Claimants who have been hurt in an accident or injured at work rarely think about paperwork. Even in minor situations, the biggest worry is more about the issue at hand: the treatment, the cost, and the timeline for the recovery. Injured claimants or workers facing an extended leave absence have plenty on their mind — but not much of it relates to paperwork processing time of their insurance claims. 

However, research tells us the processing time for a health claim – whether it’s workers compensation, medicare, or personal injury coverage — is a very real concern. We know that shorter wait times between the initial injury and the insurance settlement lead to better medical outcomes. Despite this evidence, though, wait times continue to rise: especially when they relate to a health insurance claim. 

What Is Involved in Processing a Claims Settlement, and How Long Does It Take?

Personal injury claims in the United States take between 6 months and 3 years to settle. Workers compensation settlements for claims in the US take between six months and 1-2 years. From the onset and initial injury until the settlement, the process can be long, labor intensive and paperwork heavy. Unfortunately, much of this rests outside of the patient’s control. 

Manual workload is one of the biggest culprits for medical claims. For lawyers, Independent Medical Evaluators (IMEs), and insurance company adjusters, your injury or accident comes with a paper trail. Everything from the physician you saw in the emergency room following an accident, to the time you broke your toe playing tennis is now part of your medical file. Medical, legal, and insurance professionals still process claim documents by hand, and this kind of manual work takes time. 

Say you owned a property and wanted to prove it was damaged by your tenant. To prove the appearance of the property before the damage, you might find pictures or other references to what the property looked like before the move in, with pictures taken on the tenant’s first day. Then you’d document the damage, or maybe even get an expert in to assess how it was caused. You might even interview the neighbors. At the same time, your tenant is uncovering similar information about the property – it’s been damaged before, are you sure it was fixed when they moved in? 

When the example is shifted back to health claim processing, you can see where the delays unfold. The underwriter needs to review each piece of the claim, even if it’s a relatively straightforward case. In complex situations, this process can be even more resource intensive. The insurance adjuster will look at the circumstances leading up to the claim, the coverage you have in place, and the results of any witness testimonies, medical reports, or IME findings. 

All of the medical record review takes around 30 days in a normal case. However, the procedures are important for insurance companies to have. Just like our hypothetical landlord taking ‘before’ pictures of their property, you want to prove that an injury was caused by an accident and the lawyer, doctor, or other professional examining your case will need to show that the same part of your body was working fine prior to the claim.  All this prior work and review means you can prove the extent of the injury or accident, and get the settlement you deserve at the end of the claim. 

How Can AI Help Speed Up Health Claim Settlements?

Shortening this wait time is good for both the injured party and those involved in the claim. Shorter processing times mean less burnout among doctors, lawyers, and other insurance professionals. Less paperwork helps chip away at the underwriting losses plaguing the insurance industry as a whole. So how can we reduce the wait? 

More efficient, tech driven insurance processes aren’t just on the way: they’re already here. Today’s ‘human in the loop’ insurance tools for claims processing can be used to unblock paperwork backlogs by doing manual tasks (like removing duplicates, indexing files, generating summaries, and creating a timeline) faster than a human brain. Then, the human insurance adjuster  can step in to review these insights in a fraction of the time. This means getting more of their cases off of their desk and into the ‘completed’ stage — and more injured parties past the most stressful part of settling a claim.