Insurance AI governance isn't hypothetical. Active litigation and accelerating state adoption are setting the rules in real time.
UNITEDHEALTH (LOKKEN V. UNITEDHEALTH GROUP)
AI denied. Federal court ordered discovery.
Federal court denied UnitedHealth's motion to dismiss breach of contract and implied good faith claims (Feb 13, 2025) over the nH Predict AI used to deny post-acute care in Medicare Advantage plans. Plaintiffs allege a 90% reversal rate on appealed denials. The court ordered broad discovery and UnitedHealth had until April 29 to hand over tens of thousands of documents.
ArentFox Schiff perspective; Healthcare Finance News, 2025
COLORADO DIVISION OF INSURANCE
Amended Reg 10-1-1 went effective October 15, 2025.
First US insurance regulation requiring quantitative bias testing with state-prescribed methodology for inferring race and ethnicity. Auto and health benefit plan insurers must submit annual compliance reports starting July 1, 2026. The Division of Insurance now expects evidence — not assurance — of testing methodology, frequency, and results.
Colorado DOI, SB21-169 Protecting Consumers from Unfair Discrimination
NAIC MODEL BULLETIN ADOPTION WAVE
24 states plus DC have adopted it. Pace accelerating.
Hawaii (Memorandum 2025-13A, Dec 10, 2025), Delaware (Bulletin 148, Feb 5, 2025), North Carolina (24-B-19, Dec 18, 2024), Oklahoma (2024-11, Nov 14, 2024) — and counting. The bulletin requires governance, risk management, vendor controls, and documentation. Each state's adoption layers reporting and examination obligations onto the same underlying program.
NAIC AI Model Bulletin Implementation Map, 2025