State AI Liability in Health Care: Lawsuits Test Insurers, Apps and Chatbots
November 4, 2026
Several lawsuits now test how state AI liability rules apply to AI in health care, and they have not yet produced merits findings. A Congressional Research Service (CRS) legal sidebar, LSB11467, published on August 10, 2026 and written by Wen W. Shen and Jennifer A. Staman, sets out the claims, the state laws they rely on, and questions for Congress. Some cases involve insurer coverage decisions. Others involve wellness apps and general-purpose chatbots.
State AI liability claims against health insurers
Insurers increasingly use AI tools to automate and speed up prior authorization, post-service claims review and other coverage decisions. Federal rules depend on the type of coverage. For private, employment-based plans, ERISA generally requires reasonable claims procedures and an opportunity for “full and fair review” of denied claims. Medicare Advantage plans must also base medical necessity determinations on factors specific to the enrollee, under an April 2023 final rule. Any adverse determination must be reviewed by a physician or another health care professional with appropriate expertise.
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