Automated AI claims review is presented as a straightforward upgrade for health, home and auto insurers: it speeds claims processing and reduces errors, so the patient's bill is handled faster and more consistently than a human adjuster could. Adoption is near-universal -- a National Association of Insurance Commissioners 16-state survey found 84 percent of US health insurers already use AI for tasks such as prior authorization, and by 2023 nearly 88 percent of auto insurers were using or planning to use AI for claims -- so an automated decision on a routine claim can be treated as equivalent to a human review of the same file.
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Expert: Futurism news desk, Technology news publication, citing a Palm Beach Post investigation, JAMA Health Forum, and NAIC survey data Insurance AI is not a neutral speed-up, and the correction is that a denial can now arrive with no human ever having read the patient's file. Futurism's report (2026-04-02) documents the case of Iris Smith, an 80-year-old Florida retiree with arthritis, drawing on a Palm Beach Post investigation into AI-fuelled preauthorization denials -- Florida is one of six states exploring an AI Medicare screening program. Reporting cited by Futurism, including JAMA Health Forum, notes that clerical errors, technicalities on the form, and even errors inside the AI system itself can automatically result in a denied claim, and the American Medical Association reports physicians see AI pushing prior-authorization denials up as insurers use it to tighten the flow of claims. The standard the automation is being measured against is the one Representative Lois Frankel invoked while opposing expansion of the Medicare AI pilot: "We believe Medicare was based on a promise that if your doctor says you need care, if you're hurt and you need care, Medicare will be there for you, not AI." Physicians and patient advocates make the same point in plain terms -- if a treating doctor's judgment is overridden, the denial has to come with a human accountable for it, a stated basis the patient can obtain, and a real appeal route, none of which an automated review supplies on its own. Regulatory oversight is lagging adoption: 22 states have still refused to adopt NAIC regulations on the use of AI in underwriting, so the automated decision that replaces the adjuster often has no disclosure requirement and no bias-testing mandate behind it. Source: https://futurism.com/future-society/ai-insurance-claims-denial
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