Modern Insurance Adjusting: Using and Countering AI-Powered Claim Valuation System

James Mathis | Sequoia Visions, Inc

James Mathis was employed with State Farm Insurance Company and Allstate Insurance Company in executive positions for many years. He was the named company executive on behalf of insurers in claims involving value, insurance fraud, insurance bad faith, insurance breach of contract and punitive damage litigation. He was responsible for implementing many of the claims practices and programs currently used by the insurance industry today. He is a nationally sought after speaker in the areas of claim handling, claim evaluation, claim litigation, insurance policies and Errors & Omission claims. He has testified in deposition, trial testimony and/or written professional opinions in more than 175 trials. He is often retained as a litigation consulate. He has spoken for Trial Lawyer Associations and Physician Associations in all states in the United States and in Canada.

Kate Riordan | Verisk Analytics, Inc

Kate Riordan is the vice-president of Analytics Initiatives and Compliance at Verisk. Kate began her career at Verisk as a Medicare Set Aside compliance attorney. In that role, she completed and obtained CMS approval of hundreds of Medicare Set Asides. She is fluent in Section 111 reporting requirements, the conditional payment recovery process, Medicare Advantage, Part D and Medicaid recovery. In addition to providing Medicare compliance Kate is oversaw the creation and go to market plan for Discovery Navigator, an AI powered tool that automatically enables identification and retrieval of key data points within large unstructured documents. In these roles she’s participated in numerous national presentations, client trainings and article writing.

Prior to joining Verisk, Kate worked in elder law and estate planning and brought significant experience in public policy and legislative initiatives to her role. Kate received her J.D. from Suffolk University Law School with a concentration in Health Care law and received her B.A. in Government Affairs and Legal Studies from Bowdoin College. Kate is Vice-President of the National Medicare Secondary Payer Network (MSP Network) and co-chairs the Policy & Legislative committee as well as a member of the Medicare Advocacy Recovery Coalition (MARC).

Marshall Gilinsky | Anderson Kill P.C

Marshall Gilinsky is a shareholder in Anderson Kill’s Boston office and practices in the firm’s Insurance Recovery and Commercial Litigation groups. Marshall is co-chair of the firm’s Sexual Harassment and Abuse Insurance Recovery Group and Sports, Media and Entertainment Group, and a member of the firm’s Banking and Lending Group and Restaurant, Retail & Hospitality Group.

During his nearly 30-year career representing policyholders, Marshall has recovered hundreds of millions of dollars for his clients, successfully litigating disputed claims under a variety of insurance products, including property and business interruption insurance, commercial general liability (CGL) insurance, errors and omissions (E&O) insurance, directors and officers (D&O) insurance and life insurance. Marshall has represented clients on numerous high-stakes, complex insurance claims arising out of prominent losses such as 9/11, Hurricane Katrina, Superstorm Sandy and the “Big Dig” in Boston. He also focuses extensively on assisting clients that own and manage captive insurance companies, especially with respect to resolving coverage disputes between the captive and its reinsurers.

Marshall’s success in solving clients’ problems stems from his ability to understand their businesses, as well as their insurance programs in order to maximize the value of the clients’ insurance assets. He frequently writes and lectures on a variety of topics of interest to professionals and practitioners in the insurance arena, and is frequently quoted in the press, including appearance.

Session I – Insurance Claims Practices and Procedures | 1:00pm – 3:10pm

• Insurance software claim evaluation
• Claim workup and demands
• Claim handling 120 days to policy limits

Break | 2:00pm – 2:10pm

• Additional value drivers
• Minor impacts and SIU issues to avoid

Break | 3:10pm – 3:20pm

Session II – How AI Claim Valuation Engines Are Built, Trained & Governed | 3:20pm – 3:50pm

• What data goes in/what outputs mean in practice
• Confidence ranges, severity drivers, and common failure modes
• Responsible-AI governance, audit trails, and compliance expectations
• Practical “questions to ask the carrier/vendor” toolkit for adjusters and counsel

Session III – Intersection of Insurance and AI: An Eye-on Claims Handling | 3:50pm – 4:20pm

• How AI is being used in insurance, especially claims, and why carriers adopt it such as speed, cost, consistency, and pricing accuracy
• Colossus as the cautionary model for how valuation systems can be tuned to suppress payouts and what that implies for modern AI tools
• When algorithmic reliance becomes a good-faith problem and the insurer obligation to fairly handle claims and deliver the promise to pay
• Regulatory expectations from the NAIC Model Bulletin focusing on inaccuracy, unfair discrimination, data vulnerability, and transparency and explainability
• Governance artifacts adjusters and counsel should expect and request including AIS program controls, documentation, validation and retesting, auditability, and monitoring for model drift