Florida Weighs AI Rules for Claims; Carriers Urge "Don't Undo the Fixes"
Florida lawmakers are considering new limits on how insurers use AI in claims during the 2026 session. Carriers and trade groups are pushing back on anything that could unwind recent property reform gains that steadied loss ratios and reinsurance access.
The core tension is clear: the state wants fair, explainable claims decisions; insurers want to preserve cycle times and cost improvements achieved since the reforms. Expect a debate centered on transparency, human oversight, and vendor accountability-without reintroducing litigation friction.
What AI rules are likely on the table
- Clear notice to policyholders when AI materially influences a claim decision.
- Right to human review for adverse decisions and an accessible appeal path.
- Documentation standards: model inventory, data lineage, training data sources, and change logs.
- Bias and performance testing with thresholds, exceptions, and remediation timelines.
- Third-party model oversight: contractual controls, audit rights, and SOC/validation evidence.
- Record retention for explainability and regulatory exams.
These guardrails mirror national trends and fit within principles many carriers already follow. For context, see the NAIC's high-level framework for ethical AI use in insurance (NAIC AI Principles).
Why carriers are cautious
Florida's recent reforms curbed litigation incentives and stabilized property results. Carriers fear duplicative or vague AI mandates could slow claim handling, lift LAE, or create new causes of action that reopen the door to suits.
The risk isn't regulation itself-it's misaligned requirements that conflict with existing timelines, CAT surge operations, or vendor workflows. Insurers want clarity, safe harbors, and consistency across lines to avoid operational churn.
A practical compliance playbook
- Stand up model governance: roles, RACI, and approval checkpoints for development, deployment, and retirement.
- Build an AI model inventory: purpose, inputs, training/validation datasets, versioning, owners, and risk tiering.
- Codify testing: fairness metrics by segment, performance drift thresholds, stability under stress, and re-test cadence.
- Set explainability standards: what adjusters communicate, what gets logged, and what is disclosed to policyholders.
- Require human-in-the-loop for payment denials, SIU referrals, and high-severity exposures.
- Tighten vendor contracts: data rights, subprocessor visibility, incident SLAs, assurance reports, and audit rights.
- Prepare for exams: templated reports, sampling protocols, and evidence packs mapped to likely rule text.
- Train the front line: adjusters, SIU, appeals teams, and compliance on when and how AI can be used.
Claims operations: protect speed and fairness
Separate AI use cases by risk. Keep low-risk automations (document triage, FNOL routing) moving fast under lighter controls, and apply heavier oversight to high-impact decisions (coverage, causation, fraud flags, total loss).
Track a simple scorecard: cycle time, leakage, overturn rates on appeal, SIU hit rate, and fairness metrics by geography and customer segment. Flag spikes and freeze deployments when thresholds trip.
What to watch next
- Draft bill language defining "adverse action," disclosure triggers, and private right of action (if any).
- Guidance from the Florida Office of Insurance Regulation on model documentation and exam expectations (FLOIR).
- Alignment (or conflicts) with NAIC models and other states' rules to avoid multi-state compliance drag.
- Vendor readiness: evidence packages, bias testing, and explainability artifacts at the model level.
Bottom line for Florida insurers
Plan for explainability, testing, and human review where it matters most, and you'll be positioned for compliance without giving back operational wins. Engage early on bill language and push for clear definitions and safe harbors.
If your team needs upskilling on AI oversight and practical workflows by role, explore these curated programs: AI courses by job.
Your membership also unlocks:
