AI can help you find and explain wording in an insurance policy, but it cannot reliably tell you whether a specific claim will be covered or what the insurer will pay. That outcome depends on the complete policy, the facts and evidence of the loss, applicable rules, and the insurer’s review. Treat an AI response as a starting point to check—not a coverage decision or promise of payment.
What AI can—and cannot—tell you about a claim
It can help interpret policy language
A language model can summarize a document, answer questions about it, and help locate relevant terms. For example, you can ask it to find the sections about a particular type of damage or explain a term in plain language. But a confident-sounding answer is not proof that it is right. The National Association of Insurance Commissioners (NAIC) warns that large language models can produce information that sounds accurate but is wrong, and says AI-generated information should be reviewed carefully for important decisions. NAIC: Insurance Topics | Artificial Intelligence
It cannot settle the facts of your loss
A policy summary is not the same as a decision on your claim. Coverage may depend on the exact wording in the policy and endorsements, exclusions and conditions, what happened, what the available evidence shows, and the laws or regulations that apply. If the model has not seen the complete contract or does not know important details about the loss, it cannot responsibly turn a partial explanation into a definite yes or no.
The reviewed sources do not establish an accuracy rate for AI predicting whether an individual claim will be approved. A chatbot’s prediction should not be treated as a reliable forecast of coverage or payment.
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How insurers use AI in claims
Insurers use or explore AI for operational tasks that include analyzing damage images, estimating repair costs or eventual settlement values, and detecting possible fraud. The NAIC has also reported health-insurer use of AI in claims adjudication. These are examples of insurer-side processing; they do not show that a consumer chatbot can predict the result of your claim.
NAIC survey responses indicate reported use, planned use, or plans to explore AI or machine-learning models—not accuracy, claim approvals, savings, or consumer outcomes. The figures below refer to responding insurers in reports issued on the dates shown:
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| Insurance line | Respondents reporting use, plans to use, or plans to explore AI/ML | NAIC report issued |
|---|---|---|
| Auto | 88% of 193 responding insurers | December 2022 |
| Home | 70% of 194 responding insurers | August 2023 |
| Life | 58% of 161 responding insurers | December 2023 |
| Health | 92% of 93 responding insurers | May 2025 |
These figures describe the insurers that responded to each survey, not every insurer or every claim. They also do not indicate how often AI makes a decision or whether its estimates match final outcomes. NAIC: Insurance Topics | Artificial Intelligence
What happens when AI supports an insurer’s decision?
The NAIC membership adopted its Model Bulletin on the Use of Artificial Intelligence Systems by Insurers on December 4, 2023. It says insurer decisions made or supported by AI must comply with applicable insurance laws and regulations, including rules addressing unfair trade practices. The bulletin sets out governance and risk-management expectations and describes documentation a state insurance department may request during an examination or investigation. It is guidance, not itself a model law or regulation, so state requirements and its effect vary. NAIC adoption announcement · NAIC Model Bulletin
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AI may help process information, but insurers remain responsible for decisions affecting consumers. The NAIC says claims professionals, agents, and customer-service representatives continue to review information, exercise judgment, and work with consumers. That does not establish that a person reviews every automated or AI-supported decision.
Regulators have identified risks associated with AI and big-data use, including inaccuracy, unfair discrimination or bias, data vulnerability, limited transparency or explainability, privacy concerns, and cyber threats. These are risks to manage—not proof that every insurer’s system or every AI-supported decision has those problems. NAIC: Insurance Topics | Big Data
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How to use AI to read a policy more safely
- Provide the complete relevant documents. Include the policy wording and endorsements that apply to your coverage, not just a declarations page or a summary. Remove personal details that the tool does not need, and check how it handles uploaded information.
- Ask for the source language. Request the exact policy section or endorsement text supporting the explanation so you can compare the answer with the document.
- Ask it to separate the moving parts. Have it identify the coverage grant, relevant exclusions, conditions, and limits rather than compressing them into a single yes-or-no answer.
- Ask what it does not know. Request a list of missing facts and evidence that could change the explanation. A useful response should make uncertainty visible, not disguise it as certainty.
- Verify before acting. Check every quoted passage and interpretation against the policy. If the issue affects a real claim or the answer is unclear, ask the insurer or a qualified insurance professional.
When choosing an AI tool for this task, look for source quotations, clear handling of uncertainty, meaningful privacy information, and an explicit point at which it recommends contacting a person. These checks address risks the NAIC has identified; they do not guarantee that a tool’s interpretation is correct.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.If the insurer disputes or denies your claim
- Ask for the written explanation. Ask the insurer which policy provisions and facts support its position.
- Check the explanation against the documents and evidence. Compare the cited language with your full policy and endorsements, and review the facts the insurer relied on.
- Correct errors and preserve records. Provide relevant corrections or evidence, and keep the insurer’s correspondence and claim documents.
- Get help if the disagreement remains. Contact a qualified insurance professional or consult the applicable state insurance department’s complaint channels. Procedures and deadlines can differ by state and type of insurance, so confirm the rules that apply to your claim.
An AI explanation may help you prepare questions, but it is not the insurer’s written coverage determination and does not replace advice from a qualified person when the dispute is consequential.
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