Over the past year, I’ve been talking a lot about how my clients are using AI to help manage their long-term disability claims.

But there’s another side to this conversation that I think is just as important.

Insurance companies are using AI too.

And in many cases, they’re using it in ways that aren’t obvious to the people whose claims are being assessed.

This shift isn’t necessarily a bad thing. In some ways, it’s improving efficiency. But it’s also changing how long-term disability claims are reviewed—and that’s something claimants should understand.

Like most tools, AI isn’t the issue on its own.

The impact comes from how it’s used.

The Good: Faster Processing and Better Organization

Insurance companies deal with an enormous amount of information in every long-term disability claim. Medical records, employment files, internal notes, and ongoing correspondence all need to be reviewed and assessed.

Traditionally, that process could take time.

AI is now being used to move through that information more quickly—summarizing reports, organizing files, and identifying missing pieces. Across the insurance industry, these tools are being adopted to help process large volumes of data more efficiently.

From an administrative perspective, that can be helpful. It can mean faster decisions and, in some cases, quicker access to benefits.

But that’s only part of the story.

The Shift: AI Is Influencing How Claims Are Reviewed

What I’m seeing more and more is that AI isn’t just helping organize claims—it’s influencing how they are assessed.

It’s being used to identify patterns, flag potential concerns, and highlight what an insurer may want to look at more closely.

That doesn’t mean a computer is deciding your claim.

But it does mean that certain aspects of your file may be brought to the forefront before a person even reviews it.

And that can shape the outcome.

What This Looks Like in Practice

While insurance companies don’t disclose exactly how they use AI in individual claims, I’m seeing patterns that suggest these tools are playing a role behind the scenes.

For example, I’ve had clients with chronic conditions where symptoms fluctuate over time. Their medical records might reflect that—one appointment noting some improvement, another documenting a setback.

In a human conversation, that makes sense.

But when that information is reviewed through a data-driven lens, those normal fluctuations can be flagged as inconsistencies.

I’ve also seen situations where claims are questioned because there isn’t enough “objective” evidence—despite clear and consistent reporting from the client and their treating doctor.

This tends to come up more often in cases involving chronic pain, mental health conditions, or fatigue—conditions that don’t always show up neatly in test results.

In other cases, clients find themselves under increased scrutiny without really understanding why. There may be additional requests for information, more frequent follow-ups, or even surveillance.

From the outside, it can feel arbitrary.

But in reality, it may be that the claim has been flagged based on certain patterns—whether that’s the diagnosis, the timing of the claim, or other factors that aren’t visible to the claimant.

And then there’s what I think is the biggest issue.

The human story can get lost.

A person might technically be able to perform certain tasks in isolation. But what that doesn’t capture is the fatigue that follows, the unpredictability of symptoms, or the cumulative effect of trying to function day after day with a disabling condition.

That context matters.

But it’s not something AI is equipped to fully understand.

The Risk: When Nuance Is Missed

Long-term disability claims are not just about information—they’re about interpretation.

They require an understanding of how a person’s condition affects their ability to function in their specific job, over time, in real life.

AI is very good at identifying patterns.

But it is not good at understanding nuance.

And in disability claims, nuance is everything.

Even within the insurance industry, there is recognition that AI tools can misinterpret information if they are not carefully monitored.

A Broader Concern: Fairness and Bias

There’s also a broader issue that is starting to get more attention.

AI systems are trained on data. And depending on how that data is structured, certain patterns can influence how claims are assessed.

In Canada, this raises important questions about fairness.

While this area is still evolving, there is growing recognition that oversight is needed to ensure these tools are being used responsibly.

Because at the end of the day, disability claims are not just data points.

They are people’s lives.

What This Means for Your Long-Term Disability Claim

So what does all of this mean in practice?

It means your claim may be processed more quickly—but also reviewed in a different way.

Certain details may be flagged automatically. Some aspects of your file may receive more attention than others. And parts of your claim may be assessed through a lens you don’t see.

More than anything, it means this:

Clarity and consistency matter.

How your condition is documented, how your limitations are described, and how your evidence comes together as a whole is critically important.

If you’re unsure about what insurers are looking for, you can learn more about how long-term disability claims work here:
👉https://mulqueendisabilitylaw.com/services/ltd-litigation/

And if your claim has been denied, I’ve outlined next steps here:
👉 https://www.mulqueendisabilitylaw.com/blog/long-term-disability-denied/

A Balanced Perspective

AI is not going away.

If anything, it’s becoming more integrated into the way disability claims are handled.

There are real benefits. It can improve efficiency and help insurers process information more quickly.

But there are also real limitations.

It cannot replace human judgment. It cannot fully understand lived experience. And it cannot capture the full picture of what it means to live with a disabling condition.

Why Individualized Legal Advice Matters

As the system becomes more complex, individualized legal advice becomes more important—not less.

Because while insurers may be using AI to process claims, you need someone who can step back and look at the full picture.

Someone who can identify issues before they become problems, ensure your evidence is presented clearly, and help you understand how your claim is being assessed in practice.

At Mulqueen Disability Law, we take a trauma-informed approach to disability claims. We understand that our clients are navigating both legal and health challenges at the same time.

Our role is to provide clarity and guidance—without adding to that stress.

You can learn more about how we help here:
👉 https://www.mulqueendisabilitylaw.com

Questions I’m Often Asked About AI and Insurance Companies

Are insurance companies really using AI in disability claims?
Yes. AI is increasingly being used to review information and assist in how claims are assessed.

Is AI making decisions about my claim?
Not entirely—but it may influence how your claim is reviewed.

Can AI affect whether my claim is denied?
It can play a role in how certain issues are identified or prioritized.

Is this happening in Canada?
Yes. Canadian insurers are adopting AI, although the legal framework is still evolving.

What should I do if I’m concerned?
Get advice early. Understanding how your claim is being assessed can make a significant difference.

A Final Word

The use of AI in long-term disability claims isn’t always visible.

But it is part of the process.

And that makes it even more important to ensure your claim is not just being processed—but properly understood.

Because your claim is not just data.

It’s your life.

Contact us for a Free Consultation

Mulqueen Disability Law specializes in hard-to-prove long-term disability claims for “Invisible Conditions” such as mental illness (depression, anxiety, PTSD) and chronic conditions (pain, neurological, immunological, concussion, post-COVID)  Contact us for a free confidential consultation.

Mulqueen Disability Law is a boutique law firm, focused on litigating long-term disability insurance benefit claims. Courtney Mulqueen and her team of legal professionals are Trauma-Informed Certified and have over two decades of experience exclusively in the area of long-term disability law. She and her team draw on their “insider” experience working for the insurance companies (including, Canada Life, Sun Life, Manulife, and OTIP), that they now sue for their clients.  

The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, please contact a lawyer specializing in disability law.