Artificial intelligence is everywhere, including in the insurance claims process. While AI can help insurers crunch numbers quickly and streamline routine tasks, it’s increasingly being used to process and evaluate personal injury claims, including pain-and-suffering damages.

There can be a real downside for claimants. Automated systems may undervalue claims or even deny them outright without a human ever really looking at the whole story.

For people who have already been hurt and are trying to move on with their lives, those automated decisions can feel cold, unfair, and downright frustrating.

Here’s what you need to know and what you can do if AI seems to be standing between you and a fair settlement.

Why Insurance Companies Use AI

Insurance companies increasingly rely on algorithms and AI tools to process claims because they can:

• Scan documents and data faster than humans.
• Flag patterns and inconsistencies quickly.
• Recommend settlements based on statistical models.

How AI Is Used in Personal Injury Insurance Claims

Unfortunately, AI often can’t accurately assess the real-world impact of injuries, especially when it comes to things like pain and suffering. Algorithms may rely on narrow data sets or rigid formulas that don’t reflect your individual experience, which can lead to lowball offers or improper denials. Even worse? Sometimes, it’s unclear whether an offer or denial was generated by a human at all.

What to Do if an AI-Driven Insurance Settlement Offer Seems Low

If you receive a settlement offer that seems low (or worse, a denial), there are steps you can take:

1) Ask for a Human Review – Automated systems often generate initial valuations or denials. Insist that a licensed claims adjuster or human reviewer re-evaluate your case. Human professionals can account for nuances that an algorithm can’t, such as emotional distress, long-term pain, or unique accident circumstances.

2) Don’t Accept a Low Offer Without Context – Insurance companies may use AI to justify a number. But you are not obligated to accept it. You can ask what data were used, whether human adjusters reviewed the file, and how any pain and suffering were calculated. Request this in writing. Not every state has rules yet, but some protections are emerging.

3) Document Everything – Keep copies of all correspondence, evaluation reports, medical records, bills, and communications. That documentation will matter if your case escalates.

A Look at State Law

Some states are already responding to concerns about AI in claims processing.

Florida’s Senate Bill 794
In Florida, lawmakers introduced Senate Bill 794, which would:

• Require insurers to have a qualified human professional make any claim denial decision.
• Prohibit algorithms, AI, or machine learning from being the sole basis for a denial.
• Require disclosures about who made the decision and whether AI was involved.

Under this bill, insurers couldn’t deny your claim based only on an automated system; a human would have to review and sign off on it. Insurers would also need to keep records showing how decisions were made and by whom. According to the Florida Senate, Senate Bill 794 did not become law, as it died in the Appropriations Committee on Agriculture, Environment, and General Government. This highlights the ongoing challenges states face in addressing AI’s role in insurance. LegiScan

A similar bill (House Bill 527) is also advancing in the Florida Legislature, making clear that a human must make the ultimate call on denials and reductions in payments where AI tools are involved. WUSF

What About California?

For injured victims navigating California personal injury claims, understanding how AI is regulated is especially important. California has taken steps toward human involvement in insurance decisions, especially in health and disability insurance:

• Under the Physicians Make Decisions Act (SB 1120), health and disability insurers cannot deny, delay, or modify medical services based solely on AI determination, and final decisions must involve a licensed provider’s judgment. GovTech

That law currently applies to medical-necessity decisions rather than to all personal-injury claim processing. Still, it demonstrates a broader trend of requiring human oversight when automated systems could affect real human outcomes. Healthcare Value Hub

California is also active in other areas of AI governance, though broader laws requiring human review of all types of insurance claim denials are still evolving. CalMatters

Final Takeaways: You Are Not at the Mercy of AI

AI and automated systems will continue transforming insurance, but you still have rights:

• You can challenge low or unfair offers.
• You can demand a human review of decisions.
• You can involve an attorney, such as CWC Injury Law Firm, to advocate for a full and fair settlement.

An automated number does not have the final word, especially when your pain, suffering, and future well-being are at stake.

If you’ve been injured and the insurance company’s offer seems unfair, contact us right away. We can walk you through your options and fight for the compensation you truly deserve.