- Docket No.
- District Court
- Kentucky Western
- Award damages to plaintiffs
- Declaratory and injunctive relief enjoining claim handling practices
Why this Matters:
Plaintiffs 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.
The potential wrongful denial of claims by health insurers relying on AI tools could jeopardize access to needed health care services.