Insurance claims and quotes between agents

Insurance has two consumer errands that fit an agent well. Quotes need the same facts about a driver, a vehicle or a home typed into one form after another. Claims need a first report of loss, photos, documents, and follow-up over weeks. Insurers already exchange structured data with brokers and each other. The consumer side is still forms, phone calls and email.

How it works today

Quotes. A person fills in each insurer’s online form, calls a captive agent, or works with a broker who re-keys the details into several carriers’ systems. Every quote repeats the same facts: drivers, vehicles, claims history, property details.

Claims. The first notice of loss comes by phone, app or web form. The insurer assigns a claim number and an adjuster, asks for documents and photos, and communicates by email and phone until settlement.

Industry data standards. ACORD maintains the data standards carriers, agencies and brokers use with each other: XML and AL3 for property and casualty, XML for life and annuity, and Next-Generation Digital Standards for APIs and microservices. These carry policies, quotes and claims between businesses. They are not a consumer channel.

US claim-handling rules. States regulate claim handling, most drawing on NAIC models. The Unfair Property/Casualty Claims Settlement Practices Model Regulation (#902) sets timing standards: acknowledge a claim notification within 15 days, respond to pertinent communications within 15 days, and accept or deny a claim within 21 days after receiving proof of loss. Each state’s adopted version controls. The NAIC’s model bulletin on insurers’ use of AI, adopted 4 December 2023, expects insurers to maintain a written program for AI systems and to ensure AI-supported decisions affecting consumers comply with unfair trade practice laws, including when third-party AI is involved.

Licensing. The NAIC Producer Licensing Model Act (#218) says a person may not sell, solicit or negotiate insurance without a license. It defines negotiating as conferring with or advising a purchaser about the terms of a particular contract, by a person who sells insurance or obtains it for purchasers.

Canada. Insurance conduct is provincial. In Ontario, FSRA’s guidance GR0008APP, effective 1 January 2021, adopts the CCIR and CISRO guidance on fair treatment of customers, and FSRA includes claims handling in its market conduct reviews. The CCIR and CISRO guidance has a section on claims handling and settlement: claims examined diligently and fairly through an accessible procedure, claimants told the procedures and timeframes, and timely status updates.

The agent-to-agent version

Illustrative. A policyholder’s parked car is damaged in a hailstorm. Their agent reports the claim to the insurer’s agent.

1. The agent sends the policy number, date and place of loss, a description, and photos as file parts.
2. The insurer’s agent opens a claim, returns the claim number, and moves the task to TASK_STATE_INPUT_REQUIRED for anything missing, such as where the car can be inspected.
3. As the claim moves, the insurer’s agent updates the task: inspection booked, estimate issued, payment approved.
4. The task completes when the claim is settled or closed, with the decision attached.

Step 1:

{
  "jsonrpc": "2.0",
  "id": "req-fnol-1",
  "method": "SendMessage",
  "params": {
    "message": {
      "messageId": "msg-fnol-01",
      "role": "ROLE_USER",
      "parts": [
        { "text": "First notice of loss: hail damage to an insured vehicle while parked." },
        {
          "data": {
            "policyNumber": "PA-2204-7781",
            "lossDate": "2026-09-24",
            "lossLocation": { "city": "Calgary", "region": "AB", "country": "CA" },
            "lossType": "hail",
            "vehicle": { "year": 2022, "make": "Example", "vinLast6": "4K2219" },
            "drivable": true,
            "injuries": false
          },
          "mediaType": "application/json"
        },
        {
          "url": "https://agent.example/claims/uploads/hood-01.jpg",
          "filename": "hood-01.jpg",
          "mediaType": "image/jpeg"
        }
      ]
    }
  }
}

A quote request follows the same pattern in the other direction: the person’s agent sends one structured risk profile to several insurers’ agents and gets back structured quotes to compare, each with its coverage limits and deductibles stated as data.

What has to be true

Identity. The insurer needs to know whether the agent acts for the named insured, a listed driver, or a third-party claimant. They have different rights to information.

Authority. A claim authorization should cover reporting and following one claim: sending documents, booking inspections, receiving status. Accepting a settlement offer is a larger commitment and should need the person’s explicit approval each time. For quotes, the person has to consent to the checks the insurer runs before quoting.

Licensing. An agent that only carries its user’s information and returns quotes is doing something different from one that recommends coverage. Where the line falls under each jurisdiction’s producer licensing law is not settled for software.

Record. The claim-handling clocks run from notification and proof of loss. Both sides need timestamps for when notice arrived, when each document was received, and what the insurer said and when.

Where Emissar fits

• Front Door (open to design partners): an agent endpoint in front of the insurer’s claims intake and quoting systems.
• Verify (in development): checks the calling agent before policy data is shared.
• Mandate (spec in progress): the policyholder’s authorization, scoped to one claim or one quote request.
• Ledger (spec in progress): signed, timestamped records of notice and each submission, which is what the claim clocks depend on.
• Handoff (in development): injuries, disputes and total losses go to an adjuster with the full exchange attached.
• Settle (planned): claim payments, once a settlement is accepted.

Open questions

• Will insurers accept first notice of loss from agents in a structured form, and would ACORD’s Next-Generation Digital Standards be the payload?
• Where does a consumer’s quoting agent sit under producer licensing law in each state and province?
• The NAIC bulletin addresses insurers’ own AI. Nothing comparable addresses the consumer’s agent on the other side. Does that gap matter to regulators?
• Should settlement offers be signed so the policyholder’s agent can prove what was offered?