Table automated claims steps against the model labels
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- One row per step the claims file says a system performed. Columns are the date, the step in the file's words, and the Section 4 letter only as a label. Do not find a violation.
- What the lawyer must review
- 15 U.S.C. § 1012 leaves claims handling to state law unless a federal act specifically relates to the business of insurance. NAIC model MO-900 Section 4 lists practices, including misrepresenting facts or policy provisions, failing to acknowledge with reasonable promptness, and failing to give a reasonable and accurate explanation of a denial or compromise offer. Section 3 makes such an act improper only if flagrant and in conscious disregard, or if the frequency indicates a general business practice. The model is not itself law and states that it does not create a private cause of action. California Insurance Code § 790.03 includes misrepresenting to claimants pertinent facts or policy provisions relating to coverages at issue.
- Written for / version
- United States versionUS
Who does what
| Role | What they do |
|---|---|
| Assistance | Consider narrowly defined preparation support after confirming the tool’s capability and permitted scope. |
| Lawyer | Set the scope, supervise the work closely, verify every part relied on, resolve omissions and exceptions, and approve the exact output. |
Checklist
- Confirm the output against the client’s instructions and the complete relevant source material, including omissions or contradictions.
- Resolve exceptions and record the responsible lawyer’s approval of the exact output and intended use.