Workers’ Compensation Claims: Maintaining Trust in Claims Handling : Risk & Insurance

In workers’ compensation, trust isn’t just a two-way street — it’s the only direct route from injury back to work. Yet, insurers and employers are operating in an historically challenging environment.

Suspicion of corporations and corporate leadership is at an all-time high among workers; a 2024 PwC study found that 70% of employees don’t trust their company’s leaders to follow through on commitments. Litigation in workers’ comp remains a top concern for industry executives, threatening to drive up costs and prolong claims.

In a climate defined by skepticism, empathy and communication are absolutely crucial to engendering good will and supporting workers through their most challenging moments. From thoughtfully adopting artificial intelligence (AI) in claims handling to building integrated communications procedures and emphasizing emotional intelligence training for claims handlers, insurers are taking a multi-pronged approach to improving workers’ comp outcomes.

“Our standard is that an injured worker feels cared for, and doesn’t feel ‘processed,’ if you will,” said Jason Wheeler, CSO of CorVel. “The worker’s life’s been disrupted. It’s up to us to minimize that disruption and restore their future.”

Getting and Staying Connected

There’s no time to lose at the outset of an injury, when workers are at their most vulnerable and need guidance — both to get medical care and to plan for potential scenarios that impact their household’s financial stability. The first few hours following an incident often dictate the entire trajectory of the claim, setting the tone for either cooperation or adversarial litigation.

Annette LaBarre, SVP Claims, National Accounts, MSIG USA

Recognizing this critical window, Arch Insurance requires its third-party administrators (TPAs) to make 24-hour, three-point contact with the injured worker, employer and medical provider, said Mario Bracuti, SVP of Workers’ Compensation Claims at the company.

“We expect TPA partners to help the injured worker understand the claim process, set expectations, put them at ease, and answer any questions they may have with their claim. TPAs explain when and how injured workers can expect indemnity checks, and how medical bills are submitted for payment. This helps reduce injured workers’ financial anxiety.”

Even before a formal claim is submitted by the employer, injured workers can contact a TPA nurse triage service to help determine if the worker needs self-care, or to visit an urgent care center, ER, or a preferred provider medical network. Unlike traditional nurse case management, which is typically offered after medical treatment begins, early nurse triage can operate almost as a concierge service, and a tangible value-add for workers.

Data underscores the efficacy of this immediate outreach, where almost 50% of initial triage calls result in self-care, which can safely reduce unnecessary claims for both the employer and Arch, while helping the injured worker find their proper level of care.

At Broadspire, multiple ongoing touchpoints ensure a constant stream of communication with injured workers throughout the life of a claim, said Dan Garrett, chief claims officer.

“Adjusters check in at least every 30 days, including ongoing text-based outreach to support recovery and address questions where permitted and with appropriate consent,” Garrett said. “Nurse case managers and medical teams also support care and help explain changes in treatment plans as directed by the treating provider.”

By maintaining this rhythm, carriers prevent the information vacuums that can breed anxiety, spurring workers to seek legal counsel.

Better Relationships

While consistent communication is the goal, speed is also an expectation. Fast, targeted interactions with injured workers are increasingly conducted via text messaging and digital portals.

“We now have the ability to acknowledge the loss almost immediately, to engage with an injured worker within hours versus two days,” said Annette LaBarre, SVP Claims, National Accounts at MSIG USA. Additionally, MSIG USA is in the process of developing additional technology capabilities to streamline documentation and communication.

While CorVel has offered its MyCare mobile app for more than a decade, the company is now expanding MyCare to include a fully desktop and mobile responsive website.

“We’ve found that especially for short-term care episodes, workers don’t always want to download an app,” Wheeler said. “Just being able to log in directly from a phone or computer makes a difference.”

In parallel with mobile tech, the race to adopt AI continues. Workers’ comp insurers remain cautiously optimistic, carefully balancing technological capability with human oversight.

“AI will have a transformative impact, and we want to use it where it makes sense and be careful when it comes to safety,” said Paul King, President of MyMatrixx by Evernorth.

“Using AI makes sense for discrete logical decision-making or data summarization, but when you think about a value judgment ­— for prior authorization or clinical intervention with a provider — machine learning and expert systems are a helpful tool, but they won’t replace the clinicians making those value-based calls for the immediate future.”

CorVel is using AI to summarize complex historical data on its platforms, Wheeler said.

“AI helps organize and summarize large volumes of claim information in real time. When you take over a claim that’s six months old, it takes time to get up to speed. Now we’re able to just click a button and bring up a full summary of the claim. We’re adding a query piece like ChatGPT so that injured workers, clients, and account managers can ask questions about claims.”

Ultimately, the true value of AI in workers’ compensation may not be in replacing humans, but in empowering them. At MSIG USA, LaBarre aims to deploy AI primarily to free up resources for work that requires human intuition and empathy.

Real People Who Really Care

Technology can speed up communication, help claims handlers synthesize complex information, and improve efficiencies, but the overall quality of the experience — and the perception that the employer and insurer are trustworthy — ultimately comes down to the people interfacing with the worker.

“Knowing that the person trying to help you has the ability to empathize with you is key,” LaBarre said. “It’s more than customer service — it’s being an advocate for that injured party.”

Jason Wheeler, CSO, CorVel

This advocacy mindset is critical, given that most injured workers have no prior experience with the system and arrive with a high degree of uncertainty, said Brent Bland, Senior Vice President and Head of Workers’ Compensation Claims at AmTrust.

“We develop trust through sharing detailed information on the claim process and what to expect,” Bland said. “Key principles embedded in our handling guidelines, training curriculum, and quality program include timely delivery of benefits, acting with a sense of urgency, and fair dealing in all circumstances.”

Similarly, Broadspire requires its workers’ compensation adjusters and team managers to complete mandatory empathy-based advocacy training, grounded in a simple principle: Treat the injured worker as a person, not a claim number.

“The training emphasizes communication tone and trust-building, emotional awareness, and consistent, supportive interactions,” Garrett explains.

At the same time, empathy cannot begin and end on the insurer’s side. Employers must also play an active role, keeping a positive workplace culture intact for the injured employee. LaBarre notes that employers can find immense value in creating their own internal advocacy roles.

“One of the things that I’ve recommended to larger insureds is creating some sort of workers’ compensation advocate role within their own organizations,” LaBarre said.

Whole-Person Health

Another profound shift helping build trust in workers’ compensation is a transition toward a “whole-person” health approach. Rather than viewing an injured worker through the lens of a specific injury, carriers are centering on patient well-being. As more states and municipalities redefine workers’ comp to include presumptive coverage for conditions like hypertension, mental health, cancer and other chronic illnesses, the scope of care has widened significantly.

“If you go back five years, in workers’ compensation, the medication composite was 70% pain management,” King points out. “Now it’s 50% pain management. The balance is chronic condition disease management.”

To quantify the impact of this holistic approach, MyMatrixx recently conducted a study with one of its larger payer partners. The study analyzed two groups of claimants, introducing early care-path support to one of the cohorts. The results were stark.

“Pharmacy spend was lower by $1,000 to $2,000 per claimant, and clinical spend was down by an additional $400. The kicker was that the claims closed 17-18 percent faster — an average of 79 days sooner due to a clinical intervention earlier in the claim, meaning return to work happened much faster.”

Raising the Bar for Provider Networks and Supply Chains

Developing systemic trust requires looking beyond the immediate relationship between insurers, employers, and workers. Healthcare providers and specialized vendors must also be integrated into collaborative advocacy efforts.

“What we’ve recommended to our policyholders is to invite network physicians into your facility,” LaBarre said. “Engage them, and develop relationships with them so that they, in turn, develop relationships with any injured employee that may come across their office.”

Furthermore, given the regulatory evolution toward presumptive care, King notes that MyMatrixx is seeing a growing need for highly specialized care and specialty medications. To inspire confidence among injured workers and employers alike, creating more transparency in the pharmaceutical and medical supply chain will be central.

“We want to deliver the care appropriately, timely, and affordably,” King said. “With our networks, we are moving forward with different models that would be 100 percent transparent, where we just maintain a flat fee for service and our clients are able to pay the same rates we pay for the medication.”

A Sustainable Return to Work

Every component of an advocacy-led workers’ compensation model — from the first call to transparent pharmacy networks — is built on the same goal: a successful return to work. Achieving this milestone requires an active, organic connection between the workplace and the employee during recovery.

Return-to-work initiatives often fail when employees are left in the dark about their modified duties, or when they feel pressured to perform tasks beyond their current physical capabilities. Preventing this disconnect requires continuous communication, clear expectations, and structured transitional duty programs that respect the worker’s recovery timeline.

“It’s in all parties’ best interests to ensure the best possible outcome. It’s the right thing to do. We want to help the worker achieve their pre-injury level of function and the best outcome for the injured worker, the employer, and the carrier,” Bracuti said.

By shifting the industry paradigm from transactional claims management to human advocacy, insurers are discovering that efficiency and empathy are not mutually exclusive. Treating an injured employee with dignity often leads to faster healing, reduced litigation, and lower overall cost.

“In the end, the most meaningful measure is still the injured worker’s experience,” Garrett said. “When people feel informed, supported, and guided through a stressful moment, it’s a strong indication that the model is doing what it is designed to do.” &