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Loops for insurance

Hear what your AI agent told every policyholder

Loops grades each claims and policyholder call against your SOP and the unfair claims rules your compliance lead approves, and checks the tool calls behind every promise: the policy lookup, the claim it opened, the forms it sent.

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Rule library ready. Loops is live today in collections; an insurer starts with the free 30-day audit

First notice of loss · Cedar Mutual · sample(Sample)

Agent: Thanks for calling Cedar Mutual claims. I'm an automated assistant, and this call is recorded.

1.1 metRecording and AI assistant disclosed at 00:05

Caller: A pipe burst in our kitchen last night.

Agent: To confirm it's you, what's the ZIP code on the policy and your date of birth?

Caller: 33614, and April 9, 1971.

1.3 metverify_policyholder matched at 00:31

Agent: I've opened claim 26-117045 for water damage at your home.

3.1 metcreate_claim succeeded; dated note written

Agent: Sudden pipe bursts are covered under your policy, so you'll be fine.

2.1 missedCoverage stated, but policy_lookup was never called

Agent: I'm texting you a link with your claim forms and instructions.

3.3 metsend_claim_packet returned success

2.2 missed"You'll be fine" predicts the claim outcome

The rules every call is graded against

Your SOP plus the state claims rules most states base on NAIC model law #900 and regulation #902, each approved by your compliance lead.

Before any claim detail

  1. 1.1Disclose the recording at the start, on the recordingCal. Penal Code 632; Fla. Stat. 934.03; RCW 9.73.030
  2. 1.2Say the caller is talking to an automated assistantYour SOP; NAIC AI bulletin
  3. 1.3Verify the caller against the policy record by a tool15 U.S.C. 6805; state law
  4. 1.4Check a family member's or representative's designation in the claim recordNAIC #902, 3C

What the agent may say

  1. 2.1State coverage only from the policy lookup made on this callNAIC #900, 4A; #902, 5A
  2. 2.2Never predict an outcome, an amount or a payment dateYour SOP
  3. 2.3Give only timelines the claim system returnedYour SOP
  4. 2.4Leave denials to a person with the fileNAIC #900, 4L; #902, 7A

The claim clock

  1. 3.1Open the claim and write a dated acknowledgment noteNAIC #902, 6A; Fla. Stat. 627.70131
  2. 3.2Say what must be sent in writing, and by whenNAIC #902, 5D
  3. 3.3Send the forms and instructionsNAIC #902, 6D

When the caller disputes

  1. 4.1Explain review by the state insurance departmentNAIC #902, 7H
  2. 4.2On group health plans, explain the pre-service procedure29 CFR 2560.503-1(c)(1)
  3. 4.3Never talk the caller out of a reviewYour SOP

Whether an acknowledgment went out in time needs the claim system's record. Without it, Loops marks that rule not checked, never passed.

The clock a phone report can start. A loss described to the agent can be notice even if its claim tool failed, so Loops checks the tool result and the dated note on every call.
Day 0The loss is reported on the call; forms and instructions go out promptly (#902, 6D)
Day 7Florida property claims acknowledged
Day 15Acknowledged under #902, with a dated note

Sources: NAIC model regulation #902, sections 6A and 6D; Fla. Stat. 627.70131.

Your first 30 days
  1. Connect

    A read-only key or a webhook, your claims SOP, and the claim system records the clock rules need.

  2. Approve

    Your compliance lead signs each rule beside the SOP line or claims regulation it came from.

  3. Grade

    Last month's calls, rule by rule, with the evidence for every verdict, within 72 hours of approval.

  4. Report

    Day 30: agreement with your reviewers, the rules missed at a rate, and what each release changed.

NDA and DPA before any access · Read-only key or webhook · Never writes to your agent · US data · SOC 2 Type II under NDA · Trust center

Questions

Does Loops have insurance customers today?

Not yet. Loops is live today on every AI call at three US collection agencies. The insurance rule library is ready, and an insurer's first audit runs the same way: approve the rules, then grade a month of calls with the evidence for every verdict.

Which rules does the insurance library cover?

The state unfair claims practices laws most states base on NAIC model law #900 and regulation #902, recording-consent laws, federal claims rules for group health plans, and what the NAIC AI bulletin expects of vendor AI. Your own SOP rules sit beside them, and your compliance lead approves each one before anything is graded.

Can Loops check the acknowledgment clock?

On the call, it checks that the claim tool returned success and a dated acknowledgment note was written. Whether the acknowledgment went out within 15 days under #902, or 7 for Florida property claims, needs the claim system's record, so without it that rule is marked not checked, never passed.

Why does one misstatement matter so much with an AI agent?

An agent repeats a misstatement on every call that reaches the same prompt path, so one bad instruction can meet the "general business practice" test of model law #900 on its own, and California counts a single knowing violation. Loops measures each rule's miss rate, so a pattern shows up before it becomes a finding.

What can we hand an examiner?

For any call, policy or date range: each rule's verdict, the quoted line, the tool-call record, the rule version and who approved it, the grader version, and any reviewer override with who made it and when. It exports as PDF or CSV.

Guides for your team

General information, not legal advice. Sample calls and figures are illustrative.