KYE Sector Pack Foundry · insurance claims

Agentic Governance with Authority Finality for insurance claims.

Every AI-assisted claims decision — a triage outcome, a fraud flag, a coverage decision, a settlement recommendation, a rejection — mapped to a named claims handler, bound to the obligation it discharges, and signed into an Evidence Pack at the moment it happens. The Claims Authority Pack is the KYE Sector Pack Foundry productisation that lands Agentic Governance — every act has authority, every authority has finality — inside FCA Consumer Duty, EU AI Act, UK GDPR, and DORA-regulated insurers.

FCA Consumer Duty, EU AI Act, UK GDPR, DORA — the claims perimeter.

General insurers, life and health insurers, claims TPAs, and insurtech claims platforms running AI agents across the claims lifecycle are inside a named-accountability perimeter — fair-outcome accountability for every coverage and settlement decision, human review of AI-driven adverse actions, and minimised, purpose-scoped handling of claimant personal data. AI-assisted claims operations create disputes if the insurer cannot prove authority, evidence, human review, and contestability.

Better evidence than reconstructed logs — signed at the moment, derivable from public keys alone.

The dominant evidence today is after-the-fact reconstruction. A KYE Protocol Evidence Pack plus Authority Finality outcome bound to the named handler, the policy version, the AI influence state, and the delegation chain is materially better evidence: signed at the moment of the decision and Replay-Proof against the published JWKS a regulator, ombudsman, or court can verify offline. KYE governs the authority around the model — not the claim outcome itself.

An 8-step pipeline — from AI claims decision to settled record.

The Pack rides the canonical productisation shape: rule pack, dictionary, sector pack, obligation manifest, expert-pack envelope, coverage attestation, SKU row, and this marketing surface. No Foundry-specific framework shape; the protocol substrate underneath is identical to every other Pack.

Bound to the canonical insurance claims perimeter.

  • FCA Consumer Duty (fair-outcome accountability + fair treatment)
  • EU AI Act (human oversight of high-risk AI, Article 14)
  • UK GDPR (data minimisation and purpose limitation)
  • DORA (operational resilience and evidence)

Regulators of record: FCA / EU AI Office / ICO.