AI benefit & claim denials lawsuits & cases
Algorithmic tools used by insurers or health plans to deny medically necessary care or benefits at scale, overriding clinician judgment.
2 tracked cases
- OngoingFiled Nov 14, 2023
Estate of Lokken v. UnitedHealth Group, Inc.
UnitedHealth / NaviHealth "nH Predict" AI algorithm · United States (Minnesota)
The estates of deceased Medicare Advantage enrollees allege UnitedHealth used the nH Predict AI tool to deny medically necessary post-acute care, overriding clinicians’ judgment, while allegedly knowing the tool had a roughly 90% reversal rate on appeal. A federal magistrate ordered broad discovery into UnitedHealth’s AI claims processes in 2025 and the case is proceeding.
- OngoingFiled Jul 24, 2023; class advanced Mar 2025
Kisting-Leung v. Cigna Corporation
Cigna "PxDx" automated claims-review algorithm · United States (California)
Following a ProPublica investigation, plaintiffs filed a class action alleging Cigna's PxDx algorithm enabled mass denial of claims, with reviewing doctors allegedly spending an average of about 1.2 seconds per case, contrary to California law requiring thorough, fair review. In March 2025 the court allowed the class action over the AI-based algorithm to proceed.
Other harm types
Informational summaries compiled from public sources cited on each case page. Not legal advice. Verify current status with primary sources.