An example of insurance claims and underwriting as a governed process: agents do the 8 steps, and a person signs the gate before anything irreversible happens. Download it, import it into your workspace, and adapt it to your systems.
minctrl.process/v1 · hash bd08c35c35d5…23ee
Claims adjudication and underwriting are document-heavy and slow, and a wrong coverage call carries bad-faith and regulatory liability across 50 state codes. Routine claims and risks are processed straight-through with the rule basis attached; ambiguous and high-value decisions reach a licensed adjuster/underwriter, who signs the call.
Denying or materially reducing a claim can be an unfair-claims-practice and bad-faith exposure if it's wrong, so an adjuster signs off denials and large payouts before they're issued.
| Rule | What it requires |
|---|---|
| Unfair Claims Settlement Practices (state / NAIC model) | Insurers must investigate and decide claims promptly and in good faith; unreasonable denial or delay is an unfair claims practice under state law. |
| Adverse-decision explanation & appeal rights | A denied or reduced claim generally requires a clear reason and the policyholder's appeal/complaint rights, so the deciding rationale must be recorded. |
| Anti-discrimination / rating rules | Underwriting and pricing must follow filed rating rules and may not use prohibited or unfairly discriminatory factors. |
A summary for orientation, not legal advice.
A minctrl.process/v1 document: the graph and the hash of the process it becomes.
Import into Minctrl opens this example in your workspace; one click stores it as your first version. Import JSON does the same with the file, and a file changed after download is refused.
Every connector starts in shadow: steps run, nothing leaves Minctrl until you configure a connector and switch it live.
Change signers, time limits and steps on the canvas. Each save is a new version; a running case stays on the version it started with.
The example models prompt, good-faith handling: timeliness is tracked, the rationale for every decision is recorded, and denials and material reductions carry a clear reason and the policyholder's appeal rights, logged with a tamper-evident audit hash. The rules differ by state, and meeting them depends on your own claims procedures and legal review. Minctrl holds no certification, and this is not legal advice.
No. The AI agent validates coverage, gathers evidence and recommends a decision, but denials and large payouts park at an adjuster sign-off gate. A wrong denial is unfair-claims-practice and bad-faith exposure, so a human owns those decisions.
Underwriting and pricing follow the filed rating rules, and the factors used in each decision are recorded. Because runs are deterministic and replayable, a market-conduct exam can reconstruct exactly how a risk was rated or a claim was decided.