- Docket No.
- District Court
- California Eastern
- Award damages to plaintiffs
- Declaratory and injunctive relief enjoining claim handling practices
Why this Matters:
Plaintiffs, consumers in California, filed a class action complaint alleging that the denial of certain medical claims by a national health insurance company using an algorithm constituted breach of the implied covenant of good faith and fair dealing, unjust enrichment, intentionally interfered with contractual relations, and violated California’s Unfair Competition Law. Wrongful claims denials can result in patients having to pay substantial out-of-pocket costs or even forgoing important procedures.
The potential wrongful denial of claims by health insurers relying on AI tools could jeopardize access to needed health care services.