Insurance governed-workflow blueprints
Runtime governance blueprints for insurance claims agents — FNOL / claims-intake triage and claims-settlement recommendation — mapped to the NAIC AI Model Bulletin, unfair-claims-settlement-practices law, and the EU AI Act.
Governing a Claims-Settlement Recommendation Agent: Fair, Explainable, Auditable Offers
You govern a claims-settlement recommendation agent by putting a policy gate in front of the one action that creates liability, the moment it sets a disposition and an offer amount: KLA's policy engine intercepts that Decision Request before it executes, lets routine offers within a configured authority limit proceed, and routes anything above the limit, denying coverage, or built on a thin investigation to a named adjuster in Decision Desk who can override the amount. Every recommendation, reason code, and human verdict is sealed into independently verifiable execution lineage that maps to the Unfair Claims Settlement Practices Act and the EU AI Act.
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Governing an FNOL / Claims-Intake Triage Agent (NAIC AI Bulletin + EU AI Act)
You govern an FNOL triage agent against its binding regime — the NAIC AI Model Bulletin's written AIS Program and state unfair-claims-practices law (Model #900) — not against EU AI Act Annex III, because claims-intake triage is claims handling, not the life-and-health risk assessment or pricing that Annex III(5)(c) makes high-risk. KLA enforces that with a govern-in-place policy gate on each routing decision (fast-track, adjuster queue, or SIU), routes contested fast-tracks and SIU fraud flags to a named human approver in Decision Desk before the action executes, and seals the lineage as independently verifiable evidence.
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