Insurer / Carrier — Claims Player

Audience: Insurance carriers, reinsurers, underwriters. Role: Risk bearer, policy issuer, settlement payer, panel organisation. Substrate: truth_node:organization, integration_entity (reinsurer mirror), APF roles, PoCE sessions.

1. Role in Claims Processing

The insurer is the risk bearer and policy system of record. It issues policies, collects premiums, assesses claims, and authorizes settlement payments. The insurer does not build a separate claims system — it configures the existing Sovereign OS claims engine with insurance-specific CNS types, lookup values, and panel roles.

Function	Canonical Primitive	Example
Policy issuance	`claim` (CNS: `cns://claim/type/insurance/policy`)	Policy number, coverage, premium, insured
First notice of loss	`claim` (CNS: `cns://claim/type/insurance/motor_claim`)	Loss date, location, description
Adjuster assignment	`truth_edge` (adjuster→claim)	Assignment timestamp, quorum role
Settlement	`claim` (state: `settled`) + `fn::escrow::disburse`	Payment reference, amount, reinsurer notice
Reinsurance	`integration_entity` (system: "reinsurer")	Treaty reference, cession percentage

2. Capabilities & Attestations

Capability	Required For	Attestation Source
`recognised_intake`	Broker FNOL	Broker organisation approval
`adjustment`	Adjuster role	Adjuster licensing + training
`loss_assessment`	Adjuster role	Certification + calibration
`reinsurance`	Reinsurer role	Reinsurance treaty + financial rating
`evidence_review`	Reinsurer role	Claims audit certification

All capabilities require: approved affiliation + active status + attestation. Lease TTLs: one hour for operational roles (adjuster, garage), eight hours for governance roles (reinsurer, board).

3. Panel Eligibility — Insurer

Insurers serve as the panel organisation role for insurance claim types. The declarative panel values add eligibility rules per role and claim type:

Motor claims: Broker (intake) + Adjuster (assessment) + Garage (repair) + Reinsurer (notice) — all four roles
Home claims: Adjuster + Garage/Contractor + Reinsurer — three roles
Medical claims: Adjuster + Reinsurer — two roles
Government/community lines: No panel mesh — agency mesh instead

The resolver returns eligible versus ineligible-with-reasons with zero writes and the live gate unmet. A candidate missing affiliation, capability, or attestation is reported ineligible with the explicit reason.

4. Guard Boundaries — Insurer

Boundary	Enforcement
No auto-settlement	Solver recommendations never settle; named human approver confirms via PoCE
No synthetic "OPTIMAL" verdict	Solver down → 502/503 fail closed
No PHI in match facets (medical)	Scrubbed before match; hash reference only
No fake metrics	Dashboard renders live data or honest empty states
PoCE receipt required	Every settlement has a cryptographically verifiable receipt

5. Worked Example — Insurer Motor Claim

Policy issued — claim record with cns://claim/type/insurance/policy, bound to vehicle and policyholder.
FNOL reported — broker files claim via intake, cns://claim/type/insurance/motor_claim, identity attestation required.
Adjuster assigned — panel eligibility check (two-person quorum for standard amounts).
Loss assessed — adjuster inspects, gets garage estimate, records findings.
Garage assigned — sourcing bus qualifies nearest certified garage, quote approved.
Repair completed — garage performs work, uploads evidence.
Settlement authorized — named human approver confirms via PoCE, escrow releases to garage.
Reinsurer notified — if amount exceeds retention, reinsurer notice sent via integration_entity.

Guard check: Adjuster ≠ Garage. No payment without verified repair proof. PoCE receipt sealed at every transition.

6. What We Do Not Build

No insurer-specific tables. Policy, claim, and settlement data all map to canonical claim / truth_node / integration_entity.
No pricing engine. Premium calculation is external; Sovereign OS mirrors premium references.
No synthetic risk scoring. Unless expressible as solver-gateway capability + declarative lookups.