AI Frontier Institute

Mandatory Human Reviews of Insurance Claim Denials

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This bill authorizes workers' compensation carriers, insurers, and HMOs to use artificial intelligence (AI) and machine learning (ML) systems to assist in processing claims. However, it prohibits these entities from using AI or ML systems as the sole basis for deciding to reduce, deny, or partially deny a claim. All such decisions must ultimately be made by qualified human professionals. The bill also authorizes the Office of Insurance Regulation (OIR) to conduct market conduct examinations and investigations to oversee compliance with these requirements.

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