{"id":905973,"date":"2026-08-05T15:28:24","date_gmt":"2026-08-05T21:28:24","guid":{"rendered":"https:\/\/www.myconstructionexpert.com\/blog\/?p=905973"},"modified":"2026-08-05T15:28:27","modified_gmt":"2026-08-05T21:28:27","slug":"insurance-claims-deserve-better-than-an-algorithm","status":"publish","type":"post","link":"https:\/\/www.myconstructionexpert.com\/blog\/insurance-claims-deserve-better-than-an-algorithm\/","title":{"rendered":"Insurance Claims Deserve Better Than an Algorithm\u2019s Opinion"},"content":{"rendered":"\n<p>Alexander Bein, Andrew Gann, Armina Manning and Sandra Smith Thayer | <a href=\"https:\/\/www.propolicyholder.com\/2026\/07\/insurance-claims-deserve-better-than-an-algorithms-opinion\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">McGuireWoods<\/a><\/p>\n\n\n\n<p id=\"policyholders-increasingly-turn-to-artificial-inte\">Policyholders increasingly turn to artificial intelligence (\u201cAI\u201d) platforms to answer insurance coverage questions.\u00a0 This is risky because: (1) AI models hallucinate legal content at alarming rates; and (2) AI cannot apply nuanced, fact-specific and jurisdiction-specific legal analysis.\u00a0 As OpenAI Foundation recently acknowledged, \u201cChatGPT . . . neither has nor uses any degree of legal knowledge or skill.\u201d\u00a0\u00a0<em>See\u00a0<\/em><br><a href=\"https:\/\/fingfx.thomsonreuters.com\/gfx\/legaldocs\/xmvjydomqpr\/Nippon%20Life%20v%20OpenAI%20motion%20to%20dismiss.pdf\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"><em>https:\/\/fingfx.thomsonreuters.com\/gfx\/legaldocs\/xmvjydomqpr\/Nippon%20Life%20v%20OpenAI%20motion%20to%20dismiss.pdf<\/em><\/a><em>.\u00a0\u00a0<\/em>Any policyholder who receives a <a href=\"https:\/\/www.myconstructionexpert.com\/blog\/artificial-intelligence-is-reshaping-insurance\/\">\u201cno coverage\u201d answer from AI<\/a> should consult experienced coverage counsel before accepting that conclusion.<\/p>\n\n\n\n<p id=\"the-scenario-is-increasingly-common-a-busin\">The scenario is increasingly common.&nbsp; A business suffers a loss (a cyberattack, a construction defect claim, a product liability suit) and wonders:&nbsp;<em>Does our insurance cover this?<\/em>&nbsp; Rather than call a lawyer, they open ChatGPT or some other AI platform.&nbsp; If it says \u201cno coverage,\u201d the natural instinct is to move on.&nbsp; But that instinct is often misguided.&nbsp; Policyholders feeding coverage questions into AI models and receiving plausible-sounding negative answers are walking away from claims worth pursuing.&nbsp; And the reasons for these false negatives are structural and predictable.<\/p>\n\n\n\n<p id=\"ai-platforms-are-conservative-and-are-not-designed\"><strong>AI Platforms Are Conservative and Are Not Designed to Confidently Predict Policyholder Success &nbsp;<\/strong><\/p>\n\n\n\n<p id=\"large-language-models-are-trained-on-massive-datas\">Large language models are trained on massive datasets scraped from the internet, including from&nbsp; publicly available legal materials, treatises, court opinions, and industry publications. Those sources often emphasize general rules and may fail to identify exceptions applicable to a given policyholder\u2019s specific coverage situation. As a result, AI often misses nuanced, pro-coverage arguments that policyholder counsel may identify based on experience, skill, and the exercise of judgment not available to AI. &nbsp;<br><br>Additionally, AI tends to avoid overstatement: in the case of uncertainty, AI is designed to hedge rather than confidently predict a policyholder victory. AI is more likely to say \u201ccoverage may be excluded\u201d than \u201ccoverage clearly exists\u201d when the law is unsettled or policy language is ambiguous.&nbsp; Insurance law is also highly fact-specific and may vary significantly from jurisdiction to jurisdiction, so a small change in facts or policy wording can completely change the answer. Without the necessary context provided by complete policy documentation, applicable law, and the underlying facts and circumstances, AI often defaults to a cautious analysis that does not project confidence in a successful outcome.<\/p>\n\n\n\n<p id=\"ai-platforms-often-get-the-law-wrong\"><strong>AI Platforms Often Get the Law Wrong<\/strong><\/p>\n\n\n\n<p id=\"when-it-comes-to-accuracy-on-complex-legal-questio\">When it comes to accuracy on complex legal questions, the track record of AI platforms is sobering.&nbsp; A Stanford study found that general-purpose AI models (<em>i.e.<\/em>, publicly available models not specifically developed for legal enterprise settings) hallucinate (<em>i.e.<\/em>, fabricate legal content) at rates of 58% to 82% on legal queries; specialized legal AI tools hallucinated between 17% and 33% of the time.&nbsp;&nbsp;<em>See<\/em>&nbsp;Magesh et al.,&nbsp;<em>Hallucination-Free?<\/em>, Stanford HAI (2025).<\/p>\n\n\n\n<p id=\"the-models-routinely-apply-the-wrong-state%e2%80%99s-law\">The models routinely apply the wrong state\u2019s law, cite nonexistent cases, and attribute holdings to judges who never wrote them, all with the same confident tone.&nbsp; AI does not know when it is wrong.&nbsp; For example, in&nbsp;<em>Mata v. Avianca, Inc.<\/em>, 678 F. Supp. 3d 443 (S.D.N.Y. 2023), an attorney submitted a brief containing ChatGPT&nbsp; fabricated cases.&nbsp; When challenged by the court, the attorney asked ChatGPT to confirm the cases were real; it assured him they were.&nbsp;<\/p>\n\n\n\n<p id=\"one-ai-hallucination-case-tracking-website-has-est\">One AI hallucination case-tracking website has estimated that well over 1,600 AI-generated fabrications have been submitted to courts.\u00a0\u00a0<em>See\u00a0<\/em><a href=\"https:\/\/www.damiencharlotin.com\/hallucinations\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\"><em>https:\/\/www.damiencharlotin.com\/hallucinations\/<\/em><\/a><em>.\u00a0 \u00a0<\/em>If even seasoned attorneys are failing to catch these errors, consider a business owner or risk manager with no legal training who treats an AI coverage opinion as the final word.<\/p>\n\n\n\n<p id=\"the-cost-of-a-false-answer\"><strong>The Cost of a False Answer<\/strong><\/p>\n\n\n\n<p id=\"the-risk-here-is-that-when-a-policyholder-relies-s\">The risk here is that when a policyholder relies solely on a \u201cno coverage\u201d answer from an AI platform, without consulting a coverage attorney, they may not file a claim or push back on an erroneous denial of coverage from their insurer.&nbsp; The claim dies quietly and insurance money is left on the table.<\/p>\n\n\n\n<p id=\"a-proper-coverage-analysis-requires-understanding\">A proper coverage analysis requires understanding the specific policy language (including all endorsements), applicable law, facts of the claim, and policy interpretation principles (<em>e.g.<\/em>, ambiguities are construed in favor of coverage, exclusions are interpreted narrowly against insurers, and insurers have the burden to prove exclusions apply).&nbsp; AI lacks the legal knowledge, skill, and judgment to reliably apply these bedrock principles.<\/p>\n\n\n\n<p id=\"what-a-coverage-attorney-sees-that-ai-does-not\"><strong>What a Coverage Attorney Sees That AI Does Not<\/strong><\/p>\n\n\n\n<p id=\"the-american-bar-association-has-recognized-that-l\">The American Bar Association has recognized that lawyers must understand technology risks.&nbsp; ABA Formal Opinion 512 (July 2024) requires competence, confidentiality, and independent verification when using generative AI.&nbsp; If AI is not reliable enough for trained attorneys without careful oversight, it is certainly not reliable enough for policyholders to use as a substitute for experienced coverage counsel.<\/p>\n\n\n\n<p id=\"experienced-policyholder-side-attorneys-bring-some\">Experienced policyholder-side attorneys bring something AI cannot replicate: deep legal knowledge, skill, and experience in interpreting complex insurance policy provisions, an understanding of jurisdiction-specific coverage laws and issues, and the best way to marshal the facts and craft arguments based on the policy language and the law in order to maximize coverage under your insurance policies.<\/p>\n\n\n\n<p id=\"the-last-word-should-not-belong-to-a-machine\"><strong>The Last Word Should Not Belong to a Machine<\/strong><\/p>\n\n\n\n<p id=\"ai-can-summarize-documents-and-draft-correspondenc\">AI can summarize documents and draft correspondence in seconds.&nbsp; But reliable coverage opinions require judgment, skill, and experience\u2014something AI admittedly does not possess.&nbsp;<\/p>\n\n\n\n<p id=\"key-takeaway-any-policyholder-who-has-recei\"><strong>Key Takeaway:<\/strong>&nbsp; Any policyholder who has received a denial of coverage from their insurer, or a \u201cno coverage\u201d answer from AI, should not accept that conclusion without question.&nbsp; Experienced coverage counsel could be the difference between absorbing a loss and recovering potentially millions in insurance benefits.&nbsp;<\/p>\n\n\n\n<p id=\"an-algorithm-is-a-tool-not-a-lawyer-it-sho\">An algorithm is a tool, not a lawyer.&nbsp; It should not have the last word on an insurance claim.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>When one of your cases is in need of a construction expert, estimates, insurance appraisal or umpire services in defect or insurance disputes &#8211; please call Advise &amp; Consult, Inc. at 801.641.8304, or email <a href=\"mailto:experts@adviseandconsult.net\">experts@adviseandconsult.net<\/a>.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Alexander Bein, Andrew Gann, Armina Manning and Sandra Smith Thayer | McGuireWoods Policyholders increasingly turn to artificial intelligence (\u201cAI\u201d) platforms to answer insurance coverage questions.\u00a0 This is risky because: (1) AI models hallucinate legal content at alarming rates; and (2) AI cannot apply nuanced, fact-specific and jurisdiction-specific legal analysis.\u00a0 As OpenAI Foundation recently acknowledged, \u201cChatGPT&hellip; <a class=\"more-link\" href=\"https:\/\/www.myconstructionexpert.com\/blog\/insurance-claims-deserve-better-than-an-algorithm\/\">Continue reading <span class=\"screen-reader-text\">Insurance Claims Deserve Better Than an Algorithm\u2019s Opinion<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[10721],"tags":[9895,3918,11331,22],"class_list":["post-905973","post","type-post","status-publish","format-standard","hentry","category-insurance","tag-advise-consult","tag-ai","tag-artificial-intelligence","tag-insurance","entry"],"jetpack_publicize_connections":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Insurance Claims Deserve Better Than an Algorithm\u2019s Opinion - Advise &amp; 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