For an industry that has invested heavily in digital transformation, the claims process remains uneven in places, despite significant progress. While insurers continue to roll out new platforms, automation tools and AI capabilities, the experience for customers and suppliers is still shaped by delays, duplication and fragmented systems.
For Greg Laker (pictured), chief executive officer at QuestGates, the issue is not a lack of technology, but how it is implemented. “The challenge is introducing a technology solution to solve a problem, but it then potentially passes the problem down the supply chain,” he said.
Much of that friction stems from how insurers have modernised their systems. Rather than replacing legacy infrastructure outright, many have layered new front ends onto older platforms, creating additional complexity for suppliers and additional work across the claims journey.
“For a lot of insurers, they’ve got legacy systems and have needed to bolt on front ends,” Laker said. “This potentially results in additional re-keying of data for external parties.”
The result is a process that is technically more advanced, but operationally less efficient. That progress is real, but not always evenly distributed across the claims journey. Customer-facing roles are increasingly pulled into administrative work, while delays in passing claims through to suppliers can slow the entire lifecycle. By the time a case reaches a loss adjuster, expectations of a quick decision have already been set.
That does not mean technology has failed. In lower-value claims, automation is already delivering the kind of seamless experience the industry has long promised.
Robotic process automation has reduced repetitive tasks, while digital first-notification-of-loss platforms allow customers to submit claims, validate information and receive decisions within minutes. These systems rely on increasingly mature API ecosystems, connecting insurers with third-party data sources and enabling faster decision-making.
“If you lose a watch, for example, you can go onto a system, key it into the system, it will validate it and pretty much give the customer an instant decision,” Laker said.
The picture becomes more complex as claims increase in value and complexity. Here, the impact of newer technologies, particularly AI, is more constrained than some of the industry narrative suggests.
“True generative AI is a long way away because it requires really well-structured data,” Laker said. “Most insurers and suppliers don’t have well-structured data.”
Even in relatively simple use cases, human oversight remains essential. AI is increasingly being used to extract information from emails and populate claims systems, but only within defined limits.
“We’ve set a tolerance level of 75–80%,” he said. “Information can be extracted by AI and has improved accuracy by 75% but we still believe in human intervention to ensure accuracy.”
That balance reflects a broader industry reality. AI can accelerate processes and improve consistency, but it does not remove the need for judgement, particularly in complex claims.
If there is a single limiting factor, it is not innovation but infrastructure. The effectiveness of AI, automation and analytics depends on the quality and structure of underlying data. For many organisations, that means stepping back from existing processes rather than trying to automate them as they are.
“You don’t try and fit a solution around an existing process,” Laker said. “You go back to basics and look at the end-to-end process.”
That shift has implications not just for systems, but for people. As technology becomes more embedded in claims handling, roles are evolving to require both technical understanding and traditional customer-facing skills.
The role of the loss adjuster is already changing. Technology can support decision-making in the field by capturing data, transcribing conversations and surfacing relevant information in real time, but it does not replace human judgement.
In practice, the future claims process is likely to be more connected rather than fully automated. Faster data flows, better integration and improved communication channels may reduce delays, but human interaction remains central, particularly in complex cases.
“If your house burns down or you’ve got a factory that burns down, you want someone to come out and make informed and quick decisions on site,” Laker said.
A fully frictionless claims experience already exists in some parts of the market. Low-value, high-volume claims can now be processed end-to-end with minimal intervention.
But scaling that model across more complex claims will take time. Integration challenges, legacy systems and data limitations continue to shape how quickly progress can be made.
“You can have a frictionless solution with larger claims, but that will take longer to achieve,” Laker said.
The direction of travel is clear, but so are the constraints. For all the investment in new technology, the industry is still working through the fundamentals that will determine how far and how fast that transformation can go.
