Claims industry must learn when to ditch human touch in favor of efficiency

Published: January 31, 2019

Updated: February 28, 2019

Author: Luke Jones



Canadian insurers are often told one of the best ways to reach customers is to become more personable. However, the human touch should not extend to all areas of the industry, and especially not in claims. Speakers at the recent Ontario Insurance Adjusters Association’s 2019 Claims Conference suggest a human touch should not be used in claims where it is not needed.

Streamlining some processes should be the goal. For example, in the health claims system for auto insurance. Removing the human middleman and using electronic movement for auto insurance claims forms is an example of how to successfully streamline.

“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. “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.”

Monica Kuzyk, vice president of Curo Claims Services agrees, and offered another example where the human touch is slowing processes. She discussed adjusters rechecking invoices that have already been approved through estimates, calling the practice “crazy, that shouldn’t be happening”.

Kuzyk points out the industry is complicating 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.”

None of this is to suggest humans are no longer necessary in the claims industry.

“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.”

“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,” Kuzyk added. “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.”