Your Claims Are AI-Reviewed Today

Beat the Algorithm

AuthorAuthor

William Tygart & David Grove
August 23, 2025

88% of auto insurers and 70% of home insurers are using AI to review claims right now. Restor-AI-tion staff analyzed what this means for your next submission. The difference between fast approval and endless supplements comes down to how you document.

The AI Already Reviewing Your Claims

The NAIC (National Association of Insurance Commissioners) data from August 2025 is clear: AI isn't coming to insurance - it's here.

  • Auto insurers: 88% using AI for claims

  • Home insurers: 70% using AI

  • Health insurers: 84% using AI

  • Life insurers: 58% using AI

State Farm and Progressive launched automated approval systems this month. Simple water damage claims that used to take days now approve in minutes - if the documentation matches what the AI expects.

What AI Claims Systems Actually Look For

Restor-AI-tion's analysis of carrier AI systems reveals they scan for specific patterns:

Green Flags (Fast Approval):

  • Consistent measurements across photos and notes

  • Industry-standard terminology (Category 1/2/3, Class 1/2/3/4)

  • Clear moisture readings with specific locations

  • Photos that match written descriptions

  • Logical progression of damage spread

Red Flags (Manual Review):

  • Conflicting information between sections

  • Missing standard measurements

  • Vague descriptions ("extensive damage" vs "affecting 200 sq ft")

  • Photos that don't support the narrative

  • Unusual pricing without explanation

The Speed Difference Is Massive

Real carrier data from August 2025:

Aviva UK: 23 days faster on complex claims with AI review Compensa Poland: 73% cost reduction in processing Nordic insurers: Minutes instead of days for standard claims

But here's what matters to contractors: claims that pass AI review are getting paid in 3-5 days. Claims that trigger manual review are taking 3-4 weeks.

How to Format for AI Success

Based on our analysis of successfully approved claims, here's what works:

1. Lead with standardized classifications

  • Start every description with Category and Class

  • Use IICRC S500 terminology exactly

  • Include IIcrc standard reference numbers

2. Structure your data consistently

Room: Master Bathroom
Affected Area: 120 sq ft
Water Category: 2
Class: 2
Materials Affected: Drywall, baseboard, vanity
Moisture Readings: 
- Wall A: 87% at 12", 42% at 24"
- Wall B: 92% at 12", 38% at 24"

3. Make photos tell the story

  • Wide shot showing full affected area

  • Close-ups of moisture meter readings

  • Thermal imaging if available

  • Labels on photos matching report sections

4. Use precise measurements everywhere

  • Never use "approximately" without a number

  • Always include units (feet, inches, percentage)

  • Match measurements across all documentation

The AI Advantage for Prepared Contractors

Insurance carriers report 65% fewer complaints when AI processes claims (Aviva data). Why? Consistency. AI doesn't have bad days, doesn't miss details, and processes complete documentation immediately.

Contractors who format for AI are seeing:

  • 70% fewer supplements

  • 15-day faster payment average

  • 90% first-submission approval rate

  • Fewer adjuster callbacks

Your AI-Optimized Documentation Template

Restor-AI-tion developed this structure based on successful AI-approved claims:

Section 1: Classification Block

Loss Type: [Specific cause]
Date of Loss: [MM/DD/YYYY]
Category: [1/2/3]
Class: [1/2/3/4]
Affected Area: [XXX sq ft]

Section 2: Structured Damage List

Room Name:
- Material Type: [Specific material] 
- Affected Area: [XX sq ft]
- Moisture Content: [XX%]
- Required Action: [Remove/Dry/Clean]

Section 3: Equipment Justification

Equipment Type: [Model number]
Quantity: [Number]
Placement: [Specific location]
Target: [Moisture level/Temperature]

What Triggers Manual Review

Our analysis identified these documentation mistakes that force human review:

  • Mismatched square footage between sections (instant flag)

  • Missing moisture readings (AI can't validate without data)

  • Generic descriptions (AI needs specifics to match patterns)

  • Contradicting timelines (different dates in different sections)

  • Unusual material combinations without explanation

The 15-Minute Pre-Submit Checklist

Before hitting send on any claim:

  1. Numbers match - Every measurement appears consistently

  2. Photos align - Each photo referenced in text

  3. Standards cited - IICRC or other recognized standards mentioned

  4. Timeline clear - Date of loss consistent throughout

  5. Math works - Equipment count matches affected area

Beat the Algorithm By Being Boring

The MIT study showed 95% of complex AI fails. Insurance carrier AI succeeds because it's looking for patterns, not creativity. Your claim documentation shouldn't be innovative - it should be predictable.

The carriers using AI achieved 73% cost reduction by eliminating human review of standard claims. They want your documentation to be so clear, so standard, so boring that the AI approves it in seconds.

Based on August 2025 processing speeds:

  • AI-approved claim: 3-5 days to payment

  • Human review required: 21-28 days to payment

  • Difference: 18-23 days of float you're covering

Your Action Plan

Starting with your next claim:

  1. Use the template structure above

  2. Include every measurement twice (in text and photos)

  3. Stick to industry-standard terminology only

  4. Make everything boringly consistent

  5. Track your approval speed

The carriers spent billions making AI review your claims. You can spend 15 extra minutes making sure the AI loves your documentation. That's not gaming the system - that's speaking its language.

Remember: AI doesn't negotiate, doesn't get tired, and doesn't care about your relationship with the adjuster. It only cares about complete, consistent, standard documentation. Give it what it wants, get paid three weeks faster.