JustineAI™ — Workers’ Comp Edition.

1. Stage 01Intake & compensability

   Justine runs conversational intake against the California workers’-comp schema — date of injury, employer and carrier, body parts, AOE/COE compensability, prior claims, and the statute clock. She flags cumulative-trauma exposure windows and the post-termination defense before the Application goes out. Applicant-side, California.

2. Stage 02Application & filing

   Justine assembles the California filing set — the DWC-1 claim form, the Application for Adjudication of Claim, and a Declaration of Readiness to Proceed — populated from intake with per-field provenance. Every form surfaces to the attorney for attestation before it is filed; nothing is auto-served. Client-facing letters draft in English or Spanish.

3. Stage 03Treatment & utilization review

   Justine tracks each authorized treatment request through the utilization-review process — flagging UR denials, the Independent Medical Review (IMR) appeal deadline, and out-of-MPN care. When a request is denied, she surfaces the reviewer’s stated basis against the treating physician’s report so the IMR appeal starts from the record itself.

4. Stage 04AME / PQME analysis

   Justine reads the AME or PQME report — “Justine’s read” — extracting whole-person impairment by body part, work restrictions, causation, apportionment opinions, and the P&S date. She flags where the evaluator departs from the record. Where the treating provider runs ChironAI™ Occupational Medicine, those assessments can feed the matter.

5. Stage 05MMI / P&S & impairment

   Justine watches every active matter for Maximum Medical Improvement / Permanent & Stationary signals across treating providers, then reads the impairment picture into the rating engine. She distinguishes the strict-AMA whole-person reading from a rebutted alternative before the attorney certifies anything.

6. Stage 06PD Value Engine

   The Value Engine builds the California rating string — WPI → the 1.4 future-earning-capacity factor → occupational variant → age modifier — and models permanent disability as a PD percent, a dollar value, and the swing between a strict-AMA rating and a rebutted one (Almaraz-Guzman / Ogilvie). Apportionment is carved out under Escobedo. Figures are projections for the attorney to verify against the current schedule.

7. Stage 07Settlement

   Justine models Compromise & Release against Stipulations with Request for Award, applies the ~15% judge-approved contingency fee and reasonable lien values, and reports net-to-client under each path. The attorney sees the trade-off — a clean C&R buyout versus Stips that leave future medical open — before deciding the number and the posture.

8. Stage 08MSA flag & analysis

   Justine flags when a Workers’ Compensation Medicare Set-Aside is implicated before a C&R is papered — Medicare-beneficiary status, the CMS review thresholds, open future medical — and frames the analysis the attorney needs. She does not compute the set-aside dollar amount; that stays with a WCMSA vendor and the attorney’s judgment.

9. Stage 09Closeout & compliance

   On resolution, Justine delivers the final file, exports the tamper-evident audit log for ethics review, and closes the matter. The apportionment patterns and carrier behavior the firm learned inform its next case — inside the firm’s own tenant, never a shared model.

• Compensability sub-agent

  AOE/COE analysis. Cumulative-trauma date-of-injury under the last-injurious-exposure rule. Going-and-coming and personal-comfort exceptions. Post-termination and statute-of-limitations defenses. Employer/carrier identification. Concurrent-employment average weekly wage. Prior-claim apportionment exposure. Applicant-side.

  For example — A warehouse picker files for a cumulative lumbar injury after termination. You drop the personnel file, the panel QME report, and three years of pay records. The compensability sub-agent fixes the CT date-of-injury, flags the post-termination defense the carrier will assert, surfaces a prior 2019 lumbar claim that opens an apportionment argument, and computes the average weekly wage across two concurrent employers — each value traced to its source page for you to weigh.

• Medical sub-agent

  Treating-provider chronology. Utilization-review and IMR appeal tracking. AME/PQME impairment and apportionment review — “Justine’s read” of the report. MMI / P&S signal detection. Causation linkage. ChironAI™ OM upstream assessment ingestion where the provider runs it.

  For example — A 4,000-page file across an orthopedist, a pain-management group, and a panel QME. The medical sub-agent surfaces the UR denial of a lumbar fusion, the IMR appeal window closing in eleven days, and the contradiction between the PQME’s 8% whole-person impairment and the treating surgeon’s range-of-motion measurements supporting a higher rating — with the apportionment opinion isolated for the attorney’s review.

• Rating sub-agent

  The PD Value Engine. California rating-string construction — WPI, the 1.4 FEC factor, occupational variant, age modifier. Strict-AMA versus rebutted (Almaraz-Guzman / Ogilvie). Apportionment carve-out under Escobedo. PD percent, dollar value, and the PD/$ swing. Life-pension threshold flags.

  For example — A shoulder injury with a 12% whole-person impairment from the AME. The rating sub-agent builds the California rating string, models the permanent-disability award as a PD percent and dollar value, then carves out the share apportioned to a pre-existing rotator-cuff tear — showing the swing between the strict-AMA reading and an Ogilvie rebuttal, and flagging where the adjusted rating crosses the life-pension threshold. Projections the attorney verifies against the current schedule.

• Resolution sub-agent

  C&R versus Stipulations modeling. The ~15% judge-approved contingency fee and reasonable lien values. Net-to-client under each path. Open-future-medical trade-off. WCMSA-required flag against CMS thresholds — flag and analysis, not a dollar computation.

  For example — An accepted back-and-knee claim with disputed future medical. The resolution sub-agent models a Compromise & Release against Stips-with-open-medical, applies the ~15% fee and known lien values, and reports net-to-client under each. It flags that a WCMSA is implicated — the client is Medicare-eligible and future medical is open — and tells you to resolve the set-aside before papering the C&R, without inventing the set-aside figure.

• The PD Value Engine

  The California rating string built end to end — WPI → the 1.4 FEC factor → occupational variant → age modifier — modeled as a PD percent, a dollar value, and the swing between a strict-AMA rating and a rebutted one. Projections the attorney verifies against the current schedule.

• Apportionment reasoning

  Apportionment carved out under Escobedo, with Almaraz-Guzman and Ogilvie rebuttal viability assessed. Justine shows what a rebuttal is worth in PD percent and dollars before the attorney pursues it.

• AME / PQME analysis

  “Justine’s read” of the AME or PQME report — whole-person impairment by body part, work restrictions, causation, apportionment opinions, and the P&S date, with departures from the record flagged.

• Utilization review → IMR

  Each treatment request tracked through utilization review — UR denials, the Independent Medical Review appeal deadline, and out-of-MPN care surfaced, with the appeal started from the treating physician’s own report.

• Settlement — C&R vs. Stips, net-to-client

  Compromise & Release modeled against Stipulations, the ~15% judge-approved fee and reasonable lien values applied, and net-to-client reported under each path. The WCMSA-required flag fires before a C&R is papered — a flag and analysis, not a dollar computation.

• Bilingual client communications

  Client-facing letters draft in English or Spanish, and voice dictation and read-aloud honor either language — so the applicant hears their case in the language they speak.

• Client texting with a privacy relay

  Opt-in, STOP-compliant SMS keeps the client updated on their case, and attorney alerts route through a number-privacy relay so the client never sees a personal cell number. Transmitted over Azure Communication Services on a toll-free line.

• Per-case client email

  Real client messages threaded to the matter, sent through Microsoft 365 / Outlook — the correspondence lives with the file, not in a separate inbox.

• Bilingual EN / ES client letters

  Client-facing letters draft in English or Spanish. Filings stay in English; only the client-facing correspondence switches language — so the applicant reads their own case in the language they speak.

• English & Spanish voice

  Voice dictation and read-aloud honor either language — flip to Spanish once and both dictate and listen follow (es-MX / en-US). Push-to-talk in, natural speech out.

Not legal advice · not a law firm · ABA-conduct aligned · the attorney decides. Client communications are attorney-reviewed work product.

• Compensability analysis

  Justine surfaces — On a cumulative-trauma matter, Justine fixes the date of injury under the last-injurious-exposure rule, surfaces the going-and-coming defense the carrier is poised to raise, and flags a prior accepted claim to the same body part that opens an apportionment argument — each tied to the record page that grounds it, for the attorney to weigh.

• Utilization-review appeal

  Justine surfaces — Justine catches that a UR denial of a lumbar fusion rested on a misread of the requesting physician’s report, that the IMR appeal window closes in nine days, and that the report already contains the documentation the reviewer claimed was absent — the appeal half-drafted from the record itself.

• AME / PQME scrutiny

  Justine surfaces — Across a panel QME report, Justine surfaces that the evaluator apportioned 40% to non-industrial degeneration without substantial medical evidence explaining the “how and why” under Escobedo, that the impairment number understates the documented range-of-motion loss, and that a prior consistent treating opinion contradicts the apportionment — assembling the cross-examination the attorney can run.

• PD Value Engine

  Justine surfaces — On a shoulder injury rated at 12% whole-person, Justine builds the full California rating string — the 1.4 FEC factor, occupational variant, and age modifier applied — models the PD percent and dollar value, carves out the apportioned share, and shows the PD/$ swing between the strict-AMA rating and an Almaraz-Guzman or Ogilvie rebuttal, so the attorney sees what a rebuttal is worth before pursuing it.

• Settlement & net-to-client

  Justine surfaces — Justine models C&R against Stips, applies the ~15% judge-approved fee and the reasonable lien values, and reports net-to-client under each path — surfacing that leaving future medical open on Stips exposes the client to a WCMSA problem a clean C&R buyout avoids, so the number is chosen with its consequences visible.

• Citation discipline

  Justine surfaces — Justine grounds every statute and decision it cites against a verifiable authority — reasoned from real law, never invented — and self-labels its rating and settlement outputs as projections to verify against the current schedule and CMS thresholds. The conflict check runs before the engagement letter. The attorney decides.

The AI reasons; the attorney decides.