Roundtable: Smarter claims, faster recovery – optimising return-to-work journeys

A recent Insurance Post roundtable held in association with EvolutionIQ explored how modern, AI-driven claims intelligence can transform return-to-work experiences that benefit claimants, employers and insurers alike. Fiona Nicolson reports

 

Roundtable participants 

• Daniel Simpson, chief innovation officer, Shepherds Friendly Society  
• Robert Higgins, senior claims manager, Cirencester Friendly Society 
• Ian Rowe, claims manager, Pacific Life Re 
• Claire Curley, head of retail protection claims, Zurich 
• Jackie Kerwood, head of claims strategy and governance, Aviva 
• Maxine Jannetta, head of claims, British Friendly Society
• Yvonne Braun, OBE,  director of policy for long-term savings, health & protection, ABI   
• Mike Saltzman, co-founder and co-chief executive, EvolutionIQ
• Tim Cima, director UK, EvolutionIQ 

 

The challenges of managing return-to-work pathways 

As insurers face increasingly complex disability, workers’ compensation and income-protection claims – often involving chronic conditions, mental health and long periods of absence – existing claims-handling models are coming under strain.  

The complexity of today’s claims emerged as a common theme for industry leaders, when discussing the challenges of supporting claimants in their return to work. 

Daniel Simpson of Shepherds Friendly Society reported that as well as seeing higher volumes, including more mental-health claims, there is now also a tendency for claims to involve multiple conditions. He noted that it is harder to assess duration of cases, due to more comorbidities: “It’s becoming difficult to predict how long some claims are going to last for,” he observed. 

Reflecting on the nature of today’s claims, Robert Higgins of Cirencester Friendly Society said: “Musculoskeletal claims are in some ways easier to deal with because the condition is demonstrable. You can see a clear pathway to recovery. 

The claims process is essentially a human-to-human interaction.

Jackie Kerwood, Aviva

“However, sometimes a mental-health claim can be followed by another, different condition, or a musculoskeletal condition can lead to a mental-health issue. It’s very difficult to navigate the pathway back to work, in these circumstances.

“It can also be difficult to know when to intervene, because not everyone is ready for treatment straightaway. You have to tailor everything to the needs of the individual,” he emphasised. 

The role of the claims team is in turn becoming more complex, as Aviva’s Jackie Kerwood explained: “Claims teams are dealing with multifaceted claims – and the claims process is essentially a human-to-human interaction. To be able to deal with the complexity of the claim, and also to be there for the customer can be a challenge.” 

Noting the significant contribution of insurers and their claims teams in supporting the UK workforce back to health, Yvonne Braun of the ABI said:  “Every year, 300,000 people ‘fall out’ of the workforce due to ill health and many don’t return because once they have been off sick for more than six months, it’s much less likely that they will go back to work.

“The role that insurers can play through both group income-protection insurance and retail protection in seeking to prevent this outcome, is enormously helpful.”

AI is not there to replace our claims team. It is there to support them.

Robert Higgins, Cirencester Friendly Society

Effective use of AI in the claims process and supporting the claims team

While the adoption of AI continues apace within areas such as underwriting, claims teams remain cautious. This is understandable, said Higgins: “People are naturally sceptical about AI due to fear of the unknown.” 

He argued that the way to implement it successfully is to integrate it thoughtfully and  effectively, and to be clear about why it is being used at all: “AI use has to be specific to the claims philosophy of the company and you need to make sure that it’s continually learning: it is only as good as your training. 

“It’s not there to replace – it’s there to support,” he added: “We have to make sure that we come back to that key message every time.”

Higgins also pointed out that AI can alleviate the demands on claims teams: “With the increase in mental-health claims, the conversations that claims teams are having with customers are now more challenging. Making use of AI to free up time for the team to have additional training for such conversations can only be a good thing.” 

Sharing her experience of deploying AI to date, Maxine Jannetta of British Friendly Society said: “We’re not using AI for claims guidance; we’re using it for efficiencies. We spend a lot of time on the phone, so we’re now using AI to transcribe calls, rather than the claims handler having to engage, write, listen and remember what was said, so that they can then summarise it. Hopefully that releases more time to be on the phone to customers rather than having to spend another 10-15 minutes writing up the call.”

Automation in the next five years 

One way that AI can smooth the path of the claims team, is through the use of AI-powered claims-guidance platforms, to help with the triage step of the process. 

Explaining the focus of EvolutionIQ’s platform, co-founder and co-chief executive Mike Saltzman emphasised that its purpose was to provide guidance for teams to orchestrate efficient, consistent claims management, including identifying and recommending potential priority cases: 

You want your entire team performing to the best of their ability for all claimants, at all times.

Mike Saltzman, EvolutionIQ

“Our system will say, for instance, that you have seven claims in your caseload that particularly need your attention this week, and why, along with three or four suggestions for how best to progress these claims,” he explained. 

Looking ahead to what the next five years might look like for claims, from an automation perspective, Saltzman said: “There is a notion that AI will enhance efficiency and there is truth in that. It frees up more time for claims professionals to do a great job. You want your entire team performing to the best of their ability for all claimants, at all times.

“What we’ve seen in the US based on our experience, is that caseloads may stay the same or go up a little bit, in the next few years, but the ‘effective’ caseloads will go down. 

“To give an example – someone might have had 150 disability claims on their docket five years ago, and now it may be 200, but they are actively working on just 60 of them because AI knows that the rest do not need action at the moment.  Human judgment is great in some ways, but it’s also variable in others, so this means you’ll have a more predictable business.

“It’s a much more focused way to work, enabling more claim interaction and more opportunity to support the claimant in navigating the medical system and helping them return to work – all of the things that are important in getting someone healthy back into the workplace. There is less transcribing of call notes and more time for the tasks that only humans can do, such as building trust with claimants and dealing with difficult situations.

“You will see better claims outcomes as a result, lower durations, more returns to work and less variance in claims,” he added. 

Claims team evolution 

Kerwood said she is positive about the introduction of AI into the claims process, but also stressed the importance of proceeding carefully, with rigorous testing, guardrails and governance: “I believe that the combination of human skills and technology will enable the industry to achieve what it wants to do. We need to make sure that we don’t move too quickly, but the future looks exciting,” she concluded. 

While he expects claims teams’ roles to have more of an analytical slant, with the introduction of new technology, Simpson emphasised the importance of the human factor at the point where the customer makes the claim: “This is a key moment of truth for the policy holder. 

“This plan that they have taken out is for this particular purpose, and this is the point where they have potentially been paying premiums for years and want to know if it is going to do what they were told it would do. If the human touch means that we can make the best decisions for the customer at that stage, that can only be a good thing.”

We need to help people to be confident about AI so that they can embrace what it brings.

Ian Rowe, Pacific Life Re

Given the sweeping changes AI has introduced to date, teams may need to adapt to further, ongoing change in the claims environment, over the next few years: 

Getting claims teams on board with AI is a key step towards their future role, said Ian Rowe, of Pacific Life Re: “I remember conversations about 18 months ago when we talked about how we were going to start deploying AI and data analysis in our business. People were saying that they are claims assessors, not data analysts – they were genuinely concerned that their skills were becoming redundant.

“We need to help people to be confident about AI so that they can embrace what it brings.” Rowe added that it can be a catalyst for further enhancing claims processes and stepping away from those that may have now served their purpose: “It’s an exciting opportunity for us to do some things differently,” he observed. 

Claire Curley of Zurich acknowledged the commitment of claims teams – and their fears, as she noted: “Claims teams care very deeply about the customers that they deal with, but there is a general nervousness that AI is going to come in and take everyone’s job. So, AI has started with a negative reputation.  

“It’s there to support them to be able to spend more time with customers, but it’s still quite early days. Claims teams will need to see this for themselves first.”

She added: “There hasn’t been a mass exodus of jobs as a result of the introduction of AI. It’s a tool to help facilitate and support and its input is going to grow.” 

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