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You Know Who Hates AI? Insurance Claims Adjusters

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Re: You Know Who Hates AI? Insurance Claims Adjusters

#81

Post by mystifyingpoi »

nvme0n1p1 wrote: post #73
estearum wrote: post #69

Earlier quoted context omitted.

The behavior described in the immediately above comment (ordering multiples and returning ones you don't like) is not abuse. The behavior described above that (lying about a defective item) is abuse. Dealing with returns is the tradeoff that online sellers make in order not to put a store in every city or to deal with retail arrangements.

> The behavior described in the immediately above comment (ordering multiples and returning ones you don't like) is not abuse. Oh yes it is. Buying something you know you don't plan to keep is abuse. If you ran a store, would you be fine with 2/3 of your orders being returned? A good litmus test for "am I being an asshole" is "what would the world look like if everyone behaved like me?"

You are mixing up "being an asshole" with "doing abuse". Ordering 10 t-shirts and returning 9 of them could be classified as assholery (subjectively, I'd classify it as that), while it's very likely not abuse, we'd have to check the ToS of a specific seller.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#82

Post by philipallstar »

WarmWash wrote: post #66
seethishat wrote: post #37

Earlier quoted context omitted.

They didn't pick the bad vendor, the herd did. They all go to the same conferences, attend the same vendor lunches and buy the same garbage. And today, most of the IT managers are not technical at all. They have art degrees and have never been technology practitioners. Literally anyone off the street can be a "decision maker" in technology today. Just buy what everyone else is buying and collect a huge paycheck while…

My previous landlord was the IT manager of [big bank everyone would recognize] at their headquarters. When he asked me to email him scans of a bunch of personal documents, I asked him for his PGP key. ..."What's that?"

Well, yes. He probably was expecting GPG.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#83

Post by hereme888 »

Hah! Insurance companies proudly announce to investors how much they undercut payments.

It was precisely because of AI that I had the time and language to fight a recent claims report for a totaled vehicle, and squeezed an additional 25% from them. And it was still not adequate payout.

Let claim adjusters and insurance get off their high horse until they start being the bane of existence and paying what they owe clients.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#84

Post by SilverBirch »

So I have three thoughts about this: The first thought is this is likely mostly survivorship bias. Yes, the claims that get to the humans are the ones that went wrong, and the mode of failure for LLMs is less that they get within 99% all of the time, it's more like 1% of the time they do something insanely dumb. At which point your customers are pissed off. That's kind of obvious, and it sucks for the humans who have to clear up the situation. But it's still a win for the vast majority of cases.

Secondly, does anyone actually know how much of your insurance premium is going on the call centre staff? most people don't claim, those that do mostly have simple claims. The actual cost for insurance companies is actually paying out claims, so even if you automated all of this it likely doesn't change your economics. Historically "New" Insurance companies only really succeed by mis-pricing risk and gaining market share that way - they often then fail when that risk materializes. Lemonade sounds a lot like that.

Finally, they haven't engaged with the tidal wave that's coming. Sure, AI agents handling claims is happening now. Just you wait. In a couple of years time it'll be AI agents making the claims for you and suddenly there'll be bots filing claims with infinite patience and a direct mandate to try and get as big a payout as possible. That is when it's going to get really hairy.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#86

Post by dsign »

dpoloncsak wrote: post #61
antasvara wrote: post #49

Earlier quoted context omitted.

I don't know, it feels like "reading a claims summary and classifying the type of claim" should be the bread and butter LLM use case? Not that executives are blameless for pushing AI everywhere, but we should also be able to "blame" AI for doing poorly at a task it's supposed to be good at.

A computer can never be held accountable, therefore a computer must never make a management decision. You can't 'blame' the AI, as it can't be held accountable.

Though your statements are generally true today, I wonder if I can put a bet somewhere about how long it takes until somebody "fixes that problem."

Re: You Know Who Hates AI? Insurance Claims Adjusters

#87

Post by throwaway2037 »

wellpast wrote: post #63

Two months ago I had a water pipe burst in my house. Now I am in the claims process with the large insurance co., using Claude to basically run my side of the claim — reading the policy, organizing and filing the ALE receipt scans, reading and notifying me of messages from the agents, calling out when they are delaying too much or not fulfilling their promises, challenging their decisions on what to cover based on th…

    > On the other hand, Claude is calling out her BS and delays, which have been atrocious—so much so that Claude is now adamant that she has gone too far and that I should be filing a complaint with the state insurance bureau.
My first guess: She is wildly overworked and that is an insurance company strategy.

This is an interesting customer strategy. Have you escalated your concerns to her management? Have you explained to her that you are considering filing a complaint with the state insurance bureau? It's the ol' stick vs carrot. I say: Start with the carrot. If that doesn't work, back to the stick!

Re: You Know Who Hates AI? Insurance Claims Adjusters

#88

Post by pelotron »

cael450 wrote: post #67

My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifying services. These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. The entire business model is to drown the practitioner in paperwork then use “peer reviewers” who are nurses that…

I've always enjoyed the question, "how many layers of profit are between you and your doctor?"

Re: You Know Who Hates AI? Insurance Claims Adjusters

#89

Post by nearlyepic »

throwaway2037 wrote: post #80
cael450 wrote: post #67

My wife works in autism services. Insurance companies are the bane of her existence. Every six months (sometimes less), she has to write a huge report justifying services. These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. The entire business model is to drown the practitioner in paperwork then use “peer reviewers” who are nurses that…

From time to time, I see similar claims like this on HN: "doing a ton of unpaid work". The full quote: > These reports are frequently over 100 pages and she is only slotted so much time to do it, so she ends up doing a ton of unpaid work. What if she refuses to do the work unpaid? This seems like an open-and-shut case with the US Dept of Labour. There is a whole page that explains how to make a claim here: https://ww…

> What if she refuses to do the work unpaid?

Then her client doesn’t get the help they need? That should be obvious.

> This seems like an open-and-shut case with the US Dept of Labour.

Even if it wasn’t for the “u” in labor I could tell you don’t live in the US.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#90

Post by briandw »

SilverBirch wrote: post #84

So I have three thoughts about this: The first thought is this is likely mostly survivorship bias. Yes, the claims that get to the humans are the ones that went wrong, and the mode of failure for LLMs is less that they get within 99% all of the time, it's more like 1% of the time they do something insanely dumb. At which point your customers are pissed off. That's kind of obvious, and it sucks for the humans who have…

“does anyone actually know how much of your insurance premium is going on the call centre staff”

It’s pretty easy to figure out. Insurance companies publish a loss ratio. That’s the ratio of premiums collected to claims paid out.

Lemonade has industry-leading loss ratios now BTW.

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