{"txn_id":"TX-CLM-0417","assessment_id":"ra_b6c0b129678f4358","occurred_at":"2026-10-21T09:00:00+00:00","state":"TX","line_of_business":"auto","stage":"claims","program_area":"Claims/Adjudication","ai_system":{"system_id":"fnol-fraud","model_version":"3.1","vendor":"third_party","vendor_name":"Sentinel Analytics (fictional)","high_risk_class":"fraud"},"inputs":{"feature_classes":["claims_history","geography","social_media"],"protected_factors_used":[],"ecdis_present":false,"consumer_report_used":false,"credit_used":false,"data_source_refs":["vendor://sentinel/fnol"],"consumer_token":"tok_showcase_0417"},"output":{"decision":"deny","score":0.93,"reason_codes":["F07","F12"],"premium_delta_pct":null},"human_involvement":{"reviewed":false,"reviewer_role":null,"overridden":false},"adverse_action":{"is_adverse":true,"notice_sent_at":null,"reasons_provided":false,"specific_reasons":false,"ecdis_disclosed":false,"appeal_channel":"claims@bluebonnet.example"},"carrier_note":"Rear-end collision claim; vendor fraud score 0.93 on social-media and location signals; denial letter queued automatically.","input":{"revision":1,"current_revision":1,"input_digest":"ce495dc6fffcdfecf2b5ab9466138378a90ee9677f4d1c42e1b5e74fd010c062","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":"HOLD","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 auto claims transaction. Only the configured checks were run; a result is not a legal opinion on compliance."},"evidence":{"status":"missing","asserted":["inputs.data_source_refs"],"missing":["ai_system.governance_attested","ai_system.model_doc_ref","ai_system.testing_report_ref"],"statement":"Missing evidence: ai_system.governance_attested, ai_system.model_doc_ref, ai_system.testing_report_ref. Supplied but unverified: inputs.data_source_refs."},"summary":"HOLD: 4 finding(s) under rules 2026.10+c4982313, corpus 2026-10-30-9c5dad5a. Recommended hold for the carrier's compliance review before the outcome is communicated; the carrier decides.","narrative":"On 2026-10-21, fnol-fraud v3.1 (a third-party system from Sentinel Analytics (fictional)) produced 'deny' in a TX auto claims transaction. Inputs included claims history, geography, social media. No human reviewed the output before it took effect. The outcome was adverse to the consumer; no notice to the consumer is recorded. RegBench applied 7 rule(s) in force on 2026-10-21 and recorded 4 finding(s); the most serious is 'Algorithmic denial, reduction or fraud hold with no human review' (critical, L2).","findings":[{"rule_id":"tx.542.algorithmic-denial-without-human-review","layer":"L2","judgment_basis":"black_letter","advisory":false,"severity":"critical","title":"Algorithmic denial, reduction or fraud hold with no human review","required_action":"Route to an adjuster for review before the outcome is communicated; record the reviewer and outcome.","exhibits":["C"],"content_status":"verified","citations":[{"provision_id":"tx-ins-542-003","label":"Tex. Ins. Code § 542.003 — unfair claim settlement practices prohibited","source_url":"https://statutes.capitol.texas.gov/?tab=1&code=IN&chapter=IN.542","verified":true},{"provision_id":"tx-ins-542-055","label":"Tex. Ins. Code § 542.055 — receipt of notice of claim (15-day acknowledgement)","source_url":"https://statutes.capitol.texas.gov/?tab=1&code=IN&chapter=IN.542","verified":true}]},{"rule_id":"tx.542.rejection-without-reasons","layer":"L2","judgment_basis":"black_letter","advisory":false,"severity":"high","title":"Claim rejected or reduced without stated reasons","required_action":"Hold the rejection until the reasons are stated in the claimant notice and recorded; confirm the 15-business-day clock.","exhibits":["C"],"content_status":"verified","citations":[{"provision_id":"tx-ins-542-056","label":"Tex. Ins. Code § 542.056 — notice of acceptance or rejection of claim; reasons for rejection","source_url":"https://statutes.capitol.texas.gov/?tab=1&code=IN&chapter=IN.542","verified":true},{"provision_id":"tx-ins-542-003","label":"Tex. Ins. Code § 542.003 — unfair claim settlement practices prohibited","source_url":"https://statutes.capitol.texas.gov/?tab=1&code=IN&chapter=IN.542","verified":true}]},{"rule_id":"tx.tdi.consequential-decision-without-human-review","layer":"L4","judgment_basis":"guidance","advisory":false,"severity":"high","title":"Consequential AI-supported decision taken without a person reviewing and agreeing","required_action":"Route to the responsible reviewer before the outcome takes effect; record the reviewer on the transaction.","exhibits":["B","C"],"content_status":"verified","citations":[{"provision_id":"tx-tdi-b-0003-26-human-review","label":"TDI Commissioner's Bulletin B-0003-26 (12 June 2026), Use of Artificial Intelligence — human review of consequential decisions","source_url":"https://www.tdi.texas.gov/bulletins/2026/b-0003-26.html","verified":true},{"provision_id":"tx-tdi-b-0003-26-governance","label":"TDI Commissioner's Bulletin B-0003-26 (12 June 2026) — governance, procedures on request, and monitoring","source_url":"https://www.tdi.texas.gov/bulletins/2026/b-0003-26.html","verified":true}]},{"rule_id":"doctrine.unreviewed-adverse-high-risk","layer":"L6","judgment_basis":"doctrine","advisory":true,"severity":"medium","title":"Adverse outcome from a high-risk AI system with no human review","required_action":"Route to the carrier's reviewer; record the review and any override on the transaction.","exhibits":["B","C"],"content_status":"verified","citations":[{"provision_id":"naic-ai-bulletin-s3-1-ais-program","label":"NAIC Model Bulletin on the Use of AI Systems by Insurers (adopted 4 Dec 2023), Section 3, 1.0 General Guidelines — the written AIS Program","source_url":"https://content.naic.org/sites/default/files/inline-files/2023-12-4%20Model%20Bulletin_Adopted_0.pdf","verified":true}]}],"point_in_time":{"as_of":"2026-10-21","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":"2026-10-31T05:42:56.110834+00:00","fingerprint":"d462b4c026fac898906b73ba"},"review":{"status":"resolved","outcome":"confirmed-no-change","hours_to_resolve":3.2,"reviewer_role":"adjuster","resolved_at":"2026-10-21T12:14:27.984090+00:00"},"ledger":{"seq":6624,"hash":"10f02d36748409c507576534a7361e0ea52987ce55a2b27b55ca8ef840541ed0","prev_hash":"cffb9ad7f0082e730d8add48240bc8b19f320107a0c322e6e656bbf806ab3184","recorded_at":"2026-10-21T09:00:50+00:00"}}