Emerging AI Legislation & How it Impacts You

AI has already found its way into insurance and medical claims, helping teams move faster and manage more. However, with that growth comes a new wave of attention from lawmakers who want to make sure the technology is used responsibly. As decisions increasingly rely on AI-supported tools, questions around accuracy and compliance are becoming harder to ignore.

That’s why the industry is starting to see legislation roll out across the U.S., aiming to set clearer expectations for how AI should function in sensitive areas such as claims and care outcomes. For firms, clinical specialists, and claims professionals, this shift changes the role they’re expected to play, reinforcing the need for human judgment in guiding AI.

Tracking AI Regulation in U.S. Insurance and Healthcare

States are starting to set consistent standards for how AI can be used in claims and care processes. So far, three have passed laws that support a human-in-the-loop approach.

In California, the Physicians Make Decisions Act took effect in January 2025, requiring licensed practitioners to make the final call on clinical decisions. Utah’s Artificial Intelligence Policy Act, active since May 2024, sets rules around transparency and accountability. Colorado’s Artificial Intelligence Act, coming in February 2026, will require auditability, explainability, and fairness in high-risk systems like those found in insurance and claims.

Connecticut (SB818), Illinois, and Rhode Island are also considering bills that would prevent AI from being used to deny claims without human oversight. More and more, there’s agreement industry wide that human judgment needs to stay iat the core of the process when health and claimant care is at stake, and lawmakers are taking notice.

Why Human Oversight Matters in AI Claims Review

For teams in claims and medical record review, the new laws focus on sound reasoning, expert guidance, and traceable actions. This new stance aligns with Wisedocs’ core mission. With a vision of empowering individuals’ lives by revolutionizing the claims ​ecosystem for those that need a voice, autonomy, and support, we know first hand what is at stake. It’s with this in mind that our outputs are reviewed and validated by expert-in-the-loop specialists, delivering highly defensible solutions, cited to the original document so nothing gets missed or misinterpreted.

In 2024, 66% of U.S. physicians reported using AI in their work, a 78% increase from the year before. Many use it for documentation, discharge summaries, translation, and even diagnostic support. It’s a sign that trust comes from keeping humans in the loop. In our 2025 survey report, only 16% of claims professionals trusted AI alone to make decisions. However with skilled human validation, the number rose to 60%, a nearly 4x increase in trust. The industry has spoken, and the message is clear: AI creates the most value when it empowers professionals, not when it replaces them.

AI as a Copilot, Not an Autopilot

The future of AI in claims is about having a reliable copilot, something that helps you move more efficiently while maintaining authority. Most teams don’t want full automation. They want solutions designed to support their insights, ease file review, and highlight relevant information.

A 2024 survey found 94% of insurers see more automation as a good thing, but 40% still say a human presence is essential for precision and management. That’s the model regulators are leaning toward too. The laws we’re seeing favor systems keeping humans involved, particularly when outcomes impact health and recovery. Trust comes easier when AI keeps its speed and its standards, but humans are the ones in the driver's seat.

Building Trust and Readiness as AI Rules Take Shape

AI is evolving rapidly, and the rules are starting to catch up. For claims professionals, this means using solutions that keep pace with innovation and responsibility. The best systems help you do your job better without cutting corners or leaving gaps in oversight.

As new regulations take shape, teams grounded in traceability and expert review will be ready for whatever comes next. A strong foundation builds trust, holds up under pressure, and gives you the confidence to keep moving forward.

or organizations seeking a validated and compliant claims documentation platform, Wisedocs’ Buyer’s Guide makes the evaluation process easier for first-time buyers. The included Buyer’s Cheat Sheet outlines the pros and cons of CDPs—with and without expert human oversight—so you can make the right choice. Download the guide today and find a solution that fits your needs in the face of evolving legislation.