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Workers’ compensation industry explores use of AI

Tuesday, March 20, 2018/Categories: Providers

Artificial intelligence (AI) has been making waves across multiple industries, and workers’ comp is no exception. With the rise of self-driving cars, automation, and robots, many have touted that AI will significantly reduce workplace injuries, but how will AI impact claims management?

Workers’ comp has already seen AI in the form of clinical decision support engines that help guide claims professionals, along with advanced analytics programs that look at patient data and claim outcome information to identify risk and intervention opportunities.

Machine learning seeks to take this to the next level, as AI can spot trends that human brains have previously been unable to discover, leading to further efficiencies. On the extreme end, a Japanese life insurance company replaced 34 employees with an AI system based on IBM’s Watson Explorer. The program has been trained to think like a human and analyze data before suggesting payments, but in the end, for now, payments must be reviewed and approved by a human.

News like this indicates that AI could be used to automate more and more parts of claims workflow, assisting, but not replacing humans. For instance, chatbots are evolving to better understand human interactions, and are expected to soon be able to field claimant questions and initiate the claims process when claims professionals are unavailable. 

While some may find applications such as this impersonal, others argue that a machine won’t get tired or distracted and make mistakes, and that we need look no further than programs like Amazon’s Alexa or Apple’s Siri, which are already serving millions of consumers worldwide, demonstrating the public’s willingness to embrace AI.

Only time will tell to what extent AI will penetrate claims management, but the market is certainly embracing AI, with 85% of executives planning to invest in AI over the next three years. While it may take several years, or even decades to see AI implemented on a large scale in workers’ comp, we are very likely to see more developments in the near future.


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