{"id":"https://openalex.org/W7220933469","doi":"https://doi.org/10.48550/arxiv.2610.09671","title":"InsClaimBench: Benchmarking Insurance Claim Adjudication Across the Decision Chain","display_name":"InsClaimBench: Benchmarking Insurance Claim Adjudication Across the Decision Chain","publication_year":2026,"publication_date":"2026-10-07","ids":{"openalex":"https://openalex.org/W7220933469","doi":"https://doi.org/10.48550/arxiv.2610.09671"},"language":"en","primary_location":{"id":"pmh:oai:arXiv.org:2610.09671","doi":null,"is_oa":true,"landing_page_url":"https://arxiv.org/abs/2610.09671","pdf_url":"https://arxiv.org/pdf/2610.09671","source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":"2331-8422","issn":["2331-8422"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"text"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["arxiv","datacite"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://arxiv.org/pdf/2610.09671","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5144334042","display_name":"Linqi Zhang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Zhang, Linqi","raw_affiliation_strings":["School of Computer Science and Technology , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Computer Science and Technology , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5157936899","display_name":"Chong Qi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I881766915","display_name":"Nanjing University","ror":"https://ror.org/01rxvg760","country_code":"CN","type":"education","lineage":["https://openalex.org/I881766915"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Qi, Chong","raw_affiliation_strings":["School of Integrated Circuits , Nanjing University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Integrated Circuits , Nanjing University","institution_ids":["https://openalex.org/I881766915"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5157964831","display_name":"Yan Cheng","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Cheng, Yan","raw_affiliation_strings":["School of Economics , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Economics , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5157908519","display_name":"Wanqing Cao","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Cao, Wanqing","raw_affiliation_strings":["School of Economics , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Economics , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5157939856","display_name":"Yu Liu","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Liu, Yu","raw_affiliation_strings":["School of Computer Science and Technology , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Computer Science and Technology , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5157966401","display_name":"Chenwei Lin","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Lin, Chenwei","raw_affiliation_strings":["School of Computer Science and Technology , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Computer Science and Technology , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5157943730","display_name":"Xian Xu","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I24943067","display_name":"Fudan University","ror":"https://ror.org/013q1eq08","country_code":"CN","type":"education","lineage":["https://openalex.org/I24943067"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Xu, Xian","raw_affiliation_strings":["School of Economics , Fudan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Economics , Fudan University","institution_ids":["https://openalex.org/I24943067"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T13643","display_name":"Artificial Intelligence in Law","score":0.3788999915122986,"subfield":{"id":"https://openalex.org/subfields/3308","display_name":"Law"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T13643","display_name":"Artificial Intelligence in Law","score":0.3788999915122986,"subfield":{"id":"https://openalex.org/subfields/3308","display_name":"Law"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12026","display_name":"Explainable Artificial Intelligence (XAI)","score":0.17030000686645508,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10028","display_name":"Topic Modeling","score":0.12160000205039978,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/large-language-models","display_name":"large language models","score":0.6359999775886536},{"id":"https://openalex.org/keywords/benchmark","display_name":"benchmark","score":0.4659999907016754},{"id":"https://openalex.org/keywords/error-propagation","display_name":"error propagation","score":0.7609999775886536},{"id":"https://openalex.org/keywords/auto-insurance","display_name":"automobile insurance","score":0.5569999814033508},{"id":"https://openalex.org/keywords/property-insurance","display_name":"property insurance","score":0.9649999737739563},{"id":"https://openalex.org/keywords/health-insurance","display_name":"health insurance","score":1.0}],"concepts":[{"id":"https://openalex.org/C204434341","wikidata":"https://www.wikidata.org/wiki/Q357789","display_name":"Adjudication","level":2,"score":0.9416999816894531},{"id":"https://openalex.org/C86251818","wikidata":"https://www.wikidata.org/wiki/Q816754","display_name":"Benchmarking","level":2,"score":0.6517000198364258},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.6373000144958496},{"id":"https://openalex.org/C68799949","wikidata":"https://www.wikidata.org/wiki/Q977871","display_name":"Insurance policy","level":2,"score":0.5230000019073486},{"id":"https://openalex.org/C43214815","wikidata":"https://www.wikidata.org/wiki/Q7310987","display_name":"Reliability (semiconductor)","level":3,"score":0.4546000063419342},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4413999915122986},{"id":"https://openalex.org/C84839998","wikidata":"https://www.wikidata.org/wiki/Q5249245","display_name":"Decision rule","level":2,"score":0.43970000743865967},{"id":"https://openalex.org/C184898388","wikidata":"https://www.wikidata.org/wiki/Q1435712","display_name":"Pairwise comparison","level":2,"score":0.39969998598098755},{"id":"https://openalex.org/C185798385","wikidata":"https://www.wikidata.org/wiki/Q1161707","display_name":"Benchmark (surveying)","level":2,"score":0.36660000681877136},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.33709999918937683},{"id":"https://openalex.org/C59594135","wikidata":"https://www.wikidata.org/wiki/Q5249242","display_name":"Decision model","level":2,"score":0.3353999853134155},{"id":"https://openalex.org/C149782125","wikidata":"https://www.wikidata.org/wiki/Q160039","display_name":"Econometrics","level":1,"score":0.328000009059906},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3034999966621399},{"id":"https://openalex.org/C134121241","wikidata":"https://www.wikidata.org/wiki/Q899301","display_name":"Yield (engineering)","level":2,"score":0.295199990272522},{"id":"https://openalex.org/C29513703","wikidata":"https://www.wikidata.org/wiki/Q6398174","display_name":"Key person insurance","level":3,"score":0.2831999957561493},{"id":"https://openalex.org/C42475967","wikidata":"https://www.wikidata.org/wiki/Q194292","display_name":"Operations research","level":1,"score":0.27219998836517334},{"id":"https://openalex.org/C2779662365","wikidata":"https://www.wikidata.org/wiki/Q5416694","display_name":"Event (particle physics)","level":2,"score":0.265500009059906},{"id":"https://openalex.org/C119232533","wikidata":"https://www.wikidata.org/wiki/Q873451","display_name":"Business ethics","level":2,"score":0.25450000166893005},{"id":"https://openalex.org/C123614077","wikidata":"https://www.wikidata.org/wiki/Q1364905","display_name":"Propagation of uncertainty","level":2,"score":0.25450000166893005}],"mesh":[],"locations_count":2,"locations":[{"id":"pmh:oai:arXiv.org:2610.09671","doi":null,"is_oa":true,"landing_page_url":"https://arxiv.org/abs/2610.09671","pdf_url":"https://arxiv.org/pdf/2610.09671","source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":"2331-8422","issn":["2331-8422"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"text"},{"id":"doi:10.48550/arxiv.2610.09671","doi":"https://doi.org/10.48550/arxiv.2610.09671","is_oa":true,"landing_page_url":"https://doi.org/10.48550/arxiv.2610.09671","pdf_url":null,"source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":"2331-8422","issn":["2331-8422"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":null,"is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Preprint"}],"best_oa_location":{"id":"pmh:oai:arXiv.org:2610.09671","doi":null,"is_oa":true,"landing_page_url":"https://arxiv.org/abs/2610.09671","pdf_url":"https://arxiv.org/pdf/2610.09671","source":{"id":"https://openalex.org/S4306400194","display_name":"arXiv (Cornell University)","issn_l":"2331-8422","issn":["2331-8422"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I205783295","host_organization_name":"Cornell University","host_organization_lineage":["https://openalex.org/I205783295"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"text"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7220933469.pdf","grobid_xml":"https://content.openalex.org/works/W7220933469.grobid-xml"},"referenced_works_count":6,"referenced_works":["https://openalex.org/W4394868103","https://openalex.org/W4414758332","https://openalex.org/W7130756034","https://openalex.org/W7133352242","https://openalex.org/W7165385035","https://openalex.org/W7171548355"],"related_works":["https://openalex.org/W7204834670","https://openalex.org/W7208023071","https://openalex.org/W4415524647","https://openalex.org/W7081627853","https://openalex.org/W7210291856","https://openalex.org/W4411654102","https://openalex.org/W7117160056","https://openalex.org/W7220995103","https://openalex.org/W7217183726","https://openalex.org/W7211886615"],"abstract_inverted_index":{"Recent":[0],"advances":[1],"in":[2,61,73],"reasoning-oriented":[3],"large":[4],"language":[5],"models":[6,28],"(LLMs)":[7],"have":[8],"motivated":[9],"increasing":[10],"evaluation":[11],"of":[12,117,124],"their":[13],"ability":[14],"to":[15,29,98,140,147],"perform":[16],"professional":[17],"decision":[18,43,58,128,224],"tasks.":[19],"Insurance":[20],"claim":[21,54,63,91,215],"adjudication":[22,55,96,216],"is":[23],"one":[24],"such":[25],"task,":[26],"requiring":[27],"connect":[30],"case":[31,75],"evidence,":[32],"insurance":[33,53,67],"rules,":[34,68],"intermediate":[35,208],"judgments,":[36],"and":[37,65,80,101,163,203,220],"payout":[38,99],"calculations":[39],"across":[40,56,77,114,222],"a":[41,121],"structured":[42,66],"process.":[44],"We":[45],"introduce":[46],"InsClaimBench,":[47],"an":[48],"end-to-end":[49],"benchmark":[50],"for":[51],"evaluating":[52],"the":[57,127,164,223],"chain.":[59,129,225],"Grounded":[60],"real":[62],"materials":[64],"InsClaimBench":[69],"contains":[70],"3,780":[71],"cases":[72],"375":[74],"families":[76],"auto,":[78],"property,":[79],"health":[81],"insurance,":[82],"comprising":[83],"86,656":[84],"atomic":[85,93],"rule":[86,193],"judgments.":[87],"It":[88],"evaluates":[89],"each":[90],"from":[92,133],"rules":[94],"through":[95],"modules":[97],"decisions":[100],"amounts,":[102],"with":[103,175],"controlled":[104],"factual":[105,179],"variants":[106],"testing":[107],"whether":[108],"required":[109],"changes":[110],"are":[111,169,189],"correctly":[112],"propagated":[113],"levels.":[115],"Evaluation":[116],"six":[118],"LLMs":[119],"reveals":[120],"progressive":[122],"loss":[123],"reliability":[125],"along":[126],"Payout-decision":[130],"accuracy":[131,138,152],"ranges":[132],"74.23--80.19%,":[134],"while":[135],"joint":[136],"decision--amount":[137],"drops":[139],"47.54--73.15%.":[141],"Strong":[142],"local":[143,196],"performance":[144],"also":[145],"fails":[146],"ensure":[148],"case-level":[149],"correctness:":[150],"atomic-rule":[151],"reaches":[153],"95.48%,":[154],"whereas":[155],"rule-vector":[156],"exact":[157],"match":[158],"peaks":[159],"at":[160],"only":[161],"36.90%,":[162],"most":[165,173],"frequent":[166],"module":[167,187],"errors":[168],"not":[170],"necessarily":[171],"those":[172],"associated":[174],"final-decision":[176],"failure.":[177],"Under":[178],"changes,":[180],"these":[181],"inconsistencies":[182],"further":[183],"become":[184],"propagation":[185,221],"failures:":[186],"updates":[188],"less":[190],"reliable":[191,214],"than":[192],"updates,":[194],"correct":[195,204],"judgments":[197],"can":[198,206],"still":[199],"yield":[200],"incorrect":[201],"payouts,":[202],"payouts":[205],"conceal":[207],"errors.":[209],"These":[210],"results":[211],"show":[212],"that":[213],"requires":[217],"consistent":[218],"composition":[219]},"counts_by_year":[],"updated_date":"2026-11-07T11:25:07.637180","created_date":"2026-10-09T00:00:00"}
