HB 527

Bill Subjects

Abstract

Mandatory Human Reviews of Insurance Claim Denials ; Authorizes workers' compensation carriers, insurers & HMOs to use algorithms, artificial intelligence systems, & machine learning systems to assist in processing claims; prohibits use of algorithms, artificial intelligence, or machine learning systems as sole basis for determining whether to reduce claim payment or deny claim or portion of claim; requires that decisions by carriers, insurers & HMOs to deny claim or portion of claim or reduce claim be made by qualified human professionals; specifies duties of qualified human professionals; requires carriers, insurers & HMOs to include certain information in denial communications to claimants; authorizes DFS & OIR to conduct examinations & investigations.