It seems like companies are getting a lot less trusting with their return policies.
It used to be you just email them a photo or video of the issue and they send you a replacement. Now companies won’t send one until they have received the defective one back.
I knew a guy who would buy three different kinds of a thing and return the two he didn't like... regularly. A small number of return abusers ruin things for everybody.
Then again my last two online purchases, a pair of shoes arrived stained with somebody else's socks in the box and a cordless vacuum arrived with a mismatched brush head for a different model.
Well we don't know that they're talking about clothes at all. Clothing retailers are still pretty open about returns afaik because it's kind of the only way to run an online clothes store people will actually use.
The GP described it as abuse. That's not evidence of companies calling it abuse. As you say, this is basically intrinsic to the deal of buying clothes/shoes/etc online and obviously online retailers know that and accept it, or else they would not allow it (and in turn would not exist as businesses).
It's even worse than that, because they are adamant that they aren't abusing the system, and insist that if they didn't want people doing it, they would stop taking returns.
I wonder if they were similarly blasé when companies started implementing policies to actually stop them?
That kind of argument only works where stopping the behavior is cost free, the main reason most places didn't do it before was because the number of people doing it was low so the cost of actually tracking returns rigorously outweighed the benefit of low friction returns for the 99+% of customer who weren't abusing the system. When more people start creating large numbers of returns suddenly the amount of losses they create become enough to care about stopping. (Or it becomes a low hanging fruit to squeeze more profit out of an existing business, spending customer preference/loyality for profit by cutting a small waste center)
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 should do some reading on the birth of ecommerce. This was a very explicit tradeoff that these businesses decided to make. That's why free returns are pervasive.
Now whether it's a good thing wrt the environment etc...
I'm aware of how ecommerce got started. The fact that some businesses did the math to estimate that only a small percentage of customers are assholes, doesn't mean they aren't assholes. With apologies to patio11, "The optimal amount of return abusers is non-zero."
Buying 3 new-in-box $1000 cameras and returning 2 of them covered with your smudgy fingerprints is abuse, no matter how you slice it. If everyone did it, those cameras would cost twice as much. I'm saddened but not surprised people are defending that behavior here.
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.
There are companies that cater to these types of people. Their purpose is to allow you to have things shipped to you so that you can pick the ones you like before return the things you do not. They claim to be personal stylists by learning what you like by what you keep and return. It's not abuse, it's how they want it to work
It's not just an online thing. I know people that do retail therapy knowing full well they intend to return it. I don't have the same experience, so it is befuddling to me. Something totally different than just walking around in a store and looking but not buying.
For clothing it makes sense, also much of the price of clothing is often illusory, the marginal cost for the piece of clothing is tremendously less than the price paid.
Places need to get a lot better about actually checking returned items if they're going to go back into the stream as a NIB item instead of open box. Amazon and other electronics places are bad about this with horror stories of getting expensive graphics cards either replaced with equivalent weight items or with the GPU chip harvested in some cases.
Ultimately this isn't "AI's fault". As the article points out, clueless executives who don't understand the capabilities and limitations of specific LLMs push the technology on workers so they can say they are "using AI to improve efficiency".
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.
The interesting thing about AI v. other disruptive technologies (like the internet, steam engine, etc), is that AI has been personified both by the manufacturers of it (Anthropic being the most blatant by using a human name for its product) and users.
That makes it way more likely that people blame AI (doesn't make it right by any means, but does mean that the actual blame gets diffused even more).
Not that it is necessarily the case here, but when execs go "AI shopping" they have absolutely _zero_ idea that there are basically 3-4 SOTA models, thousands of smaller models, and then an uncountable number of wrappers on whatever underlying model. The AI landscape that is totally familiar to us is covered in shroud for them.
So they Google "Insurance claim AI tool", land on a vibecoded SaaS that is just a wrapper on a pocket Chinese model spun as "your next insurance pro", and then are getting the whole department on some lone 19 yr olds weekend project.
Which clueless executives are we blaming? The ones who purchase products from vendors like OpenAI or AI-powered products that run API calls through OpenAI et al., or the vendors themselves who make bombastic claims about capabilities?
As an analogy, I don’t know if I fully blame my executives for buying Microsoft Teams when Microsoft Teams turns out to suck. Microsoft promised to my company’s executives that Microsoft Teams doesn’t suck just like Sam Altman promised that AI is so powerful and so capable of exceeding the capabilities of humans that it’s dangerous.
Maybe at some point some of the B2B customers of AI products will be suing their vendors for the kind of grossly exaggerated marketing we are seeing right now. I think that SaaS companies would never get away with it.
I don’t know that the executives at my company suddenly lost their mind and decided that hundreds of dollars of AI spend per employee is suddenly justified even though approving a simple $##/month/employee SaaS tool was previously a rigorous slog. The only reason the executives at my company suddenly changed their mind on frugality is becausey they were sold a lie by a huge industry.
We could consider them clueless for falling for that, or an alternate viewpoint is that they are victims of widespread fraud.
You should. It's their fault for picking a bad vendor. It's their fault for not finding someone with taste to solve the problem. Fundamentally its their business, pretending you can blame someone else for your ultimate accountability is stupid.
Nobody is forcing you to take poison, and saying "Well Microsoft promised me it isn't poison!!!" at this point, decades into it selling poison, doesn't make much sense.
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 working remote. People who understand tech and sort of know what they are doing, are not included.
But isn’t this also just bad implementations of AI? “It got a stupid simple answer wrong”, seems like a gpt-4o on a buggy RAG implementation from 2 years ago problem.
Hard to fathom a modern model would get any of this basic stuff wrong. I know accountants using it for (a lot more complex but similar problem) tax law parsing and it going through flawlessly.
There seems to be some bidirectional media gaslighting happening here where the doomers and glazers are talking past each other a bit.
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 don’t know anything about the treatment to deny claims then waste the practitioner’s time on appeals in the hopes that people will give up. AI has obviously made this process easier and the insurance companies absolutely hate it.
People have no idea how inefficient the U.S.’s healthcare system is. And it isn’t just the private companies. A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Then the private insurance companies adopt the same practices later.
In most states, the answer is fixed by law at either zero or one depending on whether you count insurance, because medical practices must be wholly owned by doctors.
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://www.dol.gov/agencies/whd/contact/complaints Also, if she is part of a labour union, she can raise concerns with them.
> A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons.
Can you provide some evidence for this claim? Also, does this affect the state(s) where your wife works? From what I found, 66% of Medicaid is paid for by the federal gov't, and the remaining share is funded by each state.
When there is more efficiency its a win for AI. When there are errors its the problem of the humans that are supposed to be using AI and oversee it to "make them more efficient". This has been the main source of AI fatigue for me.
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.
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.
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 them go away" use is just so perfect for the capabilities of even cheap models.
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.
Believe it or not, that's not even the topic of the article.
The article is entirely about the AI doing the first pass of the claim intake and causing a lot more work for everyone involved instead. Mis-routing, mis-categorization, hallucinating details, etc.
I read and article on here some months ago titled something like "Leftist usecases for LLMs" and one of them was negotiating bureaucracies, and that reminds me, I need to call back JCP&L about my Board of Public Utilities complaint that an LLM helped me out together.
You see, I live with in a rural area and especially since LED light bulbs have become the thing, it's been clear that we are delivered far less than 120v service a lot of the time. We live about 200 yards from the transformer that we share with several other houses, too many I believe. About two years ago I set up Home Assistant and bought one of those power monitoring rigs that you put on each circuit in your breaker box, mostly I just wanted data about where my power bill money was going. I work in FinOps in case anyone was curious.
Anyhoo, couple years later I'm analyzing several months worth of power bills vs the circuit meter readings to quantify where I can make some upgrades and save some money. After a day or so of this I mention to Claude about the voltage issues and sure enough, it puts together a whole packet for me documenting brownouts down to 95v and routine brownouts below 110v. It helps me fill out the BPU complaint form.
2 days later I get a call from JCP&L (unfortunately to my wife's phone because it's her name as the primary on the account). I want a new, larger transformer for myself and my neighbors, so I need to call them back today.
If you were monitoring the power coming into your house, why did you need claude to "put together a whole packet documenting brownouts"? Shouldn't you just have the raw data, maybe highlighted with the offending parts? Or was the prose of your complaint the issue?
Frequently you have to mention specific laws and describe how your situation matches the law or your complaints get ignored. At least this is how it works when you call your insurance company and make similar complaints.
So AI is going to take jobs not because AI is necessarily better or more appropriate, but because it accelerates bad decision making and makes those decisions exponentially worse.
See OpenAI putting the blame on a “rogue agent” for their own systems hacking other companies (which is a felony!!!!). When in reality they obviously control the while loop and tool call dispatching of the agents. But they decided to train attacker models, then run thousands of instances in parallel with the goal to solve hacking problems with close to no supervision and full execution privilege…
That company is highly amoral from top to bottom (yes even innocent Joe just cashing his million + bonuses while seeing all this crap and much more from inside and happily chugging along with 'just paying off that mortgage' tunnel vision).
Except shit, amoral behavior, backstabbing, lying at all times, just to get those sweet money and power.
Sometimes when I use coding agents I wonder, is this what having employees feel like? But it seems like a lot of employers get entirely other things out of it.
> Between May 2025 and May 2026, employment in the sector dropped a staggering 21 percent, according to BLS data.
Yeah sure. I mean, same reason why HN readers hate AI, right? It replaces their jobs.
(Obviously the difference is that the poor old claims adjusters didn't spend the last two decades "disrupting" every other industry and telling everyone else to "learn to code". Ha! If you hear a faint high noise, that's the sound of the rest of the world playing a violin, made of highly disruptive nanomaterials.)
Anecdotally, many of them are aging out and the demands of adjusters are increasing while the pay hasn’t necessarily gone up. While technically you don’t have to know the ins and outs of construction, it helps a lot and there are just not a lot of people who have that knowledge. And if they do, they often go into construction themselves or sell roofs. Both of which can be far more lucrative.
On top of that, claims software has a lot of automation but very little real AI surface area. A lot of the things AI is good at (text generation) must have certain verbiage or use legally approved templates.
Granted, this may not be the case for all verticals, but this is just my observation from 20 years. (Mostly in smaller IA firms and state-based institutions).
Also, my wife has pointed out that there haven’t been any major cats in the last few years. Katrina kept people working for years. A lack of big storms has also contributed to this.
Ageing and out and neither being replaced directly or reduce numbers coming in at the bottom/mid as others move up, is still a drop in people. If part of the reason there is less need to bring people in lower down is that a few are being expected to do the work of a few more due to automation via AI, then that is AI replacing them, just not quite as directly as “we need less people as AI makes each more efficient so there are redundancies”.
But that's the thing—there isn't any real automation for this. An adjuster has to physically go out to someone's property. They have to take pictures. They have to inspect things. They have to coordinate with 3rd parties if necessary (like engineers).
There isn't a whole lot of room for automation in much of this.
Underwriting on the other hand, that is a different story.
There are probably two camps in IT (in terms of hating AI). One is afraid that AI will replace them, the other is about to rage quit because AI is damaging to their mental health, but being forced on them by management which is as clueless that those of the insurance claims adjusters.
The difference being that the role of Engineer wasn't conceived as a layer of friction between consumers and their statutory rights to the point where a U.S. Senate subcommittee probe (Senate Homeland Security Subcommittee on Disaster Management) and state-level legal crackdowns were necessary to try and address what constituted systematic fraud by property/casualty insurance corporations.
Indeed, some of the core violations could be simply mandated as part of the inviolable system guardrails of an LLM - e.g. failed to begin investigating claims within 15 days, failed to accept or deny claims within 40 days, and failed to pay accepted claims or provide written notice of the need for additional time within 30 days, as required by law.
And at the end of the day, whatever weighting issues an LLM for Insurance Claim Adjustment has, it certainly won't steal the money and run off to a Casino with it
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 the policy, keeping a log of all of our correspondences, logging work estimates and invoices, I cant imagine doing all this tedious work myself—w/o Claude I’d probably just rollover fatigued.
Does my adjuster like this? On the one hand, I’m giving her incredibly tidy and documented receipts and logs, which I am sure is saving her time.
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.
> 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!
A SnapClaim executive ran over my dog in his Porsche and offered me a coupon for 25% off my next SnapClaim. I ran over one of his kids which scratched my bumper and hood. Insurance offered me $1250 but SnapClaim got me over $2000. Don’t let these executives get away with anything.
There's a fine line between ads and customer-offered testimonials. That's why I rely on AdTest, the latest AI innovention that tests whether a post is an ad or a testimonial.
It adds more context about how much of a scam insurance is and how they come off as hypocrites for liking to use one form of ai for themselves (camera detection) while disliking another (customers trying to get more fair payouts)
Many groups in society are actively harmful and should be ignored?
I.e. Dentists are scammers at such high rates that their opinions on how to organize society should be actively ignored. The opposite or "rule by guild" is basically https://en.wikipedia.org/wiki/Syndicalism which is the alternative "terrible ideology" to Socialism that would have taken off in a world where Germany won WW2
It used to be you just email them a photo or video of the issue and they send you a replacement. Now companies won’t send one until they have received the defective one back.
Then again my last two online purchases, a pair of shoes arrived stained with somebody else's socks in the box and a cordless vacuum arrived with a mismatched brush head for a different model.
It's interesting how companies are now redefining things they explicitly encouraged their customers to do as "abuse."
That kind of argument only works where stopping the behavior is cost free, the main reason most places didn't do it before was because the number of people doing it was low so the cost of actually tracking returns rigorously outweighed the benefit of low friction returns for the 99+% of customer who weren't abusing the system. When more people start creating large numbers of returns suddenly the amount of losses they create become enough to care about stopping. (Or it becomes a low hanging fruit to squeeze more profit out of an existing business, spending customer preference/loyality for profit by cutting a small waste center)
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.
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?"
Now whether it's a good thing wrt the environment etc...
Buying 3 new-in-box $1000 cameras and returning 2 of them covered with your smudgy fingerprints is abuse, no matter how you slice it. If everyone did it, those cameras would cost twice as much. I'm saddened but not surprised people are defending that behavior here.
Most online shops ToS say "we can ban you at any time for any reason", so their lawyers' definition of the word wouldn't be relevant here anyway.
Not so for consumer electronics
You can't 'blame' the AI, as it can't be held accountable.
That makes it way more likely that people blame AI (doesn't make it right by any means, but does mean that the actual blame gets diffused even more).
So they Google "Insurance claim AI tool", land on a vibecoded SaaS that is just a wrapper on a pocket Chinese model spun as "your next insurance pro", and then are getting the whole department on some lone 19 yr olds weekend project.
Half my colleagues are besotted with the technology and unaware that it is shaping their decision making, not the other way around.
As an analogy, I don’t know if I fully blame my executives for buying Microsoft Teams when Microsoft Teams turns out to suck. Microsoft promised to my company’s executives that Microsoft Teams doesn’t suck just like Sam Altman promised that AI is so powerful and so capable of exceeding the capabilities of humans that it’s dangerous.
Maybe at some point some of the B2B customers of AI products will be suing their vendors for the kind of grossly exaggerated marketing we are seeing right now. I think that SaaS companies would never get away with it.
I don’t know that the executives at my company suddenly lost their mind and decided that hundreds of dollars of AI spend per employee is suddenly justified even though approving a simple $##/month/employee SaaS tool was previously a rigorous slog. The only reason the executives at my company suddenly changed their mind on frugality is becausey they were sold a lie by a huge industry.
We could consider them clueless for falling for that, or an alternate viewpoint is that they are victims of widespread fraud.
Nobody is forcing you to take poison, and saying "Well Microsoft promised me it isn't poison!!!" at this point, decades into it selling poison, doesn't make much sense.
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 working remote. People who understand tech and sort of know what they are doing, are not included.
That has been my experience.
When he asked me to email him scans of a bunch of personal documents, I asked him for his PGP key.
..."What's that?"
You are not correct.
Somehow the "accountability" shifted from meaning "being reaponsible for not defrauding, lying" into "it is fault of people who were lied to".
Pretty much what this blog post says: https://hermit-tech.com/blog/ai-mania-is-eviscerating-global...
It seems pretty bad, no doubt about it
This is what they depend on actually. Scape goats for their failures. This quarter takes a hit then number go up.
Hard to fathom a modern model would get any of this basic stuff wrong. I know accountants using it for (a lot more complex but similar problem) tax law parsing and it going through flawlessly.
There seems to be some bidirectional media gaslighting happening here where the doomers and glazers are talking past each other a bit.
People have no idea how inefficient the U.S.’s healthcare system is. And it isn’t just the private companies. A ton of states purposefully overburden and underfund their Medicaid systems for ideological reasons. Then the private insurance companies adopt the same practices later.
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.
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.
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.
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.
Not saying they're not good for other things, but the "waste people's time and make them go away" use is just so perfect for the capabilities of even cheap models.
The article is entirely about the AI doing the first pass of the claim intake and causing a lot more work for everyone involved instead. Mis-routing, mis-categorization, hallucinating details, etc.
You see, I live with in a rural area and especially since LED light bulbs have become the thing, it's been clear that we are delivered far less than 120v service a lot of the time. We live about 200 yards from the transformer that we share with several other houses, too many I believe. About two years ago I set up Home Assistant and bought one of those power monitoring rigs that you put on each circuit in your breaker box, mostly I just wanted data about where my power bill money was going. I work in FinOps in case anyone was curious.
Anyhoo, couple years later I'm analyzing several months worth of power bills vs the circuit meter readings to quantify where I can make some upgrades and save some money. After a day or so of this I mention to Claude about the voltage issues and sure enough, it puts together a whole packet for me documenting brownouts down to 95v and routine brownouts below 110v. It helps me fill out the BPU complaint form.
2 days later I get a call from JCP&L (unfortunately to my wife's phone because it's her name as the primary on the account). I want a new, larger transformer for myself and my neighbors, so I need to call them back today.
Except shit, amoral behavior, backstabbing, lying at all times, just to get those sweet money and power.
Yeah sure. I mean, same reason why HN readers hate AI, right? It replaces their jobs.
(Obviously the difference is that the poor old claims adjusters didn't spend the last two decades "disrupting" every other industry and telling everyone else to "learn to code". Ha! If you hear a faint high noise, that's the sound of the rest of the world playing a violin, made of highly disruptive nanomaterials.)
Anecdotally, many of them are aging out and the demands of adjusters are increasing while the pay hasn’t necessarily gone up. While technically you don’t have to know the ins and outs of construction, it helps a lot and there are just not a lot of people who have that knowledge. And if they do, they often go into construction themselves or sell roofs. Both of which can be far more lucrative.
On top of that, claims software has a lot of automation but very little real AI surface area. A lot of the things AI is good at (text generation) must have certain verbiage or use legally approved templates.
Granted, this may not be the case for all verticals, but this is just my observation from 20 years. (Mostly in smaller IA firms and state-based institutions).
Also, my wife has pointed out that there haven’t been any major cats in the last few years. Katrina kept people working for years. A lack of big storms has also contributed to this.
> Anecdotally, many of them are aging out
Ageing and out and neither being replaced directly or reduce numbers coming in at the bottom/mid as others move up, is still a drop in people. If part of the reason there is less need to bring people in lower down is that a few are being expected to do the work of a few more due to automation via AI, then that is AI replacing them, just not quite as directly as “we need less people as AI makes each more efficient so there are redundancies”.
There isn't a whole lot of room for automation in much of this.
Underwriting on the other hand, that is a different story.
https://www.hawley.senate.gov/hawley-chairs-hearing-that-exp...
The California Department of Insurance characterized State Farm's tactics as "burying survivors in red tape at the worst moments of their lives"
https://www.insurance.ca.gov/0400-news/0100-press-releases/2...
Indeed, some of the core violations could be simply mandated as part of the inviolable system guardrails of an LLM - e.g. failed to begin investigating claims within 15 days, failed to accept or deny claims within 40 days, and failed to pay accepted claims or provide written notice of the need for additional time within 30 days, as required by law.
And at the end of the day, whatever weighting issues an LLM for Insurance Claim Adjustment has, it certainly won't steal the money and run off to a Casino with it
https://www.nicb.org/news/regional-news/broward-insurance-ad...
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 the policy, keeping a log of all of our correspondences, logging work estimates and invoices, I cant imagine doing all this tedious work myself—w/o Claude I’d probably just rollover fatigued.
Does my adjuster like this? On the one hand, I’m giving her incredibly tidy and documented receipts and logs, which I am sure is saving her time.
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.
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!
They are using the cameras to catch fraud (where claimants try to lump previous damage with damage covered by the current claim.), etc.
I.e. Dentists are scammers at such high rates that their opinions on how to organize society should be actively ignored. The opposite or "rule by guild" is basically https://en.wikipedia.org/wiki/Syndicalism which is the alternative "terrible ideology" to Socialism that would have taken off in a world where Germany won WW2