No one who’s dealt with one would ever accuse an insurance claims adjuster of being too generous, but now they might wish they had.
That’s right: in 2026, a major trend emerging in personal lines insurance — the health, home, and auto insurers most of us think about when someone mentions underwriting — is AI automation.
In the US, when a person with, say, a scratchy throat goes to an in-network family clinic for a rapid strep test, that bill is submitted to the patient’s insurer via a standardized claim form. Any human claim adjuster could see the obvious medical need for that test, and would likely approve it. But if that human adjuster were replaced with an automated AI system — replete with all their well-documented technological flaws — things become a lot less certain.
Take the case of Iris Smith, an 80-year-old Florida retiree suffering from arthritis. As an investigation by the Palm Beach Post found, Smith may be the victim of AI-fueled preauthorization denials, as her home state is one of six exploring an AI Medicare screening program.
“I don’t think a corporation… should be telling people what they can and can’t do,” Iris Smith, an 80-year-old Florida retiree suffering from arthritis told the Palm Beach Post in an investigation into the phenomenon. “My doctors know me. I know my doctors. And when I’m in pain — which is every morning, waking up to two fists that can barely open — I need something to take care of the pain.”
Florida representative Lois Frankel, a fierce opponent of the pilot program, told the Palm Beach Post she’s going to fight against any expansion of the effort into other US states. “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.”
With AI, clerical errors or technicalities on the form, and even errors with the AI system itself, can automatically result in denied claims. What’s more, insurance companies — which are always working on complex models to manage the flow of claims, and therefore minimize financial losses — are increasingly using AI to tighten the faucet.
It’s an attractive idea for insurance executives: by 2023, nearly 88 percent of auto insurance companies were reported to be using or planning to use AI for claims. According to a 16-state survey by the National Association of Insurance Commissioners, 84 percent of US health insurers are already using AI to handle things like prior authorization for medical care.
Where health insurance is concerned, the result is an escalation of the already despicable situation forced on patients by a lack of public insurance option (owing in no small part to commercial insurance giants themselves).
There are currently 22 states that have refused to adopt regulations for the use of AI in underwriting. These include the insurance industry’s typical friends like Florida and Georgia, but also some surprising entries like Oregon and Minnesota. While states may be the last line of defense for consumers against unscrupulous personal lines insurers, the development is a searing indictment on the industry as a whole.
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