Regulators covered
Which frameworks the insurance pack maps to today.
Adapter coverage
Upstream services Vortalis adapts for this vertical.
No Vortalis-side adapters ship for this vertical today. The calling system holds the upstream credentials (claims administration system, banking-payment service, customer communication channel, loss-adjuster portal) and Vortalis governs the action at the agent boundary.
Action vocabulary
The policy template for this vertical.
Actions allowed
13
Each action gated by policy at the hot path.
Anticipated require_human actions
- claim.denied
- payment.authorised
- customer.appeal_outcome
Rate-limit posture
2 000 claim.intaken per 1-hour rolling window; 2 000 claim.validity_checked per 1-hour rolling window; 1 000 payment.authorised per 1-hour rolling window; 500 claim.denied per 1-hour rolling window; 200 customer.appeal_outcome per 1-hour rolling window; 100 siu.referred per 1-hour rolling window. Defensible for a single-line-of-business engagement; multi-line insurers raise after agreement with the head of claims.
Template path: policies/sectors/insurance/claims-processing-template.yaml
Integration brief
The implementation guide your engineers read first.
Available
docs/governance/integration-briefs/insurance-claims-processing.md
Honest limits
What this sector pack does not do.
Vortalis does not pay claims; AI agents do.
The policy template gates 13 actions including payment.authorised, claim.denied, and customer.appeal_outcome. It does not move money, draft the final customer notice, or substitute for the senior handler's judgement. Payment integrity, customer fair-treatment, and the insurer's regulatory obligations remain the operator's responsibility. Vortalis records what the agent did and when; it does not authorise the funds.
FCA ICOBS conduct rules on claims handling are operator-side; the platform records the agent action and the human approval.
The FCA Insurance Conduct of Business Sourcebook (ICOBS) sets conduct expectations on UK-authorised insurers handling claims. The Vortalis chain records the agent's actions and the human approval timestamp; the conduct conclusion (whether the claim was handled fairly, in line with ICOBS) is the operator's. The FCA SM&CR pack binds the senior manager responsible on the chain.
Payment-system counterparty certification is the operator's responsibility.
The Vortalis chain captures the payment authorisation; the actual money movement happens on the operator's banking or payment-instruction service. Certification with the operator's payment counterparty (the bank's API, the insurer's payment service) sits with the operator; Vortalis records the authorisation, the bank moves the funds.
NAIC Insurance Data Security incident-notice obligations under Sections 5 and 6 are operator-side.
NAIC Model Law #668 Section 5 (investigation) and Section 6 (notice within 72 hours) bind the operator. The Vortalis chain supplies the contemporaneous record an investigation reads; the runbook for investigation, the determination of whether the event meets the notice criteria, and the channel to the state insurance commissioner are operator-side. State-level adoption of Model Law #668 varies.
The general-purpose honest limits sit at /security/limitations; this list is specific to the insurance pack.
Bring Vortalis to your insurance agents.
Read the integration brief if you would rather start with the engineering detail. Talk to us first if you would rather start with a conversation about your threat model.