You Know Who Hates AI? Insurance Claims Adjusters

(wired.com)

69 points | by joozio 2 days ago

8 comments

  • altacc 1 hour ago
  • glimshe 1 hour 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".
    • sdcfgy 44 minutes 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 50 minutes 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 45 minutes 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 7 minutes 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.

        • kakacik 33 minutes 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 20 minutes ago
            Fool me once, shame on you, fool me ten billion times its still Microsoft's fault you bought the wrong thing.
      • Aerolfos 27 minutes 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

    • dgellow 44 minutes 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
  • almost 1 hour 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.

    • LightBug1 1 hour ago
      On the flip-side, LLM's can be pretty good at coming up with almost water-tight stories for the insurance claim!
      • Jgrubb 46 minutes 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 12 minutes 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?
  • dash2 1 hour 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.)

    • nvahalik 16 minutes 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.

    • piltdownman 41 minutes 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...

  • tonyhart7 1 hour 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 54 minutes ago
      Well, more because it pulverizes personal responsibility for bad decisions ("I didn't deny your claim, the computer did"). But yeah.
      • dgellow 38 minutes 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 27 minutes 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 50 minutes ago
        so basically manager and exec dream
        • vintermann 15 minutes 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 12 minutes ago
          illegal in EU so we will be left behind by this innovation.
    • Muromec 13 minutes ago
      AI is going to take jobs because the company has to pay for AI and has less money to pay you a salary.
  • mc32 45 minutes 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 43 minutes ago
      How is that relevant? I’m sure we all hate flock here, but what does that have to do with the article?
      • drunner 26 minutes 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 29 minutes 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.
  • DivingForGold 38 minutes ago
    [flagged]
    • pavel_lishin 28 minutes ago
      This comment feels like an ad for SnapClaim.
      • bloggie 22 minutes 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 25 minutes 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.