Broker / Agent — Claims Player
Audience: Insurance brokers, agents, managing general agents (MGAs). Role: First notice of loss intake, distribution, policy placement. Substrate: truth_node:person (broker), truth_edge (broker→claim), APF intake role, PoCE sessions.
1. Role in Claims Processing
The broker is the first point of contact for claimants. Brokers handle first notice of loss (FNOL), policy placement, and distribution of claims to insurers. The broker does not adjudicate or settle — it collects and routes claims to the appropriate insurer or TPA.
| Function | Canonical Primitive | Example |
|---|---|---|
| First notice of loss | claim (CNS: cns://claim/type/insurance/motor_claim) | Loss date, location, description, photos |
| Policy placement | claim (CNS: cns://claim/type/insurance/policy) | Policy number, coverage, insurer |
| Claim routing | truth_edge (broker→claim) | Routing timestamp, target insurer |
| Distribution | integration_entity (insurer mirror) | Insurer system reference |
2. Capabilities & Attestations
| Capability | Required For | Attestation Source |
|---|---|---|
recognised_intake | Broker FNOL intake | Broker licence + errors & omissions insurance |
distribution | Broker claim routing | Broker of record appointment |
policy_placement | Broker policy issuance | Insurance licence |
All capabilities require: approved affiliation + active status + attestation. Lease TTLs: one hour for operational roles.
3. Panel Eligibility — Broker
Brokers serve as the intake role in the insurance provider panel. The declarative panel values define broker eligibility per claim type:
- Motor claims: Broker (intake) — recognised intake capability required
- Home claims: Broker (intake) — recognised intake capability required
- Medical claims: Broker role not used — medical claims use adjuster + reinsurer only
- Government/community lines: No broker role — agency mesh instead
The resolver returns eligible versus ineligible-with-reasons. A broker without recognised intake capability is ineligible for FNOL.
4. Guard Boundaries — Broker
| Boundary | Enforcement |
|---|---|
| No adjudication | Broker collects and routes only; never approves or denies |
| No settlement | Broker never touches payment; escrow controlled by insurer/finance |
| No synthetic FNOL | Missing required fields refused with 400 validation error |
| No fake metrics | Broker dashboard renders live data or honest empty states |
| Identity attestation at FNOL | Required for motor claims; optional for community tickets |
5. Worked Example — Broker Motor FNOL
- Policyholder contacts broker — vehicle accident, damage photos, location.
- Broker collects FNOL — intake map: policy_id, vehicle_id, loss_type, loss_date, location, photos, police_ref.
- Claim created:
cns://claim/type/insurance/motor_claim, bound toresource:vehicle, identity attestation required, PoCE session started. - Broker routes claim —
truth_edgefrom broker to claim, target insurer identified viaintegration_entity. - Insurer receives claim via record federation (
s184_record_federation), assigns adjuster. - Broker receives confirmation — claim status:
submitted, PoCE session ID provided. - Broker follows up — reads claim timeline via
GET /v1/claims/processing/:claimId, updates policyholder.
Guard check: Identity attestation required at FNOL for motor claims. Missing required fields refused with 400. Broker never approves or denies.
6. What We Do Not Build
- No broker-specific tables. All broker claim data maps to canonical
claim/truth_edge/integration_entity. - No adjuster function. Broker does not assess loss — that's the adjuster's role.
- No settlement function. Broker never releases payment — that's the insurer/finance role.