Insurance Claims Ripe for Innovation

The Workers Compensation industry has relied too long on outdated practices and manual processes, responsible for the inefficiency in claims management and outcomes. As we enter the fourth industrial revolution of Artificial Intelligence (AI), the emergence of partnerships among insurers with InsurTechs’ enables insurers to quickly advance digitization, improve risk management and increase customer satisfaction. After all, isn’t this the reason we are in this business? To insure bodily injury losses for injured workers and restore functional capacity and return to work through successful claims and medical management?

In recent years, the Workers Compensation industry has been criticized by consumers, policy makers and agencies of the Federal government for its lack of efficiency and delivery in meeting its original intent under the “Grand Bargain”. Most recently, the RAND corporation released a report highlighting the shortcomings identified by stakeholders including inefficient claims management and inadequate medical care.

Further complicating the challenges, is a grey wave of experienced claims handlers who are retiring, and their junior replacements are lacking in the necessary skills to manage the complexity of the workers compensation system. These workers desire both technology applications, which help them perform their jobs, and workplace flexibility...both of which can be satisfied using innovative InsurTech solutions.

According to A.M. Best’s Special Innovation Edition, October 2018, among a survey of 459 insurers’, more than 80% indicated that innovation was moderately to extremely critical to the success of their organizations, primarily for the purpose of attracting and retaining customers and gaining a competitive advantage. Further, nearly 90% were hopeful innovation would improve system or process inefficiencies within their organizations and 84% were investing or planning to invest in the use of big data and artificial intelligence.

Leaders of innovation in claims have made the following recent statements to us:

  1. Vice President, Insurance Carrier, “We are on a quest for solutions that ensure our sustainability and improve the customer experience and outcomes for injured workers.”

  2. Vice President, Insurance Carrier, “I’m worried that if we do not lead with innovation, we will fall behind in the market. We operate with a sense of urgency to drive innovation in claims, and we have developed an efficient process to engage with InsurTechs.”

  3. Senior Vice President, Self-Insured Employer, “We recognize that the market is on a rapid digital trajectory and we want to be in front of it, rather than fall behind or die.”

As the fourth Industrial Revolution is upon us, industry leaders can no longer continue with the status quo. The insurance claims vertical is ripe for innovation. Data analytics can be used to help insurers improve risk management, underwriting and claim decision making. And AI, an umbrella term for technology capable of making intelligent decisions, is being used to enable insurance services to become smarter, more cost-effective and personalized, with little human intervention. The use of meaningful data analytics to measure and monitor outcomes, contributes to the continual process improvement cycle of thriving organizations.

Care Bridge International hosts the largest independent Property & Casualty Analytic-Powered Claims Database© in the industry. The company is setting a new standard in forecasting medical treatment and costs for claims using big data analytics and AI technology-based solutions for future medical valuations, medical reserve setting, Medicare Set-Asides and Care Coordination. For more information visit:

For More Information Contact:

Michael Riccio, Customer Experience Manager

Toll-Free: 888-434-9326 Ext. 103


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