Industry Vocabulary Reference

Insurance: P&C, Life & Annuity

Comprehensive enumeration library for the Insurance vertical — Property & Casualty, Life & Annuity, Health, and Specialty/Reinsurance. Covers every subdomain where agentic AI is actively deployed as of March 2026: policy lifecycle, underwriting, rating and pricing, claims intake and adjudication, fraud detection, subrogation, loss mitigation, reinsurance, and regulatory reporting. Designed for use as OTel span attributes in an agentic AI SDK and as policy vocabulary in an OPA Rego GRC portal.

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How to use this reference

1. Start with the core file if you need the cross-industry governance baseline.
2. Then move into the vertical file to see the regulated workflow vocabulary, policy surfaces, and implementation pressure unique to this market.
3. Use the OTel attributes and policy paths here as the common language across SDK instrumentation, governance review, and evidence export.

March 2026 deployment context

As of March 2026, agentic AI in insurance is deployed across: first notice of loss (FNOL) intake and triage, automated claims severity assessment, straight-through claims processing (STP) for low-complexity claims, AI-assisted underwriting decisioning, telematics-driven auto rating, predictive model governance and bias testing (NAIC Model Bulletin, Colorado Reg 10-1-1), prior authorisation adjudication (health), fraud ring detection, subrogation opportunity identification, reinsurance placement data preparation (ACORD GRLC Gen 2.0), and ORSA narrative generation. The NAIC Model Bulletin now operates as de facto national standard, enforced via state market conduct examinations.

Risk note: 92% of health insurers, 88% of auto insurers, and 70% of home insurers report current or planned AI use (NAIC 2025 survey). The NAIC Model Bulletin requires insurers to maintain an AIS (AI System) Program covering governance, consumer notice, risk management, internal controls, and vendor management for every AI system that makes or supports regulated insurance decisions. Colorado Regulation 10-1-1 extends mandatory bias testing and annual compliance reporting to life, auto, and health lines (effective Oct 15, 2025). The UnitedHealth/NaviHealth nH Predict and Cigna PxDx class-action cases demonstrate that autonomous AI claims denial without physician review creates direct litigation exposure.

Loading Model

• Mirrored file: 03_vertical_insurance_pc_life_annuity.json
• Kind: vertical

OTel Namespaces

Primary Standards

• ACORD 2.0 — P&C XML and AL3 Standards
• ACORD Life & Annuity XML (OLI/TXLife)
• ACORD GRLC Generation 2.0 — Global Reinsurance & Large Commercial (April 2025)
• ACORD Next-Generation Digital Standards — JSON-based microservices API standard
• NAIC Model Bulletin: Use of Artificial Intelligence Systems by Insurers (December 2023; 24 states adopted as of March 2025)
• NAIC Model Act #880 — Unfair Trade Practices Act
• NAIC Model Act #900 — Unfair Claims Settlement Practices Act
• Colorado SB21-169 / Regulation 10-1-1 — Governance and Risk Management for ECDIS use (effective Oct 15, 2025; expanded to auto and health)
• New York DFS Insurance Circular Letter No. 7 (July 2024) — AI transparency expectations
• California Insurance Code §10123.135 — Prohibition on solely automated health care decisions
• HL7 FHIR v6.0 — ClaimResponse and ExplanationOfBenefit resources (health insurance claims)
• CMS Interoperability and Prior Authorization Final Rule (2024) — 72-hour expedited / 7-day standard PA timelines
• NAIC Own Risk and Solvency Assessment (ORSA) Model Act #505
• Lloyd's Blueprint Two Core Data Record (CDR) — built on ACORD standards
• EU Solvency II Directive — Pillar 2 model governance and internal model validation

Source URLs

• https://www.acord.org/standards-architecture/acord-data-standards
• https://acord.org/ACORD-about/acord-news/2025/04/10/acord-launches-grlc-generation-2.0-data-standards
• https://content.naic.org/sites/default/files/inline-files/2023-12-4%20Model%20Bulletin_Adopted_0.pdf
• https://doi.colorado.gov/for-consumers/sb21-169-protecting-consumers-from-unfair-discrimination-in-insurance-practices
• https://www.dfs.ny.gov/industry_guidance/circular_letters/cl2024_07
• https://build.fhir.org/claimresponse.html

Subdomains

Implementation examples

• Underwriting, Rating & Pricing: Rating Factor Category. OPA rule: deny any rating action where factor_category is prohibited_characteristic_proxy or social_media_derived until Colorado Reg 10-1-1 bias test has been completed and approved. (Colorado Sb21 169: ECDIS factors require bias testing for proxy discrimination)
• Underwriting, Rating & Pricing: ECDISBias Test Outcome. OPA rule: block production deployment of any underwriting model where ecdis_bias_test_outcome is testing_not_yet_performed, material_disparity_corrective_action_pending, or model_suspended_pending_remediation. (Colorado Reg 10 1 1: Annual compliance report due Dec 1 (life); July 1, 2026 (auto and health); bias test outcomes must be documented)
• Underwriting, Rating & Pricing: Insurance AIModel Inventory Status. OPA rule: deny any agentic underwriting or claims decision where the dependent model status is not_in_inventory_shadow_model or third_party_vendor_model_pending_assessment. (Naic Model Bulletin: AIS Program must maintain inventory of all AI systems used in regulated decisions)
• Claims Intake, Triage & FNOL: Claim Severity Tier. OPA rule: route all tier_7 and above claims to human adjuster — block STP. Require HITL with senior_adjuster role for tier_8 and above. Require claims_compliance_officer for tier_10.

Illustrative policy patterns

package insurance.claims

clinician_required_outcomes := {
  "denied_medical_necessity",
  "denied_not_medically_necessary_ai",
  "denied_experimental_treatment",
  "denied_pre_existing_condition"
}

deny[msg] {
  input.insurance_claim_adjudication_outcome in clinician_required_outcomes
  input.gen_ai_agent_autonomy_level in {"supervised_autonomous", "fully_autonomous"}
  input.insurance_hitl_reviewer_role != "licensed_clinician"
  msg := "California Health Code §1367.01 / NAIC #900 violation: Medical necessity denial requires documented licensed clinician review — autonomous AI-only denial is prohibited"

package insurance.underwriting

lines_requiring_co_bias_test := {
  "term_life",
  "whole_life",
  "universal_life",
  "personal_auto",
  "health_individual",
  "health_group",
  "medicare_advantage"
}

blocking_bias_statuses := {
  "testing_not_yet_performed",

From enum to evidence

The same vocabulary should carry from instrumentation through review. The OTel attribute names here become emitted metadata, those attributes become policy inputs, and those same labels should still be intelligible when a reviewer opens the decision record later.

import { VeriproofClient, VeriproofSdkOptions, SessionMetadata } from '@veriproof/sdk-core';
import { PolicyLifecycleStatus, PolicyLifecycleStatusMeta, PolicyTransactionType, PolicyTransactionTypeMeta, InsuranceLineOfBusiness, InsuranceLineOfBusinessMeta } from '@veriproof/sdk-core/verticals/insurance-pc-life-annuity';

const client = new VeriproofClient(
  VeriproofSdkOptions.createProduction({
    apiKey: process.env.VERIPROOF_API_KEY!,
    applicationId: 'insurance-pc-life-annuity-production',
  }),
);

const session = client
  .startSession('insurance-pc-life-annuity.review')
  .withSessionMetadata(SessionMetadata.forTransaction('txn-1001').withEnvironment('production'))
  .addStep('evaluate_workflow', { output: { status: 'completed' } })
  .withMetadata(PolicyLifecycleStatusMeta.otelAttribute, PolicyLifecycleStatus.application_received)
  .withMetadata(PolicyTransactionTypeMeta.otelAttribute, PolicyTransactionType.new_business)
  .withMetadata(InsuranceLineOfBusinessMeta.otelAttribute, InsuranceLineOfBusiness.personal_auto)

await session.complete();

• SDK: emit the OTel attribute shown on this page during the decision workflow.
• Policy: reference the matching `opa_policy_path` in governance rules.
• Evidence: surface the same label and value in the portal and exported record so reviewers are not translating between systems.

For a step-by-step getting-started walkthrough specific to this vertical, open the Insurance: P&C, Life & Annuity SDK quick start. For the full core API reference, continue with TypeScript, Python, or .NET.

Highlighted Enum Categories

This reference page is rendered from the mirrored JSON file inside the docs app, not from a hand-written website model.

If you need the machine-readable asset for offline review, automation, or internal diffing, use the mirrored JSON download above.

Next: open the corresponding SDK reference under SDK documentation and then compare it with the public-site industry page to see how the same vocabulary is framed commercially.