Cookbook: insurance

Gate claim payouts on adjuster approval, an in-force policy, and a verified payee, with escalation above a threshold.

A claims agent walks policyholders through filing, checks status, and can trigger a payout once a claim is approved. Moving money against a claim is the consequential action: it requires an adjuster’s approval on file, a policy that is in force, and a verified payee. Large payouts always go to a human.

This cookbook shows a latch with all four verdicts in play: ALLOW with a permit, BLOCK on missing prerequisites, ESCALATE above a threshold, and WARN at the text stages.

The scenario

• Agent claims-ai with tools claim_status, update_claim, pay_claim.
• The consequential action is pay_claim. Status checks and documentation updates never engage the payout latch.
• The runtime passes the claim’s state (approval, policy status, payee verification, amount) as args, so the PDP decides on the full context. See what crosses to the PDP.

The policy in prose

A claim payout may be executed only when a licensed adjuster has approved the claim, the policy is in force as of the loss date, and the payee account has been verified. Payouts above $25,000 require human sign-off regardless of approval state. A payout missing any prerequisite is blocked.

Crafted into a policy pack

{
  "id": "insurance-0",
  "name": "Claims Payout Authorization",
  "family": "insurance",
  "blurb": "Approval, coverage, and payee checks in front of claim payouts.",
  "tags": ["claims", "payouts", "action"],
  "checks": [
    "Adjuster approval on file",
    "Policy in force at loss date",
    "Payee account verified",
    "Amount within agent payout threshold"
  ],
  "verdicts": [
    { "verdict": "ALLOW", "when": "approved, in force, payee verified, amount within threshold" },
    { "verdict": "ESCALATE", "when": "amount exceeds threshold" },
    { "verdict": "BLOCK", "when": "approval, coverage, or payee verification missing" }
  ],
  "requirements": ["State unfair claims practices acts", "Carrier claims-handling guidelines"]
}

akhara policies attach claims-ai insurance-0 reliability-3

Authorize a payout

An approved, in-force, verified claim under the threshold:

curl -s https://api.akhara.dev/api/policy/authorize \
  -H "authorization: Bearer $AKHARA_API_KEY" \
  -H 'content-type: application/json' \
  -d '{
    "agentId": "claims-ai",
    "session": "sess_demo",
    "stage": "action",
    "tool": "pay_claim",
    "args": {
      "claimId": "clm_5108",
      "amount": 4820.00,
      "adjuster_approved": true,
      "policy_in_force": true,
      "payee_verified": true
    }
  }' | jq

{
  "verdict": "ALLOW",
  "stage": "action",
  "policyId": "insurance-0",
  "rule": "Claims Payout Authorization",
  "reason": "Adjuster approval, coverage, payee verification confirmed; amount within threshold",
  "tool": "pay_claim",
  "permitId": "permit_6b02f9a7",
  "attachedPolicyIds": ["latch-0", "latch-5", "insurance-0", "reliability-3"]
}

The payout service requires the one-time permitId, so nothing pays out on a code path that skipped authorization.

Escalate above the threshold

The same claim at $48,200 crosses the threshold. Approval state does not matter; the latch routes it to a human:

{
  "verdict": "ESCALATE",
  "stage": "action",
  "policyId": "insurance-0",
  "rule": "Claims Payout Authorization",
  "reason": "Amount exceeds agent payout threshold; human sign-off required",
  "tool": "pay_claim",
  "permitId": null,
  "attachedPolicyIds": ["latch-0", "latch-5", "insurance-0", "reliability-3"]
}

Your runtime holds the payout pending a reviewer; nothing executes while the decision is ESCALATE. A missing prerequisite, for example payee_verified: false, returns BLOCK instead.

What the latch does at runtime

During filing and status conversations, insurance-0 is dormant. It engages only on pay_claim, evaluates the claim state the runtime passed, and every outcome, including the escalations a regulator will ask about, lands in the evidence feed as a signed, joinable record tied to the session’s trajectory. See Audit and evidence.