Gate the claim, the price, and the SIU referral — at the authority line
Insurance AI does not fail in the abstract. It fails the moment a settlement clears above its limit, a price changes unreviewed, or a fraud referral goes out unchecked. KLA puts the approval threshold and the signed lineage exactly at the FNOL, settlement, and pricing decision.
01The lines AI keeps crossing
Three authority lines where an unreviewed action becomes a loss
Legal and risk teams do not object to automation in principle. They object to money-moving and customer-affecting decisions that cannot be intercepted, reviewed, or explained. KLA draws the line at exactly those moments.
A claim settlement above the delegated limit
How KLA gates it
Held for a named approver before it pays out
What the record proves
Authority band, decision rationale, and signed lineage for the payout
A pricing or eligibility change
How KLA gates it
Routed to underwriting review when it materially moves price or eligibility
What the record proves
The factors that moved the price and who approved the change
An SIU or fraud referral
How KLA gates it
Named reviewer before a customer is referred, fast-tracked, or denied for fraud
What the record proves
The AI risk signal, the human decision, and the basis for the referral
02Govern against the binding regime
Claims handling and pricing answer to different rulebooks
A single AI-governance checklist does not satisfy an insurer, because the obligation depends on what the agent is actually doing. Claims-intake triage is claims handling; risk assessment and pricing can be EU AI Act high-risk. KLA gates each decision against the regime that actually binds it.
NAIC AI Model Bulletin + state unfair-claims-practices law (Model #900)
A written AI Systems program and fair-handling duties govern routing, settlement, and denial — this is where KLA gates each FNOL and settlement decision.
EU AI Act Annex III(5)(c) for life-and-health risk assessment and pricing
Where an AI step performs the risk assessment or pricing the EU AI Act enumerates as high-risk, the human-oversight and record-keeping obligations attach.
The discrimination question is the one regulators ask first
The fastest-moving scrutiny in insurance is whether an AI model prices or selects risk in a way that proxies a protected class. Both the NAIC AI Model Bulletin and EU AI Act high-risk rules push you to create the records a fair-pricing review needs — the factors behind a pricing decision, the human accountable for it, and a path to reconstruct it. KLA captures exactly that at the moment the price or eligibility decision is made, instead of reverse-engineering it later.
Workflow blueprints
These reference blueprints walk through the exact runtime gates KLA applies to an insurance agent you already built — at first notice of loss and at the settlement recommendation — with contested fast-tracks, large settlements, and SIU fraud flags routed to a named approver before the action executes, and the lineage sealed as independently verifiable evidence. KLA governs the agent; it does not build or sell it.