Can Insurance Use AI to Deny Your Injury Is Real?
You feel the pain every day, your MRI shows a real problem, and yet the insurance company is acting like your injury is in your head. More and more, that pushback is coming from software. Hospitals now run scans through AI that flags fractures, bleeds, and herniated discs, and insurers use their own computer programs to second-guess what your doctor found. If an insurer is using AI to question whether your injury is real or whether the crash caused it, here is what you need to know about how that plays out in a Michigan claim, and why a real doctor, not an algorithm, still has the final say.
Why Your Scan Matters So Much
In most Michigan injury claims, the fight comes down to one thing: proof. Your imaging is often the strongest proof you have. In a no-fault claim, the insurer has to pay for reasonable and necessary medical care for an injury that came out of using a vehicle under MCL 500.3105, and what counts as a covered expense is set by MCL 500.3107. If you are suing the at-fault driver, you generally have to show a ‘serious impairment of body function’ under MCL 500.3135. A scan that documents a herniated disc or a fracture, and ties it to your crash, can be the difference between a paid claim and a denied one. That is exactly why insurers fight so hard over imaging, and why the software behind it now matters to you.
A Real Doctor Still Owns the Diagnosis
Here is the most important thing to hold onto: an AI tool does not testify, and it does not diagnose you. A licensed radiologist or your treating doctor reads the study, forms an opinion, and stands behind it. The software is just one tool the doctor may use, like comparing an old film. So when an insurer waves around what some algorithm ‘detected’ or ‘missed,’ the answer is that your doctor’s reasoned opinion is what carries weight, not a printout.
That opinion is treated like any other expert medical testimony in Michigan, governed by MRE 702 (which the state’s high court tightened effective May 1, 2024) and MRE 703. As long as your doctor actually reviews the images and stands behind the finding, the fact that AI helped spot it does not make the opinion go away. The harder fight comes when a party tries to treat a raw algorithm printout as the evidence itself, the same authentication problem we cover in our guide to challenging AI-generated evidence.
How Your Imaging Report Gets Into Your Case
Your actual radiology report usually comes in as a medical record. Under MRE 803(6), records a hospital makes while treating you, kept in the ordinary course, are admissible once the right foundation is laid, and a radiology report fits squarely in that category. If a party instead wants to put the underlying images or an algorithm’s flagged output in front of a jury, they have to authenticate it under MRE 901 and explain how the system produced the result. In plain terms: a report where a real doctor states the finding is on much firmer footing than a computer printout showing a ‘confidence score’ with no one to explain what that number even means.
When the Insurer Uses AI to Fight You
AI imaging tools are powerful, but they are not perfect, and that cuts in your favor when an insurer over-relies on one. Researchers have documented bias baked into the data these systems learn from, ‘black box’ results no one can fully explain, and tools that perform worse on patients unlike those they were trained on. Those weaknesses give your lawyer room to challenge an insurer who hides behind an algorithm. An insurer that cannot show how its software reached a result should not get to use that result to deny you, and a good lawyer will press exactly that point. And remember, software can miss a real injury just as easily as it can flag a fake one, so a result that downplays your pain is not the end of the story. The duty to double-check AI and not just trust it runs through our guide to AI misdiagnosis and medical mistakes in Michigan too.
| How AI shows up in your case | What it means for you | The rule that protects you |
|---|---|---|
| Software helped your doctor spot the injury | Fine, and often helpful; your doctor still owns the diagnosis | MRE 702 (tightened May 1, 2024); MRE 703 |
| Your radiology report goes into evidence | Comes in as a medical record with the proper foundation | MRE 803(6) |
| Insurer waves a raw algorithm result to deny you | Faces extra scrutiny; demand a real doctor to explain it | MRE 901; MRE 702 |
| Proving the crash caused your injury | Clear imaging supports causation and your threshold | MCL 500.3105; MCL 500.3107; MCL 500.3135 |
What to Do If an Insurer Questions Your Injury
The takeaway is reassuring, with one condition. AI-assisted imaging can strengthen your claim by documenting your injury early and clearly, and it does not poison your evidence as long as a real, qualified doctor reads the study and stands behind it. The caution is that an insurer may point to an algorithm to argue your injury ‘is not real,’ or lean on its own automated review to deny your care. When that happens, insist that a credentialed physician explain the imaging, get the actual report and images rather than a summary, and treat any purely software-driven denial with the same skepticism we describe in our guide to AI-driven no-fault denials. The medicine, explained by a person who can be questioned, is what convinces a jury, and a lawyer can make sure that happens.
Frequently Asked Questions
Can the insurance company use AI to say my injury is not real?
It can point to an algorithm or its own automated review, but a software result is not the final word. You can require a credentialed doctor to explain your imaging, and you should treat a purely software-driven denial with caution rather than accepting it.
Does AI read my scan instead of a doctor?
No. Software may flag findings, but a licensed physician makes the diagnosis and stands behind it. The doctor’s reasoned interpretation, not the algorithm’s output, is what carries weight in your case.
Can an AI imaging finding help prove my injury?
Yes, when a doctor adopts it. A radiologist or treating physician interprets the scan, with the AI as one tool, and that opinion is governed by MRE 702. The report itself comes in as a medical record under MRE 803(6), and clear imaging helps prove the crash caused your injury.
Why does my MRI or X-ray matter so much in a Michigan claim?
Because objective proof drives these cases. In a no-fault claim the insurer must pay for care for an injury from vehicle use under MCL 500.3105, and in a lawsuit against the at-fault driver you generally must meet the serious-impairment threshold in MCL 500.3135. Clear imaging helps prove both.
The insurer denied my care based on a review. Do I need a lawyer?
It is worth a free call. A software-driven or paper-only denial can often be pushed back with a real doctor’s explanation of your imaging, and a lawyer can demand the actual records and challenge a denial that ignores what your scan shows.
Did an insurer use AI to question your injury? Let a real attorney review your imaging.
Attorney Manny Chahal personally reviews every case. Free statewide consultation, day or night. No fee unless we recover.
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