Between Fear and Adoption: The AI Paradox in Medico-Legal Practice Among National Insurance Physicians

Objectives.—: To assess artificial intelligence adoption patterns, trust levels, and perceived utility among physicians conducting disability assessments for a national insurance system, with a focus on the paradox between widespread use and limited trust in artificial intelligence for medico-legal decisions. Background.—: Artificial intelligence is rapidly entering clinical workflows, yet its integration into insurance medicine-where physicians must translate complex clinical findings into legally defensible administrative decisions-remains unexplored. Physicians conducting disability assessments operate at the intersection of clinical judgment, administrative burden, and legal accountability, making them a critical population for evaluating artificial intelligence adoption and its epistemic limits. Methods.—: A cross-sectional survey was conducted in February 2026 among 428 physicians working in medical committees, appeals boards, and advisory roles at the Israeli National Insurance Institute (response rate 85.6%). The questionnaire assessed artificial intelligence usage frequency, trust in artificial intelligence-supported decisions (5-point scale), perceived risks, and preferred applications. Results.—: Artificial intelligence adoption was widespread (76% regular or occasional use; 27% daily use), yet trust remained low (mean 2.7 of 5). Daily users showed higher trust than non-daily users (odds ratio 1.81; 95% confidence interval 1.14-2.88). Administrative burden was the dominant adoption driver. Preferred applications included medical record summarization (85%), inconsistency detection (45%), and protocol drafting (35%). Most use was informal, relying on personal tools. Senior physicians expressed relational concerns; less experienced physicians emphasized technical risks. Conclusions.—: Insurance medicine physicians distinguish between instrumental trust for administrative efficiency and epistemic trust for legally accountable judgment. Artificial intelligence integration should emphasize administrative augmentation while preserving human interpretative authority.