AI, Chatbots

5 Use Cases for Chatbots in Workers Compensation

By 7 Minute Read

chatbots in workers compensation

In this blog, I want to explain how health insurance chatbots in workers compensation (workers comp) enable diverse stakeholders to engage more seamlessly and access the information they need in the reporting and handling of workers’ claims and payments.

AI at Work for Workers Compensation 

Much has been written about how chatbots and conversational AI is shaping the future of customer service and the contact center. For workers’ compensation insurance, the technology has far-reaching implications for how a broad range of stakeholders can access information regarding entitlements and navigate the whole claims and claims payment processes in more seamless and automated ways. 

Let’s take a look at the unique characteristics of this segment of the insurance market and how employers, injured employees, attorneys, medical providers, adjusters, brokers and other potential stakeholders can engage with a single chatbot to request information, check eligibility, report a claim, track the status of a claim or a claims payment, enroll in automatic payments, request payments, and receive answers to many other queries. 

Having so many different stakeholders in a process creates its own challenges as each may have a similar question that requires a different response based on who is asking. The good news is that a single chatbot can be designed and deployed to handle this. 

The Scale of Workers’ Compensation Insurance

Work-related accidents or illnesses are an unfortunate reality and one that requires businesses to purchase workers’ comp insurance. Private health insurance doesn’t necessarily cover the  costs of a work-related injury to an employee nor does it cover loss of income while a worker is recovering. This makes workers’ comp essential for employers and employees alike and it is mandated by most states in the USA for all employers.

It’s estimated that there are approximately 5 million claims made on workers’ compensation insurance annually with the providers paying out more than $62 billion per year in the US. The overall employers’ cost for insurance is over $100 billion per annum. This makes it a significant albeit small sector relative to the overall insurance market and one that has its own unique characteristics and players.

How workers’ compensation providers coordinate the information around medical benefits, entitlements, claims and payments and how well they provide access to information is key to their success. 

Making the Case for Chatbots in Workers Compensation Insurance

In any industry that has high levels of interactions and transactions across the stakeholder ecosystem, it’s easy to argue the case for more automated and frictionless engagement. Artificial Intelligence (AI) technology in the form of conversational bots (chatbots) that can understand natural language, respond appropriately, and automate workflows is at the forefront of automating digital interactions.

Digital technologies and devices have now made it possible to provide 24/7 self-service to consumers and stakeholders while also meeting the needs of a growing number of consumers that embrace the convenience of interacting with a bot to have their issues addressed and resolved. 

Chatbots, or digital assistants, can also play a complementary and supportive role to human agents, handling out-of-hours queries and routine steps in claims, payments, and billing processes. In doing so this gives human service reps more time to handle complex processes and issues, thereby alleviating pressure on the contact center staff. 

With their ability to manage common requests and workflows while recognizing when to hand off to a human agent to handle complex issues, their role in workers’ comp is significant in reducing operational costs while simultaneously enhancing user experience. 

Technology has also advanced to make these interactions with digital assistants as secure as possible. Users can be authenticated, data encrypted, chat history wiped, systems securely integrated, and data protected in secure and isolated environments. This enables more sophisticated business use cases that go beyond simple customer service engagements.

In the workers’ comp industry, a chatbot can coordinate all different parties involved in a claim to get information, register the claim, connect with the adjuster to view entitlements, get advice on accessing medical treatment and services, view, query or change payments, change addresses and more. The bot can track all this and update stakeholders on request.

6 Use Cases for Chatbots in Workers’ Comp

So what are the different scenarios for chatbots in this insurance sector or different insurance chatbots use cases?

Here are some examples:

1. Claims Bot (for Claimants and other stakeholders)


As mentioned there are different stakeholders that play a role in the claims process following a work-related employee injury or illness. Not only are the injured worker and the employer (who is the policyholder) key players in the claims process but there may also be medical providers, a broker, an insurance adjuster, and an attorney involved. In the case of state employees there can even be additional nuances that are different to that of the private sector. 

Each stakeholder has different needs and perspectives when it comes to a claim, therefore a bot may need to respond with different answers or resolution paths relative to the role. A claims bot can help these stakeholders in a variety of ways such as:

  • Filing a claim. The bot can help a user access the correct documentation or forms for filing a claim as well as provide advice on how to file. These documents and forms may differ depending on who is making the request so the bot needs to verify the stakeholder and respond accordingly. The bot can make multiple documents or forms available for the user to download. Once completed they can then upload them to the bot. Or alternately, the form can be integrated into the bot and guide a user through completion.
  • Retrieving a claim number. The injured worker may need their claim number but it could also be that their attorney, a broker, or a claims adjuster needs the claim number.
  • Checking the general status of a claim. Different stakeholders may request this info to verify what stage of the process the claim has cleared and if there are any actions required to move the claim forward.
  • Checking medical authorization status. After a claim is filed, an injured worker may want to know if they have authorization to see a medical provider or fill a prescription.
  • Updating profile information such as address, mobile number or email. For example, if the applicant has a change of address they need to inform the insurer so that any correspondence or payment checks are sent to the correct address. And, having an email and/or mobile number on file, broadens the channels for outreach to a claimant. For example, the insurer can send a one time confirmation code via text or email that grants permission for the claimant to securely and efficiently upload documents or complete other actions. 
  • Payment status. In this use case, the bot can reach out and update the applicant on when to expect a check for payment of a claim. The injured party can also check the status  and expected timeframes around payments. If they don’t receive their check within the expected timeframe, they can submit an inquiry.
  • Enroll in a Debit Card Payment. The worker may have an option to enroll in a debit card payment of their claim. The bot can be used to help them enroll and to check if they are eligible for this option and initiate an enrollment letter and code to be sent to the person. This removes a lot of manual steps and time delays in this process.
  • FAQs: Across the entire claims process a bot can also be used to respond to frequently asked questions from any one of the stakeholders. 

But how does a claimant or other stakeholder access the bot? Generally a call comes into the insurer’s IVR system that offers an option to work with the digital assistant. Once the person chooses this option, they are pulled from the IVR, and an SMS with a link to the bot is sent to their mobile device. Alternatively a bot can be made available on the workers compensation providers web portal, where applicable. 

2. Billing Bot (for Employers/Policyholders)
 The employers are the policyholders for workers’ comp insurance and are responsible for submitting premium payments to the insurer. A bot can help with important steps in the billing process, reminding clients of upcoming bills and help process payments.

A billing bot can also provide a quick link to a payment portal (proactively or reactively) where employers can submit their payment. Clients can also review statements and ask billing-related questions of the bot. In doing so the bot can reduce many of the manual-intensive tasks involved in billing as well as increase the level of on-time payments.

 3. Payment Plan Bot (for Employers)
 A payment bot can work with business clients to set up a payment plan. This can include the ability to recognize eligibility for plans, activate plans, split the payment amount into a set number, etc. The bot can work on specific logic to provide the best payment options for clients.

The bot can eliminate many of the manual steps involved in establishing a payment plan and sending out an agreement letter.

4. Collections Bot (for Employers)

Related to the Billing use case, a bot can also be deployed to reach out and remind clients of overdue bills and chase down payments. This helps the workers’ comp insurer to better manage debts and improve cash flow.

5. Registration Bot (for Medical Providers)

This bot helps medical providers (e.g. primary care physicians, specialists, physical therapists, occupational therapists) to register as a participant of the medical provider network to ensure that they are included as an option to provide services under the plan. 

Once registered, medical providers can also use the bot to easily access claim numbers,  claims information, the status of a settlement, billing and payment information, and update their contact information.

6. FAQ (for Employers) 
 An obvious but useful bot is the one that can respond to queries from business clients. This can range from the bot providing information on premium due dates, cancellation details, the amount of premium due, the last premium paid, how to calculate a premium, as well as many other typical queries. In responding to FAQs the bot can also guide the user to a relevant page on their website. 

Orchestrating Multiple Bots with a Single Virtual Assistant

With multiple use cases for bots it may appear complex to manage several bots as well as being difficult to provide a consistent and unified experience to the users. To overcome this challenge, a multi-bot model can be implemented where a master virtual assistant acts as a single interface to the user,  understanding user intent and routing requests to and from the appropriate task-oriented bots. 

This multi-bot model means that additional bots can be added or removed over time without breaking the overall experience. It also makes it easier to architect conversational AI solutions that handle diverse subject matters or use cases across the business. 

With each bot designed to be highly task-oriented it means that a single bot doesn’t have to be created to handle too many diverse intents and tasks, a scenario that leads to a degraded experience. Instead, a single virtual assistant orchestrates across multiple bots while providing a single interface to the user.

This virtual assistant acts as the conduit of all conversations with the user but has the understanding and logic to pass requests to the specific bot that can respond and execute on the intent. For the user this happens behind the scenes so is totally seamless.

How to Get Started with Chatbot Solutions

How can your worker’s compensation business get started with health insurance chatbots? Multi-bot is generally not the starting point. It’s advisable to start with a single use case, choosing one that is manageable and will demonstrate positive results quickly. Often this is something like an FAQ bot that handles the most common queries that are asked but it could even be an internal bot for the business. 

To learn more about chatbot solutions and what they can do for your business please reach out and we’d be happy to talk or provide a demo.

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