---
title: "Table automated claims steps against the model labels"
url: "https://ailawframework.com/practice/insurance-law/analyse-claims-handling-records-for-ai-driven-decisions/united-states"
type: "task_jurisdiction_version"
site: "AI Law Framework"
id: "A22-B7-2-US"
practice_area: "Insurance Law"
tier: "yellow"
lawyer_review: "required"
jurisdictions: ["US"]
last_reviewed: "2026-10-22"
---

# Table automated claims steps against the model labels

> 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.

Canonical page: https://ailawframework.com/practice/insurance-law/analyse-claims-handling-records-for-ai-driven-decisions/united-states  
Last reviewed: 2026-10-22

Site index for agents: https://ailawframework.com/llms.txt

## Key facts

| Fact | Value |
| --- | --- |
| Practice area | [Insurance Law](https://ailawframework.com/practice/insurance-law.md) |
| Human involvement | Yellow: Lawyer and AI draft together |
| 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 | United States |
| Applies to | [Analyse claims-handling records for AI-driven decisions](https://ailawframework.com/practice/insurance-law/analyse-claims-handling-records-for-ai-driven-decisions.md) |

## Checking plan

- What the AI does: 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.
- Basis: Checked against the linked sources on 22 October 2026. Confirm the current instrument before reliance.

## Notes

- A single delay is not Section 3 frequency. The 15-day claim-form figure is the model's.
- Workers' compensation is outside the model's stated purpose.
- No insurance artificial-intelligence bulletin was opened.

## Sources

- [15 U.S.C. § 1012, McCarran-Ferguson Act: regulation by State law](https://www.law.cornell.edu/uscode/text/15/1012) (checked 2026-10-22)
- [NAIC Unfair Claims Settlement Practices Act, model MO-900](https://content.naic.org/sites/default/files/model-law-900.pdf) (checked 2026-10-22)
- [California Insurance Code § 790.03, unfair methods of competition and unfair acts](https://california.public.law/codes/ca_ins_code_section_790.03) (checked 2026-10-22)

*Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*