Insurance Claims
Operational reading for adjusters, SIU investigators, and claims leaders. What a modern BI file evaluation looks like, where physics-based analysis fits in, the economics of claim leakage, and the signals that separate a legitimate injury from an inflated demand.
Every claim starts as a narrative. A police report, a recorded statement, a set of photos, a bill from a medical provider. The adjuster's job is to turn that narrative into a defensible number on a closed file. Two things have changed in the last two years that affect how that gets done: the demands are bigger, and the tools available to evaluate them are radically faster.
Nuclear verdicts and social inflation have made plaintiff attorneys more aggressive in how they anchor demands. The cases adjusters saw in 2018 as routine low-speed files now routinely arrive with $75,000 to $250,000 demand packages, backed by referrals to chiropractors, orthopedists, and pain management clinics that are often coordinated with the plaintiff's counsel. Carriers that price based on the medical bills alone end up paying for treatment that wasn't caused by the crash.
The other change is the introduction of AI-powered claim evaluation into the adjuster's daily workflow. Photo-based Delta-V estimation, damage-vs-injury mismatch scoring, and severity triage that used to require an outside expert now runs inside the claims platform on a webhook. The articles in this category walk through how that works in practice: where the analysis slots into FNOL, how adjusters read the output, when to refer to SIU, how defense counsel uses the same data downstream, and how leadership should measure whether it's actually reducing indemnity spend.
What this section covers
- BI claim triage and severity scoring using physics-based inputs
- Damage-vs-injury mismatch detection and SIU referral workflow
- Fraud red flags, staged accidents, and patterns in recorded statements
- Reserve setting anchored in crash physics rather than medical bills alone
- Claims cycle time reduction through AI-assisted intake
- Defense counsel handoff and exhibit-ready documentation
- Subrogation support and comparative fault analysis
- Nuclear verdicts, social inflation, and rising BI severity
Who this is for
P&C claims adjusters, SIU investigators, claims managers, third-party administrators (TPAs), MGAs, fleet insurers, and claims operations leaders at carriers looking to move physics analysis upstream in the claim lifecycle.
Insurance Claims articles
Frequently asked
Where does AI-powered crash analysis fit into a typical claims workflow?
At FNOL is the highest-leverage point. Photos arrive with the first notice. Running analysis on those photos gives the adjuster a Delta-V range, severity score, and mismatch flag before a recorded statement is even taken. Triage and reserve-setting then happen with physics in hand rather than three weeks later. Carriers can also run it at reserve review, at litigation referral, or on demand when a demand letter lands.
How does this improve SIU referrals?
The system produces a damage-vs-injury mismatch score with documented physics basis. When claimed injuries exceed what the crash physics can produce, the file gets flagged with a rationale an investigator can act on. Carriers running pilots typically see referral quality improve and false positive rates drop because referrals now have a quantifiable basis, not just a gut feel from the adjuster.
What impact should we expect on indemnity and cycle time?
The impact varies by line and segment, but pilot programs have shown double-digit improvements in cycle time on BI files that previously required outside expert input. Indemnity impact comes from two directions: severity right-sizing on files the carrier was overpaying and successful defense on inflated demands that previously settled without challenge. We recommend measuring both on a closed book before scaling.