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How Insurance Companies Use AI to Deny Claims – And What You Can Do About It

Artificial Intelligence is a concept that has managed to creep its way into many different aspects of life. From the voice assistants that we use to help with everyday tasks, to the algorithms underpinning the world’s major stock exchanges, AI is everywhere.

One place that the use of AI is becoming more prominent is in the world of Insurance. Insurance companies have begun to take advantage of the time saving, efficiency maximizing power of AI.

Here are some of the ways in which AI is being used by insurance companies and how it could be detrimental to your claim following an injury.

Automated Denial of Care

Artificial Intelligence has become a hot topic in the past 5 years. One of the prominent features of AI technology is the ability to automate and rapidly complete mundane, repetitive tasks.

While this is potentially a huge time and money saver for the companies implementing these systems, it calls into question exactly what decisions AI has the intelligence to make.

For example, United Health Care, a major health insurance provider in the United States, recently came under fire for its use of an AI algorithm which wrongfully denied elderly patients medically necessary coverage.

This has the potential to be an issue outside of just health insurance claims, as many insurance companies (including auto and liability insurance providers) are faced with the same task of determining which claims to deny and which to compensate. By relying on an AI algorithm to determine who is worthy of care, you run the risk of denying those who are in serious need of insurance coverage, like in the case of United Health in 2023.

Data Collection Concerns

The core value provided by AI is the way it allows you to make insights based on data. For these insights to be accurate, there is a massive amount of data needed to be collected. As a need for more and more data arises, insurance companies have turned to some ethically questionable means to get their hands on what they need.

One recent example of ethically questionable collection of data was the case of State Farm utilizing drone footage to deny coverage to clients. These drones were flown over the houses of policy holders without their consent and captured images which ultimately led to several individuals being dropped by State Farm as clients.

Another example of data being collected unethically for AI use is the case of Cox Media Group, which recently touted its “active listening” capabilities to investors. The AI driven software being used by this advertising firm allegedly utilizes data taken from individuals unknowingly, recorded through their smart phone microphone.

Asymmetric Information (Consumer vs. Provider)

One final issue that arises as a result of AI usage by insurance companies is the drastic asymmetry of information available to consumers and providers.

Oftentimes, as discussed above, individuals are not aware that their personal data is being collected (or who has access to that data). This leads to a situation in which one party (the insurance company) is put in an unfair position of power based on how little you know about their data collection scheme.

This situation of asymmetric information leads to decisions being made by insurance companies based on data that consumers did not even know was available (let alone were able to understand). This is highly unethical as it leaves consumers completely in the dark as to why their coverage is being denied and makes it very hard for individuals to advocate for themselves if they are denied coverage.

Get David Get Paid

If you were recently in an accident and were denied coverage by your auto insurance provider, it is important to get yourself an attorney who is familiar with the increasingly complex world of AI and data collection. David Femminineo and his team at Femminineo Law are on the cutting edge when it comes to legal research, and our understanding of all the relevant technologies when dealing with cases of denied insurance benefits.

Don’t hesitate, call David today at 855-65CRASH or visit our website at getdavidgetpaid.com and take your first steps towards maximum compensation today.

Hire the best personal injury lawyers in Michigan

Femminineo Law, PLLC is Michigan’s finest personal injury firm. He has succeeded in recovering hundreds of millions of dollars for victims of highway accidents, medical malpractice, slips and falls, and for wrongful death matters throughout the State of Michigan.

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