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ARTICLE · 26 MAY 2026

AI And Insurance Claims: Beware Fully Automated Decision Making

Taft, Stettinius & Hollister LLP
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Multiple U.S. states have enacted legislation regulating how health insurers can use artificial intelligence in claims coverage decisions, with Nebraska, Georgia, and Colorado establishing distinct frameworks that balance AI utilization with human oversight requirements. These statutes reflect growing legislative skepticism about replacing human judgment with AI systems, particularly in decisions that significantly impact individuals' healthcare access and coverage.

United StatesTechnology
Michael Young
Michael Young
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Among the growing number of state AI statutes, multiple states have now enacted laws governing the use of artificial intelligence technology by health insurers when determining whether or not to cover claims.

This article outlines some considerations for insurers, focusing on Nebraska, Georgia and Colorado statutes. 

  • Nebraska’s “Ensuring Transparency in Prior Authorization Act.” This statute prohibits an insurer’s utilization review agent from basing relevant coverage decisions solely on an “artificial intelligence-based algorithm.” In addition, utilization review agents must make separate disclosures whether such artificial intelligence are or will be used in the utilization review project to the Department of Insurance, health providers, “each enrollee,” and “on its public website.” Automated utilization review systems are subject to audit “at any time” by the Department of Insurance.

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