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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

#121

Earlier quoted context omitted.

The few cases where this is an advertised arrangement should be excluded from the usual situation where returns are meant for defects/errors. Even then, the one clothes example (shoes - which had been returned stained and with socks in the box) mentioned in the above still wouldn't seem like a valid return by any stretch.

Due to having extremely wide feet, in shoes that don't specifically have a wide option, my shoes can be anywhere from an 8.5 to a 10, depending on the manufacturer and style.

I've edited the above to clarify the issue in GP's shoes example was meant to be about the previous return being stained with socks in the box, not just that it was shoes in general.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#122
post #46
post #6

LLMs are really good when your primary goal is just to fob people off. So customer support when you don't care about your customers etc. I can imagine it's very appealing when you just want to come up with semi-plausable reasons to deny insurance claims. Who cares if it's wrong? They might give up anyway and you've saved paying out! Not saying they're not good for other things, but the "waste people's time and make t…

Anybody that has worked on a phone exchange knows they already do this sort of thing. Some customers just never get through to a person. This is by design.

Can confirm. Until I worked on an honest phone system tuned to actually get people connected with call centre reps, I never quite had a feel for how malicious many contact funnels have become. A good one runs like a Swiss watch, and is trivially tunable to sub-5 to 10 minutes wait times. Anything longer is a conscious choice on the company's execs part. It doesn't "just happen", and to the degree it does, it shouldn't be happening on the regular. Not if you're watching your metrics and tuning appropriately.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#123
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…

The most obvious example were the 10 States which refused to accept increased Federal funding for Medicaid that was made available with the passage of the ACA, which seems largely ideologically driven.

Otherwise the situation is more complex than the original comment suggests, and I can only speak to one state (Idaho), but I don't think the scenario is uncommon in other GOP controlled states and isn't limited to Medicaid.

Idaho has cut taxes in the state for five consecutive years, largely (IMO) on an ideological basis. This had the result, desired by many in a deeply conservative legislature, of creating budget deficits. Even the GOP is normally wary of espousing cuts directly to the state's contribution to Medicaid, but the deficit gives them cover to reduce funding and introduce barriers to service like caps on authorized services and new work requirements. Even when revenues were higher than expected for FY 2026, the governor's office had to act to actually retain those unexpected revenues as it was pretty clear that the Legislature was going to look to claw them back and continue drive down State spending. It's worth noting that health services, including Medicaid funding, represent about a third of the State's budget and their largest portion of the budget.

This whole process has been playing out in public education funding in the State for years as well. Coincidentally, charter school enrollment has increased by roughly 35% over the same 2021 - 2026 period.

Attacking a policy, program or institution financially and then pointing to the deficiencies of those same programs to further fuel funding and efficacy reductions is a pretty well established tactic in US politics as I'm sure it is elsewhere.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#124

Earlier quoted context omitted.

Well, more because it pulverizes personal responsibility for bad decisions ("I didn't deny your claim, the computer did"). But yeah.

so basically manager and exec dream

Pretty much. At least until jurisprudence makes it unambiguously clear that delegating to an AI model does not transfer liability for outcomes.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#125

Earlier quoted context omitted.

The few cases where this is an advertised arrangement should be excluded from the usual situation where returns are meant for defects/errors. Even then, the one clothes example (shoes - which had been returned stained and with socks in the box) mentioned in the above still wouldn't seem like a valid return by any stretch.

Zalando has free return for 30 days in my country, and they also include returning goods from multiple orders in a single return package as a suggestion in their FAQ. They sell clothes and also shoes. Zalando very much is operating on the principle that you order things to try them out at home and return whatever doesn’t fit or whatever you end up not liking. Just like in a physical store you try out clothes and shoe…

I've edited the above to clarify the issue in GP's shoes example was meant to be about the previous return being stained with socks in the box, not just that it was shoes in general.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#126

> Between May 2025 and May 2026, employment in the sector dropped a staggering 21 percent, according to BLS data. For early-career adjusters, the decline was even sharper: Entry-level postings have fallen 50 percent since 2025… When your business model has gotten to the point where people cheer for a guy who murdered one of their CEOs, it’s not surprising that people would not be interested in joining and may see bei…

I think Insurance Claims Adjusters as a occupation was on decline for some time even before the latest boom in AI. Since 90s I believe the most of major Insurance companies shifted a strategy, claims are seen as a source of profit and adjuster are now seen as a nuisance that often increase the payout for claims, so their role were diminished to form-fillers in different software systems.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#127

Earlier quoted context omitted.

Zalando has free return for 30 days in my country, and they also include returning goods from multiple orders in a single return package as a suggestion in their FAQ. They sell clothes and also shoes. Zalando very much is operating on the principle that you order things to try them out at home and return whatever doesn’t fit or whatever you end up not liking. Just like in a physical store you try out clothes and shoe…

I've edited the above to clarify the issue in GP's shoes example was meant to be about the previous return being stained with socks in the box, not just that it was shoes in general.

Makes sense :) My bad for not understanding what you meant there.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#128

Earlier quoted context omitted.

The few cases where this is an advertised arrangement should be excluded from the usual situation where returns are meant for defects/errors. Even then, the one clothes example (shoes - which had been returned stained and with socks in the box) mentioned in the above still wouldn't seem like a valid return by any stretch.

Due to having extremely wide feet, in shoes that don't specifically have a wide option, my shoes can be anywhere from an 8.5 to a 10, depending on the manufacturer and style.

> Due to having extremely wide feet, in shoes that don't specifically have a wide option, my shoes can be anywhere from an 8.5 to a 10, depending on the manufacturer and style.

As someone with wide feet, I don’t buy shoes unless they specifically have width options. It’s not particularly easy to do unless you really like traditional men’s leather shoes and boots, but there are some athletic shoe makers that offer wide width shoes (NB and Hoka for sure).

Even given all of the above, I still own shoes in 3-4 different sizes because shoe sizes are not standardized between makers, like you said.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#129

Earlier quoted context omitted.

>You can't 'blame' the AI, as it can't be held accountable. Seems like more of a semantic distinction IMO. Yes, I can't technically "blame" the AI because it's not accountable. But what word would you suggest for "I had [X technology] handle [Y task] and it failed to perform that task?" I can't "blame" my router if I lose internet and it prevents me from jumping on a Zoom call, but it's also true that the router fail…

Do you blame the hammer for bending the nail, or the person driving it? AI is nothing more than a tool being used by people. When my internet goes down, I blame either my ISP for having an outage, or the manufacturer of my router (assuming it's a router issue? Haven't had that happen personally but I'm certain it exists) (Or i did something dumb with my ufw again but that's on me) If you create an autonomous system a…

Humans are autonomous systems created by other humans. Yet, at some point, we stop blaming parents for the actions of their children.

LLMs aren’t there yet, but they might get there. My point is that your descriptions fail to capture when or why exactly the blame would shift.

Re: You Know Who Hates AI? Insurance Claims Adjusters

#130
post #129

Earlier quoted context omitted.

Do you blame the hammer for bending the nail, or the person driving it? AI is nothing more than a tool being used by people. When my internet goes down, I blame either my ISP for having an outage, or the manufacturer of my router (assuming it's a router issue? Haven't had that happen personally but I'm certain it exists) (Or i did something dumb with my ufw again but that's on me) If you create an autonomous system a…

Humans are autonomous systems created by other humans. Yet, at some point, we stop blaming parents for the actions of their children. LLMs aren’t there yet, but they might get there. My point is that your descriptions fail to capture when or why exactly the blame would shift.

llms have the ability to act without being affected by the actions, consequences or successes. what it means to blame has to be defined.
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