Quit Paying Claims. Prevent Them!!!

Post pandemic, Insurance premium inflation became a pain. Claims got harder to settle. Customers started calling insurance companies the enemy. The core issue is in the biz model of the industry.

The insurer and the customers sit on opposite sides of the table. The insurer wins when claims do not get paid. The customer wins when they do. So both sides hide. The customer hides health conditions. The insurer hides behind fine print. When something goes wrong, claims adjusters & lawyers show up. Trust disappears. And the actual risk the flood, the accident, the disease wins every time.

For centuries, every brain in this industry has been focused on two things: calculating risk and fighting over claims. Both sides fighting over who gets the bigger slice of cake.

AI enables us to ask a different question. What if both sides made the cake bigger together?

Here is what AI changes. It lets insurers stop guessing about risk and start seeing it. In real time. And the moment you can see a risk forming, you can prevent it. When you prevent risk, the customer does not suffer, and the insurer does not pay. Both win. The fight is over. They are partners now.

Tesla proved this with math, not theory. Tesla Insurance loses money in California where regulators banned real-time driving data for underwriting. Tesla Insurance in other U.S. states, where it uses actual braking, speed, and accident data make profits. Same company. Same cars. Same technology. One can see what is happening on the road. The other is guessing. That single difference turned a losing business into a profitable one. For the insurer and the driver.

Now picture this across India.

A farmer in Vidarbha. Satellite AI detects drought stress three weeks before he can see it. A call reaches him in Marathi. He adjusts irrigation. The insurer sends prevention funds because saving the crop costs less than paying the claim. The harvest survives. Nobody fights.

A Pune construction site. AI cameras spot a worker without a helmet in a danger zone. The supervisor is alerted in seconds. The fall never happens. Six months of safety data later, the contractor's premium drops thirty percent. The worker goes home alive.

A family rushes their father to hospital at midnight. The insurer's AI is already talking to the hospital billing system. Overcharges are flagged. The family holds their father's hand instead of fighting at the billing counter at two in the morning.

Currently health insurance premiums have gone very high in India. What if the insurers incentive the customers with a free annual blood test and use the data to adjust premiums. Healthy people pay less. Show early warning signs, the insurer connects you with a doctor before it gets expensive. Both sides profit from keeping you well.

Same structure in every example. Insurer and customer on the same side. Making the cake bigger together instead of fighting over slices.

UPI penetration is at population scale because of trust. But India's insurance penetration is low. Not because people cannot afford it. Because people do not trust it. A farmer does not trust he will be paid. A worker does not trust the insurer cares whether he lives or dies. A family resents premiums that ignore how carefully they live.

AI-driven risk mitigation earns trust by being useful before the crisis. The farmer gets the warning call. The worker gets the safer site. The family gets preventive care. Insurance stops being a grudge purchase and becomes something that protects your life every day.

Most insurers will get this wrong. They will bolt AI onto the old model. Chatbots. Faster claims. Automated underwriting. That is not transformation. That is making a broken car go faster.

Real transformation means measuring claims prevented, not processed and not rejected. It means new incentives, new data systems, new customer relationships built on alignment instead of suspicion. That requires a partner who knows where the old model breaks and can build what replaces it technology, operations, and incentives together.

Most insurers are not ready for this shift. The ones who get ready first will own the next decade of Indian insurance. The rest will spend that decade wondering what happened.

Author: Akhil Reddy Ramolla, CEO, Assuretrac

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of IIA and IIA does not assume any responsibility or liability for the same.