THE BILL ITSELF
SB 202
Mandatory Human Reviews of Insurance Claim Denials
Florida Senate - 2026 SB 202 By Senator Bradley 6-00238-26 2026202__
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A bill to be entitled
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An act relating to mandatory human reviews of
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insurance claim denials; creating s. 627.4263, F.S.;
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defining terms; requiring that insurers’ decisions to
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deny a claim or any portion of a claim be made by
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qualified human professionals; specifying the duties
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of qualified human professionals; requiring an insurer
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to maintain certain records; prohibiting the use of
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algorithms, artificial intelligence, or machine
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learning systems as the sole basis for determining
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whether to adjust or deny a claim; requiring insurers
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to include certain information in denial
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communications to claimants; requiring that certain
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insurers detail certain information in their claims
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handling manual; authorizing the Office of Insurance
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Regulation to conduct market conduct examinations and
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investigations under certain circumstances;
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authorizing the Financial Services Commission to adopt
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rules; providing an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 627.4263, Florida Statutes, is created
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to read:
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627.4263 Mandatory human reviews of claim denials.—
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(1) As used in this section, the term:
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(a) “Algorithm” means a clearly specified mathematical
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process for computation which uses rules designed to give
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prescribed results.
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(b) “Artificial intelligence system” means a machine-based
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system that may have varying levels of autonomy and that can,
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for a given set of objectives, generate outputs, such as
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predictions, recommendations, or content, influencing decisions
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made in real or virtual environments.
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(c) “Machine learning system” means an artificial
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intelligence system that has the ability to learn from provided
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data without being explicitly programmed.
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(d) “Qualified human professional” means an individual who,
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under the Florida Insurance Code, has the authority to adjust or
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deny a claim or a portion of a claim and may exercise such
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authority over a particular claim.
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(2) An insurer’s decision to deny a claim or any portion of
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a claim must be made by a qualified human professional.
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(3) A qualified human professional shall, before
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determining whether to adjust or deny a claim or a portion of a
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claim, do all of the following:
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(a) Analyze the facts of the claim and the terms of the
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insurance policy independently of any artificial intelligence
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system, machine learning system, or algorithm.
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(b) Review the accuracy of any output generated by such a
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system or algorithm.
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(c) Conduct any review of a claim adjustment or claim
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decision that was made by another qualified human professional.
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(4) An insurer shall maintain detailed records of the
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actions of qualified human professionals who are required to
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perform the actions under subsection (3), including:
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(a) The name and title of the qualified human professional
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who made the decision to deny a claim or a portion of a claim
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and of any qualified human professional who reviewed a claim
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adjustment or claim decision.
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(b) The date and time of the claim decision and of any
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review of the claim adjustment.
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(c) Documentation of the basis for the denial of the claim
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or a portion of the claim, including any information provided by
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an algorithm, an artificial intelligence system, or a machine
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learning system.
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(5) An algorithm, an artificial intelligence system, or a
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machine learning system may not serve as the sole basis for
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determining whether to adjust or deny a claim.
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(6) In all denial communications to a claimant, an insurer
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shall:
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(a) Clearly identify the qualified human professional who
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made the decision to deny the claim or a portion of the claim;
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and
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(b) Include a statement affirming that an algorithm, an
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artificial intelligence system, or a machine learning system did
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not serve as the sole basis for determining whether to deny the
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claim or a portion of the claim.
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(7) An insurer that uses an algorithm, an artificial
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intelligence system, or a machine learning system as part of its
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claims-handling process shall detail in its claims-handling
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manual the manner in which such systems are to be used and the
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manner in which the insurer complies with this section.
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(8) The office may conduct market conduct examinations and
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investigations or use any method it deems necessary to verify
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compliance with this section.
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(9) The commission may adopt rules to implement this
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section.
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Section 2. This act shall take effect July 1, 2026.