AI-Enabled Fraud Tops List Of Emerging Claim Severity Risks, Survey Finds

AI-enabled fraud and data authenticity is the factor most likely to increase claim severity over the next three to five years, according to nearly a third, or 32%, of attendees surveyed at the 2026 RIMS conference by CorVel. Social inflation, including larger verdicts and prolonged litigation, ranked second as a likely cost driver at 25%, the survey at the conference found.

Other factors RIMS conference attendees cited as most likely to increase claims severity were: medical inflation and more complex comorbidities, 17%; economic volatility tied to supply chain or tariff-driven cost pressure, 14%; and workforce constraints related to adjuster capacity and experience gaps, 11%.

CorVel said the results reflect an industry navigating rapid transformation as new technologies create opportunities for efficiency while introducing emerging risks and implementation challenges.

Fraud Concerns Rise With AI Sophistication

CorVel said the survey results point to a growing reality for claims organizations as AI becomes more accessible and sophisticated: concerns around fraudulent documentation, manipulated information, and data authenticity are becoming increasingly important. At the same time, the report noted that continued social inflation places pressure on claim costs and litigation exposure.

CorVel said that when implemented responsibly, AI can also serve as a tool for identifying fraud, waste, and abuse by helping claims teams recognize patterns and anomalies that might otherwise go undetected. Effective AI fraud prevention strategies, according to CorVel, include layered verification processes, continuous monitoring, strong governance practices, and ongoing education for claims teams.

That tension between opportunity and risk carried into questions about AI adoption itself. Asked to identify the biggest barrier to using data or AI effectively in claims today, 33% of respondents cited governance concerns, including privacy, security, compliance, and model risk.

CorVel’s survey also found other AI barriers include: a lack of skills or time to operationalize insights, 23%; trust and validation issues, such as difficulty proving return on investment or explaining recommendations, 17%; data silos or poor interoperability across stakeholders, 15%; and budget or integration complexity with legacy systems, 12%.

CorVel said the findings demonstrate that successful AI adoption requires more than innovative technology alone, and that organizations need governance frameworks supporting ongoing transparency, security, and accountability.

Faster Access To Care Seen As Top Opportunity

Asked what would most improve the claimant and injured worker experience while improving outcomes, the top response was faster access to appropriate care, cited by 30%. Next was clearer and more consistent communication, 25%; improved return-to-work planning and accommodations, 19%; better coordination across stakeholders, 14%; and stronger behavioral health support, 12%.

CorVel said the responses reinforce what decades of claims data has consistently shown: early intervention matters, and delays in treatment can affect recovery timelines, increase claim duration, and contribute to higher overall costs. Timely access to appropriate care, the report said, often leads to improved claimant satisfaction, better clinical outcomes, and more efficient claim resolution. CorVel noted that respondents also emphasized communication, return-to-work planning, stakeholder coordination, and behavioral health support, underscoring the value of a holistic approach to claims management.

Execution, Not Just Insight, Defines High Performers

Respondents identified speed, specifically time to triage and first contact, as the characteristic that best differentiates a high-performing claims program today, with 30% selecting that answer. Cost control followed at 27%, and claimant experience and claim outcomes were cited at 22% and 21%, respectively.

Notably, CorVel said no respondents identified proactive insights as the primary differentiator, suggesting that execution remains more important than information alone.

CorVel said the findings reinforce a broader industry truth: even the most sophisticated analytics and technology platforms deliver limited value if they are not effectively integrated into current workflows and action is delayed. Early engagement, rapid triage, and prompt communication, according to the report, create opportunities to influence outcomes before costs escalate and complications emerge.

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