Business function

AI use cases for claims

First notice of loss, assessment, settlement and recovery of insurance claims.

Use cases: 12
Deployments: 57
Organizations: 53
Outcome disclosed: 49%

12 Claims use cases

53 organizations in 22 countries run these use cases in public. 49% of those 57 deployments disclose a measurable outcome.

Insurance

AI agent for first notice of loss claims intake

A first notice of loss agent is an AI agent that takes the first notice of loss from a policyholder by phone, chat or app. It identifies the policy, collects the facts of the incident and the evidence the claim type needs, opens the claim in the claims system, tells the customer what happens next, and hands complex, injured or vulnerable claimants to a human handler.

Deployments

7 public, best grade B

Reported accuracy

90%

DOMCURA, vendor claim

InsuranceTravel and hospitality

AI agent for travel insurance claims and assistance

A travel insurance claims and assistance agent is an AI agent that helps insured travellers with claims and assistance around the clock, in their own language. It answers cover questions, takes claims for delays, cancellations, lost baggage and medical costs, reads the receipts and certificates travellers upload, settles simple claims within set limits, and connects medical emergencies and complex cases to the assistance team at once.

Deployments

2 public, best grade B

Reported automation rate

up to 70%

Allianz Partners, organization claim

Insurance

AI for catastrophe and exposure assessment in insurance

AI catastrophe exposure assessment is AI that turns satellite and geospatial data into a fast, portfolio wide view of which policies and properties are exposed to a catastrophe. It covers before and immediately after the event, so exposure managers and claims teams can quantify the loss, prioritize response and reach affected customers first, without waiting for ground surveys.

Deployments

3 public, best grade C

Autonomy

Assist

Insurance

AI for claims triage and straight through processing

Claims triage and straight through processing is AI that reads each new insurance claim and its documents and scores its complexity, cover questions, fraud and recovery signals. It sends each claim to the right handling path and handler, and settles simple, low risk claims end to end within set limits without a person touching them.

Deployments

11 public, best grade B

Reported automation rate

about 55%

Lemonade, organization claim

Cross industryBanking

AI for drafting customer letters and outbound notices

AI for outbound notice drafting writes the letters and notices operations must send at scale, such as arrears notices or decline letters. It also covers complaint responses, servicing confirmations and product change notices, from case data and approved templates and clauses, in the customer's language, for a person to approve where the notice is regulated.

Deployments

6 public, best grade B

Reported cycle time reduction

25%

SS&C GIDS and RS, vendor claim

InsuranceHealthcare

AI for health insurance prior authorization and claims adjudication support

AI for health insurance prior authorization and claims adjudication reads prior authorization requests, medical claims and appeals, and prepares a summary and recommendation for a clinician or adjudicator. It works from the clinical and billing documents attached to each case, extracts diagnoses, treatments and costs, and checks them against the policy and published clinical criteria, while the clinician or adjudicator makes every adverse decision.

Deployments

6 public, best grade B

Median handling time reduction, vendor reported

50%

3 deployments

HealthcareInsurance

AI for healthcare claims fraud, waste and abuse detection

AI for healthcare claims fraud, waste and abuse detection reads healthcare claims and provider billing patterns to flag fraud, waste and abuse for a payment integrity investigator. It checks claims before or shortly after payment and sends every flag with its reasons to the investigator, while a narrow set of clear rule violations can be denied automatically before payment.

Deployments

3 public, best grade B

Autonomy

Assist

Insurance

AI for insurance claims fraud detection

Claims fraud detection is AI that scores every insurance claim for fraud from first notice of loss onwards, combining claim, policy, document, image and network data. It finds suspicious claims, organised rings and inflated losses, and sends each alert with its reasons to a claims handler or special investigations unit for review.

Deployments

12 public, best grade B

Autonomy

Assist

Insurance

AI for litigation and recovery triage

AI for litigation and recovery triage scores open insurance claims and overdue accounts for the risk that they end up in litigation or formal legal recovery. It also ranks the attorneys, law firms or recovery agencies likely to get the best result, so a claims handler, legal panel manager or collections specialist can act early instead of after the case has already escalated.

Deployments

2 public, best grade B

Autonomy

Assist

Insurance

AI for parametric insurance claims triggering

AI for parametric claims triggering builds the index a parametric insurance policy pays against, then measures the triggering event itself, such as a wildfire's extent once it happens. The models are trained on historical, simulated and satellite or radar data, and their output lets a deterministic engine calculate and release the payout without an adjuster assessing the loss on site.

Deployments

2 public, best grade B

Autonomy

Autonomous

Insurance

AI for photo based damage assessment in insurance claims

Photo based damage assessment is computer vision that assesses vehicle or property damage from photos or video for an insurance claim. The photos or video can come from the policyholder, a repairer or an adjuster. The AI identifies the damaged parts and the repair or replace decision, produces or checks the repair estimate, and flags total losses and inconsistencies for a person to review.

Deployments

12 public, best grade B

Reported accuracy

95%

Ping An Insurance (Group) Company of China, organization claim

Insurance

AI for subrogation opportunity detection

AI subrogation detection is AI that reads open and closed claims to find cases where a third party is wholly or partly liable. It estimates liability and the recoverable amount under the applicable negligence and recovery rules, and sends scored recovery opportunities with their reasons to the subrogation team.

Deployments

3 public, best grade B

Autonomy

Assist

What the evidence says

Computed from the 57 public deployments behind these use cases. Numbers update with every checked record.

Benchmarks with at least 3 pooled values

Benchmarks across Claims use cases
KPI	Median	Reported range	Data points	Claimed by
Automation rate	55%	45% to 89% Not pooled: up to 70%	3plus 1 up to	2 organization, 1 vendor
Accuracy	95%	90% to 98%	3	1 organization, 2 vendor
Handling time reduction	50% vendor reported	50% to 54%	3	3 vendor