SB 794 Florida Senate · 2025 Regular Session

Mandatory Human Reviews of Insurance Claim Denials

Summary

Mandatory Human Reviews of Insurance Claim Denials; Requiring that insurers’ decisions to deny claims or any portion of a claim be made by qualified human professionals; prohibiting using algorithms, artificial intelligence, or machine learning systems as the sole basis for determining whether to adjust or deny a claim; requiring insurers to include certain information in denial communications to claimants, etc.

Issues: ✓ Healthcare ✓ Technology

Bill status died 1 of 4 stages cleared

Introduction

Mar 2025

Committee Review

Floor Vote

Governor

Introduced Mar 4, 2025 Last action Jun 16, 2025

Maddy AI version diff · 1 comparison

What changed between versions

S 794 Filed → S 794 c1 · 5 edits

MODERATE

The bill was amended from a simple committee substitute to a final committee substitute with expanded definitions, additional requirements for insurers using automated systems, and a later effective date. The changes strengthen consumer protections by clarifying what constitutes prohibited automated decision-making and adding specific duties for qualified human professionals.

Scope change

The bill now explicitly covers claims adjustments in addition to claim denials, and applies to insurers that use any type of automated system in their claims handling process.

DEFINITION

Added specific definitions for 'algorithm', 'artificial intelligence system', and 'machine learning system' to clarify what technologies are prohibited from being the sole basis for claim decisions.

REQUIREMENT

Added specific duties for qualified human professionals including analyzing facts independently, reviewing algorithm outputs, and conducting reviews of other professionals' decisions.

Added requirement for insurers using automated systems to detail their usage and compliance in their claims handling manual.

TIMELINE

Changed effective date from July 1, 2025 to January 1, 2026.

ENFORCEMENT

Added authority for the Financial Services Commission to adopt rules implementing the section.

Floor votes

How they voted

No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Mar 26, 2025

Upper · Passed

Now in Appropriations Committee on Agriculture, Environment, and General Government

upper

Mar 26, 2025

Upper · Passed

Pending reference review under Rule 4.7(2) - (Committee Substitute)

upper

Mar 20, 2025

Upper · Passed

On Committee agenda-- Banking and Insurance, 03/25/25, 8:30 am, 412 Knott Building

upper

Mar 4, 2025

Introduced

upper

Feb 28, 2025

Committee

Referred to Banking and Insurance; Appropriations Committee on Agriculture, Environment, and General Government; Rules

upper

1 primary · 0 co-sponsors