You Know Who Hates AI? Insurance Claims Adjusters

(wired.com)

105 points | by joozio 2 days ago

13 comments

  • cm2187 56 minutes ago
    Meanwhile insurance fraudsters love AI, and its ability to manipulate photos!
    • Gigachad 51 minutes ago
      It seems like companies are getting a lot less trusting with their return policies.

      It used to be you just email them a photo or video of the issue and they send you a replacement. Now companies won’t send one until they have received the defective one back.

      • colechristensen 39 minutes ago
        I knew a guy who would buy three different kinds of a thing and return the two he didn't like... regularly. A small number of return abusers ruin things for everybody.

        Then again my last two online purchases, a pair of shoes arrived stained with somebody else's socks in the box and a cordless vacuum arrived with a mismatched brush head for a different model.

        • WarmWash 23 minutes ago
          It's even worse than that, because they are adamant that they aren't abusing the system, and insist that if they didn't want people doing it, they would stop taking returns.
          • estearum 5 minutes ago
            The behavior described in the immediately above comment (ordering multiples and returning ones you don't like) is not abuse. The behavior described above that (lying about a defective item) is abuse.

            Dealing with returns is the tradeoff that online sellers make in order not to put a store in every city or to deal with retail arrangements.

        • jordanb 29 minutes ago
          The thing is this was the pitch for buying clothes online: worried it won't fit? Just return it. No questions asked! We'll even pay return shipping!

          It's interesting how companies are now redefining things they explicitly encouraged their customers to do as "abuse."

          • estearum 6 minutes ago
            The GP described it as abuse. That's not evidence of companies calling it abuse. As you say, this is basically intrinsic to the deal of buying clothes/shoes/etc online and obviously online retailers know that and accept it, or else they would not allow it (and in turn would not exist as businesses).
  • glimshe 2 hours ago
    Ultimately this isn't "AI's fault". As the article points out, clueless executives who don't understand the capabilities and limitations of specific LLMs push the technology on workers so they can say they are "using AI to improve efficiency".
    • antasvara 48 minutes ago
      I don't know, it feels like "reading a claims summary and classifying the type of claim" should be the bread and butter LLM use case? Not that executives are blameless for pushing AI everywhere, but we should also be able to "blame" AI for doing poorly at a task it's supposed to be good at.
      • WarmWash 15 minutes ago
        Not that it is necessarily the case here, but when execs go "AI shopping" they have absolutely _zero_ idea that there are basically 3-4 SOTA models, thousands of smaller models, and then an uncountable number of wrappers on whatever underlying model. The AI landscape that is totally familiar to us is covered in shroud for them.

        So they Google "Insurance claim AI tool", land on a vibecoded SaaS that is just a wrapper on a pocket Chinese model spun as "your next insurance pro", and then are getting the whole department on some lone 19 yr olds weekend project.

      • dpoloncsak 21 minutes ago
        A computer can never be held accountable, therefore a computer must never make a management decision.

        You can't 'blame' the AI, as it can't be held accountable.

        • voncheese 4 minutes ago
          The interesting thing about AI v. other disruptive technologies (like the internet, steam engine, etc), is that AI has been personified both by the manufacturers of it (Anthropic being the most blatant by using a human name for its product) and users.

          That makes it way more likely that people blame AI (doesn't make it right by any means, but does mean that the actual blame gets diffused even more).

      • fluoridation 41 minutes ago
        No, silly. If you pray for something and it comes true then praise be to god; if it doesn't then you did it wrong.
    • sdcfgy 1 hour ago
      Don't underestimate the ability of workers to completely misunderstand the capabilities and drive it from the bottom up too.

      Half my colleagues are besotted with the technology and unaware that it is shaping their decision making, not the other way around.

    • Grombobulous 1 hour ago
      Which clueless executives are we blaming? The ones who purchase products from vendors like OpenAI or AI-powered products that run API calls through OpenAI et al., or the vendors themselves who make bombastic claims about capabilities?

      As an analogy, I don’t know if I fully blame my executives for buying Microsoft Teams when Microsoft Teams turns out to suck. Microsoft promised to my company’s executives that Microsoft Teams doesn’t suck just like Sam Altman promised that AI is so powerful and so capable of exceeding the capabilities of humans that it’s dangerous.

      Maybe at some point some of the B2B customers of AI products will be suing their vendors for the kind of grossly exaggerated marketing we are seeing right now. I think that SaaS companies would never get away with it.

      I don’t know that the executives at my company suddenly lost their mind and decided that hundreds of dollars of AI spend per employee is suddenly justified even though approving a simple $##/month/employee SaaS tool was previously a rigorous slog. The only reason the executives at my company suddenly changed their mind on frugality is becausey they were sold a lie by a huge industry.

      We could consider them clueless for falling for that, or an alternate viewpoint is that they are victims of widespread fraud.

      • hilariously 1 hour ago
        You should. It's their fault for picking a bad vendor. It's their fault for not finding someone with taste to solve the problem. Fundamentally its their business, pretending you can blame someone else for your ultimate accountability is stupid.

        Nobody is forcing you to take poison, and saying "Well Microsoft promised me it isn't poison!!!" at this point, decades into it selling poison, doesn't make much sense.

        • seethishat 1 hour ago
          They didn't pick the bad vendor, the herd did. They all go to the same conferences, attend the same vendor lunches and buy the same garbage. And today, most of the IT managers are not technical at all. They have art degrees and have never been technology practitioners.

          Literally anyone off the street can be a "decision maker" in technology today. Just buy what everyone else is buying and collect a huge paycheck while working remote. People who understand tech and sort of know what they are doing, are not included.

          That has been my experience.

          • WarmWash 9 minutes ago
            My previous landlord was the IT manager of [big bank everyone would recognize] at their headquarters.

            When he asked me to email him scans of a bunch of personal documents, I asked him for his PGP key.

            ..."What's that?"

          • simonuv 57 minutes ago
            [dead]
        • kakacik 1 hour ago
          Thats a fraud and host of other charges with that poison, and I see no difference with overhyped llms.

          You are not correct.

          • hilariously 1 hour ago
            Fool me once, shame on you, fool me ten billion times its still Microsoft's fault you bought the wrong thing.
        • watwut 29 minutes ago
          I think that we need to start blaming vendors for blatant lies. Systematically, again amd again. And actually punish them.

          Somehow the "accountability" shifted from meaning "being reaponsible for not defrauding, lying" into "it is fault of people who were lied to".

      • Aerolfos 1 hour ago
        > We could consider them clueless for falling for that, or an alternate viewpoint is that they are victims of widespread fraud.

        Pretty much what this blog post says: https://hermit-tech.com/blog/ai-mania-is-eviscerating-global...

        It seems pretty bad, no doubt about it

      • le-mark 1 hour ago
        > We could consider them clueless for falling for that, or an alternate viewpoint is that they are victims of widespread fraud.

        This is what they depend on actually. Scape goats for their failures. This quarter takes a hit then number go up.

    • dgellow 1 hour ago
      Given how the AI industry lies about capabilities and is pushing the rollout with all their weight, the blame doesn’t go fully on their customers
    • pj_mukh 53 minutes ago
      But isn’t this also just bad implementations of AI? “It got a stupid simple answer wrong”, seems like a gpt-4o on a buggy RAG implementation from 2 years ago problem.

      Hard to fathom a modern model would get any of this basic stuff wrong. I know accountants using it for (a lot more complex but similar problem) tax law parsing and it going through flawlessly.

      There seems to be some bidirectional media gaslighting happening here where the doomers and glazers are talking past each other a bit.

  • cael450 6 minutes ago
    My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifying services. These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. The entire business model is to drown the practitioner in paperwork then use “peer reviewers” who are nurses that don’t know anything about the treatment to deny claims then waste the practitioner’s time on appeals in the hopes that people will give up. AI has obviously made this process easier and the insurance companies absolutely hate it.

    People have no idea how inefficient the U.S.’s healthcare system is. And it isn’t just the private companies. A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Then the private insurance companies adopt the same practices later.

  • altacc 2 hours ago
  • kkaske 19 minutes ago
    When there is more efficiency its a win for AI. When there are errors its the problem of the humans that are supposed to be using AI and oversee it to "make them more efficient". This has been the main source of AI fatigue for me.
  • bix6 50 minutes ago
    You see Bob, a company is like a clock…
    • chris_va 13 minutes ago
      well let's hope we don't cover him
  • almost 2 hours ago
    LLMs are really good when your primary goal is just to fob people off. So customer support when you don't care about your customers etc. I can imagine it's very appealing when you just want to come up with semi-plausable reasons to deny insurance claims. Who cares if it's wrong? They might give up anyway and you've saved paying out!

    Not saying they're not good for other things, but the "waste people's time and make them go away" use is just so perfect for the capabilities of even cheap models.

    • snarfy 51 minutes ago
      Anybody that has worked on a phone exchange knows they already do this sort of thing. Some customers just never get through to a person. This is by design.
    • larrik 47 minutes ago
      Believe it or not, that's not even the topic of the article.

      The article is entirely about the AI doing the first pass of the claim intake and causing a lot more work for everyone involved instead. Mis-routing, mis-categorization, hallucinating details, etc.

    • LightBug1 2 hours ago
      On the flip-side, LLM's can be pretty good at coming up with almost water-tight stories for the insurance claim!
      • Jgrubb 1 hour ago
        I read and article on here some months ago titled something like "Leftist usecases for LLMs" and one of them was negotiating bureaucracies, and that reminds me, I need to call back JCP&L about my Board of Public Utilities complaint that an LLM helped me out together.

        You see, I live with in a rural area and especially since LED light bulbs have become the thing, it's been clear that we are delivered far less than 120v service a lot of the time. We live about 200 yards from the transformer that we share with several other houses, too many I believe. About two years ago I set up Home Assistant and bought one of those power monitoring rigs that you put on each circuit in your breaker box, mostly I just wanted data about where my power bill money was going. I work in FinOps in case anyone was curious.

        Anyhoo, couple years later I'm analyzing several months worth of power bills vs the circuit meter readings to quantify where I can make some upgrades and save some money. After a day or so of this I mention to Claude about the voltage issues and sure enough, it puts together a whole packet for me documenting brownouts down to 95v and routine brownouts below 110v. It helps me fill out the BPU complaint form.

        2 days later I get a call from JCP&L (unfortunately to my wife's phone because it's her name as the primary on the account). I want a new, larger transformer for myself and my neighbors, so I need to call them back today.

        • bigfishrunning 1 hour ago
          If you were monitoring the power coming into your house, why did you need claude to "put together a whole packet documenting brownouts"? Shouldn't you just have the raw data, maybe highlighted with the offending parts? Or was the prose of your complaint the issue?
          • throwaway173738 58 minutes ago
            Frequently you have to mention specific laws and describe how your situation matches the law or your complaints get ignored. At least this is how it works when you call your insurance company and make similar complaints.
          • bluGill 51 minutes ago
            There is still a lot of work to take the raw data and put it into a useful format. LLMs are really good at that (when they don't hallucinate data).
  • tonyhart7 2 hours ago
    So AI is going to take jobs not because AI is necessarily better or more appropriate, but because it accelerates bad decision making and makes those decisions exponentially worse.
    • vintermann 1 hour ago
      Well, more because it pulverizes personal responsibility for bad decisions ("I didn't deny your claim, the computer did"). But yeah.
      • axus 24 minutes ago
        When you remove decision-making, there is still responsibility for negligence
      • dgellow 1 hour ago
        See OpenAI putting the blame on a “rogue agent” for their own systems hacking other companies (which is a felony!!!!). When in reality they obviously control the while loop and tool call dispatching of the agents. But they decided to train attacker models, then run thousands of instances in parallel with the goal to solve hacking problems with close to no supervision and full execution privilege…
        • kakacik 1 hour ago
          That company is highly amoral from top to bottom (yes even innocent Joe just cashing his million + bonuses while seeing all this crap and much more from inside and happily chugging along with 'just paying off that mortgage' tunnel vision).

          Except shit, amoral behavior, backstabbing, lying at all times, just to get those sweet money and power.

      • tonyhart7 1 hour ago
        so basically manager and exec dream
        • vintermann 1 hour ago
          Sometimes when I use coding agents I wonder, is this what having employees feel like? But it seems like a lot of employers get entirely other things out of it.
        • Muromec 1 hour ago
          illegal in EU so we will be left behind by this innovation.
    • Muromec 1 hour ago
      AI is going to take jobs because the company has to pay for AI and has less money to pay you a salary.
    • LelouBil 57 minutes ago
      That's why the eu AI act makes every person affected by an AI decision in most relevant industries entitled to a human explanation.
  • dash2 2 hours ago
    > Between May 2025 and May 2026, employment in the sector dropped a staggering 21 percent, according to BLS data.

    Yeah sure. I mean, same reason why HN readers hate AI, right? It replaces their jobs.

    (Obviously the difference is that the poor old claims adjusters didn't spend the last two decades "disrupting" every other industry and telling everyone else to "learn to code". Ha! If you hear a faint high noise, that's the sound of the rest of the world playing a violin, made of highly disruptive nanomaterials.)

    • mrweasel 47 minutes ago
      There are probably two camps in IT (in terms of hating AI). One is afraid that AI will replace them, the other is about to rage quit because AI is damaging to their mental health, but being forced on them by management which is as clueless that those of the insurance claims adjusters.
    • nvahalik 1 hour ago
      AI isn’t replacing adjusters.

      Anecdotally, many of them are aging out and the demands of adjusters are increasing while the pay hasn’t necessarily gone up. While technically you don’t have to know the ins and outs of construction, it helps a lot and there are just not a lot of people who have that knowledge. And if they do, they often go into construction themselves or sell roofs. Both of which can be far more lucrative.

      On top of that, claims software has a lot of automation but very little real AI surface area. A lot of the things AI is good at (text generation) must have certain verbiage or use legally approved templates.

      Granted, this may not be the case for all verticals, but this is just my observation from 20 years. (Mostly in smaller IA firms and state-based institutions).

      Also, my wife has pointed out that there haven’t been any major cats in the last few years. Katrina kept people working for years. A lack of big storms has also contributed to this.

      • dspillett 44 minutes ago
        > AI isn’t replacing adjusters.

        > Anecdotally, many of them are aging out

        Ageing and out and neither being replaced directly or reduce numbers coming in at the bottom/mid as others move up, is still a drop in people. If part of the reason there is less need to bring people in lower down is that a few are being expected to do the work of a few more due to automation via AI, then that is AI replacing them, just not quite as directly as “we need less people as AI makes each more efficient so there are redundancies”.

    • piltdownman 1 hour ago
      The difference being that the role of Engineer wasn't conceived as a layer of friction between consumers and their statutory rights to the point where a U.S. Senate subcommittee probe (Senate Homeland Security Subcommittee on Disaster Management) and state-level legal crackdowns were necessary to try and address what constituted systematic fraud by property/casualty insurance corporations.

      https://www.hawley.senate.gov/hawley-chairs-hearing-that-exp...

      The California Department of Insurance characterized State Farm's tactics as "burying survivors in red tape at the worst moments of their lives"

      https://www.insurance.ca.gov/0400-news/0100-press-releases/2...

      Indeed, some of the core violations could be simply mandated as part of the inviolable system guardrails of an LLM - e.g. failed to begin investigating claims within 15 days, failed to accept or deny claims within 40 days, and failed to pay accepted claims or provide written notice of the need for additional time within 30 days, as required by law.

      And at the end of the day, whatever weighting issues an LLM for Insurance Claim Adjustment has, it certainly won't steal the money and run off to a Casino with it

      https://www.nicb.org/news/regional-news/broward-insurance-ad...

  • wellpast 17 minutes ago
    Two months ago I had a water pipe burst in my house.

    Now I am in the claims process with the large insurance co., using Claude to basically run my side of the claim — reading the policy, organizing and filing the ALE receipt scans, reading and notifying me of messages from the agents, calling out when they are delaying too much or not fulfilling their promises, challenging their decisions on what to cover based on the policy, keeping a log of all of our correspondences, logging work estimates and invoices, I cant imagine doing all this tedious work myself—w/o Claude I’d probably just rollover fatigued.

    Does my adjuster like this? On the one hand, I’m giving her incredibly tidy and documented receipts and logs, which I am sure is saving her time.

    On the other hand, Claude is calling out her BS and delays, which have been atrocious—so much so that Claude is now adamant that she has gone too far and that I should be filing a complaint with the state insurance bureau.

  • DivingForGold 1 hour ago
    [flagged]
    • pavel_lishin 1 hour ago
      This comment feels like an ad for SnapClaim.
      • bloggie 1 hour ago
        A SnapClaim executive ran over my dog in his Porsche and offered me a coupon for 25% off my next SnapClaim. I ran over one of his kids which scratched my bumper and hood. Insurance offered me $1250 but SnapClaim got me over $2000. Don’t let these executives get away with anything.
      • Waterluvian 1 hour ago
        There's a fine line between ads and customer-offered testimonials. That's why I rely on AdTest, the latest AI innovention that tests whether a post is an ad or a testimonial.
  • mc32 1 hour ago
    Follow-up question, [Do] You know who loves flock cameras? Insurance Claim Adjusters.

    They are using the cameras to catch fraud (where claimants try to lump previous damage with damage covered by the current claim.), etc.

    • dgellow 1 hour ago
      How is that relevant? I’m sure we all hate flock here, but what does that have to do with the article?
      • drunner 1 hour ago
        It adds more context about how much of a scam insurance is and how they come off as hypocrites for liking to use one form of ai for themselves (camera detection) while disliking another (customers trying to get more fair payouts)
      • lcnPylGDnU4H9OF 1 hour ago
        No clue what OP's intention was but I'll note that the software on object recognition cameras typically makes use of a vision model.
      • Der_Einzige 50 minutes ago
        Many groups in society are actively harmful and should be ignored?

        I.e. Dentists are scammers at such high rates that their opinions on how to organize society should be actively ignored. The opposite or "rule by guild" is basically https://en.wikipedia.org/wiki/Syndicalism which is the alternative "terrible ideology" to Socialism that would have taken off in a world where Germany won WW2