What authority do State Departments of Insurance have over automated claims and AI vendors?
Under state Unfair Claims Settlement Practices Acts (UCSPA) and the NAIC Model Bulletin on Artificial Intelligence Systems in Insurance, insurance carriers maintain strict, non-delegable legal accountability to state insurance commissioners for every claim evaluation, deduction, downcoding, and denial generated by software:
- Licensed Adjuster Mandate: States like California (Cal. Ins. Code § 14021) and Texas (Tex. Ins. Code § 4101) prohibit automated algorithms from adjusting or settling claims without licensed human adjuster investigation.
- Prompt Payment Statues: Insurers cannot cite third-party software processing queues or model retraining delays to justify late claim payments beyond statutory deadlines (e.g., Texas Ch. 542 imposes 18% annual penalty interest).
- Vendor Examination Subpoenas: While software vendors (e.g., CCC, Mitchell, EvolutionIQ) are not directly licensed, insurance commissioners possess statutory power to examine carrier contracts, algorithmic governance audits, and model bias validation files.
Statutory Prompt Payment Penalty Calculator
Estimate accrued statutory penalty interest, statutory violation damages, and carrier bad-faith exposure when insurers delay claims past mandatory state deadlines.
Claim & Jurisdiction Parameters
Estimated Carrier Penalty Exposure
| State | Official Department of Insurance | Consumer Portal | Governing Statute | Prompt Pay | NAIC AI Status | Regulatory & Claims Focus |
|---|---|---|---|---|---|---|
|
AL
Alabama
|
Alabama Department of Insurance
www.aldoi.gov
|
File Claim Complaint | Ala. Code § 27-12-24 & Ala. Code § 27-1-17 | 45 days | Reviewing |
Focuses on catastrophic storm claims handling, monitoring third-party aerial roof imagery in property underwriting, and enforcing timely claim dispute resolution. |
|
AK
Alaska
|
Alaska Division of Insurance
www.commerce.alaska.gov/web/ins
|
File Claim Complaint | Alaska Stat. § 21.36.125 & Alaska Admin. Code tit. 3, § 26.040 | 30 days | Adopted |
Enforces Artificial Intelligence Systems governance programs under Bulletin B 24-01 while maintaining oversight of claim adjustment delays across remote territories. |
|
AZ
Arizona
|
Arizona Department of Insurance and Financial Institutions
difi.az.gov
|
File Claim Complaint | Ariz. Rev. Stat. § 20-461 & Ariz. Admin. Code R20-6-801 | 30 days | Reviewing |
Mandates licensed physician director review for automated health claims denials under HB 2175 and enforces prompt investigation standards under unfair claims rules. |
|
AR
Arkansas
|
Arkansas Insurance Department
insurance.arkansas.gov
|
File Claim Complaint | Ark. Code Ann. § 23-66-206 & Ark. Ins. Dept. Rule 43 | 45 days | Adopted |
Requires written insurer AI programs under Bulletin 13-2024 to prevent algorithmic bias while actively monitoring prompt settlement of storm-related property claims. |
|
CA
California
|
California Department of Insurance
www.insurance.ca.gov
|
File Claim Complaint | Cal. Ins. Code § 790.03 & Cal. Ins. Code § 14021 | 40 days | Notice Issued |
Enforces Bulletin 2022-5 and Cal. Ins. Code § 14021 against touchless auto adjusting, biometric claim surveillance, and unlicensed algorithmic claims processing. |
|
CO
Colorado
|
Colorado Division of Insurance
doi.colorado.gov
|
File Claim Complaint | Colo. Rev. Stat. § 10-3-1104 & SB 21-169 | 60 days | Notice Issued |
Pioneered nation-leading algorithmic fairness mandates under SB 21-169 and Regulation 10-1-1, requiring carriers to conduct statistical testing to prevent algorithmic bias. |
|
CT
Connecticut
|
Connecticut Insurance Department
portal.ct.gov/cid
|
File Claim Complaint | Conn. Gen. Stat. § 38a-816 & Conn. Agencies Regs. § 38a-816-1 | 30 days | Adopted |
Requires annual AI compliance certifications under Bulletin MC-25 to ensure carriers proactively test and audit third-party algorithms for unfair discrimination. |
|
DE
Delaware
|
Delaware Department of Insurance
insurance.delaware.gov
|
File Claim Complaint | Del. Code Ann. tit. 18, § 2304(16) & 18 Del. Admin. Code § 902 | 30 days | Adopted |
Enforces Bulletin No. 148 holding carriers accountable for AI systems and ensuring algorithmic claim assessment tools do not evade unfair claims settlement standards. |
|
FL
Florida
|
Florida Office of Insurance Regulation
floir.com
|
File Claim Complaint | Fla. Stat. § 626.9541 & Fla. Stat. § 627.70131 | 60 days | Reviewing |
Strictly enforces shortened post-catastrophe claims deadlines and scrutinizes automated desk-adjusting tools to curb unjustified property loss reductions. |
|
GA
Georgia
|
Office of the Commissioner of Insurance and Safety Fire
oci.georgia.gov
|
File Claim Complaint | Ga. Code Ann. § 33-6-34 & Ga. Comp. R. & Regs. 120-2-52 | 60 days | Reviewing |
Monitors insurer compliance with statutory claims response times and investigates consumer complaints regarding automated vehicle total-loss calculations. |
|
HI
Hawaii
|
Hawaii Insurance Division
cca.hawaii.gov/ins
|
File Claim Complaint | Haw. Rev. Stat. § 431:13-103 & Haw. Rev. Stat. § 431:13-108 | 30 days | Adopted |
Oversees catastrophe claim settlements following wildfire disasters while requiring verifiable audit trails for automated claim handling systems. |
|
ID
Idaho
|
Idaho Department of Insurance
doi.idaho.gov
|
File Claim Complaint | Idaho Code § 41-1329 & IDAPA 18.01.21 | 30 days | Reviewing |
Protects consumer transparency in personal lines adjustments and examines insurer reliance on automated estimating software during market conduct reviews. |
|
IL
Illinois
|
Illinois Department of Insurance
idoi.illinois.gov
|
File Claim Complaint | 215 Ill. Comp. Stat. 5/154.6 & Ill. Admin. Code tit. 50, § 919 | 30 days | Adopted |
Audits algorithmic claims and underwriting models under Bulletin 2024-08 to eliminate systemic disparate impact and ensure strict prompt payment adherence. |
|
IN
Indiana
|
Indiana Department of Insurance
www.in.gov/idoi
|
File Claim Complaint | Ind. Code § 27-4-1-4.5 & Ind. Code § 27-8-5.7-6 | 30 to 45 days | Reviewing |
Regulates insurer use of aerial imagery in property evaluations and enforces statutory clean-claim payment timeframes. |
|
IA
Iowa
|
Iowa Insurance Division
iid.iowa.gov
|
File Claim Complaint | Iowa Code § 507B.4 & Iowa Admin. Code r. 191-15.41 | 30 days | Adopted |
Enforces Bulletin 24-01 requiring documented insurer governance over predictive modeling and validation of third-party algorithmic claims adjusting tools. |
|
KS
Kansas
|
Kansas Insurance Department
insurance.kansas.gov
|
File Claim Complaint | Kan. Stat. Ann. § 40-2404 & Kan. Admin. Regs. § 40-1-34 | 30 days | Reviewing |
Protects policyholders against arbitrary automated claim depreciations and upholds statutory prompt payment standards in property and casualty losses. |
|
KY
Kentucky
|
Kentucky Department of Insurance
insurance.ky.gov
|
File Claim Complaint | Ky. Rev. Stat. Ann. § 304.12-230 & 806 Ky. Admin. Regs. 12:095 | 30 days | Adopted |
Implements Bulletin 2024-02 ensuring artificial intelligence systems comply with Kentucky's Unfair Claims Settlement Practices Act and avoid discriminatory outcomes. |
|
LA
Louisiana
|
Louisiana Department of Insurance
www.ldi.la.gov
|
File Claim Complaint | La. Rev. Stat. Ann. § 22:1892 & La. Rev. Stat. Ann. § 22:1973 | 30 days | Reviewing |
Imposes strict statutory penalties for bad-faith delays in catastrophe claims and regulates insurer use of aerial imaging and algorithmic roof inspections. |
|
ME
Maine
|
Maine Bureau of Insurance
www.maine.gov/pfr/insurance
|
File Claim Complaint | Me. Rev. Stat. Ann. tit. 24-A, § 2164-D & Me. Rev. Stat. Ann. tit. 24-A, § 2436 | 30 days | Notice Issued |
Issued Bulletin 483 governing external consumer data and aerial imagery to ensure transparent notice and consumer challenge procedures in underwriting and claims. |
|
MD
Maryland
|
Maryland Insurance Administration
insurance.maryland.gov
|
File Claim Complaint | Md. Code Ann., Ins. § 27-303 & Md. Code Regs. 31.15.07 | 30 days | Adopted |
Requires comprehensive AI governance and third-party vendor oversight under Bulletin 24-11 to prevent algorithmic proxy discrimination across claims operations. |
|
MA
Massachusetts
|
Massachusetts Division of Insurance
www.mass.gov/orgs/division-of-insurance
|
File Claim Complaint | Mass. Gen. Laws ch. 176D, § 3 & 211 Code Mass. Regs. 123.00 | 30 to 45 days | Adopted |
Applies Bulletin 2024-09 to scrutinize predictive algorithms for demographic bias while strictly enforcing consumer protections under Chapter 176D. |
|
MI
Michigan
|
Michigan Department of Insurance and Financial Services
www.michigan.gov/difs
|
File Claim Complaint | Mich. Comp. Laws § 500.2026 & Mich. Comp. Laws § 500.2006 | 30 to 60 days | Adopted |
Mandates written AI risk management protocols under Bulletin 2024-20-INS to prevent unfair discrimination in auto no-fault and property damage claims. |
|
MN
Minnesota
|
Minnesota Department of Commerce
mn.gov/commerce/insurance
|
File Claim Complaint | Minn. Stat. § 72A.201 & Minn. Stat. § 60A.0811 | 30 to 60 days | Reviewing |
Monitors algorithmic decision systems during market conduct examinations and rigorously enforces statutory prompt settlement deadlines. |
|
MS
Mississippi
|
Mississippi Insurance Department
www.mid.ms.gov
|
File Claim Complaint | Miss. Code Ann. § 83-5-29 & Miss. Code Ann. § 83-9-5(1)(h) | 25 to 35 days | Adopted |
Scrutinizes automated adjusting tools during catastrophic storm recovery and enforces statutory prompt pay guidelines to prevent delayed claim payouts. |
|
MO
Missouri
|
Missouri Department of Commerce and Insurance
insurance.mo.gov
|
File Claim Complaint | Mo. Rev. Stat. § 375.1007 & Mo. Code Regs. tit. 20, § 100-1.010 - 1.060 | 30 days | Reviewing |
Actively participates in NAIC AI working groups while auditing carrier automated claims systems for compliance with Missouri prompt pay and vexatious refusal laws. |
|
MT
Montana
|
Montana Commissioner of Securities and Insurance
csimt.gov
|
File Claim Complaint | Mont. Code Ann. § 33-18-201, § 33-18-232 | 30 days | Reviewing |
Enforces statutory unfair trade practices and bad-faith claim settlement rules while evaluating carrier algorithmic tools and consumer data privacy. |
|
NE
Nebraska
|
Nebraska Department of Insurance
doi.nebraska.gov
|
File Claim Complaint | Neb. Rev. Stat. § 44-1540; 210 Neb. Admin. Code § 60-008 | 15 days | Adopted |
Enforces Unfair Claims Settlement standards and requires insurers to maintain written Artificial Intelligence Systems governance programs under Notice CB-142. |
|
NV
Nevada
|
Nevada Division of Insurance
doi.nv.gov
|
File Claim Complaint | Nev. Rev. Stat. § 686A.310; Nev. Admin. Code § 686A.675 | 30 days | Adopted |
Protects consumers against deceptive claims practices and requires insurers deploying AI to implement comprehensive governance per Bulletin 24-001. |
|
NH
New Hampshire
|
New Hampshire Insurance Department
www.insurance.nh.gov
|
File Claim Complaint | N.H. Rev. Stat. Ann. § 417:4; N.H. Code Admin. R. Ins 1002.05 | 30 days | Adopted |
Enforces prompt claims investigation mandates and holds carriers strictly accountable for algorithmic decisions under Docket INS 24-009-AB. |
|
NJ
New Jersey
|
New Jersey Department of Banking and Insurance
www.nj.gov/dobi
|
File Claim Complaint | N.J. Stat. Ann. § 17:29B-4; N.J. Admin. Code § 11:22-1.5 | 30 days | Adopted |
Mandates prompt claim settlement compliance and requires formal AI risk management and anti-bias controls under Bulletin 25-01. |
|
NM
New Mexico
|
New Mexico Office of Superintendent of Insurance
www.osi.state.nm.us
|
File Claim Complaint | N.M. Stat. Ann. § 59A-16-20, § 59A-16-21.1 | 30 days | Reviewing |
Investigates unfair claims settlement practices and monitors automated claims triage tools to ensure fair and timely adjudication. |
|
NY
New York
|
New York State Department of Financial Services
www.dfs.ny.gov
|
File Claim Complaint | N.Y. Ins. Law § 2601; 11 NYCRR Part 216 | 30 days | Notice Issued |
Enforces nation's strictest AI claims and underwriting governance under Circular Letter No. 7 (2024), requiring empirical bias testing and external consumer data audits. |
|
NC
North Carolina
|
North Carolina Department of Insurance
www.ncdoi.gov
|
File Claim Complaint | N.C. Gen. Stat. § 58-63-15, § 58-3-225 | 30 days | Adopted |
Applies unfair trade practices enforcement and Bulletin 24-B-12 to ensure transparency and accountability in insurer artificial intelligence systems. |
|
ND
North Dakota
|
North Dakota Insurance Department
www.insurance.nd.gov
|
File Claim Complaint | N.D. Cent. Code § 26.1-04-03, § 26.1-36-37.1 | 15 business days | Reviewing |
Enforces statutory claim payment deadlines while developing tailored regulatory guidance based on the NAIC AI Model Bulletin. |
|
OH
Ohio
|
Ohio Department of Insurance
insurance.ohio.gov
|
File Claim Complaint | Ohio Rev. Code Ann. § 3901.381; Ohio Admin. Code § 3901-1-54 | 21 days | Reviewing |
Monitors unfair property and casualty claims settlement practices while assessing AI guardrails to protect policyholders from algorithmic errors. |
|
OK
Oklahoma
|
Oklahoma Insurance Department
www.oid.ok.gov
|
File Claim Complaint | Okla. Stat. tit. 36, § 1250.7, § 1219 | 45 days | Adopted |
Enforces the Unfair Claims Settlement Practices Act and Bulletin LH/PC 2024-02 to prevent automated claims settlement bias and improper denials. |
|
OR
Oregon
|
Oregon Division of Financial Regulation
dfr.oregon.gov
|
File Claim Complaint | Or. Rev. Stat. § 746.230, § 743B.450 | 30 days | Notice Issued |
Targets unfair claims settlement practices and issues regulatory guidance on artificial intelligence and consumer data protection. |
|
PA
Pennsylvania
|
Pennsylvania Insurance Department
www.insurance.pa.gov
|
File Claim Complaint | 40 Pa. Stat. Ann. § 1171.5; 31 Pa. Code § 146.6 | 45 days | Adopted |
Enforces Unfair Insurance Practices standards and Notice 2024-04 requiring insurers to maintain documented AI governance and testing frameworks. |
|
RI
Rhode Island
|
Rhode Island Department of Business Regulation, Insurance Division
dbr.ri.gov/insurance
|
File Claim Complaint | R.I. Gen. Laws § 27-9.1-4, § 27-18-61 | 30 days | Adopted |
Regulates unfair claim settlement practices and enforces Insurance Bulletin 2024-02 to oversee insurer AI systems and third-party vendor models. |
|
SC
South Carolina
|
South Carolina Department of Insurance
www.doi.sc.gov
|
File Claim Complaint | S.C. Code Ann. § 38-59-20, § 38-59-230 | 21 business days | Reviewing |
Investigates improper claim settlement practices while actively formulating administrative guidance on insurer AI adoption and licensee accountability. |
|
SD
South Dakota
|
South Dakota Division of Insurance
dlr.sd.gov/insurance
|
File Claim Complaint | S.D. Codified Laws § 58-33-67, § 58-12-20 | 30 days | Reviewing |
Enforces unfair claim settlement prohibitions and prompt pay deadlines while reviewing insurer utilization of automated claims processing. |
|
TN
Tennessee
|
Tennessee Department of Commerce and Insurance
www.tn.gov/commerce/insurance-division.html
|
File Claim Complaint | Tenn. Code Ann. § 56-8-105, § 56-7-109 | 21 calendar days | Reviewing |
Enforces statutory claims payment timeliness and monitors the integration of machine learning algorithms in claims handling. |
|
TX
Texas
|
Texas Department of Insurance
www.tdi.texas.gov
|
File Claim Complaint | Tex. Ins. Code Ch. 542 (Prompt Payment Act) & Ch. 4101 | 15 business days | Notice Issued |
Aggressively enforces Chapter 542 18% statutory penalty interest and Bulletin B-0003-26 requiring human-in-the-loop oversight and licensed adjuster accountability. |
|
UT
Utah
|
Utah Insurance Department
insurance.utah.gov
|
File Claim Complaint | Utah Code Ann. § 31A-26-301, § 31A-26-301.6; Utah Admin. Code R590-190 | 30 days | Reviewing |
Enforces unfair claims settlement rules under R590-190 while monitoring insurer adoption of AI underwriting and claims automation systems. |
|
VT
Vermont
|
Vermont Department of Financial Regulation, Insurance Division
dfr.vermont.gov
|
File Claim Complaint | 8 V.S.A. § 4724, § 3665; 18 V.S.A. § 9418 | 30 days | Adopted |
Enforces fair claim settlement standards and requires insurers to implement comprehensive AIS governance programs under Bulletin 226. |
|
VA
Virginia
|
Virginia State Corporation Commission, Bureau of Insurance
scc.virginia.gov/pages/Bureau-of-Insurance
|
File Claim Complaint | Va. Code Ann. § 38.2-510, § 38.2-3407.15 | 40 days | Adopted |
Enforces market conduct standards and Administrative Letter 2024-04 requiring insurers to manage AI bias, governance, and vendor oversight. |
|
WA
Washington
|
Washington State Office of the Insurance Commissioner
www.insurance.wa.gov
|
File Claim Complaint | Wash. Rev. Code § 48.30.010; Wash. Admin. Code § 284-30-330 | 30 days | Adopted |
Enforces unfair claims settlement rules under WAC 284-30-330 and requires insurers to maintain AI governance frameworks per TAA 2024-01. |
|
WV
West Virginia
|
West Virginia Offices of the Insurance Commissioner
www.wvinsurance.gov
|
File Claim Complaint | W. Va. Code § 33-11-4(9), § 33-45-2 | 30 days | Adopted |
Enforces unfair trade practices prohibitions and Bulletin 24-06 requiring comprehensive AI system risk governance programs. |
|
WI
Wisconsin
|
Wisconsin Office of the Commissioner of Insurance
oci.wi.gov
|
File Claim Complaint | Wis. Stat. § 628.46; Wis. Admin. Code Ins § 6.11 | 30 days | Adopted |
Strictly enforces Section 628.46 30-day prompt pay requirements while applying NAIC AI guidance to carrier claims handling systems. |
|
WY
Wyoming
|
Wyoming Department of Insurance
doi.wyo.gov
|
File Claim Complaint | Wyo. Stat. Ann. § 26-13-124, § 26-15-124 | 45 days | Reviewing |
Enforces unfair claims settlement prohibitions under Section 26-13-124 while evaluating AI model governance and consumer fairness standards. |
|
DC
District of Columbia
|
District of Columbia Department of Insurance, Securities and Banking
disb.dc.gov
|
File Claim Complaint | D.C. Code § 31-2231.17, § 31-3132 | 30 days | Adopted |
Enforces fair claim settlement practices and Bulletin 24-IB-02-05/21 mandating algorithmic transparency and bias mitigation in insurer AI systems. |
|
PR
Puerto Rico
|
Office of the Commissioner of Insurance of Puerto Rico
ocs.pr.gov
|
File Claim Complaint | 26 L.P.R.A. § 2716a; Rule 73 of Insurance Code Regulations | 90 days | Reviewing |
Enforces unfair claim adjustment practices under Section 2716a and Rule 73 while tracking NAIC model guidance for AI implementation. |
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Frequently Asked Regulatory & Claims Oversight Questions
Authoritative answers on state insurance department jurisdictions, market conduct exams, AI Model Bulletin enforcement, and policyholder complaint procedures.
A State Department of Insurance (DOI)—sometimes called a Division of Insurance or Department of Financial Services—is the state government administrative agency authorized by statute to regulate the business of insurance, license insurance carriers, adjusters, and third-party administrators (TPAs), and enforce state Unfair Claims Settlement Practices Acts (UCSPA). When an insurance company wrongfully delays, undervalues, or denies a claim, state DOIs maintain dedicated Consumer Services and Market Conduct Examination divisions empowered to investigate complaints, subpoena carrier files, issue administrative fines, and order restitution.
To file an official insurance complaint against an insurer: 1) Locate your state's official DOI complaint portal in the directory below; 2) Gather your policy number, claim number, date of loss, adjuster communications, estimate worksheets, and written denial letters; 3) Clearly describe the statutory violation, such as failure to meet prompt payment deadlines, failure to conduct a reasonable physical inspection, or improper automated downcoding; 4) Submit the complaint online. State law requires the insurer to submit a formal written response to the DOI within 15 to 30 days.
As of 2026, 23 jurisdictions have formally adopted the NAIC Model Bulletin on the Use of Artificial Intelligence Systems by Insurers (including Alaska, Arkansas, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Oklahoma, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, West Virginia, Wisconsin, and the District of Columbia), while key leading states like California, New York, Colorado, and Texas have issued customized regulatory bulletins, circular letters, or statutes governing algorithmic bias and testing.
No. Under state adjuster licensing statutes (such as California Insurance Code § 14021 and Texas Insurance Code Chapter 4101) and the NAIC Model Bulletin, insurance claim determinations, evaluations, and settlements require licensed human adjuster oversight. Automated touchless claims algorithms that issue adverse coverage determinations or automatic deduction percentages without a documented human investigation violate statutory adjusting mandates and constitute unfair claims settlement practices.
Statutory prompt payment deadlines establish legally binding timeframes for insurance companies to acknowledge receipt of a claim, commence investigation, accept or reject the claim, and issue payment. Typical statutory windows range from 15 to 30 days (e.g., Texas Insurance Code Chapter 542 establishes a strict 15-business-day response requirement backed by 18% annual penalty interest plus reasonable attorney's fees; California mandates claim acceptance or rejection within 40 calendar days; New York within 30 days).
Claimants, adjusters, and advocates reporting algorithmic claim suppression should provide: 1) Software vendor estimating worksheets (e.g., CCC ONE, Mitchell SmartAdvisor, Guidewire ClaimCenter, EvolutionIQ) showing automated condition deductions, aftermarket parts mandates, or algorithmic downcoding flags; 2) Written correspondence showing denial generated without human on-site inspection; 3) Timeline logs documenting statutory response deadline delays; and 4) Carrier denial letters lacking specific factual or policy language justification.
State insurance commissioners regulate licensed insurance carriers directly. Under the NAIC Model Bulletin and state examination statutes, carriers are strictly responsible for the actions and compliance of their third-party vendor systems. Consequently, state examiners require carriers to produce third-party vendor audit logs, model governance documentation, training data bias tests, and validation certificates during targeted market conduct examinations.
An individual consumer complaint focuses on resolving a single claimant's dispute with an insurer (such as an unpaid repair bill or delayed payment). In contrast, a Market Conduct Examination is a comprehensive regulatory audit where state examiners review hundreds or thousands of carrier claim files, internal adjusting guidelines, software algorithms, and compliance records to detect systemic patterns of unfair claims practices, unlawful automated deductions, or statutory licensing violations across an entire line of business.
Submitting Evidence of Algorithmic Claims Suppression
Are you a claims adjuster, software engineer, or regulatory examiner with internal carrier guidelines, model validation audits, or evidence of automated downcoding programs? Submit documentation securely and confidentially to our investigative research desk.