STP Fast-Track Auto Claims — Playbook
Audience: Insurers, TPAs, brokers, garages. Playbook Type: Sourcing + Solve + Optimize loop Status: Soft (practice) — not yet LIVE Source: D-09 — Optimization Capability (developer) §1.1 (procurement.basket_split@1), Claims Plane — Processing Claims, Guarded Transitions, and Declarative Packs §4 (motor claims pack)
1. Use & Purpose
Straight-through processing (STP) for small auto claims — fast-track claims that can be settled with minimal human intervention. The playbook takes a motor claim from first notice of loss to settlement, using solver-assisted garage selection and escrow-backed payment, with a named human approver confirming before any money moves.
Optimizers propose, claim gates authorize, never settle or pay. The solver-gateway recommends the garage and estimate; a human adjuster approves; PoCE seals the receipt.
2. Who Uses It
| Player | Role |
|---|---|
| Policyholder | Reports loss via broker or direct intake |
| Broker | First notice of loss (FNOL) intake |
| Adjuster | Loss assessment, approval |
| Garage | Repair execution, evidence upload |
| Insurer | Risk bearer, settlement payer |
| Reinsurer | Notice for high-value claims |
3. Flow
| Step | Actor | Action | Gate |
|---|---|---|---|
| 1 | Broker | FNOL intake: policy, vehicle, loss type, location, photos | Identity attestation required at FNOL |
| 2 | System | Claim created: cns://claim/type/insurance/motor_claim, PoCE session started | Required fields validated; 400 if missing |
| 3 | Adjuster | Assigned via panel eligibility (two-person quorum for amounts > $500) | SOD: adjuster ≠ garage |
| 4 | Solver | procurement.basket_split@1 recommends garage + estimate branch_and_bound 1.4.0 | Fail closed: solver down → 503, no synthetic OPTIMAL |
| 5 | Human adjuster | Approves garage + estimate | Named human confirms; never auto-approves |
| 6 | Garage | Performs repair, uploads completion photo + parts invoice | Evidence required: photo, arrival point, sign-off |
| 7 | Inspector | Verifies repair quality, signs off | SOD: inspector ≠ garage |
| 8 | Finance | Escrow releases to garage against verified proof | fn::escrow::disburse against inspector sign-off |
| 9 | System | Claim finalized with PoCE receipt | All transitions recorded; receipt sealed |
4. Guard Rails
- Identity attestation required at first notice of loss for motor claims.
- Two-person quorum for claim amounts above $500.
- Solver verdicts are gates, not approvals. The solver may recommend but never settles.
- Evidence required: photos, authority report, garage estimate, inspector sign-off.
- No match means no assignment. If no qualified garage is available,
fill_infeasibleverdict — no fake match. - External verdicts honoured. A negative verdict blocks settlement.
- Escrow releases only against verified proof. No cash handling — payment via escrow disbursement.
5. Evidence & Rollout
| Element | Detail |
|---|---|
| Version | 1.0.0 (Soft) |
| Source pack | Motor claims (Kenya) — cns://claim/type/insurance/motor_claim |
| CNS types | cns://claim/type/insurance/motor_claim, cns://resource/vehicle |
| Lookup values | Guard policies, quorum bands, SLA windows, panel roles, intake maps (NATS KV) |
| PoCE integration | fn::lifecycle::start_poce_session → record_poce_step → finalize_poce_session |
| Solver capability | procurement.basket_split@1, engine branch_and_bound 1.4.0 |
| Escrow | fn::escrow::hold / fn::escrow::disburse / fn::escrow::rollback |
| Rollout path | Soft → pilot in single ward/region → LIVE gate (all readiness probes pass) |
| Low-resource behavior | FNOL via WhatsApp/USSD/walk-in; garage works from issued list; verification via supervisor tap or SMS code |
Soft ≠ LIVE honesty: Nothing sets live_gate_met without REAL probe results. Env flags alone never count.
6. What We Do Not Build
- No synthetic settlement. The solver never settles or pays; a named human approver confirms via PoCE.
- No fake garage matches. Unqualified providers are never shortlisted.
- No synthetic "OPTIMAL" verdict. Solver down → 503 fail closed.
- No fake metrics (e.g., "99% auto-settlement rate"). Live data or honest empty states.