All claims adjusters face both complicated and straightforward cases when processing personal claims. When handling those complex claims, we mainly see three common challenges.

Desktop assessments – without the need for outside help

Personal claims management begins when a claim is filed and a claims adjuster is assigned to the case. The claims adjuster gathers all necessary information to make an assessment, like medical journals.

For many cases, the claims adjuster doesn’t need outside help. Cases like these are commonly called desktop assessments, and it means the claims handler assesses without help from a medical advisor. The claims adjuster then has the mandate and everything they need to make the assessment themselves. This way of working is common in many countries like Sweden, although the process might look different in other countries.

Handling complex claims

For more complex and complicated personal claims, the process isn’t as straightforward. Several areas of medical expertise might be needed for significant injuries and accidents with physical and mental disorders. It may require additional supporting data and an assessment from a medical advisor employed by the insurance company or an external party.

Handling these complex claims will result in a few common challenges; these are the main three.

Challenge 1: inefficiency

Many insurance companies are still handling processes manually, without digital tools. The process might be exceptionally handled – but is often very ineffective. The processing time where documents are being scanned and sent back and forth through the postal service or email takes a lot of time. Also, the different ways of handling medical journals – both manually and digitally – take time.

This mixture of analog and digital makes the process inefficient, and it ends up being time-consuming for both the insurance company and the claimant. A smarter digital approach needs to be implemented. Read more about Mavera’s solution and how we have created a smarter way to manage personal claims.

Challenge 2: security

In personal claims management, sensitive information is at the center, and it is crucial to handle it according to rules and regulations, such as the GDPR. Because of this combination of analog and digital systems and ways of working, a lot of paperwork is involved, and claims adjusters must manually move information between systems, which is a security risk.

Human errors, such as documents disappearing in mail handling, happen and are obviously a security risk. A lot of medical statements are also saved on local computers to be uploaded to different systems. Such security hatches are also dangerous.

Challenge 3: subjectivity

It is an undeniable fact that both a claims adjuster’s and medical advisor’s subjective opinions and previous experience could unintentionally influence a case. After all, we are only humans.

We at Mavera know that all insurance companies want to do what’s right and make the best possible decisions for their clients. To do so and to be able to make decisions as unbiased as possible, we offer reliable decision support for claims adjusters and medical advisors.

Challenges associated with desktop assessments

The three challenges described above are also affecting desktop assessments. Since these are the majority of cases, automating some parts can lead to substantial time savings. However, as they also contain sensitive personal information, they must be handled according to all necessary rules and regulations.

Desktop assessments handle more uncomplicated matters, but even though they focus on minor injuries, it’s vital that neither previous experiences or subjectivity influence the decisions. The claims adjuster has a lot of responsibility to make sure this doesn’t happen.

Continue reading: Internal digital development vs. an insurance platform provider

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