Can GenAI fix insurance claims headaches?, Mike Daly

Not by itself, despite all the hype. I answer why in the sections below :

Not by itself
Claims require far more than just GenAI
Options to deploy GenAI in claims
Further Reading

Not by itself, despite all the hype.

The data stored by insurers is so incomplete, across so many tech stacks, made worse by 80% or more being hidden in the data solos across those stacks. GenAI that is deployed across those unconnected layers will suffer from LLMs that have been trained to hallucinate. Adding AgenticAI adds to the nightmare, errors, and compliance-busting outputs.

MACH-architected core & PAS platforms could answer that issue, but most insurers are reliant on platforms like Guidewire that are not MACH ( micro-services, API rich, Cloud-Native, and Headless). More on MACH platforms later. Let's stick with Claims and What use cases are best suited for the current AI maturity of both GenAI and insurers?

“Really proud that we are pioneering in the industry with our talented team & partners. We’ve 6 scaled GenAI use cases creating value and benefit for our customers today and will have more than double that by year end. Time to change the industry for the better!”

Source Chris Pearce COO esure

One area considered ripe for improvement is claim handlers’ scripts. The same 10-question script for claims handlers managing a storm event may not be right for every situation. “Rigid claims scripts and manual processes no longer fit the complexity of modern claims – whether it’s a storm-damaged property, a motor collision with layered liability issues, or a business interruption claim,” says David Scott, partner at HF and managing director of HighFive.

Rory Yates describes that in the business model transformation, #esure have implemented. In the home & contents market that included the integration and deployment of RightIndem claims management platform with the EIS #MACH architected core platform.

“Yates, global strategy lead at EIS, says the automation of call scripts is among the best use cases he has seen for Gen AI, helping call-handlers quickly understand a customer’s context and respond in a more informed, personalised way.”

Insurance Post

GenAI is also being used to translate languages in realtime, to triage claims more accurately and suggest the most relevant claims pathway based on the likely size and complexity of the claim. It can help claims handlers with drafting correspondence and assisting in valuations. GenAI’s ability to manage correspondence and digest complex documents is also transforming the day-to-day work of claims teams.

Claims can be very complex; not just CAT events, extreme weather and the tortuous subrogation process in motor and home claims that can leave claimants in a black hole and very unhappy. And we know where unhappy customers go- to another insurer.

Augmenting professional claim handler teams

As a part of the business transformation model GenAI could augment human claims handlers just as Remy Gounel states-

“I used to be a claims handler, and I know how much correspondence and complex documents they face – the capacity of GenAI to summarise it means a huge gain of time. Rémy Gounel, subject matter expert, claims at Shift Technology” Insurance Post

Avoiding hallucinations

#GenAI, #LLM technology mimicks the information it finds from the data it is trained on, and, therefore, when the large models like #CHATGP #Mistral#Claude.ai et al are trained on practically every internet data source, they ingest both accurate and inaccurate data. Having crawled through practically every digit of data available, they have had to create synthetic data, which heightens the potential for hallucinations and, therefore, outcomes. A warning comes from a current test case between Toyota North America, Progressive Insurance, and disgruntled motorists.

Filed 'in the U.S. District Court for the Eastern District of Texas, the lawsuit centers on vehicles manufactured by Toyota from model year 2018 onward. Plaintiff Philip Siefke, a Florida resident who owns a 2021 Toyota RAV4 XLE, claims the automaker's tracking systems collect extensive data such as location, speed, acceleration, braking behavior, voice commands and even call logs, which are then shared or sold to third parties like Progressive Insurance.

According to the complaint, “tens of thousands” of Toyota owners across the U.S. may have been impacted by what the lawsuit describes as the unauthorized surveillance and monetization of driver behavior.'

Autobody News June 24th 2025

See further reading for the link to the article.

There are many other class action lawsuits against insurers and GenAI vendors, so insurers must be able to see, control, and test the sources of data used to train the models.

The highly regulated insurance industry cannot rely on AI for complete automation and straight-through processing #STP without rigorous testing, learning, and measuring result accuracy continuously until insurers can be sure that they achieve compliance standards.

That is made possible with help from data and AI partners who have proven success in that area. They may create private specialist language models #SLM from internal data sources and trusted external sources, applying and combining domain knowledge from the insurer with their own data and AI technology and models. That demands a cooperative and collaborative relationship that can apply the hard yards required to exploit GenAI.

Claims requires far more than just GenAI

Claims platforms must deliver a vital benefit- be able to target the many audiences involved in settling claims e.g. brokers, fleet managers, supply chain partners ( both prime and subcontract) and the many specialists such as loss adjustors, engineers, repair networks. That is where many a delay occurs when these are unconnected with the claims management platform. The longer the elapsed time the higher the cost. This year the motor and homes markets have softened leading to reduced premiums but that may be an illusory comfort when markets harden again. Cost of living pressures and the predominance and preference of price comparison websites make it easy for consumers to shop around for the cheapest price. And that trend is increasing and not helped by so many policies being similar and therefore more a commoditised product than a differentiated product tailored to different customers needs.

Insurers held back by legacy technology are product-centred focused on polcies rather than customers. Newer #MACH architected core platforms can solve that issue but it take courage for an insurer to replatform. Without that investment they become increasingly vulnerable to competition that has taken that leap. The acquisition of esure by Ageas was stated to be partly to implement the technological innovation achieved by esure, which includes the successful leveraging of GenAI. See further reading for more on that.

Genasys has just published a well-researched blog entitled Future Insurance Trends: Navigating the Evolving UK Insurance Sector in 2025. No hype, just good analysis with references, diagnosis, and prognosis, including a section on claims: -

Claims Process: This is a critical battleground for customer loyalty. Customers of leading insurers are 20% more likely to find the claim submission process clear and 30% more satisfied with the settlement amount, resulting in a 30% higher likelihood of renewal. This underscores the importance of the insurance customer experience in driving retention.

The journey to CX excellence requires insurers to embed customer experience within their broader business strategy, design seamless multi-channel journeys, and leverage data and AI for optimisation. This includes reducing friction in key journeys like claims and renewals, enhancing first-contact resolution, and improving engagement through digital accessibility and personalisation. A single customer view for frontline employees is crucial for providing faster, more informed service, reducing frustration, and improving retention within the insurance sector. This focus on insurance customer experience is a continuous insurance industry trend.

Underlying Trend: The emphasis on clarity and ease reflects a deeper understanding that customer satisfaction in insurance is built on frictionless interactions, not just product features. This is a direct response to evolving customer expectations shaped by digital experiences in other sectors, impacting the future of insurance.
Causal Relationship: Investing in streamlined processes and clear communication directly leads to higher customer satisfaction, which in turn drives increased loyalty and renewal rates within the insurance industry. Conversely, legacy systems and siloed data hinder real-time integration, limiting personalisation and seamless service delivery, leading to customer dissatisfaction and churn.

What options to deploy AI in Claims?

In the core platform
Build in-house
Licence the digital claims platform

In the core platform

Modern MACH architecture core and PAS platforms include claims modules as part of an integrated ecosystem in which data flows across the whole value chain. Examples include (alphabetical order) :

EIS
FintechOS
Genasys
Instanda
Majesco
Ignite

For single lines of business, this can work well, whilst when looking for an enterprise solution across LOB insurers tend to deploy a specialist claim platform like RightIndem or Five Sigma. See section 3

Chris Pearce, COO esure, stated that it has deployed 6 use cases to date with more in the pipeline and they have deployed both from their claim module for motor and integrated RightIndem for home claims.

The AA has the claims module from its core platform ICE whilst in parallel deploying motor claim digital FNOL and claim processing from RightIndem.

The number of lines of business is one deciding factor, the various core systems, typically different for different LOB, are key factors in this decision process.

Build in-house

This is a common line to follow for many insurers, especially Tiers one and two. Run a POC with some innovative insurtechs, adopt the learning points, and assign the task to IT to build. Too many insurtechs take the bait without qualifying that the insurer understands the problem(s) to be solved and why. And, importantly, that there will be a budget made available for the chosen short-listed insurtechs. Without this in place, pilot purgatory is the most likely outcome for all parties involved.

With so many low-code, no-code options from insurtechs that have proven success, I wonder why insurers would take this route. They could build the claim solution in Unqork, which would offer a MACH architecture claim module, but that does not come cheap and you still have to know the what, why, and when of the problem. Central and LOB, IT departments tend to jump straight into solutions before the problems are prioritized and understood across all participants impacted.

In my experience, the likely outcome will be a combination of over time, under spec, or over budget, and sometimes all three!

License a digital claim platform

Esure, The AA, NN Group Nederland and AIOI Nissay Dowa are all part of a larger group of insurers that have taken this journey.

We needed to solve the complexities within claims supply chain and go beyond simply receiving a digital new claim notification. We chose RightIndem as our strategic partner as their solution gives us the opportunity to co-ordinate the claims solution eco system via a single platform. Their advanced technology, existing supply chain integrations, and customisable solutions impressed us, offering the flexibility we need, giving our customers a simpler and smarter experience.

Mark Ferguson, Head of Claims, Suppliers & Partnerships @ AIOI Nissay Dowa

There are various options available, including those below (in alphabetical order) :

360 Globalnet
Claims technology with Synergy Cloud
- Home and Property focus
Cotality, the CoreLogic rebranding
- Home, contents, property, and supply chain ecosystem
Five Sigma
Ignite part of Verisk
RightIndem

My own research over the last few years suggests that RightIndem and Five Sigma offer the ultimate option for multiple lines of business, digital FNOL, full claim management from FNOL to settlement, and the ability to deploy GenAI and other AI tools. Combined with the MACH architecture, core platforms both offer cost-effective solutions. Home claims only? Claims Technology/Synergy Cloud and Cotality both offer a complete solution.