---
title: "Label what the file says an insurer's tool did on a claim"
url: "https://ailawframework.com/practice/personal-injury-and-compensation/assess-claims-involving-insurer-ai-decision-tools/united-states"
type: "task_jurisdiction_version"
site: "AI Law Framework"
id: "A21-B8-3-US"
practice_area: "Personal Injury & Compensation (workers compensation, CTP/TAC, medical negligence)"
tier: "yellow"
lawyer_review: "required"
jurisdictions: ["US"]
last_reviewed: "2026-10-22"
---

# Label what the file says an insurer's tool did on a claim

> 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.

Canonical page: https://ailawframework.com/practice/personal-injury-and-compensation/assess-claims-involving-insurer-ai-decision-tools/united-states  
Last reviewed: 2026-10-22

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

## Key facts

| Fact | Value |
| --- | --- |
| Practice area | [Personal Injury & Compensation (workers compensation, CTP/TAC, medical negligence)](https://ailawframework.com/practice/personal-injury-and-compensation.md) |
| Human involvement | Yellow: Lawyer and AI draft together |
| 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 | United States |
| Applies to | [Assess claims involving insurer AI decision tools](https://ailawframework.com/practice/personal-injury-and-compensation/assess-claims-involving-insurer-ai-decision-tools.md) |

## Checking plan

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

## Notes

- The model is not law until a state enacts it. The 15-day claim-form period is the model's, not a national rule.
- A single delay is not Section 3 frequency.
- Do not apply the model to a workers' compensation claim. 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.*