Today, the released 2025 annual claims reports from multiple insurance companies reveal that the insurance industry is undergoing a paradigm shift from "digital tool assistance" to "AI-driven" operations. A review of 2025 claims data from institutions including Ping An Life, ICBC-AXA Life Insurance, Tencent's WeSure, and ZA ONLINE indicates that the development of claims services is no longer limited to speed improvements, but has shifted towards the deep involvement of large AI models in complex liability determinations and the realization of one-stop "medical insurance + commercial insurance" settlements through direct data connections. The data shows that numerous insurance companies and internet platforms achieved a significant leap in claims quality and efficiency in 2025. Ping An Life paid out a cumulative total of 41.51 billion yuan annually, with a claim approval rate as high as 99.2%; ICBC-AXA Life Insurance paid 2.51 billion yuan in claims over the year, protecting 2.861 million person-times; ZA ONLINE paid out 17.9 billion yuan in claims for the year, handling approximately 2.9 million cases daily on average; the Tencent WeSure platform recorded a cumulative claims payout of 8.4 billion yuan. Behind these payout figures, the penetration rate of large AI model technology is significantly influencing the operational efficiency of insurers, with the automated review and settlement rate at some institutions approaching fifty percent.
Large AI models have become the core engine for improving claims efficiency. The most notable change in the 2025 insurance industry claims process is the deep evolution of large AI models from "document recognition" to "logical reasoning and liability determination." Ping An Life disclosed in its claims report that the company has formally introduced the DeepSeek large model to build a new intelligent review engine. Currently, 93% of automatically reviewed claims at Ping An Life can achieve accurate liability determination within 60 seconds. This technological upgrade directly compressed the fastest record for a single claim settlement to just 8 seconds. The practices of ZA ONLINE similarly confirm the trend towards AI-driven decision-making. In the health insurance sector, AI is now fully integrated into the entire claims process. With the guidance of an intelligent assistant, over 90% of health insurance users can achieve "one-time submission" of claims materials, and over 45% of claims cases are settled through automated review, with the fastest settlement time being a mere 15 seconds. ZA ONLINE also empowers diverse digital life scenarios, such as pet insurance and accident insurance, through AI technology. By integrating large models with small vertical-domain models, it automates processing in areas like image diagnosis, liability assessment, and medical record information extraction, handling over ten thousand cases per month automatically for pet and accident insurance, with an anomaly recognition accuracy rate of 98%. As an internet platform, Tencent WeSure's AI application places greater emphasis on proactive guidance in complex claim reporting environments. Based on its self-developed large model intelligent agent platform, Tencent WeSure has achieved automatic recognition and form-filling for medical documents through its AI smart reporting system, realizing "one-click reporting and automatic form completion." Furthermore, the claims assistant can provide 24/7 online Q&A, covering high-frequency questions about material preparation and progress tracking, and can translate complex claim notices into more easily understandable conclusions. A Tencent Cloud whitepaper on core insurance system transformation points out that the industry's previously cumbersome business processes are being systematically streamlined and simplified. Breaking down the barriers between sales, underwriting, customer service, and claims can significantly enhance overall business operational efficiency and quality, which is also key to supporting customer experience upgrades.
Direct payment channels are solving the problem of upfront medical cost payment. Beyond optimizing the claims experience through online apps, various insurers aggressively pursued the physical integration of insurance payments with medical scenarios in 2025. Platforms like Tencent WeSure made substantial progress in alleviating "upfront payment pressure" by connecting with public payment systems. Tencent WeSure, in collaboration with WeChat Pay and other parties, piloted and launched the nation's first "commercial insurance direct payment" express channel within the WeChat Pay ecosystem. Under this model, users can simultaneously complete direct deductions for both medical insurance reimbursement and commercial insurance claims when settling their hospital bills via WeChat Pay, achieving "claims settlement upon discharge." This "direct payment" model breaks down the long-standing "data silos" between insurance companies and medical institutions. In the traditional claims process, users needed to pay out-of-pocket first, then collect documents to apply for reimbursement from the insurer; commercial insurance direct payment brings financial services forward to the moment the expense occurs. ICBC-AXA Life Insurance also highlighted achievements in digital integration in its 2025 claims report. Through Shanghai's "One Code for All Claims" insurance code, it broke down data barriers between medical and commercial insurance, achieving real-time data exchange between ICBC-AXA Life and the medical insurance system with customer authorization. This eliminated the step of submitting claims materials for customers, cumulatively serving nearly 60,000 person-times and providing a convenient, highly efficient claims experience. Ping An Life's "Direct Fast Claim" service also experienced explosive growth in 2025. The 2025 claims report shows that its "Direct Fast Claim" service handled nearly 3 million cases annually, with payouts exceeding 14 billion yuan, representing a year-on-year increase of over 200%. Concurrently, Ping An Life's "Smart Pre-claim" service, which provides advance payments, handled 53,000 cases annually, amounting to over 4.91 billion yuan. This shift from "post-event compensation" to "in-process prepayment" and "scenario direct payment" not only alleviates the financial burden on patients but also transforms the perception of insurance protection from being a "policy document" to "instant credit."
Inclusive financial innovation is expanding the boundaries of service. Simultaneously, the reach of insurance services is rapidly extending towards new urban residents and vulnerable groups with technological support. A report from Tencent WeSure shows that as of December 2025, its "Love Protection Public Welfare Plan" had cumulatively provided coverage for over 450,000 person-times from disadvantaged groups, with claim payouts exceeding 25.49 million yuan. This inclusive model, leveraging the reach of internet platforms, brings traditionally hard-to-reach marginalized populations into the safety net. Furthermore, the "Flexible Worker Insurance" solution launched by Tencent WeSure for the gig economy has provided daily settlement insurance coverage to over 20 million person-times, precisely addressing the accident risk protection needs for groups like delivery riders and domestic workers under new economic models. As an internet-based insurer, ZA ONLINE also demonstrated impressive claims performance in supporting small and micro-enterprises and new urban residents. In 2025, ZA ONLINE cumulatively served the new urban resident demographic over 160 million person-times, provided protection for nearly 2,000 enterprises, covering 9 major industries including property management, construction, and logistics. In terms of supporting the real economy, ZA ONLINE handled 17.88 million claims for small, micro, and medium-sized enterprises throughout the year, amounting to 421 million yuan. This high-frequency, small-amount, yet wide-coverage claims service highlights the unique value of digital insurance in risk dispersion and social governance. ICBC-AXA Life Insurance, leveraging the channel advantages of a bank-affiliated insurer, has integrated inclusive insurance into the broader landscape of pension finance. It donated nearly 6.5 billion yuan in comprehensive insurance coverage to residents in Jiangxi, Yunnan, Henan, Fujian, Tianjin, and Shandong, benefiting a total population of over 180 million people.
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