Workers Comp

Artificial intelligence may help combat workers comp fraud

Louise Esola

October 17, 2018 Reprints

Claims Management Technology Workers Comp Cost Control Workers Comp Coverage More + Less -

Artificial intelligence has the potential to become a useful tool in efforts to detect workers compensation fraud, experts say.

Insurers who utilize chatbots — either a computerized voice on the phone or an online chat with a computer — in early claims processing can get more information than they would the traditional way, said James Benham, chief executive officer of Bryan, Texas-based JNKnowledge Inc., a technology firm that creates insurtech solutions.

“We are enabling injured workers to communicate with insurance companies over voice instead of filling out forms,” he said.

“People hate writing things … when you allow them to speak something, you get more information,” Mr. Benham added.

Chatbots can transcribe these conversations, enabling claims organizations and risk managers to get as much as 10 times the information they would have received on a form, he said.

“When you compare safety reports that are written versus spoken you see so much more,” Mr. Benham said. “If you are a risk manager, you always want more information (on incidents).”

Fraud detection is another plus when it comes to artificial intelligence such as chatbots, with the emerging technology having the ability to identify verbal cues such as long pauses that may indicate possible fraud, experts say.

Skip Brechtel, Metairie, Louisiana-based executive vice president and chief information officer for third-party administrator Cannon Cochran Management Services Inc., said the industry is closely watching the fraud detection technology.

“By the tone of voice you can verify whether the claimant is being truthful or providing potentially fraudulent information,” said Mr. Brechtel.

“It won’t give you a guaranteed result, but it will tell you that the person has the potential to be lying,” added Mr. Benham.