AI vs. human touch in workers’ comp claims management

PropertyCasualty360.com: How will AI impact workers’ compensation claims in 2025?

Gurtcheff: I expect artificial intelligence (AI) to infiltrate most, if not all aspects of the claims process to enhance workers’ compensation for injured workers this year.

AI's ability to automate routine, administrative tasks will enable employees to focus on more strategic initiatives in support of the ultimate goal—ensuring injured workers return to work faster and healthier, while also remaining a compassionate partner throughout the process.

PropertyCasualty360.com: What about low-risk medical claims?

Gurtcheff: Typically, these claims require minimal involvement from claims agents and processors. By leaning on and leveraging AI to handle these claims, agents and processors are given time back to focus on patient interactions, which contributes to better experiences and higher quality of care for the injured worker.

PropertyCasualty360.com: Is it important to maintain human interaction in claims management? Why?

Gurtcheff: The “high-tech” aspect focuses on adopting and investing in new technologies that create better efficiencies across workers compensation, but one can argue that the “high-touch” aspect is more important. The human touch is irreplaceable in claims management—especially in maintaining the empathy necessary for effective communication between adjusters and injured workers.

Humans express care and emotion whereas technology cannot replicate these feelings. Humans have empathy towards one another and technology cannot replace the reassuring smile and tone of an adjuster working to expedite a patient’s claim.

PropertyCasualty360.com: How might humans and AI work together?

Gurtcheff: Humans are invested in the well-being of patients and the status of their health and technology should be used to supplement the care journey – not replace it. We cannot rely on technology to accelerate the future of workers’ compensation without factoring in the significant role humans have, and will continue to have, in the injured workers’ care journey.

PropertyCasualty360.com: What excites you about technology’s future role in workers’ compensation?

Gurtcheff: What excites me most about the future use of artificial intelligence in workers’ compensation is the direct impact that the technology is having on managing risk, increasing claims efficiency, and developing a risk management talent pipeline. For those worried that AI will replace their jobs, they must revisit this view.

The adoption of AI and other emerging technologies is increasing exponentially across the insurance industry, new job titles and responsibilities are forming, and eventually, the talent pool will have to adjust to meet new demand. Prompt engineering, for example, did not exist several years ago, but now it’s the basis of new career paths.

To date, AI has had a remarkable impact on workers’ compensation and claims management, and we can expect that impact to increase over time. However, if we cannot fill open roles with professionals who understand both technological and human aspects of claims management, I fear the industry will not accelerate at the pace that is needed to ensure constant care and support for injured workers.

See also:

• How to invest in workers with disabilities
• The cost of hidden chronic conditions
• Cold weather workplace injuries surge amid arctic blasts