Exploring tech adoption for workers' compensation claims

Technology continues to play a major role in all aspects of the insurance industry and the workers’ compensation area is no exception. AI allows insurers to manage vast amounts of data on workers and recurring injuries, recovery times and best practices. It also allows injured employees to communicate with carriers and care providers almost instantaneously and learn about co-occurring conditions that could affect their recovery process. Better and earlier communication can significantly change the outcomes for employees and employers, while reducing the final costs for insurers.

Digital Insurance reached out to Leah Cooper, global chief digital officer at Sedgwick in a written interview to ask what she’s seeing in terms of technology adoption as it relates to workers’ comp, as well as the importance of balancing insurtech with human interaction on these claims. Cooper leads the company’s R&D efforts, led the team that created the company’s cloud-based, multilingual platform, and is also exploring practical but strategic uses for GenAI as part of their toolbox.

DI: How has the use of technology changed in the workers’ compensation space over the last few years?

Cooper: The advent of Generative AI has shaken up everyone’s expectations regarding how quickly and in what ways companies can realize savings by automating routine tasks. In the workers’ comp arena, this isn’t as simple as clicking a button, because the industry is highly regulated and very established with respect to our method for administering claims. However, many companies throughout our industry are taking advantage of GenAI right now. They may be using it to summarize documentation and speed up time to resolution on a claim, they may use GenAI to analyze and detect cases for fraud, and they may even evolve customer support options by automating responses to questions about the status of a claim.

All of these great advances do not, and will not, replace the need for humans to make decisions about claims. Judgment calls should always remain in the hands of people who can react thoughtfully and with empathy, above and beyond that which a set of rules and logic can do. Technology can better position people to do that, though: if you can read what’s in a document using GenAI and combine that with predictive models or other intelligent tools, then you can empower an examiner to expedite and resolve claims more efficiently and accurately than ever. Additionally, with better insight into data and risk, companies can allocate their resources more effectively. Enabling administrators to pay attention to claims that need the most support and highest level of human intervention is one of the most significant benefits that technology can deliver.

DI: What are some of the greatest challenges to managing claims in this area for workers, employers and insurance companies?

Cooper: One of the biggest challenges that technologists face today is adoption. How do we foster faith in these new tools, which have had some notorious stumbles? Can they be incorporated safely and effectively into our well-established processes? A company’s AI governance and ability to determine the right technology for a particular function. There is such incredible potential. But successful implementation of new technology requires extensive collaboration, planning, change management, legacy technology integration and quality assurance — all working in tandem to transform the business. We, as leaders and innovators, will continue to be tested to recognize how we can overhaul our legacy processes, and then find the time and resources to do so.

DI: What are the most valuable types of tools or technologies affecting the management of workers’ comp claims? How are they changing this area?

Cooper: Generative AI is the obvious choice here, for the reasons stated above. But GenAI is only one tool in an arsenal of options here: predictive modeling, fraud detection capabilities, sentiment analysis, real-time exchange of data through application programming interface (API) all of these combine to form a technology-enabled workflow that can support examiners in new and exciting ways.

DI: Are you finding that workers are comfortable with the increased use of technology to manage their claims?

Cooper: The launch of new technology is best when it incorporates the opinions of the people who are in the trenches every day — namely, claims professionals and the injured workers they support. Tech-driven tools have transformative potential; they can bring greater efficiency to workers’ comp claims and facilitate better access to care. Consumer-centric self-service platforms offer convenient, secure online access to real-time claims and case information, so injured workers can be more proactive and in the know on their claims. But insurers, employers and service providers must carefully balance the efficiencies of new technologies with the risk of losing the personal touch. The employee experience is important and should be individualized.

Despite its many benefits, technology is not a substitution for personal interaction. At Sedgwick, we believe the best way to employ technology is to leverage its capabilities to perform manual tasks — giving our claims professionals more opportunities to deliver empathy through meaningful human connection and engagement. This approach is essential when it comes to more complex claims. For example, providing individualized, compassionate care after an injury or illness is crucial, and technology can further enhance the process. Along with automating basic functions like eligibility, AI can serve as the backbone for predictive models developed to identify when an individual might benefit from a clinical intervention, such as a call from a nurse case manager or a review of their prescriptions.

DI: What concerns you about the adoption of technology in this space?

Cooper: With all the new, interesting and fun technology out there, companies will race to implement it, hoping to realize savings almost immediately. There are a couple of dangers here. First, any technology implementation needs to conform to the same rigorous IT security standards and data protection rules as traditional software development. Rushing to insert tools like GenAI without ensuring that your data and practices are locked down can jeopardize privacy and security. Second, that rush to implement can make it difficult to establish accurate returns on investment (ROIs) and set realistic expectations for digital transformation. Creating valid metrics to quantify success will be needed to ensure that those investments in technology are actually transforming the business.

DI: What excites you the most about how technology is changing the practice of workers’ comp?