Decerto Publishes The 2026 Claims Decisioning Pulse: Research from US Claims Leaders
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Decerto today published The 2026 Claims Decisioning Pulse, a 17-page research brief based on a structured survey of 20 respondents conducted between May 8 and May 29, 2026. The report coversfive operational and regulatory signals shaping how US carriers deploy AI inclaims operations - including findings that diverge from prevailing industry narratives about claims AI readiness.
Survey respondents included Chief Claims Officers, VPs of Claims, Heads of Claims, COOs, Claims Technology Leads, and Senior Claims Adjusters at US insurance carriers ranging from under $250 million to over $20 billion in direct written premium, across P&C personal lines, commercial lines, specialty, and multi-line operations.
Five signals stood out
- Only 3 of 20 surveyed respondents use AI-assisted decisioning - and all three are Claims Technology / Digital Claims Leads, not Chief Claims Officers. The other 17 still make meaningful claims decisions manually or with workflow support only. Zero respondents reported autonomous claims decisioning at scale.
- Where AI is in production, it lives on the edges of the process - document understanding, FNOL intake, fraud signals at first notice, triage and routing -not at the moment of decision. Reserve recommendation, the mostdecision-adjacent capability, is deployed at only 2 of 20 respondents.
- 12 of 20 respondents (close to two-thirds of the sample) flagged “adjuster time spent collecting data vs. evaluating the claim” as the largest operational gap - exceeding cycle time, real-time visibility, and decision consistency as the top reported pain point.
- Data quality and fragmented systems is the #1 blocker for Claims AI deployment (7 of 20 respondents), with ROI uncertainty close behind (5 of 20). The two binding constraints work together: a defensible business case cannot be built when the underlying data foundation isn’t yet in place.
- Of the 14 respondents exposed to the audit-trail standard, only 3 (about 21%) said they could produce a complete decision audit trail for a state Department of Insurance examiner within 5 business days. The NAIC AI Systems Evaluation Tool entered pilot examinations across 12 US states in Q1 2026, with 24 states having adopted the underlying Model Bulletin or substantively similar guidance.
The report introduces a regulatory framework that reframes how US carriers should sequence Claims AI deployments. The NAIC Model Bulletin directs state regulators to assess “the extent to which humans are involved in the final decision-making process” when reviewing a carrier’s AI program. The practical implication: straight-through processing (STP) in US claims works end-to-end on the approval path, while the adverse path - denial, reduction, fraud-flagged outcomes - routes to an adjuster or supervisor by regulatory design. Business cases built on autonomous decisioning projections fail when this constraint hits implementation.
The report contextualizes findings with public industry data from the J.D. Power 2025 U.S. Property Claims Satisfaction Study, the NAIC Model Bulletin, McKinsey & Company research on claims operations, and Deloitte’s 2024 survey of 200 US insurance executives on scaling generative AI in insurance.
About the methodology
The 2026 Claims Decisioning Pulse is a qualitative pulse check based on a structured survey conducted between May 8 and May 29, 2026. The report does not claim to be a statistically representative benchmark of the US insurance market. It documents directional signals from senior claims practitioners and triangulates findings with publicly available industry data.Full methodology and limitations are disclosed in the report.
Access the report
The full 17-page report is availableat no cost (form gate only, no paywall):
→ Download The 2026 Claims Decisioning Pulse
VPs of Claims and CCOs at US P&Ccarriers can also book a 40-minute Claims AI assessment session with Decerto’s Claims AI lead, Maciej Wir-Konas, to walk through what the framework means fortheir 2026 deployment plans.
30 Minutes with Decerto Specialist
Walk through your specific carrier stack and tell us where it hurts most. We'll tell you within the call which Decerto products solve it, what the realistic timeline is, and whether you should keep what you have. NDA signed before the call if needed.
