H527 · Mandatory Human Reviews of Insurance Claim Denials

Mandatory Human Reviews of Insurance Claim Denials ; Authorizes workers' compensation carriers, insurers &HMOs to use artificial intelligence systems & machine learning systems to assist in processing claims; prohibits use of 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 to deny claim or portion of claim or reduce claim be made by qualified human professionals; authorizes OIR to conduct market conduct examinations & investigations.