summary
Introduced
11/24/2025
11/24/2025
In Committee
03/05/2026
03/05/2026
Crossed Over
03/05/2026
03/05/2026
Passed
Dead
Introduced Session
2026 Regular Session
Bill Summary
An act relating to mandatory human reviews of insurance claim denials; creating s. 440.131, F.S.; defining terms; authorizing workers' compensation carriers to use artificial intelligence systems and machine learning systems to assist in processing claims; prohibiting the use of artificial intelligence or machine learning systems as the sole basis for determining whether to reduce a claim payment or deny a claim or portion of a claim; requiring that carriers' decisions to deny a claim or portion of a claim or reduce a claim be made by qualified human professionals; specifying the duties of qualified human professionals; requiring a carrier to maintain certain records; requiring carriers to include certain information in denial communications to claimants; requiring that certain carriers detail certain information in their claims-handling manual; authorizing the Department of Financial Services to conduct examinations and investigations under certain circumstances and to adopt rules; providing penalties; creating s. 627.4263, F.S.; defining terms; authorizing insurers to use artificial intelligence systems and machine learning systems to assist in processing claims; prohibiting the use of artificial hb527-02-c2 intelligence or machine learning systems as the sole basis for determining whether to reduce a claim payment or deny a claim or portion of a claim; requiring that insurers' decisions to deny a claim or portion of a claim or reduce a claim be made by qualified human professionals; specifying the duties of qualified human professionals; requiring an insurer to maintain certain records; requiring insurers to include certain information in denial communications to claimants; requiring that certain insurers detail certain information in their claims-handling manual; authorizing the Office of Insurance Regulation to conduct market conduct examinations and investigations under certain circumstances; authorizing the Financial Services Commission to adopt rules; creating s. 641.31091, F.S.; defining terms; authorizing health maintenance organizations to use artificial intelligence systems and machine learning systems to assist in processing claims; prohibiting the use of artificial intelligence or machine learning systems as the sole basis for determining whether to reduce a claim payment or deny a claim or portion of a claim; requiring that health maintenance organizations' decisions to deny a claim or reduce a claim or portion of a claim be made by qualified human professionals; hb527-02-c2 specifying the duties of qualified human professionals; requiring a health maintenance organization to maintain certain records; requiring health maintenance organizations to include certain information in denial communications to claimants; requiring that certain health maintenance organizations detail certain information in their claims-handling manual; authorizing the office to conduct market conduct examinations and investigations under certain circumstances; authorizing the commission to adopt rules; providing an effective date.
AI Summary
This bill establishes mandatory human reviews for insurance claim denials across various types of insurance, including workers' compensation, general insurance, and health maintenance organizations. It defines "artificial intelligence system" and "machine learning system" as automated systems that can learn from data and generate outputs, and a "qualified human professional" as an individual authorized to adjust or deny claims. While insurers are permitted to use AI and machine learning systems to *assist* in processing claims, these automated systems cannot be the *sole* basis for reducing a claim payment or denying a claim or a portion of it. Instead, such decisions must be made by a qualified human professional who independently analyzes the claim, reviews the AI's output for accuracy, and determines that the claim is not payable or should be reduced. Insurers must maintain detailed records of these human decisions, including the professional's credentials and the basis for the decision, and provide specific contact information and a statement confirming AI was not the sole basis for denial in written communications to claimants. The bill also requires insurers to detail their AI usage in their claims-handling manuals and grants regulatory bodies the authority to conduct examinations and adopt rules to ensure compliance, with penalties for violations.
Committee Categories
Business and Industry
Sponsors (4)
Other Sponsors (2)
Commerce Committee (House), Insurance & Banking Subcommittee (House)
Last Action
Received (on 03/05/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.flsenate.gov/Session/Bill/2026/527 |
| Analysis - Commerce Committee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2026/527/Analyses/h0527c.COM.PDF |
| BillText | https://www.flsenate.gov/Session/Bill/2026/527/BillText/c2/PDF |
| Analysis - Commerce Committee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2026/527/Analyses/h0527b.COM.PDF |
| BillText | https://www.flsenate.gov/Session/Bill/2026/527/BillText/c1/PDF |
| Analysis - Insurance & Banking Subcommittee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2026/527/Analyses/h0527a.IBS.PDF |
| https://www.flsenate.gov/Session/Bill/2026/527/Amendment/245389/PDF | |
| Analysis - Insurance & Banking Subcommittee (Post-Meeting) | https://www.flsenate.gov/Session/Bill/2026/527/Analyses/h0527.IBS.PDF |
| BillText | https://www.flsenate.gov/Session/Bill/2026/527/BillText/Filed/PDF |
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