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Insurers may use AI to review damage photos, estimate repair costs, flag possible fraud, or support other parts of a claim. That does not mean every claim is decided by AI—or that an automated tool made the final decision. If you disagree with an outcome, ask what policy terms and evidence support it, whether AI contributed, who reviewed the result, and how to request reconsideration.
Where AI can enter the claims process
AI and machine-learning systems can assist with tasks such as assessing photos of damage, estimating repair costs, analyzing historical data, estimating settlement values, and detecting possible fraud. An insurer might use a system to sort or summarize information, produce an estimate, or flag a claim for closer review. These are possible uses, not proof that any particular insurer uses AI in a particular claim.
The National Association of Insurance Commissioners (NAIC) describes AI as something that may automate, augment, or support human decisions, depending on how it is used. A tool that extracts information or flags a case is not necessarily the same as a system that makes—or effectively determines—a consequential decision about coverage or payment.
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NAIC survey results show that many responding insurers reported current AI or machine-learning use, or plans to use or explore it. The figures below combine those categories; they do not measure the share of all insurers, policies, or claims decided by AI.
| Insurance line | Respondents reporting current use, plans to use, or plans to explore AI/ML | Survey responses summarized by NAIC |
|---|---|---|
| Auto | 88% of 193 responding insurers | 2022 responses |
| Homeowners | 70% of 194 responding insurers | 2023 responses |
| Life | 58% of 161 responding insurers | 2023 responses |
| Health | 92% of 93 responding insurers | 2025 responses |
The NAIC page summarizing these survey results was updated in 2026. These are responding-company survey figures, not a census of the market and not a count of claims handled automatically.
What oversight applies—and where it differs
NAIC model guidance
The NAIC’s Model Bulletin on the Use of Artificial Intelligence Systems by Insurers was adopted in December 2023. It sets out expectations for insurer governance and records that regulators may request. It is a model document for state regulators, not one nationwide statute: its adoption and legal effect depend on the jurisdiction. The NAIC also says AI-supported decisions affecting consumers remain subject to applicable insurance laws, including rules on fairness, accuracy, and consumer protection.
Texas’s 2026 example
Texas Department of Insurance (TDI) Commissioner’s Bulletin B-0003-26, issued June 12, 2026 and updated July 16, 2026, says Texas insurance laws apply to AI-supported decisions and discusses unfair claim settlement and discrimination rules. For consequential decisions, TDI states that it “expects a person to review and agree with all decisions before action is taken.” This is TDI’s expectation for regulated entities in Texas; it should not be treated as a guarantee that applies in every state.
What to ask if you question a claim decision
Start with the decision notice and your policy. Ask for answers in writing where possible, and keep a copy of what you send and receive.
- What policy provision and claim facts support the outcome? Ask the insurer to explain the amount, denial, or reduction and identify the relevant policy terms.
- What information and evidence were considered? Ask whether the decision relied on photographs, estimates, records, or other evidence. If something is missing or inaccurate, ask how to correct or supplement it.
- Did an automated system or AI tool contribute? If so, ask what part of the process it supported and who is responsible for reviewing the result. Asking is useful, but the sources cited here do not establish a universal right to receive details about a model or a particular AI disclosure.
- What review options and deadlines apply? Ask how to request reconsideration, appeal, or independent review, and where the procedure appears in your policy or decision notice.
- How can you submit additional evidence? If you have records or an independent estimate, ask where and how to send them and how they will be considered.
What to do if the insurer’s response does not resolve the dispute
Keep a clear claim record
Save the policy, claim number, decision notices, estimates, bills, photographs, and copies of anything you submit. Keep a chronology of calls, letters, and emails, including dates and the names or roles of people you spoke with. If you file a complaint, the NAIC advises explaining the facts and timeline, referring to policy wording where possible, and stating the outcome you want.
Follow the review process for your type of insurance
For a health insurance denial, check the notice and plan documents for internal appeal and external review steps and deadlines. In relevant cases, an external review is conducted by an independent third party after an internal appeal. The applicable procedures depend on the plan and rules; health-plan timeframes should not be assumed to apply to auto, homeowners, or life claims.
For other lines of insurance, use the reconsideration or appeal route described in the decision notice and policy, and pay attention to the stated deadlines. Procedures vary by policy and jurisdiction.
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Contact your state insurance department when direct resolution fails
If a claim 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 position. A department can investigate matters within its authority, but it does not act as your lawyer or represent you in court.
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