Using AI to read your insurance policy? Check this

Deciphering the fine print of a health or life insurance policy can be a daunting task due to its lengthy pages filled with complex terminology and technical language. However, artificial intelligence (AI) can assist policyholders in breaking down the intricate details, although a simplified summary may not provide the complete picture.

To effectively utilize AI for understanding a policy, it is crucial to ask specific questions rather than requesting a generic summary. Policyholders should provide clear instructions, such as asking the AI to explain each clause individually, list coverage and exclusions, mention waiting periods, deductibles, co-payments, sub-limits, eligibility rules, and claim deadlines, while citing the relevant page or clause for each detail.

Certain situations may require additional prompts. For instance, when dealing with a life policy, one should inquire about riders, premium obligations, lapse and revival, surrender value, nomination, and claim procedures. Additionally, asking AI to differentiate between the policy's actual wording and its interpretation is beneficial, and flagging any unclear or inconsistent information is essential.

It is important to note that AI cannot determine the acceptance of future claims, as it may not account for comorbidities associated with pre-existing diseases or the insurer's internal records. Furthermore, while AI can quickly identify specific waiting periods, such as a three-year waiting period for diabetes, it cannot accurately predict the outcome of a claim based on an elderly person's medical history and how various conditions may interact.

Additionally, policyholders should be aware that AI operates based on rigid logic, and the Indian insurance industry relies heavily on empathy and ground-level execution. While a chatbot can translate the fine print, it lacks the human context necessary to understand how that fine print applies during a medical crisis. Therefore, policyholders should supplement AI-generated summaries with a thorough review of the policy schedule, endorsements, and insurer records, seeking important clarifications in writing.

It is also crucial to mask personal and medical details, including the dependent's earnings (PED) information, before uploading documents to AI. In summary, while AI can simplify the initial reading of an insurance policy, it should not replace a thorough examination and understanding of the policy's terms, conditions, and potential exceptions.