A new wave of class action lawsuits is sweeping through the healthcare industry—this time, targeting the use of artificial intelligence in making critical care decisions. Major health insurers, including UnitedHealth, Humana, and Cigna, are facing mounting legal scrutiny over allegations that they’ve relied on AI-driven tools to systematically deny necessary medical treatments, potentially putting patients’ lives at risk.
The Core Allegation: Algorithm Over Judgment
At the heart of these lawsuits is the allegation that insurance companies are allowing algorithms, not medical professionals, to determine what care is approved or denied. Plaintiffs claim that these AI models are not just assisting in the review process—they’re effectively overriding medical judgment in favor of cost-saving decisions.
In the case of UnitedHealth, a high-profile class action filed in late 2023 accuses the company of using an AI tool called nH Predict to deny rehabilitation stays for elderly patients. The lawsuit alleges that the system’s denial rates are exceptionally high and that appeals rarely reverse the decisions. Critics argue this amounts to rubber-stamping denials without appropriate human oversight.
Similarly, Humana and Cigna are under fire for allegedly deploying automated systems that assess claims in bulk, sometimes denying treatments in mere seconds. In Cigna’s case, internal documents surfaced showing physicians “signing off” on dozens or even hundreds of claims at a time using an AI-assisted review platform—raising serious questions about due process and clinical integrity.
Legal Theories and Patient Impact
The lawsuits hinge on several legal claims, including breach of contract, bad faith denial of benefits, and violations of consumer protection laws. Some cases are also exploring whether these practices run afoul of federal healthcare regulations like ERISA or Medicare Advantage rules.
The stakes are high. Denied care can mean delayed treatment, extended suffering, or worse. For patients managing chronic conditions, rehabilitation needs, or cancer therapies, even short delays can drastically alter outcomes.
What’s Next?
As the lawsuits move forward, they could set important precedents about how AI should (and shouldn’t) be used in the healthcare system. The cases may also fuel regulatory attention from agencies like the Department of Health and Human Services or the Centers for Medicare & Medicaid Services, which have started to raise questions about algorithmic transparency and fairness in healthcare decision-making.
For now, the industry is watching closely. These lawsuits signal a broader reckoning with how artificial intelligence is reshaping care delivery—and who gets to make the final call when it comes to your health.
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