{"txn_id":"HL-CLM-1043","assessment_id":"ra_be927f3fdf214516","occurred_at":"2026-09-30T19:55:58+00:00","state":"TX","line_of_business":"health","stage":"claims","program_area":"Claims/Adjudication","ai_system":{"system_id":"claims-adjud","model_version":"5.1","vendor":"internal","vendor_name":null,"high_risk_class":"claims"},"inputs":{"feature_classes":["medical_records","claims_history"],"protected_factors_used":[],"ecdis_present":false,"consumer_report_used":false,"credit_used":false,"data_source_refs":[],"consumer_token":"tok_40f8dd1504"},"output":{"decision":"deny","score":0.632,"reason_codes":["E-114"],"premium_delta_pct":null},"human_involvement":{"reviewed":true,"reviewer_role":"adjuster","overridden":false},"adverse_action":{"is_adverse":true,"notice_sent_at":null,"reasons_provided":true,"specific_reasons":false,"ecdis_disclosed":false,"appeal_channel":null},"carrier_note":null,"input":{"revision":1,"current_revision":1,"input_digest":"c5d391bb03354fd54f6872e55644b52f000db1ec5a316214e3f4ccfe2634fb45","digest_ok":true,"note":"input_digest is SHA-256 over the canonical JSON of the transaction revision assessed; it is inside the assessment the ledger hashes."},"assessment":{"disposition":"PASS","coverage":{"status":"supported","state_rules_applied":6,"general_rules_applied":0,"advisory_rules_applied":1,"rules_considered":30,"rules_applied":["doctrine.unreviewed-adverse-high-risk","tx.544.prohibited-basis","tx.542.rejection-without-reasons","tx.542.algorithmic-denial-without-human-review","tx.tdi.consequential-decision-without-human-review","tx.tdi.third-party-data-source-unrecorded","tx.traiga.ai-discrimination-context"],"statement":"6 state-specific and 0 general black-letter rule(s) applied to this TX health claims transaction. Only the configured checks were run; a result is not a legal opinion on compliance."},"evidence":{"status":"carrier_asserted","asserted":["ai_system.governance_attested","ai_system.model_doc_ref","ai_system.testing_report_ref"],"missing":[],"statement":"Supplied by the carrier and not verified by RegBench: ai_system.governance_attested, ai_system.model_doc_ref, ai_system.testing_report_ref."},"summary":"PASS: 0 finding(s) under rules 2026.10+c4982313, corpus 2026-10-30-9c5dad5a. No configured check fired; the case file is recorded. This is not a compliance conclusion.","narrative":"On 2026-09-30, claims-adjud v5.1 (an internally developed system) produced 'deny' in a TX health claims transaction. Inputs included medical records, claims history. A human reviewed the output by a adjuster. The outcome was adverse to the consumer; no notice to the consumer is recorded. RegBench applied 7 rule(s) in force on 2026-09-30 and recorded no findings.","findings":[],"point_in_time":{"as_of":"2026-09-30","basis":"transaction_date","rules_version":"2026.10+c4982313","corpus_snapshot":"2026-10-30-9c5dad5a","engine_version":"regbench-engine/0.5.0","model_version":"deterministic-1"},"evaluated_at":"2026-10-31T05:42:55.847537+00:00","fingerprint":"9c89caeac48e3c93ec4cb769"},"review":null,"ledger":{"seq":6546,"hash":"c3d6e4a552407bad0ca19add2be77d4d6240844fb941f4dbc348b8491b9e7dde","prev_hash":"d3589515e3bd03a5b0b66c5b22329f862326c0f78faac58e4677b236f8cef2eb","recorded_at":"2026-09-30T19:58:11+00:00"}}