AI FNOL intake and claim triage

The agent may collect first notice of loss, classify claim type and complexity from cited FNOL answers, and propose a route: the STP path or an adjuster. It may not decide coverage. It may not issue or trigger payment. If the proposed route cannot cite both the FNOL answers used and the complexity rule those answers satisfy, the claim stays off STP.

Treat the agent as a structured interviewer with a routing recommendation, not as the claims system of record. Coverage, reserves, and payment stay with an adjuster, or with a later payment control that this page does not grant. Guidewire, Duck Creek, Snapsheet, CCC Intelligent Solutions, and other systems in that class remain the file of record.

A route record is complete only when it names the path, points at the answers, and points at the rule. A label such as "simple auto" with no pointers is not a route. It does not unlock STP.

Run the same required fields your intake desk already uses. Typical required facts include date and time of loss, loss location, policy or vehicle identifier, parties involved, a description in the caller's words, injury status, driveability if the claim is auto, and whether police or emergency services attended. Ask one fact at a time. Read back numbers, names, and dates. Store the caller's words for free-text fields. Do not rewrite a vague answer into a precise one.

If the caller says "last week sometime," that is not a loss date. Keep their phrase in the notes, or leave the date field blank. Filling in "Tuesday" so the form looks complete invents a loss fact. Later classification will cite a date nobody gave.

Do not let intake guess severity from "it's pretty bad." If the caller has photos, record that images exist and pass them to computer vision damage assessment. Injury packets, demand letters, or medical bills that arrive with the notice belong with medical and legal document synthesis. Intake only records that documents were received and who sent them.

Capture identifiers the way the caller states them. A partial VIN, a nickname for a vehicle, or "the policy on my phone" is not a completed identifier. Record what you have and flag the rest as missing. Do not finish the form from a previous call or a lookalike policy. Voice and chat must write the same FNOL schema.

Classification is a claim about the file. Every claim-type label and every complexity outcome must point at specific FNOL field identifiers plus the written complexity rule those values satisfy. Cite the rule by name and version. If the rule lives only in trainer notes, you cannot cite it, and STP is not available.

Illustrative example, not a measured result: a personal auto caller reports a parking-lot scrape, no injuries, no airbag deployment, one other vehicle, details exchanged, and the insured can drive the car. The agent cites those field values. The desk rule treats driveable, no injury, single other party, and no disputed liability as low complexity. STP is allowed only if the route record includes both cites: the FNOL field IDs and values, and the rule clause. If the rule also requires a clear liability statement and the caller only said "I think they hit me," liability is not cited. The route cannot be STP. Send it to an adjuster with the incomplete liability field flagged.

A route that says "low complexity, STP" with no pointer to FNOL answers is a failure mode. A reviewer cannot tell whether the agent heard "no injury" or assumed it. Treat that as an incomplete classification. Do not add answers after the call to make the cite appear.

Fraud checks are not FNOL answers. If a watchlist or velocity alert fires, send the file to real-time fraud pattern detection and keep the intake route on the adjuster path until those checks return. Do not write a fraud score into a loss field. Do not use a model confidence number as a substitute cite for the complexity rule.

Empty stays empty. If the policy number is unknown, the VIN is incomplete, the location is "somewhere on the highway," or the caller will not say whether anyone was hurt, leave those fields blank and list them as missing. Do not copy a similar claim. Do not default "no injury" because the caller sounded calm. Do not default "driveable" because they stayed on the phone.

Blanks change the route. A complexity rule that needs injury status, driveability, complete third-party identity, or a usable loss date cannot be satisfied by silence. The honest output is classification incomplete, route to adjuster, missing-field list attached.

Inventing a loss fact to unlock STP is worse than a blank. A guessed date of loss, an inferred "minor" damage label, a fabricated third-party name, or an assumed deductible looks like evidence. The blank is visible. The invention is not. If a required fact is missing, the agent stops classifying that dimension and says so.

STP on this page means intake has recommended the straight-through path. It does not mean paid. Payment is a separate control. See straight-through claims payment. Do not auto-pay from FNOL triage.

The STP path requires two cites on the same route record. First, FNOL answers: field identifiers and the values the caller actually gave. Second, the complexity rule: named rule version and the clause those values meet. Without both, the route is adjuster. An adjuster still owns coverage and payment in every case, including files that later qualify for STP payment under a different control. Intake eligibility is not coverage, not a reserve, and not a check.

When you route to an adjuster, pass the same package: cited answers, blanks, any classification you could not complete, and the rule clause that was not met. The adjuster should not have to replay the call to learn what was asked.

Failure mode: a route with no FNOL cite. "Most parking-lot claims go STP" is not a cite. A model score without field pointers is not a cite. Do not auto-route those files to STP. Hold them on the adjuster queue.

Failure mode: treating triage as paid. If the workbench shows "STP" beside a dollar amount, or a downstream job issues payment because intake said STP, intake has crossed its authority. Stop that path. The route may stand. Payment waits.

Failure mode: inventing a loss fact so the rule lights up. If you had to manufacture driveability, injury status, or liability to meet the clause, you do not have a cite. Route to the adjuster and keep the invented value out of the file.

Hand the structured FNOL and the route into the claims stack you already run. Guidewire, Duck Creek, Snapsheet, CCC Intelligent Solutions, and peers in that class remain the file of record. Do not teach the agent those products' coverage or payment screens. Intake ends when the file is routed with both cites, or parked with blanks for an adjuster.

Before go-live, review route records, not only happy-path transcripts. For each record, confirm every classified field points at an FNOL answer, blanks stayed blank, no loss fact appears that the caller did not state, STP appears only with both cites, and no payment instruction left the intake step. If the complexity rule cannot be cited by name and version, STP stays closed until the rule is written down.