Hunton Employment & Labor Perspectives

In the case The Estate of Gene B. Lokken v. UnitedHealth Group, Inc., No. 23-CV-3514 (JRT/SGE) (D. Minn.), the plaintiffs alleged that the defendant insurer had denied claims using an artificial intelligence program without human review. They sought discovery into the insurer’s use of AI. When the insurer refused, they moved to compel and the Minnesota federal court granted the motion. Although this case deals with health insurance, its principles are widely applicable to all other types of insurance. Insurers are increasingly using AI to evaluate or even deny claims without human review. They also use it to challenge policyholders’ expenses as too high. Courts are beginning to allow discovery into how AI was used in the claim process. Accordingly, requests for AI chat files, use policies, and documents concerning oversight of AI should now be a standard part of every policyholder’s discovery requests in coverage litigation.

Sanctions are an extreme remedy; frequently sought, but seldom granted.  Such was the case in Hunton Andrews Kurth LLP’s action on behalf of hotel and casino, Treasure Island, LLC (“Treasure Island”), against Affiliated FM Insurance Company (“AFM”) in federal court in Nevada, where AFM “hid” documents which refute the insurer’s defense on the central disputed issue in Treasure Island’s case—and many more actions seeking insurance coverage for losses arising from the COVID-19 pandemic.  A copy of the sanctions order can be found here.

An amended version of the Comprehensive Insurance Disclosure Act recently went into effect in New York State. This law applies to all civil lawsuits filed in New York State Court on or after December 31, 2021. The first disclosures required by the law will be due soon and it is important for defendants to be aware of their new obligations.

Recently, Florida’s First District Court of Appeals handed down a victory for policyholders when it affirmed a Circuit Court’s order compelling an insurer to produce its underwriting manual in a breach of contract action.   In People’s Trust Insurance Co. v. Foster, No. 1D21-845 (Fla. 1st DCA Jan. 26, 2022), the policyholder, Mr. Foster, filed a breach of contract claim against his insurer, People’s Trust, after People’s Trust failed to pay his insurance claim for damage caused to Mr. Foster’s home due to a leaking water pipe. People’s Trust denied Foster’s claim because “Foster’s pipe damage predated the policy’s inception.”