Label what the file says an insurer's tool did on a claim
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- One row per automated step the claims file describes. Columns are the step, the document and page, and the Section 4 letter only as a label for the conduct the page describes. Do not write that a practice was unfair.
- What the lawyer must review
- 15 U.S.C. § 1012 leaves insurance to state law unless a federal act specifically relates to the business of insurance. NAIC model MO-900 is not that law. An act in Section 4 is an unfair practice only if Section 3 is met: flagrant and in conscious disregard, or frequency that indicates a general business practice. The model's purpose excludes workers' compensation, fidelity, suretyship, and boiler and machinery insurance, and it 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. You decide.
- 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.