FL H0527

Prohibits workers' compensation carriers, insurers, and health maintenance organizations from using artificial intelligence or machine learning systems as the sole basis for denying or reducing insurance claim payments

Requires all claim denial or reduction decisions to be made by a "qualified human professional" who must independently analyze claim facts and policy terms, review AI/ML output accuracy, and determine the claim is not payable

Mandates carriers maintain detailed records of human reviewer decisions, including reviewer name, title, business address, unique identifier, decision date/time, and documentation of denial basis

Requires written denial communications to claimants include reviewer contact information (email, phone, address, unique identifier) and a statement affirming AI/ML was not the sole basis for the decision

Authorizes the Department of Financial Services, Office of Insurance Regulation, and Financial Services Commission to conduct examinations, investigations, and adopt rules to enforce compliance; effective July 1, 2026