We don't envy personal injury claims assessors. For all the industry expertise and experience they possess, they’re constantly buried in complex documents.
For every claim there’s a long, unformatted medical report, littered with complex and sensitive information. And for each report, a whole history of case admin to root through: details of the accident, medical history, symptoms, treatment received, diagnostics, and more.
Quickly absorbing this information to judge the overall credibility of each claim, while following a set of industry regulations and internal best practices – all while a backlog of hundreds of new claims piles up – is a daunting task for an assessor with only a desktop and a strong coffee for support.
Armed with the combined power of Decision Intelligence and Gen AI, though, this becomes a different story.
Turning complex reports into readymade outcomes
The medical reports in personal injury claims are a perfect use case for the combined powers of Gen AI and Decision Intelligence, which can first interpret, and then infer, reasoned decisions from the information within them to arrive at an intelligent outcome.
Let’s take a walk through how that works in practice, in a process we call Decision Augmentation.
- Gen AI extracts relevant information from the body of the medical report.
Saving time-consuming manual work, your Large Language Model (LLM) can automatically interpret free format reports to extract information such as the name of the claimant, type of accident, dates and more, and present it to your claims assessor.
- Decision Intelligence automatically fires prompts to your LLM to check information and suggest next steps.
viabl.ai, our Decision Intelligence platform, checks and clarifies information in the medical report by automatically firing a series of LLM prompts, driven by the pre-captured domain knowledge of expert risk assessors.
By following a line of questioning in a Decision Tree modeled on your company’s best practices, viabl.ai is able to reach an objective, transparent and auditable assessment of the claim, as well as fill in missing or ambiguous information.
- Your claims assessor makes an informed call about the merits of the personal injury claim.
Presented to your claims assessors in easy UI dashboards, viabl.ai assists your experts in quickly establishing the overall validity of the claim pertaining to the medical report.
And because viabl.ai’s Decision Intelligence is based on your domain expertise, you can rely on its built-in compliance guard-rails for cross-checking the LLM results to verify claims and mitigate against the risk of errors (or hallucinations).
- viabl.ai applies decision mining to predict the expected claims cost and confirm level of cover
Decision Augmentation isn’t just about accelerating case-processing; it also enables the claims handler to make better, more informed decisions. A technique called decision mining can be used to predict the cost of the claim based on historical claims data to determine coverage, and to make recommendations on the right level of compensation and any conditions to be applied.
This model can continuously improve over time, as more data becomes available with each case that is processed. In effect, every new insurance claim becomes a mechanism for optimising claims performance.
- Rinse and repeat at scale.
Take your new AI-powered claims assessment process company-wide to enhance and accelerate decision-making across the board. By applying Decision Augmentation at scale, your firm can see a 40% reduction in Average Handling Times across thousands of claims.
And with 80% of the world’s data residing in unstructured text according to IBM, it’s likely there’ll be many more document-heavy use cases in your business that can be transformed with viabl.ai.
Are you or any of your claims assessment teams drowning in your caseload? Buried in documents and reports? Now’s the time to act, before your backlogs do any more damage to your bottom line — or your overworked assessors.
Get in touch today to discuss what Decision Augmentation can do for your insurance claims assessors.