Are Computer “Bots” Making Your Healthcare Decisions?
Enigma Forensics CEO Lee Neubecker and David Bryant from Bryant Legal Group discuss computer “bots” used by insurance companies as a way to underwrite policies and making insurance claims decisions. Bots are now determining how a given claim should be scored. See how ediscovery plays a role in getting success for your client.
The transcript of the video follows
Lee Neubecker: I’m here today with David Bryant from the Bryant Legal Group and we’re going to talk a little bit about health insurance claims in his work, helping people get the coverage they deserve.
David Bryant: Nice to be here, Lee, thanks for taking the time to stop by. We’re seeing a very significant shift in the insurance industry with respect to claims adjudication and claims determinations. One way of looking at how this change is happening is to look at the dollar volume that’s being invested into underwriting insurance policies and making claims decisions. The first metric I’d like to share with you is there is a company out of Europe that did some research on money flowing into what’s now called Insurance Tech, and approximately two billion dollars went into the Insurance Tech arena in 2016. This money is being deployed into not only underwriting, but how claims are made and I think everyone out there is familiar with Watson and the new term artificial intelligence. And how that’s playing out in the insurance industry is that a lot of claims decision-making is being taken out of the hands of individuals and being given to what we’ll call “bots”, robots, or termed a “bot” in tech speak. So these algorithms which will be designed by very bright people, such as yourself, to determine what a given claim should be scored. And if there’s a certain score, then a claims individual will be required to deny that claim. This is problematic for some of the insurance companies because if it’s discovered, through the discovery process, it can wind up hurting them in litigation for bad faith denial of a claim.
Lee Neubecker: So, David, can you tell me a little bit about what you do at the onset of one of your case matters to help make sure that you could argue your case in court?
David Bryant: So there’s really two phases to insurance claims. There’s the appeal process and then there is court. If your claim is denied I can always sue an insurance company in court. Typically that’s in Federal Court. I primarily practice in Federal Court but I do State Court as well. So once I wind up in a court setting I will send a litigation hold letter to the general counsel of the insurance company and that letter secures that all of the data in its electronic format is preserved. So if I want the emails on a particular claim individuals hard drive, that information should be present when I request that information by way of that litigation hold letter. When I do discovery in Federal Court we’re looking for electronically stored information. I’m not looking for paper any longer because we’re looking to get the metadata that’s embedded in that electronic information so we can find out who looked at it, when it was looked at, when it was altered. So, Enigma Forensics having the skill set to be able to determine who touches electronic files, who views electronic files, we will bring in your firm in those circumstances when we want that type of information in litigation. Lee Neubecker: So can you give me an example of when you’ve had to rely upon our computer forensic services for us to help you out with a matter and how that played a role in getting success for your client?
David Bryant: So we handle primarily health insurance and disability insurance claims on behalf of individuals and physician groups. So one of the matters that you handled for us dealt with a disability insurance claim and we were looking for certain key words and key word phrases that were on the server or hard drives of the particular individuals at the insurance company. Being able to cull through all this data is a Herculean task and would be extremely expensive for the defendants. So the defendants will typically go to the Court and say, “Judge, this is going to cost us way too much “money and interrupt our normal course of business. “We don’t want, Mr. Bryant, to have access “to this information or put us through the trouble “and cost of doing it.” I brought in your firm and your services and you were able to explain to the judge that you could do a search of all of the information held by the insurance company and find these key words and submit them to the Court in-camera, so there was no privacy concerns, and report to the judge what your findings were. The case soon settled thereafter.
Lee Neubecker: They usually do. Well thank you for being on the show today. If you need to reach David, his info is on the screen. Thank you.