AI Frontier Institute

Mandatory Human Reviews of Insurance Claim Denials

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Florida SB 202 (2026), sponsored by Senator Bradley, creates s. 627.4263, F.S., requiring that all insurance claim denials be made by a 'qualified human professional'—defined as an individual authorized under the Florida Insurance Code to adjust or deny claims. Before issuing a denial, the qualified human professional must independently analyze the claim facts and policy terms, review the accuracy of any AI or algorithmic output, and conduct any required peer review (s. 627.4263(3)). Algorithms, artificial intelligence systems, and machine learning systems are explicitly prohibited from serving as the sole basis for adjusting or denying a claim (s. 627.4263(5)). Insurers must maintain detailed records identifying the decision-maker, timestamps, and the basis for each denial, including any AI-generated information (s. 627.4263(4)). Denial communications to claimants must identify the qualified human professional who made the decision and include an affirmative statement that AI was not the sole basis for the denial (s. 627.4263(6)). Insurers using such systems must document their use and compliance procedures in their claims-handling manual (s. 627.4263(7)). The Office of Insurance Regulation may conduct market conduct examinations to verify compliance, and the Financial Services Commission may adopt implementing rules (ss. 627.4263(8)–(9)). The act takes effect July 1, 2026.

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