His Therapist’s Notes Were in the File.
The Complaint Says Defendants
Never Reviewed Them.

Gene B. Lokken was 91 when a fall fractured his leg and ankle. His estate’s federal complaint says medical records containing his therapist’s notes were submitted to defendants for review, and alleges defendants did not review them before cutting off coverage. UnitedHealth disputes that nH Predict is used to make coverage determinations. A federal court has ordered discovery into how the system works and whether it was designed to supplant physician decision-making.

By William Douglas Baker

Founding Editor

On or around May 5, 2022, according to the federal complaint that now carries his name, 91-year-old Gene B. Lokken fell at home in Wisconsin and fractured his leg and ankle. The weeks that followed have a familiar shape: a hospital admission, a skilled nursing facility, a slow return of strength. By late June his orthopedic doctor had cleared him for weight-bearing physical therapy in a protective boot. The therapists reported he was, in the complaint’s words, “slowly building his strength and mobility,” and that continued intensive physical therapy was medically necessary.

On or around July 20, 2022, two and a half weeks into that therapy, his coverage stopped. The denial, as the complaint quotes it: “More inpatient days at the skilled nursing facility are not medically necessary. A safe discharge plan has been recommended.”

What makes Estate of Lokken v. UnitedHealth Group a filing this record has to carry is not the denial itself. It is one sentence in paragraph 52, describing what had been submitted to the defendants for review at the moment of the decision. The physical therapist’s notes — submitted to the defendants for review — read: “Neuromuscular: Decreased movement/mobility. Musculoskeletal: Paralysis/Weakness.” The complaint’s allegation is one clause long: “Defendants did not review these records when deciding whether Mr. Lokken required additional post-acute care.”

What decided instead, the complaint alleges, was an algorithm. naviHealth’s nH Predict, as the complaint describes it, compares a patient’s diagnosis, age, living situation, and physical function against a database of six million past patients to project a discharge date — an input list with no line on it for a therapist’s notes. The complaint pleads that the defendants held their operation to those projections with unusual force: targets keeping skilled-nursing stays within 1% of the projected days, and employees “disciplined and terminated, regardless of whether a patient requires more care” when they deviated. The projections themselves, paragraph 37 alleges, were “rarely, if ever, communicated with patients or their doctors” — and when patients or doctors asked to see them, they were told the information was proprietary. Mr. Lokken’s family appealed; the complaint says the rejection letter reasoned that he was self-feeding and needed minimal help with hygiene, logic that ran against the therapist’s documented notes. The family paid out of pocket, $12,000 to $14,000 a month, until he died in the facility on July 17, 2023.

What Is Actually in Dispute

Every sentence above is an allegation, and UnitedHealth contests the load-bearing one. Its position, recorded in the court’s own March 9, 2026 discovery order, is that the claim rests on a “faulty premise” — the premise that nH Predict is used to make coverage determinations. The company’s public statement, given to STAT the day the suit was filed, puts its own account on the record: “The tool is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home. Coverage decisions are based on CMS coverage criteria and the terms of the member’s plan.” The lawsuit, it added, “has no merit and we will defend ourselves vigorously.” The court declined to resolve the question at the discovery stage, calling it “a merits-based argument that the parties can address later in this litigation.” No court has found that an algorithm decided Mr. Lokken’s coverage. No court has found that it didn’t.

What the court did do, in that same order, is compel the answer into the open. Magistrate Judge Elkins ordered UnitedHealth to produce documents on how nH Predict works, its development goals — and, in the order’s own words, “whether it was designed to supplant physician decision-making,” including the identities of the people who built it. The schedule now in force moves toward class certification: expert declarations by September 14, 2026, the motion itself by December 31. The question this edition files is narrower than the lawsuit’s, and it survives either answer.

In this record’s clinical register, the alleged failure has a name: Contextual Ambiguity, one of the five clinical characteristics of Digital Derangement Syndrome™ — context captured, then allegedly bypassed. It is the coldest of the five, because it defeats the standard reassurance. The reassurance says: document everything, structure everything, get your facts into the system, and the system will see you. Mr. Lokken’s therapist did every one of those things. The complaint does not plead that the system was unable to read the notes. It pleads that reading them was never on the path the decision took.

That is why this filing belongs in a record about recognition, not just a record about insurance. More and more of professional life now runs upstream of some deciding layer — a claims pipeline, a screening model, an answer engine — that ingests what a professional documents and renders a verdict downstream of it. The assumption built into every one of those systems is that presence in the file is weight in the decision. Lokken is being litigated over the distance between those two things. Answer Engine Authority™ rests on the same distinction. Capture is the floor, not the proof; installation is the architecture designed to make the record impossible to bypass at the moment the decision runs. Being in the file is not being read.

The litigation will decide, on facts not yet found, whether an algorithm made the decision and whether the review happened. What the complaint has already made part of the record is quieter: the notes were there, it pleads, and they said what they said. Whether anyone reviewed them is precisely what remains to be proven.