Evidence-based claims adjudication: a technology-based learning tool for automobile insurance claims adjusters

Abstract

My thesis aimed to 1) develop an evidence-based claims adjudication framework for automobile insurance claims adjusters; 2) develop a technology-based learning (TBL) tool to train Aviva Canada claims adjusters about evidence-based claims adjudication and the evidence-based management of neck pain; and 3) evaluate the learning, design and engagement constructs of the tool. I adapted Sackett’s evidence-based medicine framework for claims adjudication. I conducted a systematic review of the literature to determine the effectiveness of TBL tools to improve claims adjusters’ knowledge of clinical practice guidelines. I developed an online, asynchronous, self-directed, module-based curriculum. I evaluated the learner-centered constructs of the TBL tool in a sample of adjusters using a validated questionnaire. Results indicated the majority of participating adjusters agreed with the learning, design and engagement constructs of the TBL tool. My research can be used to inform future development of online tools to educate and train adjusters about clinical evidence.