Mandatory Human Reviews of Insurance Claim Denials

What this bill does

Requires that insurers' decisions to deny claims or any portion of claim be made by qualified human professionals; provides duties of qualified human professionals before they make certain determinations; requires insurers to maintain certain records; prohibits algorithms, artificial intelligence systems, & machine learning systems from being used as sole basis for determining whether to adjust or deny claim or portion of claim; requires insurers to include certain information & statements in denial communications to claimants; requires that certain insurers detail certain information in their claims-handling manual; authorizes OIR to conduct market conduct examinations & investigations.