DeBofsky Law flags AI-driven disability claim denials

DeBofsky Law says disability insurers are increasingly using artificial intelligence to review appeals, and the firm is already seeing denial letters that appear to overlook submitted medical evidence. The warning matters because long-term disability and ERISA claimants may need to scrutinize denials more closely as AI becomes more common in benefits decisions.

Why it matters: - Disability claim denials can determine whether people keep or lose income replacement benefits. - DeBofsky Law says AI-assisted review is raising the risk that insurers will miss or ignore medical evidence in appeals. - The trend could affect both long-term disability and ERISA-governed claims, where deadlines are short and mistakes can be costly.

What happened: - DeBofsky Law said it is seeing a consistent pattern in recent disability claim denials. - The firm said insurers appear to be leaning on artificial intelligence to review appeals. - The firm flagged the issue at the start of the fourth quarter of 2026 as it prepared clients and referral partners for a fast-changing claims process. - Founding partner Mark DeBofsky said the shift is changing how claims get decided.

The details: - In a 2026 survey of 502 HR and benefits decision-makers, more than half identified claims adjudication as an AI application used by a disability carrier or third-party administrator, according to the Integrated Benefits Institute. - DeBofsky Law said its own casework shows denial letters that do not engage with submitted medical evidence and appear automated rather than reviewed. - Mark DeBofsky said one recent appeal included a neuropsychological evaluation, but the insurer's consultant said there was no evidence of impairment without referencing the evaluation. - DeBofsky Law said it uses AI internally to manage large medical record sets, but only with attorney oversight. - The firm said the concern is AI used as a substitute for judgment, including situations where a claim consultant dismisses objective test results or a court leans on an AI-drafted opinion. - DeBofsky pointed to a warning from the U.S. Court of Appeals for the Seventh Circuit that judges are not required to search a record for arguments a party failed to make clearly. - The firm said that caution matters even more when an AI system, rather than a person, is doing the reading. - DeBofsky Law said more information is available at the firm's approach to claim appeals and litigation.

Between the lines: - The firm is not arguing that AI itself is the problem; it is warning about weak oversight and rubber-stamp decision-making. - If denial letters are increasingly generated or reviewed by AI, claimants may have a harder time spotting errors unless they read every line carefully. - The warning also suggests insurers may gain speed, but not necessarily accuracy, from automation.

What's next: - DeBofsky Law said it will keep tracking how AI appears in claim files and court filings. - The firm plans to keep briefing clients and referral partners on what to watch for as AI becomes standard on the insurer side. - Claimants are being told to review denial letters closely, flag missing or misstated evidence, and contact an attorney before appeal deadlines expire. - Long-term disability appeals typically have a 180-day window. - Some health benefit appeals must be filed within days. - The firm warned claimants not to use public AI tools to draft appeals because private medical and financial information may be absorbed into the system's training data.

The bottom line: - DeBofsky Law says AI is no longer a distant issue in disability claims; it is already shaping denials, and claimants need to assume the review may be less human than it looks.