Why the human touch is sometimes bad for claims

The claims industry in Canada has to be wary about complicating the claims process by putting a “human process” in place where one is not needed, speakers said last week at the Ontario Insurance Adjusters Association’s 2019 Claims Conference in Toronto.

Think about Health Claims for Auto Insurance, an electronic system for transmitting auto insurance claim forms between insurers and healthcare facilities in Ontario.

“This is still a dream… [but] if the invoice matched the approved treatment plan, the payment would be automatically made,” said Scott MacDonald, national claims director of accident benefits with The Co-operators, during the conference. “Why am I touching it? The decision was made when I approved the treatment plan. Why can’t we automatically pay that invoice? Those conversations are happening, but it’s time, energy and dollars.”

An adjuster looking at an invoice that they’ve already approved off an estimate is “crazy, that shouldn’t be happening,” added Monica Kuzyk, vice president of Curo Claims Services. She acknowledged that the industry tends to overburden things, “or we think it’s more complicated than it has to be and then we put a human process in place when we don’t need to. We have to be disciplined about not throwing a human intervention into a process where there doesn’t need to be. That will be our challenge over the next little while.”

On the flip side, the industry needs to implement human intervention when it’s needed. “There’s time when we need to stick our nose in too,” MacDonald said. “There’s times when something might not feel right or smell right and there is a knowledge, experience and wisdom there, whether AI [artificial intelligence] provides that as a flag or we provide that with experience as a flag that we need to go in and intervene. But also get involved if the client is going through a digital process; we need to be able to know where they need us to get involved.”

Policyholders now want to be part of the process, too, by pointing out a broken pipe, for example. “That’s going to continue to happen,” Kuzyk said. “We need to get out of the way of some of these things and let them happen.”

For Kuyzk, it’s about letting claims people do what they want to do. “An adjuster at the front line talking to an insured who is at the side of the road and an ambulance is on the way, that’s value,” she said. “That’s when people want to talk to us. When they’ve had a fire, that’s when an adjuster adds value. Helping a family through a crisis of a fatality, that’s when an adjuster adds value.

“That’s what they signed up for,” she said. “These are the people that said, ‘On any given day, I’m going to work to talk to people that had probably the worst trauma happen to them and my best day is moving that marker just a little bit and helping them.’ This is what claims people want to do, let’s let them do that. Let’s not have them filling out forms and issuing payments and worrying about their mail. That’s not what we want them to do.”