1 September 2025 • 3 min read

Claims automation – the twin engine that balances efficiency and empathy

Claims automation acts as a "twin-engine system" that balances high-speed operational efficiency with the human empathy required during catastrophic events. While AI handles predictable, high-volume tasks like fraud detection and triage, human specialists remain essential for navigating complex, emotionally charged cases that build long-term client trust.

iTOO

iTOO

Catastrophic events are high-stress, emotionally charged situations where insurance clients have extremely high expectations and pressure their insurance providers to deliver with absolute precision and no room for error, while also demanding consistent service quality.

AI-driven automation in claims processing functions as a “twin-engine system,” according to Nadia Shiba, Specialist Claims Manager at ITOO Special Risks. In this context, the process involves not only operational efficiency but also the integration of empathy into every client interaction. The balance between technology and human insight is crucial where high stress and heightened client expectations dominate.

“In our world, empathy is tightly coupled with precision, and this pairing is non-negotiable. So, in the context of catastrophic events, this duality becomes even more critical. In this context, AI is not a replacement but a complement to the human element. While automation can streamline the claims process, it cannot replace the human judgment required for nuanced, personalised assessments,” says Shiba.

“What is striking is the macroeconomic toll of these disasters. Weather-related events, such as floods, storms and droughts, are increasing in frequency and severity. Global assessments estimate that disaster-related costs have already exceeded $2.3 trillion, and the trajectory suggests this will only rise.”

This means that insurance providers’ systems must be resilient, scalable and ready to absorb surges in claim volumes without compromising quality. AI can play a vital role here as it can triage and settle straightforward claims, such as those with clear documentation, verifiable imagery and minimal ambiguity.

For example, AI can validate timestamps, detect fraudulent images and confirm alignment with reported events. These are the “standard” claims that can be efficiently processed, freeing up human specialists to focus on the complex ones.

“Complex claims, by contrast, demand cognitive depth and emotional intelligence. They often involve distressed clients, unclear circumstances or disputes that require contextual understanding and negotiation. In these cases, empathy is not a luxury, but the engine of trust. And trust is the currency of our business,” says Shiba.

“Another layer to this is the concept of assignment liability. It is a reminder of the pressure our teams face daily. As caseloads grow, so does the emotional toll. Burnout becomes a real risk, not just for individuals, but for the business as a whole. That is why precision and empathy must be protected as core capabilities. They are not just operational but also strategic.”

Ultimately, in times of crisis, clients expect to be guided. They expect clarity, fairness and human connection. To meet that expectation, insurers need robust planning, emotionally supported teams, and intelligent systems that enhance – not replace – the human touch. AI should be the silent partner that handles the predictable, allowing people to focus on the profound.

However, Shiba notes that any AI solution must do more than automate; it must elevate. Used responsibly and strategically, AI can drive productivity, reduce errors and support better decision-making. But the emphasis must always be on responsible use. If the tools make incorrect decisions, approving what should not be paid, or denying what should be honoured, insurers might not only face operational risk, but also reputational damage.

“In claims, caseloads are a constant, and as we are often reminded that we are the shop window of the business. If our service falters, if our handling lacks precision or empathy, it not only affects the claim; it affects the brand,” she says.

“Personally, I’m optimistic about AI’s potential. I love the idea, but I remain cautious and advocate for its responsible use. As the world evolves, so too will AI, the ability to deliver what is needed will materialise, however human involvement will still be required. Exploration is vital – but so is vigilance.”