Liability
Algorithmic Insurance Claim Denial
Using an automated prediction to deny or terminate coverage without the individualized clinical review the policy or statute requires.
Pleaded in 3 of the 98 matters on this docket
Governing law
State contract law and the implied covenant of good faith and fair dealing; state insurance codes; overlaid by ERISA and Medicare Act preemption
Damages
Contract damages, restitution and injunctive relief. Extracontractual and punitive damages are frequently unavailable because of preemption.
Limitations period
Governed by the contract or the applicable plan document; often shortened by the policy itself.
Reference material about publicly available law, current as of the date this file was compiled. It is not legal advice and it does not describe anyone’s particular situation. Statutes and limitations periods vary by jurisdiction and change.
Matters pleading this claim
Barrows v. Humana
U.S. District Court for the Western District of Kentucky (Louisville Division) · 3:23-cv-00654
nH Predict (naviHealth / Humana)
Filed 2023-12-12 · Class Action
DiscoveryEstate of Lokken v. UnitedHealth Group
U.S. District Court for the District of Minnesota · 0:23-cv-03514
nH Predict (naviHealth / UnitedHealth)
Filed 2023-11-14 · Class Action
DiscoveryKisting-Leung v. Cigna
U.S. District Court for the Eastern District of California · 2:23-cv-01477
PXDX / PxDx automated claim review (Cigna)
Filed 2023-07-24 · Class Action
DismissedUnconfirmed