AI’s Evolution in Claims: From Hype to Real Impact

AI has been present in claims for some time—think drone imaging or automated fraud detection—but the use cases are growing more advanced and more accessible. Meanwhile, plaintiff counsel is adopting AI at a rapid pace to simplify their own work, which introduces new urgency for insurers to keep up.

Solutions like Datatrack's DigitalOwl platform now makes AI-powered medical record summarisation, demand letter analysis and intelligent data extraction available to casualty and worker’s compensation teams. 

Here’s what AI is currently doing in claims and where it’s headed:

• Powering medical record summarization, document comparison, and demand letter analysis
• Surfacing actionable insights early in the claims process to support enhanced evaluations
• Identifying inconsistencies across medical and legal documents
• Helping route claims to the right claims professional based on case complexity
• Moving beyond simple data automation to serve as a decision-support tool for frontline professionals

The Skills Claims Professionals Need Now

Curiosity is one of the most important qualities for claims professionals moving forward.

AI will not remove the need for human judgment, but it will require users to think differently. Rather than reviewing every page of a document, claims professionals will need to interpret, evaluate, and guide decision-making based on AI-supported findings. This means getting comfortable testing unfamiliar tools and staying open to change.

Leadership plays a critical role here. Encouraging employees, especially experienced claim professionals, to explore AI for everyday tasks like letter drafting or research creates early familiarity and trust. Appointing a claims champion who understands the technology and can guide teammates through practical use cases is another powerful way to foster confidence and accelerate adoption across the team.

What Makes a Great Leader in an AI-Enabled Claims Operation?

Data will become more accessible, more complex, and more central to every decision. That’s why leaders are accelerating their evaluation of how tools and solutions are used to generate insights and outputs relevant for their organizations.

This shift includes:

• Encouraging claims champions within units to lead adoption
• Helping teams understand the value of AI for their work
• Developing measures of Impact on claim outcomes
• Letting efficiency gains speak for themselves
• Supporting hands-on training for tenured claims professionals
• Some resistance is inevitable. But in most cases, once claims professionals see the accuracy and consistency that AI can bring, they don’t want to go back. The key is to start with real problems and real workflows—and build momentum from there.

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Claims teams are under pressure from all sides. Plaintiff Lawyers are using AI to increase the volume and complexity of demand letters, sometimes sending multiple demands at a time with tight deadlines. With smarter tools and strong leadership, claims professionals can keep up with the rapidly transforming industry.