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CS/CS/HB 527 2026
CODING: Words stricken are deletions; words underlined are additions.
hb527-02-c2
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to mandatory human reviews of 2
insurance claim denials; creating s. 440.131, F.S.; 3
defining terms; authorizing workers' compensation 4
carriers to use artificial intelligence systems and 5
machine learning systems to assist in processing 6
claims; prohibiting the use of artificial intelligence 7
or machine learning systems as the sole basis for 8
determining whether to reduce a claim payment or deny 9
a claim or portion of a claim; requiring that 10
carriers' decisions to deny a claim or portion of a 11
claim or reduce a claim be made by qualified human 12
professionals; specifying the duties of qualified 13
human professionals; requiring a carrier to maintain 14
certain records; requiring carriers to include certain 15
information in denial communications to claimants; 16
requiring that certain carriers detail certain 17
information in their claims-handling manual; 18
authorizing the Department of Financial Services to 19
conduct examinations and investigations under certain 20
circumstances and to adopt rules; providing penalties; 21
creating s. 627.4263, F.S.; defining terms; 22
authorizing insurers to use artificial intelligence 23
systems and machine learning systems to assist in 24
processing claims; prohibiting the use of artificial 25
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
intelligence or machine learning systems as the sole 26
basis for determining whether to reduce a claim 27
payment or deny a claim or portion of a claim; 28
requiring that insurers' decisions to deny a claim or 29
portion of a claim or reduce a claim be made by 30
qualified human professionals; specifying the duties 31
of qualified human professionals; requiring an insurer 32
to maintain certain records; requiring insurers to 33
include certain information in denial communications 34
to claimants; requiring that certain insurers detail 35
certain information in their claims-handling manual; 36
authorizing the Office of Insurance Regulation to 37
conduct market conduct examinations and investigations 38
under certain circumstances; authorizing the Financial 39
Services Commission to adopt rules; creating s. 40
641.31091, F.S.; defining terms; authorizing health 41
maintenance organizations to use artificial 42
intelligence systems and machine learning systems to 43
assist in processing claims; prohibiting the use of 44
artificial intelligence or machine learning systems as 45
the sole basis for determining whether to reduce a 46
claim payment or deny a claim or portion of a claim; 47
requiring that health maintenance organizations' 48
decisions to deny a claim or reduce a claim or portion 49
of a claim be made by qualified human professionals; 50
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
specifying the duties of qualified human 51
professionals; requiring a health maintenance 52
organization to maintain certain records; requiring 53
health maintenance organizations to include certain 54
information in denial communications to claimants; 55
requiring that certain health maintenance 56
organizations detail certain information in their 57
claims-handling manual; authorizing the office to 58
conduct market conduct examinations and investigations 59
under certain circumstances; authorizing the 60
commission to adopt rules; providing an effective 61
date. 62
63
Be It Enacted by the Legislature of the State of Florida: 64
65
Section 1. Section 440.131, Florida Statutes, is created 66
to read: 67
440.131 Mandatory human reviews of claim denials.— 68
(1) As used in this section, the term: 69
(a) "Artificial intelligence system" means a machine-based 70
system that may have varying levels of autonomy and that can, 71
for a given set of objectives, generate outputs, such as 72
predictions, recommendations, or content, influencing decisions 73
made in real or virtual environments. 74
(b) "Machine learning system" means an artificial 75
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
intelligence system that has the ability to learn from provided 76
data without being explicitly programmed. 77
(c) "Qualified human professional" means an individual 78
who, under the Florida Insurance Code, has the authority to 79
adjust or deny a claim or a portion of a claim and may exercise 80
such authority over a particular claim. 81
(2) A carrier may use an artificial intelligence system or 82
a machine learning system to assist in processing claims, 83
including generating recommendations to reduce a claim payment 84
or to approve or deny a claim or a portion of a claim, in 85
accordance with this section. 86
(3) A decision to reduce a claim payment or deny a claim 87
or a portion of a claim may not be made solely on the basis of 88
an artificial intelligence system or a machine learning system. 89
A carrier's decision to reduce a claim payment or deny a claim 90
or a portion of a claim must be made by a qualified human 91
professional. 92
(4) If an artificial intelligence system or a machine 93
learning system assists in processing a claim, the qualified 94
human professional must do all of the following before reducing 95
a claim payment or denying the claim or a portion of the claim: 96
(a) Analyze the facts of the claim and the terms of the 97
insurance policy independently of any artificial intelligence 98
system or machine learning system. 99
(b) Review the accuracy of any output generated by such a 100
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
system. 101
(c) Determine that the claim or portion of the claim is 102
not payable under the terms of the insurance policy and should 103
be denied or that the claim payment should be reduced. 104
(5) A carrier shall maintain detailed records of the 105
actions of qualified human professionals who are required to 106
perform the actions under subsection (4), including: 107
(a) The name, the title, the business address, and the 108
unique identifier associated with the name of the qualified 109
human professional who made the decision to reduce the claim 110
payment or deny the claim or a portion of the claim. 111
(b) The date and time of the qualified human 112
professional's decision. 113
(c) Documentation of the basis for the reduction of the 114
claim payment or denial of the claim or a portion of the claim, 115
including any information provided by an artificial intelligence 116
system or a machine learning system. 117
(6) In all written denial communications to an injured 118
employee, a carrier shall include: 119
(a) An e-mail address, a telephone number, a business 120
address, and a unique identifier, in lieu of the name of the 121
qualified human professional who made the decision to reduce the 122
claim payment or deny the claim or a portion of the claim; and 123
(b) A written statement affirming that an artificial 124
intelligence system or a machine learning system did not serve 125
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
as the sole basis for determining whether to reduce the claim 126
payment or deny the claim or a portion of the claim. 127
(7) A carrier that uses an artificial intelligence system 128
or a machine learning system as part of its claims-handling 129
process shall detail in its claims-handling manual the manner in 130
which such systems are to be used and the manner in which the 131
carrier complies with this section. 132
(8) The department may conduct examinations and 133
investigations it deems necessary to verify compliance with this 134
section. 135
(9) The department may adopt rules to implement this 136
section. 137
(10) Failure to comply with this section shall be 138
considered a violation of this chapter and is subject to 139
penalties as provided for in s. 440.525. 140
Section 2. Section 627.4263, Florida Statutes, is created 141
to read: 142
627.4263 Mandatory human reviews of claim denials.— 143
(1) As used in this section, the term: 144
(a) "Artificial intelligence system" means a machine-based 145
system that may have varying levels of autonomy and that can, 146
for a given set of objectives, generate outputs, such as 147
predictions, recommendations, or content, influencing decisions 148
made in real or virtual environments. 149
(b) "Machine learning system" means an artificial 150
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
intelligence system that has the ability to learn from provided 151
data without being explicitly programmed. 152
(c) "Qualified human professional" means an individual 153
who, under the Florida Insurance Code, has the authority to 154
adjust or deny a claim or a portion of a claim and may exercise 155
such authority over a particular claim. 156
(2) An insurer may use an artificial intelligence system 157
or machine learning system to assist in processing claims, 158
including generating recommendations to reduce a payment or to 159
approve or deny a claim or a portion of a claim, in accordance 160
with this section. 161
(3) A decision to reduce a claim payment or deny a claim 162
or a portion of a claim may not be made solely on the basis of 163
an artificial intelligence system or a machine learning system. 164
An insurer's decision to reduce a claim payment or deny a claim 165
or a portion of a claim must be made by a qualified human 166
professional. 167
(4) If an artificial intelligence system or a machine 168
learning system assists in processing a claim, the qualified 169
human professional must do all of the following before reducing 170
a claim payment or denying the claim or a portion of the claim: 171
(a) Analyze the facts of the claim and the terms of the 172
insurance policy independently of any artificial intelligence 173
system or machine learning system. 174
(b) Review the accuracy of any output generated by such a 175
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
system. 176
(c) Determine that the claim or portion of the claim is 177
not payable under the terms of the insurance policy and should 178
be denied or that the claim payment should be reduced. 179
(5) An insurer shall maintain detailed records of the 180
actions of qualified human professionals who are required to 181
perform the actions under subsection (4), including: 182
(a) The name, the title, the business address, and the 183
unique identifier associated with the name of the qualified 184
human professional who made the decision to reduce the claim 185
payment or deny the claim or a portion of the claim. 186
(b) The date and time of the qualified human 187
professional's decision. 188
(c) Documentation of the basis for the reduction of the 189
claim payment or denial of the claim or a portion of the claim, 190
including any information provided by an artificial intelligence 191
system or a machine learning system. 192
(6) In all written denial communications to an insured, an 193
insurer shall include: 194
(a) An e-mail address, a telephone number, a business 195
address, and a unique identifier, in lieu of the name of the 196
qualified human professional who made the decision to reduce the 197
claim payment or deny the claim or a portion of the claim; and 198
(b) A written statement affirming that an artificial 199
intelligence system or a machine learning system did not serve 200
CS/CS/HB 527 2026
CODING: Words stricken are deletions; words underlined are additions.
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
as the sole basis for determining whether to reduce the claim 201
payment or deny the claim or a portion of the claim. 202
(7) An insurer that uses an artificial intelligence system 203
or a machine learning system as part of its claims-handling 204
process shall detail in its claims-handling manual the manner in 205
which such systems are to be used and the manner in which the 206
insurer complies with this section. 207
(8) The office may conduct market conduct examinations and 208
investigations it deems necessary to verify compliance with this 209
section. 210
(9) The commission may adopt rules to implement this 211
section. 212
Section 3. Section 641.31091, Florida Statutes, is created 213
to read: 214
641.31091 Mandatory human reviews of claim denials.— 215
(1) As used in this section, the term: 216
(a) "Artificial intelligence system" means a machine-based 217
system that may have varying levels of autonomy and that can, 218
for a given set of objectives, generate outputs, such as 219
predictions, recommendations, or content, influencing decisions 220
made in real or virtual environments. 221
(b) "Machine learning system" means an artificial 222
intelligence system that has the ability to learn from provided 223
data without being explicitly programmed. 224
(c) "Qualified human professional" means an individual 225
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
who, under the Florida Insurance Code, has the authority to 226
adjust or deny a claim or a portion of a claim and may exercise 227
such authority over a particular claim. 228
(2) A health maintenance organization may use an 229
artificial intelligence system or a machine learning system to 230
assist in processing claims, including generating 231
recommendations to reduce a claim payment or to approve or deny 232
a claim or a portion of a claim, in accordance with this 233
section. 234
(3) A decision to reduce a claim payment or deny a claim 235
or a portion of a claim may not be made solely on the basis of 236
an artificial intelligence system or machine learning system. A 237
health maintenance organization's decision to reduce a claim 238
payment or deny a claim or a portion of a claim must be made by 239
a qualified human professional. 240
(4) If an artificial intelligence system or a machine 241
learning system assists in processing a claim, the qualified 242
human professional must do all of the following before reducing 243
a claim payment or denying the claim or a portion of the claim: 244
(a) Analyze the facts of the claim and the terms of the 245
health maintenance contract independently of any artificial 246
intelligence system or machine learning system. 247
(b) Review the accuracy of any output generated by such a 248
system. 249
(c) Determine that the claim or portion of the claim is 250
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
not payable under the terms of the health maintenance contract 251
and should be denied or that the claim payment should be 252
reduced. 253
(5) A health maintenance organization shall maintain 254
detailed records of the actions of qualified human professionals 255
who are required to perform the actions under subsection (4), 256
including: 257
(a) The name, the title, the business address, and the 258
unique identifier associated with the name of the qualified 259
human professional who made the decision to reduce the claim 260
payment or deny the claim or a portion of the claim. 261
(b) The date and time of the qualified human 262
professional's decision. 263
(c) Documentation of the basis for the reduction of the 264
claim payment or denial of the claim or a portion of the claim, 265
including any information provided by an artificial intelligence 266
system or a machine learning system. 267
(6) In all written denial communications to a subscriber, 268
a health maintenance organization shall include: 269
(a) An e-mail address, a telephone number, a business 270
address, and a unique identifier, in lieu of the name of the 271
qualified human professional who made the decision to reduce the 272
claim payment or deny the claim or a portion of the claim; and 273
(b) A written statement affirming that an artificial 274
intelligence system or a machine learning system did not serve 275
CS/CS/HB 527 2026
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
as the sole basis for determining whether to reduce the claim 276
payment or deny the claim or a portion of the claim. 277
(7) A health maintenance organization that uses an 278
artificial intelligence system or a machine learning system as 279
part of its claims-handling process shall detail in its claims-280
handling manual the manner in which such systems are to be used 281
and the manner in which the health maintenance organization 282
complies with this section. 283
(8) The office may conduct market conduct examinations and 284
investigations or use any method it deems necessary to verify 285
compliance with this section. 286
(9) The commission may adopt rules to implement this 287
section. 288
Section 4. This act shall take effect July 1, 2026. 289