TALLAHASSEE, Fla. – A Florida Senate Committee is considering a bill filed by a local lawmaker that would keep insurance companies from relying on artificial intelligence to deny claims.
The Senate Banking and Insurance Committee will take up a bill (SB 794) filed by Sen. Jennifer Bradley, R-Fleming Island.
The measure would require “human reviews” of decisions to deny insurance claims and prevent AI from being the basis for denials.
The bill refers to a “qualified human professional” many times and states the professional includes but isn’t limited to “a supervisor, claims manager, or licensed claims adjuster having authority over a claim.”
An insurer’s decision to deny a claim would need to be reviewed, approved, and signed off by a qualified professional.
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Providers will have to keep records and document the review process for denied claims including:
- The name and title of the qualified professional who reviewed the denial decision.
- The date and time of the review by the professional.
- Documentation of the basis for the denial, including additional information provided by automated tools.
When explaining a denial to a claimant, the insurer needs to:
- Clearly identify the professional who reviewed the decision.
- Include a statement stating that AI, automated system, or a machine learning algorithm did not serve as the basis for determining whether to deny a claim.
Insurers would also have to submit periodic compliance reports and could be subjected to an audit of claim denials.
