AI Insurance Claim Assessment

osop_version: "1.0"
id: "ai-claim-assessment"
name: "AI Insurance Claim Assessment"
description: "AI assesses damage from photos and checks coverage; adjuster makes final decision."

nodes:
  - id: "submit_claim"
    type: "human"
    subtype: "input"
    name: "Submit Claim"
    description: "Policyholder uploads claim form, photos, and incident description."

  - id: "ai_damage"
    type: "agent"
    subtype: "llm"
    name: "AI Damage Assessment"
    description: "Analyze photos to estimate damage type, severity, and repair cost."
    security:
      risk_level: "medium"

  - id: "coverage_check"
    type: "system"
    name: "Coverage Verification"
    description: "Match claim against policy terms, deductibles, and exclusions."

  - id: "adjuster_review"
    type: "human"
    subtype: "review"
    name: "Adjuster Review"
    description: "Claims adjuster reviews AI assessment and coverage determination."
    security:
      approval_gate: true

  - id: "settle"
    type: "api"
    subtype: "rest"
    name: "Process Settlement"
    description: "Issue payment or denial letter to policyholder."

edges:
  - from: "submit_claim"
    to: "ai_damage"
    mode: "sequential"
  - from: "ai_damage"
    to: "coverage_check"
    mode: "sequential"
  - from: "coverage_check"
    to: "adjuster_review"
    mode: "sequential"
  - from: "adjuster_review"
    to: "settle"
    mode: "sequential"
  - from: "adjuster_review"
    to: "ai_damage"
    mode: "fallback"
    label: "Request additional photo analysis"