate outliers, state concentration, year-over-year anomalies.

wc-engine ingests BLS Survey of Occupational Injuries reference rates and runs three deterministic checks per engagement. Same kernel that ships every other JIL vertical: customer-profile gated on lob = 'workers_compensation_carrier', sealed CREB on every finding, FRE 902(14) self-authentication. One kernel, 8 industry verticals, 175 production checks, 273 production services.

In plain English

What this POC shows.

If you're a workers' comp insurer SIU, a state DOI fraud bureau, or a self-insured employer, this is the short answer for what's being detected on BLS-shaped industry injury data.

What's the dataset?

BLS-shaped industry injury rate data, plus deterministic outlier rules. 1.8K records modeled. Public, free, reproducible.

What did JIL find?

207 findings: NAICS injury-rate outliers (employers reporting injury rates inconsistent with their industry baseline), state concentration (geographic clustering of high-cost claims), year-over-year anomalies (sudden injury-rate jumps without operational change).

Why does this matter?

WC fraud (employer mis-reporting + claimant fraud) is a $30B+ annual loss line. Public industry data shows the patterns; nobody runs systematic outlier detection across the full employer universe. JIL does.

What this is NOT

Not a fraud determination. Not a coverage decision. 'Flagged' = 'industry data shows an anomaly worth review.' The SIU still owns the human judgment + investigation.

How do I run this on my book?

If you're an insurer, we run the catalog over your loss-run alongside the BLS public surface to surface employer outliers + claim patterns. Turnaround: 5-10 days.

3
Production checks live
SOII
BLS Survey of Occupational Injuries
8954
Engine port (internal)
CREB
Sealed receipt per finding
Section 01 - Three production checks

What wc-engine fires on.

wc_naics_outlier

NAICS-by-year cohort, 2.0x national mean.

NAICS-by-year cohort whose incidence_rate exceeds 2.0x the national mean for that year. Material indicator of carrier-level loss-ratio exposure and OSHA inspection priority. Regulatory basis: BLS SOII methodology, OSHA 29 CFR 1904, NCCI Class Code framework.

wc_state_concentration

Single state holds 60%+ of cohort DAFW.

NAICS cohort where a single state accounts for 60%+ of days-away-from-work cases nationwide in a given year. Signals geographic-cluster underwriting risk or fraud-ring concentration. Regulatory basis: NCCI Experience Rating Plan, state WC statutes.

wc_yoy_anomaly

Year-over-year incidence change beyond +/- 50%.

NAICS-state cohorts with year-over-year incidence_rate change exceeding +/-50%. Bidirectional: large drops trigger underreporting investigations; large spikes trigger experience-modification review. Regulatory basis: BLS SOII, OSHA 29 CFR 1904.

Section 02 - Sample CREB

What the WC carrier takes to NCCI or the state DOI.

finding_id      : e2a8f0c1-...-wc-naics-outlier-001
check_id        : wc_naics_outlier
subject_type    : naics_year
subject_id      : 56|2023
severity        : high
incidence_rate  : 6.76 per 100 FTE
national_mean   : 2.65 per 100 FTE
ratio           : 2.55x peer cohort
regulatory_basis: BLS SOII, OSHA 29 CFR 1904, NCCI Class Code
code_version    : wc-engine@2026.05.01-wc-1
Section 03 - Methodology

Deterministic, replayable, court-defensible.

Same kernel as the other 7 verticals. NAICS-outlier is a SQL aggregate against the per-year national mean; state-concentration is a per-NAICS DAFW share computation; YoY-anomaly self-joins prior-year rates. No stochastic LLM in the verdict path. Ava (the in-house agentic AI) groups, narrates, and routes findings; it never produces the underlying flag.

Customer engagement adds depth. Tier 2 brings carrier-supplied claim event records, medical bills, employer payroll records, named-actor cross-reference. Optional NPPES medical-provider lookup for billing-mill detection. The public-data POC above is the Tier 1 baseline, included in every engagement.
Reality check. Statistical outliers are not adjudicated fraud. wc-engine surfaces cohorts that warrant investigation, sorted with each finding's NCCI / OSHA / state-DOI escalation path pre-computed. Underwriting and SIU teams act on the output.
Built on the JIL Settlement Engine

One kernel. Eight industries. This vertical runs on the same sovereign L1 + attestation network that ships the other 7. Kernel age: 18+ months. Adding a vertical: ~1 week. Competitor moat: build the kernel first.

See the engine