Rapid Assessment of Disability Claims During and Post COVID-19

Eligibility monitoring for increased disability claims during & post COVID-19.

Project Budget* - $12.7M

Partner Co-investment* - $8M

Supercluster Co-investment* - $4.7M

Project Collaborators

Project Overview

In the past, downturns in the Canadian economy have triggered higher than normal insurance disability claims. The current COVID-19 pandemic has caused an exceptionally large spike in life & disability claims (both legitimate and malingered). These disability claims are due to the health and physical impact of Covid-19 as well as mental impact of the pandemic led by increased loss in jobs and life.

This increased level of disability claims translates into higher cost of group benefits and insurance for employers sometime by up to 30 per cent costing Canadians ~$4 billion. Higher premiums will be hard for the many businesses already reeling from the pandemic shutdown. Having to pay an extra $300 per staff member could prompt small and medium businesses to opt for reduced health benefit plans, layoffs or wage freezes.

The Rapid Assessment of Disability Claims during and post COVID-19 project is aiming to limit the rise in premiums by building a tool to discover the malingered or fraudulent applications that could make up to 10 per cent of disability claims. These claims can rapidly escalate insurance costs.

Project lead, Owl Labs, has developed and is enhancing a technology platform that can more rapidly assess disability applications and supporting evidence to see if the application meets eligibility requirements while flagging suspicious claims. Current methods rely primarily on manual analysis and depend on agents reviewing based on their “feel” during interactions with applicants, or claimants refusal to submit documents on time. This process only uncovers a small portion of fraudulent claims leaving Canadians and Canadian businesses susceptible to increased premium payments.

The automated review process will look for supporting or suspicious evidence, then use that to provide agents with a prioritized list of highly suspicious claims and only the related evidence for further review. This is expected to boost the fraud detection rate by a factor of four and eliminate the human biases that typically cloud the manual process. In addition, this tool ensures more privacy because an investigator does not have personal details on all applicants and the process is encrypted from start to finish.

Automated assessments will also help speed up payments to eligible applicants, helping those individuals in their time of need.

In the future, the platform will be adapted to help detect fraud for other types of insurance, including workers compensation and health.

*amounts at time of project selection

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