Status: Investigating claims · Last updated November 2026
If your health insurer denied or cut short coverage for care your doctor said you needed, and an algorithm may have made that call, you may have a claim. Insurers increasingly use artificial intelligence to review claims and predict how much care a patient “should” need. Lawsuits allege these tools have overridden doctors and pushed elderly and seriously ill patients out of care too soon.
At Wieand Parker Arreola, we are investigating claims involving AI-driven insurance denials and other automated decisions that harm people. This page explains how these tools are used, the leading lawsuits and who may qualify. Call (215) 666-7777 for a free, confidential case review.
Health insurers and their contractors use predictive software to:
Most patients never learn an algorithm was involved. They simply receive a denial letter, often while still recovering.
In November 2023, families of two deceased Medicare Advantage members filed a proposed class action in federal court in Minnesota against UnitedHealth Group and its subsidiary naviHealth. One was a 91-year-old Wisconsin man recovering from a broken leg and ankle. The suit alleges the companies used an AI model called nH Predict to cut off post-acute care, such as skilled nursing and rehab, in place of doctors’ judgment. It also alleges the companies pressured employees to stick to the model’s predictions.
The complaint alleges most denials that patients appealed were overturned, but that the companies knew few patients would appeal. The court later allowed breach-of-contract and good-faith claims to proceed, focused on whether UnitedHealth broke its promises that coverage decisions would be made by clinical staff. In March 2026, the court ordered broad discovery into the insurer’s AI-driven claims processes. UnitedHealth denies the claims and says the tool supports, but does not make, coverage decisions.
A similar class action, Barrows v. Humana, is pending in federal court in Kentucky over Humana’s use of the same naviHealth tool. As of October 2026, the court had set a schedule for the plaintiffs to seek class certification.
Denials often hit people at their most vulnerable, such as older adults leaving the hospital after a stroke, fracture or surgery. Families may be forced to pay out of pocket, move a loved one home before it is safe or go without care. Early discharge can lead to falls, infections, readmissions and worse. If a loved one was harmed in a facility after coverage ended, see our nursing home neglect practice.
These are the main factors we review:
Appeal the denial; many denials are overturned on appeal. Keep every denial letter, explanation of benefits, discharge notice and doctor’s note supporting the care. Track what you paid out of pocket. Ask the insurer in writing for the criteria and records used to decide your claim.
You may not be told. Patterns such as a fast, form-based denial or a set number of approved days can be clues. Lawsuits and discovery can reveal the tools used.
Some claims against Medicare Advantage plans are limited by federal law. The UnitedHealth case shows that certain contract-based claims can proceed. A lawyer can review your plan.
Possibly. The UnitedHealth case was brought by families of members who died. We can review what happened.
If an insurer cut off care you or a loved one needed, contact Wieand Parker Arreola for a free, confidential case review. If we take your case, you pay no fee unless we recover compensation for you. See our other class action and mass tort cases and all of our technology and AI claims.
Call (215) 666-7777 or contact us online for a free case review.
This article is for general information only and is not legal or medical advice. Reading it does not create an attorney-client relationship. Litigation details are current as of November 2026 and may change.
