Some market insights here from EvolutionIQ and it looks at the challenges of triaging injury claims.
As regulators judge income protection providers with increasing fastidiousness on customer outcomes, the rise of AI solutions that enable personalised journeys has been exceptionally well timed.
There are signs, particularly from the US, that the rapid proliferation of AI-powered claims guidance is moving the income protection market into a new era of hyper-personalisation, whereby providers can optimise bespoke customer journeys and help individuals get back to work faster.
This can involve a blend of digital and human touch points, with AI-powered claims guidance enabling adjusters to give customers extra support, where needed, at the earliest point possible.
Targeted Support
Across the US, the enablement of targeted support has been a major factor for EvolutionIQ’s clients.
At the Insurtech Insights conference, Mike Estep, President of Prudential’s Group Insurance Division, and Brad Rothenberg, Vice President of CNA’s Claim Transformation & Technology Division provided compelling examples of how EvolutionIQ has changed their claims operations.
They discussed how staff were empowered to pinpoint high opportunity claims earlier for tailored support, in turn expediting the process to help injured workers recover and return to work sooner.
A common thread through users’ experiences of claims guidance approach is the speed at which it frees up adjusters and claims examiners to focus on the cases – the people – who require closer assistance.
In short, it enables frontline adjusters to understand claimants’ needs sooner and time to be more empathetic in their interactions.
At the heart of this is the way claims guidance differs from traditional triage, by providing support throughout the entire claims lifecycle. It can analyse and synthesise unstructured data at scale, mimicking the way humans process information, but without the manual effort.
The result is that both claimants and insurance companies benefit form speedier outcomes.
A top US disability insurer using EvolutionIQs’ claims guidance AI software in its short-term disability block of claims has observed this tangible difference; it saw a 4x increase in its fast-track claims pipeline. The accuracy in predicting outcomes, based on claims guidance’s understanding of the nuance of particular claims combined with institutional knowledge of similar claims, drove much improved outcomes. This insurer now has 95% accuracy in precisely assigning claims to the fast-track workflow.
At a different US insurer, the claims guidance drove a 73.5% increase in attention being directed to at-risk claims that needed adjuster investigation and actions within the first week of deployment.
The triage conundrum
The challenges of traditional triage were explored in our recent roundtable with income protection experts from VitalityLife, L&G, Cirencester Friendly, Unum, Aviva, and Swiss Re.
One issue, which again linked to the onus on personalisation, was a need to distinguish customers requiring most support from the general mass of claims as fast as possible, to focus specialist care and attention to them.
In an example where technology made the difference, Zurich assessed a backlog of musculoskeletal and mental health claims, in which some people had been on the books for nine years. Zurich used technology to trial a virtual physio and electronic tracking of people’s movements which involved 15 to 20 claimants, all of whom had been in claim for at least 12 months.
In one case, a lawyer who had been off work for a long period was back at work within six weeks for a part-time role, saving Zurich £28,000 benefit a year over potentially the next 15 years.
Scaling quality
Contrary to popular belief, AI can enhance rather than replace jobs. AI-powered claims guidance is a prime example of how technology can benefit the workforce.
For clients, our solutions empower staff to excel in their roles, to work on the claims that require more profound, compassionate levels of support for sick and injured people looking to return to work. Our technology enables insurance companies to optimise operations and free up employees’ time to provide services with the highest value. This doesn’t mean scaling back; it means scaling up the quality of the customer experience.
Deteriorating UK Benefits and Workplace
There’s another, systemic reason why this point about intuitive claims guidance is important – the sheer number of people still out of work due to illness or injury.
Using the UK as an example, there are 2.8 million people out of work due to ill health and disability, prompting the government’s Work and Pensions Secretary Liz Kendall to declare that employment support needs fundamental reform.
In a directly-linked issue, income protection providers are still seeing high claims volumes in the UK, with one attendee at EvolutionIQ’s roundtable seeing a 30% uplift in 2022, followed by a 25% increase in 2023.
The rising volume has made quick access to healthcare records crucial to halt the build-up of backlogs.
Andrew Wibberley, co-chair of the Income Protection Task Force commented, “Sales of income protection have increased by over 50% in the last 3 years, driven in part by NHS challenges and longer waiting times for treatment. Advisers and insurers are doing a good job in getting more people protected but insurers must leverage advanced technologies now to support Claims teams for increasing claims volumes today and in the future.
By doing so, they can optimise customer outcomes and accelerate return-to-work times. Technology now offers the opportunity to blend digital efficiency with human empathy, enabling more personalised, timely support. Insurers that adopt these solutions will not only improve their operational performance but also enhance the overall customer experience, crucial as regulatory scrutiny around customer outcomes intensifies.”
The possible dream
The promise of AI may sound like an impossible dream but practical case studies are emerging frequently, demonstrating where the science of AI is changing the art of the possible for providers, and improving the bottom line.
By pairing claims professionals with an AI claims guidance system, we can empower them to achieve more, faster, and with greater accuracy. While the potential of AI might seem like a distant dream, real-world examples are proving that AI can revolutionise how providers operate and improve their financial results.
And there’s another key difference it could make.
The typical lens through which AI is written about in financial services is that it puts jobs at risk. AI-powered claims guidance can be understood moreover to empower employees to better serve customers, more compassionately and efficiently and drive better outcomes for claimants.
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