Bill > S0794

This bill establishes new requirements for insurance claim denials in Florida, focusing on ensuring human oversight in the claims process. The legislation defines key terms like algorithms, artificial intelligence systems, and machine learning systems, and mandates that qualified human professionals must make all decisions to deny claims or portions of claims. These professionals are required to independently analyze claim facts, review the accuracy of any technological outputs, and conduct reviews of previous claim decisions. Insurers must maintain detailed records of these decisions, including the name of the professional making the decision, the date and time, and documentation supporting the denial. The bill explicitly prohibits using algorithms, AI, or machine learning systems as the sole basis for claim denials. When communicating claim denials, insurers must identify the specific human professional responsible and affirm that no automated system was the sole decision-maker. Insurers using such technological systems in their claims process must document their usage in their claims handling manual. The Office of Insurance Regulation is authorized to conduct market conduct examinations to verify compliance, and the Financial Services Commission can adopt rules to implement these requirements. The law is set to take effect on January 1, 2026.