Table of Contents
Key Takeaways
- State regulators found that claims work is the largest area where big auto insurers use artificial intelligence.
- Outside vendors usually build the models that price settlements and read crash photos.
- Two dozen states adopted guidance on insurer use of artificial intelligence, and Utah did not.
- The rules here still require firm deadlines, a real investigation, and a written explanation of any payment.
Insurance companies use artificial intelligence to sort, price, and sometimes decide injury claims, and yours may already have passed through one. Nothing announces it, and no letter tells you a model scored your file before the offer arrived. That number becomes the ceiling you negotiate down from unless someone challenges the math behind it.
Good Guys Injury Law represents injured people throughout the state, and we treat a software-generated figure the way we treat any opening offer, as something the insurer has to justify. Claim-handling rules do not change because a computer produced the number. If an offer reached you faster than anyone could have read your medical records, ask our team to look at it before you respond.
What the Insurance Industry’s Own Regulators Found
The clearest picture comes from insurance regulators rather than from the companies themselves. Working through the National Association of Insurance Commissioners, regulators in nine states surveyed large auto insurers about their use of artificial intelligence and machine learning. Of the 193 companies that responded, about 88% use, plan to use, or are exploring it, and claims was the largest area of use at 70%.
The Four Places a Model Shows Up in a Claim File
Regulators also asked where those claims models operate. Companies most often described them as an information resource for adjusters, which sounds harmless enough.
At least 50 insurers reported three further uses: Determining settlement amounts, making claim assignment decisions, and evaluating images of the loss. The survey recorded how much human judgment remains in each. Settlement amounts tend to involve augmentation, where the model produces an answer and advises the person deciding, while claim assignment tends to be automated.
Who Builds the Model That Prices Your Claim
Ownership of these systems matters more than people expect. The same survey found that third parties, not in-house teams, tend to build models that set settlement amounts and evaluate images of loss. Insurers named 28 distinct outside vendors in claims alone.
That distance creates a practical problem. When someone asks how a figure was reached, part of the answer sits with a software company with no relationship to you and no duty to explain itself.
The AI Guidance Two Dozen States Adopted and Utah Did Not
In December 2023, insurance regulators published a model bulletin reminding insurers that decisions affecting consumers must comply with existing insurance law even when advanced analytical technologies support them. It is guidance rather than statute, so it carries weight only where a state insurance department issues it.
As of April 2026, 25 states had adopted that bulletin. Utah is not among them, and it does not appear on the regulators’ separate list of states with insurance-specific artificial intelligence guidance.
The gap is narrower than it sounds. There is no dedicated rulebook here for automated claims decisions, but the existing claim-handling rules reach every decision an insurer makes, whatever produced it.
What Utah Requires No Matter Who Runs the Numbers
Those rules focus on conduct rather than technology. They tell an insurer what to do and when, and none of it shifts because a model generated the figure. What you get is a set of concrete requests you can make and concrete dates you can hold an insurer to.
Deadlines the Insurer Has to Meet
An insurer has 15 days to acknowledge a notice of loss and 30 days after receiving a complete proof of loss to finish its investigation and say whether it accepts or denies the claim. A request for a substantive response carries its own 15-day clock.
Extensions exist, but they are not silent. An insurer needing more time must say so in writing within that first 30 days and give reasons, then repeat the explanation every 45 days while the investigation stays open. A claim that has already been refused raises separate questions, and what to do when an insurer denies a car accident claim covers those.
Explanations You Can Require
A payment is not supposed to arrive as a bare number. The same rules make it an unfair claim settlement practice to pay without a statement describing the coverage and how the amount was calculated. Refusing a claim without a reasonable investigation carries the same label, as does withholding policy limits from someone who asks.
Statute adds to that. An insurer denying a claim or offering a compromise must promptly give a reasonable explanation of the basis for it, and misleading someone about the filing deadline is prohibited.
One rule deserves attention when an outside vendor sits in the loop. Paying an employee, producer, or contractor based on the savings an insurer gains by denying claims is itself an unfair claim settlement practice.
Where an Automated Number Goes Wrong on an Injury Claim
These systems produce averages well. The rules that decide a case here are not averages, and a few of them regularly separate a modeled figure from what a claim is worth.
The Threshold Question a Model Can Miss
Utah law bars general damages after an automobile accident unless the injured person sustained death, dismemberment, permanent disability or impairment based on objective findings, permanent disfigurement, a bone fracture, or medical expenses above $3,000. General damages means pain and suffering, not bills and wages.
The bone fracture category took effect in 2021, and the restriction does not apply to an uninsured motorist claim. Whether you have crossed that line turns on documentation in your own file, not on a pattern drawn from other people’s.
Fault Allocation Is Not a Simple Percentage
Shared fault is not a matter of shaving a tidy percentage off a number. Recovery requires the combined fault of the defendants to exceed your own, and that comparison can include fault allocated to parties immune from suit and to people never named in the case.
An adjuster has a financial reason to push your share upward. A model trained on resolved files has no opinion about whether that reason is sound. We treat the fault split as something to be proven, particularly on car accident claims where the police report is ambiguous.
The Treatment Still Ahead of You
Historical data describes finished cases. Yours is not finished, and a future surgery, ongoing therapy, or a permanent lifting restriction may appear nowhere in the record on the day an offer is generated.
If an offer has arrived and you are unsure whether it accounts for care you have not received yet, call (801) 506-0800 and ask us to look at it before you sign.
How We Push Back on a Software-Driven Offer
At Good Guys Injury Law, challenging a number means making the insurer show its work, and the habits behind negotiating with insurance companies apply here. Several steps do most of that job:
- Request the basis in writing. We ask which coverage the offer falls under and how the amount was calculated.
- Establish value independently. We gather records, bills, and provider statements tying a diagnosis to the collision rather than to a category.
- Preserve what decays. We request video, vehicle inspections, and scene evidence while those still exist.
- Document the care ahead. We ask treating providers what the coming year looks like so an offer has to answer for it.
- Change the posture of the file. Moving toward litigation changes who inside the company may evaluate a claim.
None of that is exotic, and all of it is work no model performs on your behalf.
What to Do Before You Accept an Offer
You do not need an attorney to start protecting your own file. People misjudge deadlines most, and they vary depending on who caused the harm.
A claim against a governmental entity is barred unless a notice of claim is filed within one year after the claim arises. A city vehicle or a county road crew puts you on that shorter clock.
The Utah Insurance Department also accepts complaints about claim handling. Several steps are worth taking right away:
- Ask in writing how the offer amount was calculated, and keep the response.
- Get any denial and its reasons in writing rather than over the phone.
- Note the date the insurer received your proof of loss and count 30 days forward.
- Keep your own record of treatment, missed work, and out-of-pocket costs.
- Have the offer reviewed before you sign, because a release closes the claim even if treatment later costs far more.
Several of the common insurance mistakes that quietly lower a claim happen in this window. The team at Good Guys Injury Law would rather hear from you before you sign than after.
Frequently Asked Questions About Insurance Company AI and Injury Claims
Can an insurance company use software to decide what my claim is worth?
Yes, and regulators have documented the practice across large auto insurers. The rules for how a claim is investigated, explained, and paid apply either way.
Do I have a right to know how my settlement offer was calculated?
You can ask, and a claim payment should arrive with a statement describing the coverage and how the amount was reached. We make that request in writing.
How long does an insurer have to respond to my claim?
It has 15 days to acknowledge a notice of loss and 30 days after a complete proof of loss to accept or deny it. Any extension requires written reasons.
Does the state regulate how insurers use artificial intelligence?
Not specifically. Two dozen states issued guidance on insurer use of artificial intelligence, and this one did not, so general claim-handling rules carry that weight.
Can I dispute a low offer that came from an automated system?
Yes. An offer is an opening position, and we respond by documenting value independently rather than arguing with the number on its own terms.
Where do I report an insurance company for mishandling my claim?
The state insurance regulator accepts complaints about claim handling. We can also review whether the conduct you describe crosses a line the rules already draw.
Talk With a Utah Personal Injury Attorney Before You Accept an Automated Offer
If a settlement offer landed in your inbox before anyone could have finished reading your chart, the speed itself is worth questioning.
Good Guys Injury Law handles injury claims from seven offices across Utah, and an attorney works your file directly rather than passing it to a paralegal. Our team works on a contingency fee basis, so nothing is owed up front. We will tell you plainly what your options look like, what an offer appears to leave out, and whether you need an attorney at all.
Call (801) 506-0800 for a free case evaluation, or reach us through our contact page, and let a person look at the number before you accept it.
