Workers' Comp Technology Shifts From Automating Tasks to Shaping Claim Decisions
Workers' compensation insurers are moving beyond digitizing processes to using artificial intelligence that directly influences how claims are managed and resolved. The shift reflects a fundamental change in how technology serves the industry: instead of simply handling paperwork faster, it now helps adjusters make better decisions on complex cases.
Sandip Chatterjee, chief product officer at MedRisk, described the evolution plainly. "Technology was largely about digitizing the process - claims systems, document management, rules engines, and reporting," he said. "Today, it's about changing the decisions."
The Caseload Problem
Adjusters face mounting pressure. A survey by Healthesystems found that 55% of adjusters reported having too many claims to manage in 2026, up from 40% the previous year.
This volume forces workers' comp professionals to spend time on administrative tasks instead of higher-value work: fraud identification, Medicare Set-Asides, settlements, and the biopsychosocial model of care that injured workers need.
AI as a Support Tool, Not a Replacement
Industry leaders are careful to frame AI as augmentation rather than automation. "Machine learning, generative AI are no longer about prediction. It's more about augmentation," said Annette Labarre, vice president and director of workers' compensation at MSIG USA.
The practical application is straightforward: tools can now process hundreds of pages of medical records in minutes, work that previously consumed hours of an adjuster's day. But speed alone isn't the goal. "We have to take all that into consideration with empathy," Labarre said, referring to both the injured worker and the adjuster handling the claim.
Claim Summarization and Decision Support
One specific AI application gaining traction is claim summarization. When an adjuster takes over a file or returns to a claim after weeks away, an AI summary provides quick context on what has happened.
Ryan Murphy, VP of product for enterprise claims at CorVel, explained the difference from earlier predictive analytics: "We're getting away from just aggregating data to create dashboards and things that would tell you what happened previously on your program, and we're using it more now to inform decisions and support decisions along the way."
Outcomes Matter More Than Speed
Insurance carriers emphasize that time savings are secondary to better claim outcomes. Douglas Anderson, workers' compensation claims leader at Liberty Mutual, said: "Time savings are nice, but we are first and foremost focused on better outcomes through reduced loss costs, better decision quality, and a smoother customer experience."
Liberty Mutual uses claim summarization, chatbots, and custom generative AI tools to improve that experience. Anderson noted that commercial customers have responded positively to AI products like predictive model alerts and automatically-generated summaries.
"Our philosophy is to earn the benefits of AI while actively managing the risks, and to treat AI as a governed capability," he said.
Solving Problems, Not Following Trends
With 74% of firms indicating that generative AI is a key claims and underwriting function, there is risk of overhyping technology without delivering results. MedRisk's approach sidesteps that trap by focusing on specific problems.
"We did not choose technology because it was 'AI.' We chose it because it solves three core problems: getting the claim on the right track early, reducing administrative burden, and improving consistency in decision-making," Chatterjee said. "The real test is whether technology improves outcomes without compromising fairness, accuracy, or the claimant experience."
Underwriting Gets Smarter Earlier
AI applications extend beyond claims handling into underwriting. Matt Zender, SVP of workers' compensation strategy at AmTrust, described how the technology identifies which risks need closer attention and which don't.
"Technology helps us to identify which risks deserve deeper underwriting attention, and which ones don't," Zender said. At AmTrust, a majority of submissions now qualify for straight-through processing, eliminating unnecessary manual review on low-risk accounts.
This allows underwriters to focus energy where it matters - on complex risks where human judgment adds real value.
The Human Element Remains Central
Across the industry, leaders stress that adjusters remain the face of the company. MSIG's Labarre put it directly: "It ultimately comes down to having the adjusters be the face of the company and to work directly with the injured workers in a way that helps them recover and know that there's an empathetic person on the other end of that line."
The technology succeeds only when it frees adjusters to do that work - the work that requires judgment, empathy, and expertise that machines cannot replicate.
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