Read the full stored bill text
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
sub
section
(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:
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(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 its claims
-
handling
82
manual the manner in which such systems are
to be
used and the
83
manner in which the insurer complies with this section.
84
(8) The office may conduct market conduct examinations and
85
investigations or use any method it deems necessary to verify
86
compliance with this section.
87
(9)
The commission may adopt rules to implement this
88
section.
89 Section 2. This act shall take effect July 1, 2026.