The Problem
A major weather event hits and hundreds of first-notice-of-loss (FNOL) claims arrive over a weekend. Your adjusters can only handle so many a day. Without triage, a $450,000 total-loss claim with a displaced family sits in the same queue as an $800 windshield claim. The cost is not just inefficiency — slow handling of severe claims is a regulatory and reputational risk.
Why a Black-Box LLM Fails Here
Asking an LLM "how urgent is this claim?" gives you a number with no basis. You cannot defend "priority 0.78" to a regulator reviewing whether you handled a severe claim promptly, and you cannot reproduce the triage decision. Insurance claims handling is regulated; the decision basis has to be inspectable.
The Governed Architecture
- The LLM reads. It extracts structured fields from the FNOL report — damage type, estimated severity, whether the policyholder is displaced, property type. It never sets the priority.
- A DMN policy table decides. Your triage policy as a deterministic table: severity thresholds, displacement flags, and property type map to a priority tier, an adjuster level, and benefit triggers.
- BPMN routes. Priority-1 claims go to a senior adjuster within the SLA window; benefits like Additional Living Expense (ALE) are triggered automatically when the rule says so.
Try It Live
Go to archiet.com/agents and open the FNOL Triage agent. Type:
Policyholder James Okafor, policy #HO-882341. Reporting flood damage to
primary residence. Basement and ground floor affected. Preliminary estimate
$85,000. Policyholder is displaced and staying in a hotel.Click Run governed agent:
1. The LLM extracts (shown read-only):
{
"policy_number": "HO-882341",
"peril": "flood",
"property_type": "primary_residence",
"estimated_loss": 85000,
"displaced": true
}2. The DMN policy table evaluates and fires: estimated loss > $50,000 AND displaced AND primary residence → Priority 1, assign senior adjuster within 4 hours, trigger ALE benefits. Rule FNOL-RULE-P1.
3. BPMN routes to the senior-adjuster queue with a 4-hour SLA and opens the ALE workflow.
4. The audit trail records the firing rule, the conditions met, the extracted JSON, and the timestamp — proof the severe claim was triaged correctly and promptly.
The Regulatory Angle: Timely Claims Handling
Most jurisdictions impose claims-handling timeliness requirements — acknowledging the claim and beginning the investigation within a set window. When triage is a deterministic DMN table with a logged decision and an SLA attached to each priority tier, you have a defensible, inspectable record that severe claims were identified and routed promptly. If an examiner asks why a claim was handled the way it was, you point to the rule and the timestamp, not to an adjuster's recollection.
Generate This for Your Own System
Describe a claims-intake or FNOL workflow in Archiet's Blueprint Wizard and the governed triage agent is generated with your severity thresholds, your priority tiers, and your SLA windows extracted from your PRD. The decision engine, policy model, endpoints, and UI come wired and auditable.
The same governed pattern powers invoice approval, loan adjudication, prior authorisation, refund/retention, and KYC/AML in the gallery.