Insurance

Insurance Scenario¶

Model: Security-first · Entry: AuthAgent · Handoffs: Mixed (B2C announced, B2B discrete)

Architecture¶

flowchart TB AA[AuthAgent<br/>Security Gate] --> PA[PolicyAdvisor<br/>B2C] AA --> FNOL[FNOLAgent<br/>B2C] AA --> SA[SubroAgent<br/>B2B] PA --> FNOL FNOL --> PA PA --> H[Human Agent] FNOL --> H SA --> H

Two caller types:

Type	Auth Method	Flow
B2C (Policyholder)	Policy + Name + SSN4	→ PolicyAdvisor / FNOLAgent
B2B (Claimant Carrier)	Company Code + Claim #	→ SubroAgent

Agents¶

Agent	Purpose	Key Tools	Reference
AuthAgent	Entry, identity verification	`verify_client_identity`, `verify_cc_caller`	→ Details
PolicyAdvisor	Policy inquiries	`get_policy_details`, `get_coverage_details`	→ Details
FNOLAgent	File new claims	`file_new_claim`	→ Details
SubroAgent	B2B subrogation	`get_coverage_status`, `evaluate_rush_criteria`	→ Details

Related: ClaimsSpecialist handles ongoing claims processing

Test Scripts¶

Script 1: B2B Subrogation (Golden Path)¶

Claimant carrier rep calling about claim recovery — tests all 6 inquiry steps

Setup

scenario: insurance
insurance_role: cc_rep
test_scenario: golden_path

Full Conversation

#	Caller (Lisa)	Agent	Tool
Auth
1	"Lisa Chen, Contoso Insurance"	"Company code?"	—
2	"CI-1234"	"Claim number?"	—
3	"CLM-2024-1234"	—	`verify_cc_caller`
4	—	(SubroAgent) "Got it. What do you need?"	→ discrete
1️⃣ Coverage
5	"Confirm coverage?"	"Coverage confirmed. Active policy."	`get_coverage_status`
2️⃣ Liability
6	"Liability?"	"Accepted at 80%."	`get_liability_decision`
3️⃣ Limits
7	"PD limits?"	"$50k. Your demand is within limits."	`get_pd_policy_limits`
4️⃣ Payments
8	"Payments made?"	"$14,832 on Nov 15. Check #84521."	`get_subro_payments`
5️⃣ Demand
9	"Demand status?"	"$43,847.52 under review. Sarah Johnson handling."	`get_subro_demand_status`
6️⃣ Rush
10	"We need this expedited"	"Third call detected. Other criteria?"	`evaluate_rush_criteria`
11	"Deadline in 30 days"	"Two criteria met. Flagged for rush."	—

Validated

[x] B2B auth via company code
[x] Discrete handoff (no greeting)
[x] All 6 inquiry steps pass
[x] Rush auto-detects call history
[x] Rush requires 2+ criteria

Script 2: Policyholder Claim Status¶

Customer checking on existing claim

Full Conversation

#	Caller (John)	Agent	Tool
1	"Check on my claim"	"Policy number?"	—
2	"POL-AUTO-789012"	"Name and SSN4?"	—
3	"John Smith, 1234"	"Verified. Your Oct 15 claim?"	`verify_client_identity`
4	"What's the status?"	"Under investigation. Mike Johnson handling."	`get_claim_status`
5	"When do I get paid?"	"3 business days after completion. $500 deductible applies."	`get_payment_status`

Validated

[x] Policy + name + SSN4 auth
[x] Claim status retrieval
[x] Payment timeline explained

Script 3: First Notice of Loss (FNOL)¶

Filing a new claim after accident

Full Conversation

#	Caller (Maria)	Agent	Tool
1	"I was in an accident"	"Are you okay? Let me help file a claim."	—
2	[Provides policy + verification]	—	`verify_client_identity`
3	—	(FNOLAgent) "Tell me what happened"	→ announced
4	"Rear-ended at stoplight"	"When?"	—
5	"An hour ago"	"Where?"	—
6	"Main & 5th"	"Injuries?"	—
7	"No, just vehicle damage"	"Creating claim..."	`file_new_claim`
8	—	"Claim CLM-2024-NEW123. Adjuster calls within 24h."	—

Validated

[x] Empathetic response
[x] Announced handoff to FNOLAgent
[x] Loss details collected
[x] Immediate claim number

B2B Subrogation: 6-Step Flow¶

1️⃣ Coverage → 2️⃣ Liability → 3️⃣ Limits → 4️⃣ Payments → 5️⃣ Demand → 6️⃣ Rush

Step	Question	Tool	Returns
1️⃣	"Coverage confirmed?"	`get_coverage_status`	Confirmed / Denied / CVQ
2️⃣	"Liability decision?"	`get_liability_decision`	% + basis
3️⃣	"PD limits?"	`get_pd_policy_limits`	Limits + demand comparison
4️⃣	"Payments made?"	`get_subro_payments`	List with dates/amounts
5️⃣	"Demand status?"	`get_subro_demand_status`	Status + handler
6️⃣	"Rush eligible?"	`evaluate_rush_criteria`	Requires 2+ criteria

Rush Criteria (need 2+)¶

Criterion	Check
Third+ call	⚡ Auto-detected
Deadline < 60 days	Caller provides
Litigation pending	Caller provides
Prior demands ignored	Caller provides

Test Scenarios¶

`test_scenario`	Claim	What It Tests
`golden_path`	CLM-2024-1234	Full B2B workflow
`demand_paid`	CLM-2024-005678	Already paid
`coverage_denied`	CLM-2024-003456	Policy lapsed
`liability_denied`	CLM-2024-002468	Fault rejected
`demand_exceeds_limits`	CLM-2024-024680	$85k vs $25k limit

Configuration¶

registries/scenariostore/insurance/orchestration.yaml

name: insurance
start_agent: AuthAgent

agents:
  - AuthAgent
  - PolicyAdvisor
  - FNOLAgent
  - SubroAgent

handoffs:
  # B2C: Announced (new specialist greets)
  - from: AuthAgent
    to: PolicyAdvisor
    tool: handoff_policy_advisor
    type: announced

  - from: AuthAgent
    to: FNOLAgent
    tool: handoff_fnol_agent
    type: announced

  # B2B: Discrete (seamless for professionals)
  - from: AuthAgent
    to: SubroAgent
    tool: handoff_subro_agent
    type: discrete

  # Cross-specialist
  - from: PolicyAdvisor
    to: FNOLAgent
    tool: handoff_fnol_agent
    type: announced

  - from: FNOLAgent
    to: PolicyAdvisor
    tool: handoff_policy_advisor
    type: announced