Florida bill requires human oversight of claims denials, introducing new regulations for insurance companies in Florida across the state. The proposed law aims to ensure that a qualified human professional reviews and approves all insurance claim denials, even when artificial intelligence or automated systems are used in the claims process.

Florida Bill Requires Human Oversight of Claims Denials

The new legislation, introduced in the Florida Legislature in 2025, directly addresses the growing use of artificial intelligence (AI) and machine learning in insurance claim processing. Lawmakers state the bill is designed to protect consumers from automated errors and ensure fair treatment during the claims process, especially in light of recent issues where Florida insurance law has left homeowners facing claim denials.

According to the bill text, insurance companies operating in Florida must have a human claims officer independently examine any claim that is denied. This review must occur separately from any AI, machine learning system, or algorithm involved in the initial decision.

Key Provisions of the Florida Bill

• Human Oversight Required: All insurance claim denials must be reviewed by a qualified human professional.
• Independent Review: The human reviewer must evaluate the claim independently of any AI or automated system.
• Documentation: The human claims officer must sign off on the denial decision, confirming the review process.
• Scope: The law applies to all lines of insurance regulated in Florida, including property, casualty, health, and auto insurance.

Lawmakers say these measures are intended to prevent errors or unfair outcomes that may result from automated claim handling. The bill also aims to increase transparency and accountability in insurance operations statewide, a move influenced by recent penalties imposed on Florida insurance companies for mishandling hurricane claims.

Background: Rise of AI in Insurance Claims

Insurance companies in Florida and across the United States have increasingly adopted AI and machine learning to process claims more efficiently. These technologies can quickly analyze large volumes of data and identify potential fraud or inconsistencies.

However, concerns have grown about the risk of automated systems denying valid claims or failing to account for unique circumstances. Consumer advocates argue that human oversight is necessary to ensure fairness and accuracy in claim decisions.

How AI Is Used in the Claims Process

• Automated Review: AI systems can scan claim documents, photos, and policy details to recommend approval or denial.
• Fraud Detection: Algorithms may flag suspicious claims for further investigation.
• Efficiency: Automation reduces processing time and administrative costs for insurers.

Despite these benefits, critics warn that AI may lack the ability to consider context, nuance, or individual hardship. The Florida bill responds to these concerns by requiring human professionals to have the final say on claim denials, a step that some believe could help reduce the rise in hurricane claim denials linked to recent insurance reforms.

Details of the Proposed Law

The bill specifies that a “qualified human professional” must review each claim denial. This person must be trained and authorized by the insurer to assess claims independently of any automated system.

According to the legislation, the human reviewer must:

• Examine all supporting documents and evidence related to the claim
• Verify the accuracy of the AI or algorithm’s recommendation
• Sign off on the final denial decision, providing written documentation

Insurance companies must maintain records of these reviews and make them available to state regulators upon request. The law also requires insurers to notify policyholders that a human review has taken place if their claim is denied.

Impact on Florida Insurance Companies

If enacted, the law would require insurers to update their claims handling procedures and invest in additional staff training. Companies relying heavily on automation may need to adjust workflows to ensure compliance with the new human oversight requirement.

Industry experts say the bill could slow down some claim processing times but may improve consumer trust in the system. The Florida Office of Insurance Regulation would be responsible for monitoring compliance and enforcing the new rules.

Legislative Status and Next Steps

As of October 2025, the bill is under consideration in the Florida Legislature. Lawmakers are reviewing feedback from insurance companies, consumer groups, and technology experts.

Supporters of the bill argue that it will strengthen consumer protections and reduce wrongful denials. Opponents caution that it may increase administrative costs for insurers and lead to longer wait times for claim decisions.

According to official sources, the legislation may be amended before a final vote. Details may be updated as the legislative process continues.

Regulatory Context and Enforcement

The Florida Office of Insurance Regulation oversees insurance company practices in the state. If the bill becomes law, the agency would issue guidance on compliance and conduct audits to ensure insurers follow the human oversight requirement.

Violations could result in penalties or other enforcement actions. Policyholders who believe their claim was denied without proper human review would have the right to file a complaint with the state regulator.

Comparison to Other States

Florida’s proposed law is among the first in the United States to specifically mandate human oversight of AI-driven claim denials. Other states have begun to examine similar issues as automation becomes more common in the insurance industry.

National consumer advocacy groups are watching Florida’s legislation closely as a possible model for future regulations elsewhere.

Frequently Asked Questions About Florida Bill Requiring Human Oversight of Claims Denials

What does the Florida bill on human oversight of claims denials require?

The bill requires that a qualified human professional review and approve every insurance claim denial in Florida, even if AI or automated systems are used. The human reviewer must sign off on the decision independently of any machine or algorithm.

How will this law affect insurance companies in Florida?

Insurance companies will need to update their claims processes to include a human review for all denials. They may need to hire or train staff to comply with the new requirements.

Are all types of insurance claims covered by the bill?

Yes, the bill applies to all regulated insurance lines in Florida, including property, casualty, health, and auto insurance. All claim denials must receive human oversight.

Can you appeal a claim denial if you think it was not properly reviewed?

Policyholders can file a complaint with the Florida Office of Insurance Regulation if they believe their claim was denied without proper human review. The agency will investigate and take action if necessary.

Where are official updates about the bill available?

Updates and the full text of the bill are available on the Florida Legislature’s official website and through the Florida Office of Insurance Regulation. Details may be updated as the legislative process continues.

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