Insurers may use AI to review damage photos, estimate repair costs, flag possible fraud, or help assess a claim’s value. That does not mean every insurer uses AI, or that an automated system made the final decision on your claim. If you disagree with an outcome, ask for its policy basis and supporting evidence in writing, whether an automated tool contributed, and how to seek a review.
What AI can do during a claim
AI is an umbrella term for systems that process information and help generate an assessment or recommendation. In claims handling, insurers may use AI to analyze photographs of damage, estimate repair costs, sort or extract information from claim documents, compare a claim with historical data, estimate a settlement value, or flag a claim for possible fraud review.
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Those tasks do not all carry the same weight. A tool that organizes files or flags a case for further attention is different from one whose output determines, or effectively determines, whether coverage is provided or how much is paid. The National Association of Insurance Commissioners (NAIC) says models may automate, augment, or otherwise support human decisions, depending on how they are used. A listed use is an example, not proof that a particular company uses AI for your claim.
How common insurers say AI may become
NAIC survey figures show how many responding insurers said they currently use, plan to use, or plan to explore AI or machine-learning models. The figures combine those three categories; they are not the share of all insurers, policies, or claims decided by AI.
| Insurance line | Respondents reporting current use, plans, or exploration | Survey responses summarized by NAIC |
|---|---|---|
| Auto | 88% of 193 responding auto insurers | 2022 survey responses; NAIC page updated in 2026 |
| Homeowners | 70% of 194 responding homeowners insurers | 2023 survey responses; NAIC page updated in 2026 |
| Life | 58% of 161 responding life insurers | 2023 survey responses; NAIC page updated in 2026 |
| Health | 92% of 93 responding health insurers | 2025 survey responses; NAIC page updated in 2026 |
These are respondent-company survey results, not a count of decisions made with AI. They also do not establish whether any specific insurer used a model in a particular claim.
What regulators say about AI and claim decisions
Using AI does not remove an insurer’s obligations under applicable insurance laws. The NAIC says AI-supported decisions that affect consumers remain subject to rules including those concerning fairness, accuracy, and consumer protection.
NAIC model guidance is not a nationwide statute
The NAIC adopted its Model Bulletin on the Use of Artificial Intelligence Systems by Insurers in December 2023. It sets out expectations for insurer governance and records that regulators may request. It is a model document for state regulators, so its adoption and legal effect depend on the jurisdiction; it is not, by itself, one binding rule that applies identically across the country.
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In Texas, Department of Insurance Commissioner’s Bulletin B-0003-26, issued June 12, 2026 and updated July 16, 2026, says existing Texas insurance laws apply to AI-supported decisions and discusses unfair claim settlement and discrimination rules. It states: “If a regulated entity uses AI to make a consequential decision, TDI expects a person to review and agree with all decisions before action is taken.” That is TDI’s expectation for regulated entities in Texas, not a guarantee that the same requirement applies in every state.
What to ask if you disagree with a claim decision
Start with the decision notice and your policy. Ask clear questions in writing, keep a copy of what you send, and request a written response.
- What supports the decision? Ask which policy provision and claim facts support the denial, reduction, or payment amount, and request an explanation in writing.
- What evidence was considered? Ask whether the insurer reviewed your photographs, estimates, records, or other submissions. Identify anything you believe is missing or inaccurate, and ask how to correct or supplement it.
- Did an automated tool contribute? Ask whether AI or another automated system helped assess the claim, estimate damage or value, or flag possible fraud. If it did, ask what part of the process it supported and who is responsible for reviewing its output.
- How can you request another review? Ask what reconsideration, appeal, or independent-review process is available, what deadline applies, and where the process is described in your policy or decision notice.
- How should you submit more evidence? If you have additional documents or an independent estimate, ask where to send them and how the insurer will consider them.
Asking whether AI contributed is a practical question, but the cited NAIC consumer materials do not establish a universal right for every policyholder to receive model details or a specific AI disclosure. Your right to an explanation or review depends on the applicable rules, policy, claim type, and circumstances.
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Organize the record
Keep a chronology of calls, letters, emails, claim numbers, notices, estimates, bills, photographs, and documents you submitted. When describing the dispute, use the policy wording where possible, lay out the facts and timeline, and state the outcome you are seeking. These are among the practical steps recommended by NAIC consumer complaint guidance.
Follow the review route for your type of insurance
For a health insurance denial, check the denial notice and plan documents for the internal appeal and any external-review process, including the applicable deadlines. In relevant cases, an external review is conducted by an independent third party. The procedures and timing depend on the plan and rules that apply; health-plan timelines should not be assumed to govern auto, homeowners, or life claims.
Contact your state insurance department
If direct discussions do not resolve a claim that appears unfairly delayed or denied, or you believe the insurer has not honored the policy, you can contact your state department of insurance. Complaint procedures vary by state. Departments commonly accept complaints online, by mail, or by phone and may ask the insurer to explain its handling. A department may investigate within its authority, but it does not represent you in court.
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