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Insurance companies randomly deny claims just to see if you’ll fight it. If you don’t, they’ll know they can deny more if your claims in the future. This is illegal, but if it’s a “bug” in the software or “AI” than they get away with it. Actually it’s harder with AI since people are more skeptical and have already caught them doing it. However this may be due to the AI being trained on the intentionally buggy software.
They actually do use software to find deniable claims that would theoretically have to be reviewed by a doctor. The doctor pulls up a while page of to be denied claims and theoretically gives them the legally required review all at once in the 30 seconds before he hits the button. There is no reason NOT to feed propensity to accept fake denial into the equation. You could even white wash it by presuming that prior denials that stuck were indication of bad claims and assert you are measuring their proclivity for filing wasteful claims.
I believe this based off my limited interactions with insurance companies. I was in a car crash that was 100% caused by the idiot who was fucking with their phone instead of looking at what they were crashing into. Their insurance company tried to stick me with months of rental fees from when my car was being repaired. I eventually filed a complaint with my state insurance commissioner and told their insurance company what's up, they got right on it after that. Literally, that same day they had multiple people contacting me to say we're all good now and apologizing about the misunderstanding.
Employers do this with time clock theft. It's the #1 thieved thing