Insurance AI Agents,
Monitored for Fairness

1. Target

   Policy, claim and quote records across portals, call-centre tools and quoting APIs

2. Trigger

   Retrieval or output references a policyholder outside the authenticated session binding

3. Action — enforced

   Platform blocks the response, purges the foreign record, and throttles accounts showing enumeration patterns

4. Human override

   None — cannot be overridden in session

Logged evidenceSession id · bound policy id · blocked record id · retrieval hash · timestamp

1. Target

   Claim PDFs, emails, photos and medical reports parsed by FNOL and adjudication agents

2. Trigger

   Directive-shaped content detected inside a submitted artifact during extraction

3. Action — enforced

   Platform neutralizes the content, quarantines the artifact, and adjudicates only from clean extracted facts

4. Human override

   None — cannot be overridden in session

Logged evidenceArtifact hash · detection pattern · quarantine id · parser version · timestamp

1. Target

   Denial recommendations across health, motor and property claims at every severity band

2. Trigger

   Adverse decision queued without a documented case-specific reviewer determination

3. Action — enforced

   Platform holds the denial, forces case-specific review with reasons per SB 1120 and CMS rules, and blocks machine-speed batches

4. Human override

   Claims manager — issue the determination with recorded case-specific rationale

Logged evidenceClaim id · model score and version · reviewer identity · rationale text hash · review duration · timestamp

1. Target

   Coverage, exclusion and claim-status statements in every policyholder-facing channel

2. Trigger

   Statement lacks a citation to the customer’s issued policy version and current PDS

3. Action — enforced

   Platform blocks the statement, quotes the filed wording verbatim, and escalates ambiguity to a human adjuster

4. Human override

   Product counsel — publish corrected wording through the document control system

Logged evidenceStatement hash · policy version · PDS id · block code · escalation id · timestamp

1. Target

   Product suggestions, replacement prompts and sales scripts in service and outbound channels

2. Trigger

   Output would constitute personal advice or a licensed producer act under state DOI or ASIC rules

3. Action — enforced

   Platform suppresses the recommendation, serves factual product information only, and hands off to a licensed producer

4. Human override

   Licensed producer — deliver the advice under their own licence in a recorded session

Logged evidenceMessage id · advice classifier verdict · suppression code · handoff record · timestamp

1. Target

   Quoting and binding pipelines consuming rate tables, filings and underwriting rules

2. Trigger

   Rate or rule version differs from the current state DOI filing effective today

3. Action — enforced

   Platform blocks the quote, reloads the filed version, and reconciles quote-bind parity before issue

4. Human override

   Pricing actuary — certify the rate version in the filing register

Logged evidenceQuote id · rate version · filing reference · parity check result · timestamp

1. Target

   Call-centre identity verification and high-risk servicing requests on policyholder accounts

2. Trigger

   Caller requests payout, beneficiary or contact changes with only voice-based identity signals

3. Action — enforced

   Platform denies the change, requires multi-factor verification through registered channels, and flags clone-suspect audio

4. Human override

   Fraud operations supervisor — approve after documented out-of-band identity verification

Logged evidenceCall id · voiceprint risk score · MFA result · change request id · timestamp

1. Target

   Photos, receipts, invoices and consent artifacts submitted through digital claims and enrollment

2. Trigger

   Media authenticity checks fail, or provenance metadata is missing on payment-driving evidence

3. Action — enforced

   Platform holds settlement, requests originals or alternate proof, and routes suspect artifacts to SIU

4. Human override

   SIU lead — clear the artifact after forensic review recorded in the case file

Logged evidenceArtifact hash · authenticity scores · provenance result · hold state · SIU case id · timestamp

1. Target

   New business, reinstatement and beneficiary changes across all distribution channels

2. Trigger

   KYC screening incomplete, degraded or returning an unresolved PEP or sanctions hit

3. Action — enforced

   Platform blocks issuance, holds the application, and routes the hit to compliance for disposition

4. Human override

   Financial crimes compliance officer — disposition the hit in the screening case manager

Logged evidenceApplication id · screening provider result · list versions · hit disposition · timestamp

1. Target

   Collections, cancellation and claims communications touching customers with vulnerability indicators

2. Trigger

   Distress or hardship cues detected, or a vulnerability flag active on the account

3. Action — enforced

   Platform pauses automated action, routes to a trained specialist, and preserves regulatory-clock deadlines meanwhile

4. Human override

   Customer advocacy manager — resume via documented specialist assessment

Logged evidenceAccount id · cue transcript span · flag state · specialist assignment · clock status · timestamp