Civil Liability of AI-Assisted Telemedicine in Remote Patient Care: Ethical Governance, Patient Rights, and Insurance Models in Iran

Background: Artificial intelligence is increasingly integrated into telemedicine and remote patient care, improving access, triage, and follow-up while also creating new risks for patient safety, informed consent, privacy, and accountability. WHO guidance stresses that AI in health should be governed through human autonomy, transparency, accountability, and effective redress.who Objective: This article examines how civil liability should be allocated in AI-assisted telemedicine and whether existing Iranian legal and insurance arrangements can adequately protect patients. It also proposes a future insurance model that distributes risk across clinicians, institutions, and developers in a way consistent with ethical governance.ncbi.nlm.nih+2 Methods: We conducted a structured normative-comparative review of WHO governance guidance, international legal-ethical literature on AI liability and telemedicine, and Iranian legal scholarship on civil liability, telemedicine, and medical responsibility. The analysis focused on accountability, informed consent, insurance coverage, irreparable harm, and the role of each actor in AI-mediated care.ncbi.nlm.nih+2 Results: The evidence shows that AI-assisted telemedicine creates a layered liability structure in which adverse outcomes may arise from clinical oversight failures, institutional deployment errors, or technology defects. In Iran, current legal doctrine can partially address these harms through general civil-liability rules, but it does not yet provide a complete framework for AI-specific coverage, compensation, or auditability. Insurance therefore becomes a key governance tool, but its current form must be expanded to cover AI-mediated risks, especially where harms are severe or irreversible.pmc.ncbi.nlm.nih+3 Conclusions: A patient-centered approach to AI-assisted telemedicine should combine civil liability, mandatory disclosure, documentation, and layered insurance coverage. In Iran, this model is legally plausible under existing doctrine but requires targeted regulation to become fully operational. Such reform would better align healthcare innovation with medical ethics, patient protection, and fair compensation.who+2