A lawsuit has been filed against US insurer Cigna alleging it used advanced technology such as artificial intelligence (AI) and algorithms to unfairly decline claims in seconds without opening files. 

The suit, filed by Clarkson Law Firm, says Cigna declined more than 300,000 payments this way over two months last year, spending an average of 1.2 seconds reviewing each request. 

“Had Plaintiffs and Class members known that the Cigna Defendants would evade the legally required process for reviewing patient claims and delegate that process to its PXDX algorithm to review and deny claims, they would not have enrolled with Cigna,” it said. 

The suit alleges the life and health insurer used technology to "systematically, wrongfully, and automatically deny its insureds the thorough, individualised physician review of claims guaranteed to them by California law and, ultimately, the payments for necessary medical procedures owed to them under Cigna’s health insurance policies”. 

Cigna’s PXDX (procedure-to-diagnosis) algorithm allowed it to automatically deny payments in batches of hundreds or thousands at a time for treatments that did not match preset criteria, with no individual physician review process, which the suit says is legally required. 

Cigna responded that PXDX “is only used on the most common, low-cost procedures to verify that the codes are submitted correctly, which helps expedite physician reimbursement,” according to US media. There was no use of AI or algorithms to review claims where the code was incorrect or inappropriate, it said. 

The lawsuit says after the PXDX system denies claims, Cigna doctors sign off on denials in batches without opening each patient’s files to conduct a more detailed review of the treatments, injuries, medical history, or any ambiguities and complications. 

"In violation of California law, the Cigna Defendants wrongfully delegated their obligation to evaluate and investigate claims to the PXDX system, including determining whether medical expenses are reasonable and medically necessary,” it said.