Florida SB 202: Mandatory Human Reviews of Insurance Claim Denials

Bill Text

202 
Mandatory Human Reviews of Insurance Claim Denials 
2025-10-15T08:45:55Z 
Requiring that insurers’ decisions to deny a claim or any portion of a claim be made by qualified human professionals; prohibiting the use of algorithms, artificial intelligence, or machine learning systems as the sole basis for determining whether to adjust or deny a claim; authorizing the Office of Insurance Regulation to conduct market conduct examinations and investigations under certain circumstances, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 202 

 By Senator Bradley 

 6-00238-26 2026202__ 
 1 A bill to be entitled 
 2 An act relating to mandatory human reviews of 
 3 insurance claim denials; creating s. 627.4263, F.S.; 
 4 defining terms; requiring that insurers’ decisions to 
 5 deny a claim or any portion of a claim be made by 
 6 qualified human professionals; specifying the duties 
 7 of qualified human professionals; requiring an insurer 
 8 to maintain certain records; prohibiting the use of 
 9 algorithms, artificial intelligence, or machine 
 10 learning systems as the sole basis for determining 
 11 whether to adjust or deny a claim; requiring insurers 
 12 to include certain information in denial 
 13 communications to claimants; requiring that certain 
 14 insurers detail certain information in their claims 
 15 handling manual; authorizing the Office of Insurance 
 16 Regulation to conduct market conduct examinations and 
 17 investigations under certain circumstances; 
 18 authorizing the Financial Services Commission to adopt 
 19 rules; providing an effective date. 
 20 
 21 Be It Enacted by the Legislature of the State of Florida: 
 22 
 23 Section 1. Section 627.4263, Florida Statutes, is created 
 24 to read: 
 25 627.4263 Mandatory human reviews of claim denials.— 
 26 (1) As used in this section, the term: 
 27 (a) “Algorithm” means a clearly specified mathematical 
 28 process for computation which uses rules designed to give 
 29 prescribed results. 
 30 (b) “Artificial intelligence system” means a machine-based 
 31 system that may have varying levels of autonomy and that can, 
 32 for a given set of objectives, generate outputs, such as 
 33 predictions, recommendations, or content, influencing decisions 
 34 made in real or virtual environments. 
 35 (c) “Machine learning system” means an artificial 
 36 intelligence system that has the ability to learn from provided 
 37 data without being explicitly programmed. 
 38 (d) “Qualified human professional” means an individual who, 
 39 under the Florida Insurance Code, has the authority to adjust or 
 40 deny a claim or a portion of a claim and may exercise such 
 41 authority over a particular claim. 
 42 (2) An insurer’s decision to deny a claim or any portion of 
 43 a claim must be made by a qualified human professional. 
 44 (3) A qualified human professional shall, before 
 45 determining whether to adjust or deny a claim or a portion of a 
 46 claim, do all of the following: 
 47 (a) Analyze the facts of the claim and the terms of the 
 48 insurance policy independently of any artificial intelligence 
 49 system, machine learning system, or algorithm. 
 50 (b) Review the accuracy of any output generated by such a 
 51 system or algorithm. 
 52 (c) Conduct any review of a claim adjustment or claim 
 53 decision that was made by another qualified human professional. 
 54 (4) An insurer shall maintain detailed records of the 
 55 actions of qualified human professionals who are required to 
 56 perform the actions under subsection (3), including: 
 57 (a) The name and title of the qualified human professional 
 58 who made the decision to deny a claim or a portion of a claim 
 59 and of any qualified human professional who reviewed a claim 
 60 adjustment or claim decision. 
 61 (b) The date and time of the claim decision and of any 
 62 review of the claim adjustment. 
 63 (c) Documentation of the basis for the denial of the claim 
 64 or a portion of the claim, including any information provided by 
 65 an algorithm, an artificial intelligence system, or a machine 
 66 learning system. 
 67 (5) An algorithm, an artificial intelligence system, or a 
 68 machine learning system may not serve as the sole basis for 
 69 determining whether to adjust or deny a claim. 
 70 (6) In all denial communications to a claimant, an insurer 
 71 shall: 
 72 (a) Clearly identify the qualified human professional who 
 73 made the decision to deny the claim or a portion of the claim; 
 74 and 
 75 (b) Include a statement affirming that an algorithm, an 
 76 artificial intelligence system, or a machine learning system did 
 77 not serve as the sole basis for determining whether to deny the 
 78 claim or a portion of the claim. 
 79 (7) An insurer that uses an algorithm, an artificial 
 80 intelligence system, or a machine learning system as part of its 
 81 claims-handling process shall detail in i