Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.

Why this Matters:

Plaintiffs, estates of patients who had post-acute care coverage terminated, filed a class action complaint alleging that a national health insurance company’s reliance on artificial intelligence (AI) tools to deny certain medical claims under Medicare Advantage plans constituted breach of contract, breach of the implied covenant of good faith and fair dealing, unjust enrichment, and insurance bad faith. The improper usage of AI to make coverage decisions, while ignoring clinical determinations made by providers, can prevent patients from being able to afford critical treatments and harm patient health.

Potential Impact:

The potential wrongful denial of claims by health insurers relying on AI tools could jeopardize access to needed health care services.