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Make sense of any

Workers Comp Claim

Generate accurate and consistent data from any document, any layout.

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Workers Compensation Intelligence

The world's best workers comp claim extraction

Accelerate workers compensation claims processing. Extract injury details, incident circumstances, medical treatment, wage information, and return-to-work status from claims. Enable faster adjudication and compliance reporting with structured claims data.

workers-comp-claim.pdf

Viewer

JSON

claim_number

WC-2024-00567

date_filed

2024-03-16

employer

name: Construction Services Inc, address: 500 Builder Lane, Denver, CO 80201, fein: 84-1234567, policy_number: WC-POL-2024-789

employee

name: Carlos M. Rodriguez, ssn: ***-**-6789, date_of_birth: 1985-04-22, address: 789 Oak Street, Denver, CO 80205, phone: (303) 555-4567, job_title: Carpenter, hire_date: 2019-06-15, employment_status: Full-time

injury

date_of_injury: 2024-03-15, time_of_injury: 10:30 AM, location: Job Site - 123 Main St, Denver, CO, body_part_affected: Lower back, nature_of_injury: Strain/Sprain, cause_of_injury: Lifting heavy materials, description: Employee was lifting lumber materials weighing approximately 80 lbs when he felt a sharp pain in his lower back. Immediately reported to supervisor.

Witnesses

1 item

name

phone

James Wilson

(303) 555-7890

medical_treatment

initial_treatment_date: 2024-03-15, treating_physician: Dr. Sarah Anderson, MD, facility: Denver Occupational Health Clinic, diagnosis: Lumbar strain L4-L5, treatment_provided: Physical examination, X-rays, prescribed muscle relaxants and physical therapy

wage_information

average_weekly_wage: 1200, days_worked_per_week: 5, hours_per_day: 8, hourly_rate: 30

lost_time

time_lost_from_work: true, last_day_worked: 2024-03-15, expected_return_date: 2024-03-29, work_restrictions: No lifting over 10 lbs, no bending/twisting

employer_signature

true

employer_signature_date

2024-03-16

employee_signature

true

employee_signature_date

2024-03-16

{ "claim_number": "WC-2024-00567", "date_filed": "2024-03-16", "employer": { "name": "Construction Services Inc", "address": "500 Builder Lane, Denver, CO 80201", "fein": "84-1234567", "policy_number": "WC-POL-2024-789"}, "employee": { "name": "Carlos M. Rodriguez", "ssn": "***-**-6789", "date_of_birth": "1985-04-22", "address": "789 Oak Street, Denver, CO 80205", "phone": "(303) 555-4567", "job_title": "Carpenter", "hire_date": "2019-06-15", "employment_status": "Full-time"}, "injury": { "date_of_injury": "2024-03-15", "time_of_injury": "10:30 AM", "location": "Job Site - 123 Main St, Denver, CO", "body_part_affected": "Lower back", "nature_of_injury": "Strain/Sprain", "cause_of_injury": "Lifting heavy materials", "description": "Employee was lifting lumber materials weighing approximately 80 lbs when he felt a sharp pain in his lower back. Immediately reported to supervisor."}, "witnesses": [ { "name": "James Wilson", "phone": "(303) 555-7890"} ], "medical_treatment": { "initial_treatment_date": "2024-03-15", "treating_physician": "Dr. Sarah Anderson, MD", "facility": "Denver Occupational Health Clinic", "diagnosis": "Lumbar strain L4-L5", "treatment_provided": "Physical examination, X-rays, prescribed muscle relaxants and physical therapy"}, "wage_information": { "average_weekly_wage": 1200, "days_worked_per_week": 5, "hours_per_day": 8, "hourly_rate": 30 }, "lost_time": { "time_lost_from_work": true, "last_day_worked": "2024-03-15", "expected_return_date": "2024-03-29", "work_restrictions": "No lifting over 10 lbs, no bending/twisting"}, "employer_signature": true, "employer_signature_date": "2024-03-16", "employee_signature": true, "employee_signature_date": "2024-03-16"}

workers-comp-claim.pdf

Viewer

JSON

claim_number

WC-2024-00567

date_filed

2024-03-16

employer

name: Construction Services Inc, address: 500 Builder Lane, Denver, CO 80201, fein: 84-1234567, policy_number: WC-POL-2024-789

employee

name: Carlos M. Rodriguez, ssn: ***-**-6789, date_of_birth: 1985-04-22, address: 789 Oak Street, Denver, CO 80205, phone: (303) 555-4567, job_title: Carpenter, hire_date: 2019-06-15, employment_status: Full-time

injury

date_of_injury: 2024-03-15, time_of_injury: 10:30 AM, location: Job Site - 123 Main St, Denver, CO, body_part_affected: Lower back, nature_of_injury: Strain/Sprain, cause_of_injury: Lifting heavy materials, description: Employee was lifting lumber materials weighing approximately 80 lbs when he felt a sharp pain in his lower back. Immediately reported to supervisor.

Witnesses

1 item

name

phone

James Wilson

(303) 555-7890

medical_treatment

initial_treatment_date: 2024-03-15, treating_physician: Dr. Sarah Anderson, MD, facility: Denver Occupational Health Clinic, diagnosis: Lumbar strain L4-L5, treatment_provided: Physical examination, X-rays, prescribed muscle relaxants and physical therapy

wage_information

average_weekly_wage: 1200, days_worked_per_week: 5, hours_per_day: 8, hourly_rate: 30

lost_time

time_lost_from_work: true, last_day_worked: 2024-03-15, expected_return_date: 2024-03-29, work_restrictions: No lifting over 10 lbs, no bending/twisting

employer_signature

true

employer_signature_date

2024-03-16

employee_signature

true

employee_signature_date

2024-03-16

{ "claim_number": "WC-2024-00567", "date_filed": "2024-03-16", "employer": { "name": "Construction Services Inc", "address": "500 Builder Lane, Denver, CO 80201", "fein": "84-1234567", "policy_number": "WC-POL-2024-789"}, "employee": { "name": "Carlos M. Rodriguez", "ssn": "***-**-6789", "date_of_birth": "1985-04-22", "address": "789 Oak Street, Denver, CO 80205", "phone": "(303) 555-4567", "job_title": "Carpenter", "hire_date": "2019-06-15", "employment_status": "Full-time"}, "injury": { "date_of_injury": "2024-03-15", "time_of_injury": "10:30 AM", "location": "Job Site - 123 Main St, Denver, CO", "body_part_affected": "Lower back", "nature_of_injury": "Strain/Sprain", "cause_of_injury": "Lifting heavy materials", "description": "Employee was lifting lumber materials weighing approximately 80 lbs when he felt a sharp pain in his lower back. Immediately reported to supervisor."}, "witnesses": [ { "name": "James Wilson", "phone": "(303) 555-7890"} ], "medical_treatment": { "initial_treatment_date": "2024-03-15", "treating_physician": "Dr. Sarah Anderson, MD", "facility": "Denver Occupational Health Clinic", "diagnosis": "Lumbar strain L4-L5", "treatment_provided": "Physical examination, X-rays, prescribed muscle relaxants and physical therapy"}, "wage_information": { "average_weekly_wage": 1200, "days_worked_per_week": 5, "hours_per_day": 8, "hourly_rate": 30 }, "lost_time": { "time_lost_from_work": true, "last_day_worked": "2024-03-15", "expected_return_date": "2024-03-29", "work_restrictions": "No lifting over 10 lbs, no bending/twisting"}, "employer_signature": true, "employer_signature_date": "2024-03-16", "employee_signature": true, "employee_signature_date": "2024-03-16"}

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