Can digitized claims replace human touch?

With insurtech solutions making headway in workers compensation as a way to improve efficiency and organization, claims experts are saying too much technology could be a bad thing in an era where patient advocacy has become the norm.

“Everybody is excited about artificial intelligence and the new technology,” said Stephen Sandberg, Atlanta-based director of sales for core solutions for risk management information systems provider Origami Risk LLC. “But it’s not to replace the claims professional; it’s to enhance the claims experience.”

Most workers comp carriers and third-party administrators are putting technology solutions to work — from chatbots that collect information and claims management software to applications that organize tasks and send notices — yet in recent years these same organizations have touted a more worker-friendly model that many have said can lead to less troublesome claims and fewer issues such as malingering and litigation.

Could the two — technology and the personable approach — coexist? Comp professionals say: tread carefully.

Risk managers speaking at a panel on top industry concerns at the California Workers Compensation Conference in Dana Point, California, in September warned that too much automation in claims handling could make matters worse when dealing with claims and the emotional experience of being injured — and that a lack of human communication leads to litigation.

Claims professionals “love all the stuff automated, but you still have the human factor,” said Karen Fry, who oversees workers compensation claims at Commerce Casino, a casino and hotel in Commerce, California. “You have (injured workers) who need that human contact … we can’t expect them to know workers compensation.” “People still want to talk to people,” she told attendees. “Especially when we hear, ‘I got an attorney because no one talked to me.’”

Kurt Leisure, vice president of risk services for Calabasas, California-based The Cheesecake Factory Inc., said it’s especially true in the case of automated messages that aim to provide an injured worker information on their claim — which he referred to as “spam calls.”

“Workers comp can be a little confusing for people who have never had a claim before,” he said.

The adjusters, in turn, are on “data overload” with the influx of digital information. “They do start to ignore it after a while,” he said.

“I can see where automation really helps,” said Karen Townsend, senior manager for health, safety and environment for Gaithersburg, Maryland-based Sodexo USA, a facilities and food service company. “The word I use is ‘streamline.’ If it’s documentation, find out how to use innovation and to streamline your documentation.”

Other industry stakeholders are taking note, saying claims organizations should automate mundane tasks but keep the human voice on the line.

“I think there has to be a balance,” said Max Koonce, Bentonville, Arkansas-based chief claims officer for Sedgwick Claims Management Services Inc., a third-party administrator with a nurse-case management system that hinges on constant contact with the injured worker.

“I do not ever see a time when a physical injury does not require some kind of human touch” in managing the claim, he said. “There is always going to have to be that human touch that is focused on advocacy.”

Rohit Verma, Peachtree Corners, Georgia-based global chief operating officer for claims management firm Crawford & Co., said the push for technology in the industry comes from clients who are seeking efficiency and speed in claims processing.

“There’s a lot of push toward technology,” he said. “While a number of conversations are happening at boardroom levels about what needs to be done with technology, I still believe this is a people business … Most of us feel comfortable talking to a human being.”

Mr. Verma said claims organizations that aim to appropriately apply technology must evaluate the type of communication at hand. For checking the status of an indemnity payment or a medical evaluation, a computer program could work.

However, checking the status of a claim could call for a live voice.

“Let’s say the claim is denied and the reason is, ‘I don’t have coverage.’ That triggers me to want to talk to someone,” he said. “I can never be convinced by a machine. I want to explain and put forth my point of view.”

Conversely, “I don’t want to dial in and wait three minutes in a queue if I am just checking my claim,” he said. “Machines are useful in that they are speeding things up that used to take a long time.” 

Indemnity payment notifications, for example, could come in the form of a text message, according to Mr. Sandberg, adding that computer programs make claims and the process “more visible” for both the injured worker and the claims organization.

By deploying technology, “adjusters can spend more with the claimant instead of talking about payments,” he said.

“We need to be somewhere striking that balance where it is not all machine or not all human,” said Mr. Verma. An injury “is a very emotional event, so I do believe that empathy is really critical.”