The proposed bill mandates that all insurance claim denials, including those in workers' compensation, general insurance, and health maintenance organizations (HMOs), undergo mandatory human reviews. While the use of algorithms, artificial intelligence, and machine learning is permitted to assist in processing claims, these technologies cannot be the sole basis for decisions to reduce or deny claims. Qualified human professionals must independently analyze claims, verify the accuracy of automated outputs, and ensure compliance with insurance policy terms. The bill also requires carriers to maintain detailed records of the actions taken by these professionals, including their identification and the rationale for their decisions.

Additionally, the bill introduces specific requirements for HMOs regarding claim payments and denials. It mandates that HMOs provide documentation when reducing claim payments or denying claims, including the date and time of the decision made by a qualified human professional and the basis for the decision. All written denial communications must include contact information for the decision-maker and a statement confirming that automated systems did not solely determine the outcome. The bill empowers the Department of Financial Services and the Office of Insurance Regulation to conduct examinations and investigations to ensure compliance, with penalties for non-compliance. The act is set to take effect on July 1, 2026.