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Modern Insurance Adjusting: Using and Countering AI-Powered Claim Valuation System

AI transforms insurance claims handling—learn how valuation engines work, maximize claim values, and navigate regulatory requirements effectively.

2026-02-19 13:00:00

3 hours

Program Details

2026-02-19 13:00:00

Program Details

2026-02-19 13:00:00

Over 1,000+ webinars

2026-02-19 13:00:00

3 hours

Course Overview

Mastering AI-Driven Insurance Claims Practices

2026-02-19 13:00:00

Participants will learn how AI software evaluates claims, strategies to maximize claim value, and regulatory compliance requirements. These skills enable practitioners to effectively navigate algorithmic claims handling and advocate for fair policyholder outcomes.

Format

CLE Credit

3h CLE Credits

Level

Intermediate

Length

3

Key topics that will be covered

01
AI Systems
Major insurers use Colossus, TEACH, and Shift to determine settlement values.
02
Demand Strategy
Include 11 specific statements after liability to increase AI value determinations.
03
Documentation
Diagnose injuries by body part using CMS 1500 and supplemental forms.
04
TBI/PTSD
Over 50% of auto victims have TBI; AI cannot evaluate these claims.
05
Timing
Claims maximize in value at 120 calendar days from accident date.
06
Regulatory Compliance
NAIC Model Bulletin requires AI transparency, validation, and consumer notice from insurers.

Program schedule

clock 1:00 pm - 3:10 pm EST

Insurance Claims Practices, Procedures, and AI Evaluation Software

This session explores the 187 AI programs used by insurers across the United States, including major systems like Colossus and TEACH, and how they determine claim values, liability, and fraud. Attendees will learn essential documentation requirements, the 11 demand statements that beat AI programs, and strategic timing for maximizing claim value within the critical 120-day window.

James MathisJames Mathis
Kate RiordanKate Riordan
Marshall GilinskyMarshall Gilinsky
clock 3:20 pm - 3:50 pm EST

How AI Claim Valuation Engines Are Built and Governed

This technical deep-dive examines how AI valuation engines are constructed, trained with structured and unstructured data, and governed through responsible AI frameworks. Participants will gain practical knowledge about machine learning approaches, multimodal models for medical record review, and essential guardrails including bias detection, model drift monitoring, and human-in-the-loop validation processes.

James MathisJames Mathis
Kate RiordanKate Riordan
Marshall GilinskyMarshall Gilinsky
clock 3:50 pm - 4:20 pm EST

AI and Insurance: Good Faith and Regulatory Compliance

This session investigates how algorithmic reliance can become a good-faith problem, using Colossus and the Allstate-McKinsey scandal as cautionary examples of valuation systems tuned to suppress payouts. Attendees will learn about NAIC Model Bulletin requirements for transparency, explainability, and consumer notice, plus the governance artifacts adjusters and counsel should request when AI drives claims decisions.

James MathisJames Mathis
Kate RiordanKate Riordan
Marshall GilinskyMarshall Gilinsky
James Mathis

James Mathis

Sequoia Visions, Inc

Kate Riordan

Kate Riordan

Verisk Analytics, Inc

Marshall Gilinsky

Marshall Gilinsky

Anderson Kill P.C

James Mathis

James Mathis

Sequoia Visions, Inc

Former insurance industry executive with extensive experience in claims handling, evaluation, and litigation. Nationally sought after speaker on insurance-related topics including claim handling, insurance fraud, bad faith, and breach of contract.

Recognition & Leadership

Nationally sought after speaker who has spoken for Trial Lawyer Associations and Physician Associations in all states in the United States and in Canada.

Experience

Employed with State Farm Insurance Company and Allstate Insurance Company in executive positions for many years. Named company executive on behalf of insurers in claims involving value, insurance fraud, insurance bad faith, insurance breach of contract and punitive damage litigation. Responsible for implementing many claims practices and programs currently used by the insurance industry. Has testified in deposition, trial testimony and/or written professional opinions in more than 175 trials. Often retained as a litigation consultant.
Kate Riordan

Kate Riordan

Verisk Analytics, Inc

Vice-president of Analytics Initiatives and Compliance at Verisk with expertise in Medicare compliance, Section 111 reporting requirements, conditional payment recovery process, Medicare Advantage, Part D and Medicaid recovery.

Education & Credentials

J.D. from Suffolk University Law School with a concentration in Health Care law. B.A. in Government Affairs and Legal Studies from Bowdoin College.

Recognition & Leadership

Participated in numerous national presentations, client trainings and article writing.

Professional Involvement

Vice-President of the National Medicare Secondary Payer Network (MSP Network). Co-chairs the Policy & Legislative committee. Member of the Medicare Advocacy Recovery Coalition (MARC).

Experience

Began career at Verisk as a Medicare Set Aside compliance attorney, completing and obtaining CMS approval of hundreds of Medicare Set Asides. Oversaw the creation and go to market plan for Discovery Navigator, an AI powered tool for identification and retrieval of key data points within large unstructured documents. Prior to joining Verisk, worked in elder law and estate planning with significant experience in public policy and legislative initiatives.
Marshall Gilinsky

Marshall Gilinsky

Anderson Kill P.C

Shareholder practicing in Insurance Recovery and Commercial Litigation with nearly 30 years of experience representing policyholders and recovering hundreds of millions of dollars for clients in disputed insurance claims.

Recognition & Leadership

Frequently writes and lectures on topics of interest to professionals and practitioners in the insurance arena. Frequently quoted in the press.

Professional Involvement

Co-chair of the firm's Sexual Harassment and Abuse Insurance Recovery Group and Sports, Media and Entertainment Group. Member of the firm's Banking and Lending Group and Restaurant, Retail & Hospitality Group.

Experience

Nearly 30-year career representing policyholders, successfully litigating disputed claims under property and business interruption insurance, commercial general liability (CGL) insurance, errors and omissions (E&O) insurance, directors and officers (D&O) insurance and life insurance. Represented clients on high-stakes, complex insurance claims arising out of prominent losses such as 9/11, Hurricane Katrina, Superstorm Sandy and the Big Dig in Boston. Focuses extensively on assisting clients that own and manage captive insurance companies, especially with respect to resolving coverage disputes between the captive and its reinsurers.
James Mathis

James Mathis

Sequoia Visions, Inc

Former insurance industry executive with extensive experience in claims handling, evaluation, and litigation. Nationally sought after speaker on insurance-related topics including claim handling, insurance fraud, bad faith, and breach of contract.

Recognition & Leadership

Nationally sought after speaker who has spoken for Trial Lawyer Associations and Physician Associations in all states in the United States and in Canada.

Experience

Employed with State Farm Insurance Company and Allstate Insurance Company in executive positions for many years. Named company executive on behalf of insurers in claims involving value, insurance fraud, insurance bad faith, insurance breach of contract and punitive damage litigation. Responsible for implementing many claims practices and programs currently used by the insurance industry. Has testified in deposition, trial testimony and/or written professional opinions in more than 175 trials. Often retained as a litigation consultant.
Kate Riordan

Kate Riordan

Verisk Analytics, Inc

Vice-president of Analytics Initiatives and Compliance at Verisk with expertise in Medicare compliance, Section 111 reporting requirements, conditional payment recovery process, Medicare Advantage, Part D and Medicaid recovery.

Education & Credentials

J.D. from Suffolk University Law School with a concentration in Health Care law. B.A. in Government Affairs and Legal Studies from Bowdoin College.

Recognition & Leadership

Participated in numerous national presentations, client trainings and article writing.

Professional Involvement

Vice-President of the National Medicare Secondary Payer Network (MSP Network). Co-chairs the Policy & Legislative committee. Member of the Medicare Advocacy Recovery Coalition (MARC).

Experience

Began career at Verisk as a Medicare Set Aside compliance attorney, completing and obtaining CMS approval of hundreds of Medicare Set Asides. Oversaw the creation and go to market plan for Discovery Navigator, an AI powered tool for identification and retrieval of key data points within large unstructured documents. Prior to joining Verisk, worked in elder law and estate planning with significant experience in public policy and legislative initiatives.
Marshall Gilinsky

Marshall Gilinsky

Anderson Kill P.C

Shareholder practicing in Insurance Recovery and Commercial Litigation with nearly 30 years of experience representing policyholders and recovering hundreds of millions of dollars for clients in disputed insurance claims.

Recognition & Leadership

Frequently writes and lectures on topics of interest to professionals and practitioners in the insurance arena. Frequently quoted in the press.

Professional Involvement

Co-chair of the firm's Sexual Harassment and Abuse Insurance Recovery Group and Sports, Media and Entertainment Group. Member of the firm's Banking and Lending Group and Restaurant, Retail & Hospitality Group.

Experience

Nearly 30-year career representing policyholders, successfully litigating disputed claims under property and business interruption insurance, commercial general liability (CGL) insurance, errors and omissions (E&O) insurance, directors and officers (D&O) insurance and life insurance. Represented clients on high-stakes, complex insurance claims arising out of prominent losses such as 9/11, Hurricane Katrina, Superstorm Sandy and the Big Dig in Boston. Focuses extensively on assisting clients that own and manage captive insurance companies, especially with respect to resolving coverage disputes between the captive and its reinsurers.

Credits by state

AK3.0
AL3.0
AR3.0
AZ3.0
CA3.0
CO3.0
CT3.0
DC3.0
DE3.0
FL3.0
GA3.0
HI3.6
IA3.0
ID3.0
IL3.0
IN3.0
KS3.0
KY3.0
LA3.0
MA3.0
MD3.0
ME3.0
MI3.0
MN3.0
MO3.6
MS3.0
MT3.0
NC3.0
ND3.0
NE3.0
NH180.0
NJ3.6
NM3.0
NV3.0
NY3.5
OH3.0
OK3.5
OR3.0
PA3.0
RI3.5
SC3.0
SD3.0
TN3.0
TX3.0
UT3.0
VA3.0
VT3.0
WA3.0
WI3.5
WV3.6
WY3.0

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MCLE Credits

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Approved
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Pending
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Approved
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Requirements

The Alabama State Bar MCLE Commission requires attorneys to complete 12 credits, including 1 ethics, by December 31 of each year. All credits must be reported by February 15 of the following year. A maximum of 12 credits, including 1 ethics credit, may be carried over for 1 year only.  

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  • Attorneys can earn unlimited “live” credit through live seminars, live webcasts, and co-sponsored locations with MyLAWCLE-Alabama approved programs
  • Attorneys are limited to 6 credits per compliance period of “online” programs through MyLAwCLE On-Demand programs