In This Article
Introduction
Insurance operations involve high-volume, repetitive tasks: triaging claims, answering policy questions, and managing renewal cycles. Agents and adjusters spend hours on routine inquiries that could be accelerated with AI assistance. OpenClaw helps agencies automate inquiry handling, draft claim summaries, and send renewal reminders — while keeping sensitive data under your control with local-first architecture.
Here's what we're covering: workflows for independent agents, agencies, and carriers. Regulatory considerations apply — never automate binding decisions. Use OpenClaw for administrative tasks: triage, drafting, reminders. See compliance patterns for regulated data. One agency cut policy inquiry response time by 50% — we'll show you the setup.
Claims Triage & Routing
Incoming claims can be triaged by OpenClaw: extract key details (type, amount, urgency), categorize, and route to the right adjuster. The agent drafts a summary for your review. Never let it approve or deny — human decision required. Use local models if claims data is sensitive.
Claim extraction. The agent reads the claim: "Policy #, claim type, loss date, estimated amount, claimant contact." Extracts and populates fields. You verify. Reduces data entry for adjusters.
Categorization. "Auto, property, liability, workers comp." The agent categorizes based on content. You define categories; the agent applies. Routes to the right specialist.
Urgency scoring. "Total loss, injury, high-value → immediate. Minor fender bender → normal queue." The agent suggests priority; you can override. Helps prioritize the workload.
Summary drafting. "Claim #12345: Auto collision, 2/15/26. Policyholder: [name]. Claimed amount: $8,500. Third party involved. Suggested: assign to auto adjuster, priority 2." You assign; the agent accelerated the prep.
Never approve. Claims approval and denial are regulated. OpenClaw assists with triage and drafting; adjusters decide. Document the boundary in your procedures.
Policy Inquiry Handling
Common policy questions (coverage limits, deductibles, payment options) can be drafted by the agent from your knowledge base. Store FAQs in memory. The agent personalizes responses; you approve before sending. Escalate complex or disputed inquiries.
Coverage questions. "What's my coverage for [X]?" The agent pulls from your policy data (if integrated) or KB. "Your policy includes [coverage] at [limit]. Deductible: [X]." You verify and send. Never let the agent interpret coverage — that can create binding implications.
Payment options. "How do I pay my premium?" Standard FAQ. The agent drafts from your template. You approve. Low risk; high volume.
Endorsement requests. "I want to add [coverage]." The agent drafts a response: "To add [coverage], we'll need [info]. Here's the process." You verify and send. Don't let the agent approve endorsements — that requires underwriting.
Escalation. Disputes, coverage complaints, legal threats — the agent recognizes and routes to a licensed agent. "Customer disputes claim denial. Escalate to claims supervisor."
Renewal Reminders
A Heartbeat task runs weekly: "Policies expiring in 30 days." The agent compiles a list, drafts reminder messages. You review and send. Reduces lapse rates without manual tracking.
Renewal list. Connect to your policy management system (Applied, Vertafore, etc.) via API. The agent pulls policies expiring in 30, 14, 7 days. Compiles a list; you prioritize.
Reminder drafting. "Your [policy type] policy expires on [date]. To renew, [action]. Contact us for questions." The agent personalizes; you approve and send. Or: enable autonomous for standard reminders after validation.
Lapse prevention. "Policy #12345: 7 days to expiry. No renewal received. Suggested: call or email." The agent surfaces at-risk policies; you follow up. Reduces involuntary lapses.
Cross-sell. "Policyholder has auto only. Consider: umbrella, home." The agent can flag opportunities. You decide whether to reach out. Don't let the agent make sales — that requires a licensed agent.
Compliance Considerations
Insurance is regulated. Don't automate binding decisions. Use OpenClaw for administrative tasks: triage, drafting, reminders. Document what the agent does in your compliance records. Consider data sovereignty for cross-border operations.
Licensing. Only licensed agents can advise on coverage, bind policy, or approve claims. OpenClaw assists; it doesn't practice. Document: "AI drafts; licensed agent reviews and approves."
PHI. Health insurance involves PHI. See HIPAA guidance. Use local models for PHI-adjacent workflows. Don't put PHI into cloud AI.
Documentation. Log agent actions: what it drafted, who approved, when. Retain for regulatory exams. Your compliance team will want to understand the boundary.
State variations. Insurance is state-regulated. Rules vary. Don't assume one workflow fits all. Document state-specific considerations in your procedures.
Implementation Checklist
- □ Connect OpenClaw to policy management system (if API available)
- □ Create triage and routing rules; store in memory
- □ Export policy FAQs and templates; store in memory
- □ Define escalation rules (disputes, legal, coverage)
- □ Set up renewal reminder Heartbeat
- □ For sensitive data: use local models
- □ Document use in compliance procedures
- □ Run in draft-only for 2 weeks
FAQ
Can OpenClaw access our policy management system? Yes, via API if your PMS exposes one. Many systems (Applied, Vertafore, etc.) have APIs. OpenClaw can read policy data for triage and drafting. Write access (if any) requires careful control — typically you don't need it.
What about PHI in health insurance? Health insurance involves PHI. See HIPAA guidance. Use local models for PHI-adjacent workflows. Don't put PHI into cloud AI. Document your data handling.
Can it handle claims approval? No. Claims approval and denial are regulated activities requiring human judgment. OpenClaw assists with triage and drafting; adjusters decide. Document this clearly.
What about E&O? Errors and omissions insurance may have questions about AI use. Document your controls: human review, approval workflow. Work with your E&O carrier if needed.
Wrapping Up
Insurance benefits from automation that respects regulatory boundaries. OpenClaw supports that balance: triage, drafting, reminders — with human approval for all binding decisions. Document your use; use local models for sensitive data. OpenClaw Consult advises on compliant deployment for insurance agencies and carriers.