AI isn’t replacing insurance company decision makers yet, as new legislation filed in Florida is aimed at requiring mandatory human reviews of claim denials.
Florida’s HB 527 (and companion bill SB 202) would apply to information provided to insurers by algorithms, artificial intelligence systems, or machine learning systems, none of which may serve as the sole basis for adjusting or denying a claim, in whole or in part.
The bills also state that when an insurer plans to use algorithms, artificial intelligence systems, or machine learning systems in its claims handling processes, it must detail in its claims handling manual the manner in which the systems are to be used and how the systems comply with the law.
The person who reviews claim denials would have to be a “qualified human professional” — “an individual who, under the Florida Insurance Code, has the authority to adjust or deny a claim or a portion of a claim and may exercise such authority over a particular claim.”
According to HB 527 and companion bill SB 202, before adjusting or denying a claim or a portion of a claim, the professional would be required to:
- “Analyze the facts of the claim and the terms of the insurance policy independently of any artificial intelligence system, machine learning system, or algorithm;
- “Review the accuracy of any output generated by such a system or algorithm; and
- “Determine that the claim or portion of the claim is not payable under the terms of the insurance policy and should be denied or that the claim payment should be reduced.”
Sponsors of the proposed legislation Rep say the bill “’addresses a growing challenge in our insurance markets’ with a ‘clear and reasonable safeguard’ against algorithm-driven decisions.”
In 2023, the National Association of Insurance Commissioners (NAIC) approved a model bulletin on the use of AI by insurance companies. It outlines the need for processes and controls to prevent possible AI inaccuracies, discriminatory biases, and data vulnerabilities.
The bulletin reminds insurers of established regulatory laws, such as the Unfair Trade Practices Model Act, that regulate unfair methods of competition or unfair or deceptive acts. It states that governance and controls on AI systems are needed to comply with these laws.
It is likely this proposed litigation will be challenged on a federal level, as the President recently signed an executive order blocking states from enforcing their own laws regulating artificial intelligence.
