Complaints spike over claims delays
Celent reports a surge in claims complaints driven by delays and denials — regulators and analysts are flagging that insurers must streamline adjudication and dispute-handling to avoid rising customer friction. The trend pressures carriers to provide clearer audit trails and faster SIU escalations. (x.com)
Celent’s March 5, 2026 analysis of NAIC data shows claim‑handling issues rose in 2025 with delays constituting 22% of complaints, unsatisfactory settlements 13%, denials 12%, and total consumer complaints up 7% year‑over‑year. (celent.com) The NAIC has made consumer protection and market‑conduct monitoring a stated priority for 2025, formalizing increased oversight of claims practices across state regulators. (content.naic.org) State enforcement activity has followed: regulators imposed more than $40 million in fines against health insurers in the first six weeks of 2026 for violations that included payment‑processing delays and mishandled member complaints. (insights.wchsb.com) Celent’s 2026 claims‑technology research profiled 19 life‑claims administration platforms and highlighted configurable adjudication, decisioning logic, and full auditability as key vendor differentiators for reducing dispute volumes. (celent.com) Vendor disclosures and Celent recognition underscore that ‘full auditability’ and AI‑driven document processing are now purchase criteria; Neutrinos was named a Celent Technology Standout for AI decisioning and audit‑ready adjudication in its life claims suite. (prnewswire.com) Industry studies show 67% of SIU functions now use advanced analytics while many investigations remain manual, creating referral bottlenecks that extend adjudication timelines and raise complaint risk. (4warn.com) Regulators are also tightening expectations for SIU capability and fraud plans; New York DFS requires insurers’ Fraud Prevention Plans to include a standalone SIU and clear escalation protocols. (dfs.ny.gov) Consultancies and legal practices are advising carriers to accelerate SIU escalations and strengthen audit trails to avoid market conduct actions, while watchdog coverage documents regulators’ intensified scrutiny of claims‑handling communications and disclosures. (legal.thomsonreuters.com) (insurancecurator.com) Celent and market reviews also signal a crowded incumbent landscape—vendors count more than 30 established P&C claims platforms—creating an opportunity for InsurTechs that can demonstrate measurable reductions in delay, clearer audit trails, and faster SIU orchestration. (sapiens.com) Analysts and vendors are mining the NAIC Consumer Complaint Database to prioritize targets for product outreach, with Insurify reporting 35,063 auto‑insurance complaints in 2025 (a 7.5% rise from 2024), signaling specific carrier profiles that sales and ABM teams can segment for claims‑workflow solutions. (insurancecurator.com) (insurify.com)
