Handling claims, answering policyholders, keeping products compliant: Claude agents that prepare the work of claims handlers and experts, within DORA, Solvency II and the EU AI Act.
An AI agent for insurance is a Claude agent that handles the document work of the insurance value chain: opening and investigating claims, answering policyholders, checking supporting documents, monitoring product compliance. It flags unusual files and leaves settlement, pricing and every decision that commits the policyholder to claims handlers and experts.
Insurance combines financial regulation, consumer protection and sensitive data. Four texts define what an agent can do, and under which conditions.
Insurance and reinsurance undertakings fall within DORA (EU 2022/2554), in application since 17 January 2025. An AI model hosted by a provider follows the same rules as any ICT service: contract, register of information, testing, and an exit strategy if the service supports a critical or important function.
Annex III of the EU AI Act lists risk assessment and pricing of natural persons in life and health insurance as high-risk. Handling a motor claim is not on the list; health pricing is. The obligations apply from 2 December 2027.
Solvency II requires an effective system of governance and written policies, notably on risk management and, where relevant, outsourcing. An agent relying on an external provider may fall under the outsourcing rules: if it touches a critical or important activity, the supervisor is notified in advance, and the insurer remains fully responsible.
The Insurance Distribution Directive (IDD) requires any contract offered to be consistent with the customer’s demands and needs. An agent can prepare the needs assessment or compare cover; the advice and its record remain the distributor’s responsibility.
The agent opens the file, checks the documents received, chases missing ones, matches the claim against the policy cover and flags inconsistencies. The handler gets a file ready for a decision, the expert only the cases that warrant one.
Repeated claims, edited documents, unlikely timelines: the agent spots the signals and explains why a file deserves a second look. It never labels a claim as fraud; it hands over to the dedicated team.
Questions about cover, reimbursement tracking, certificates: the agent answers from the policyholder’s actual contract, quoting the clause, and routes to an adviser as soon as a complaint or a sensitive situation appears.
Reviewing information documents, checking consistency between policy wordings and marketing material, tracking regulatory change: the agent prepares the gaps, compliance validates.
Life or health pricing, claim refusals, cancellations: these decisions commit the policyholder and some are high-risk. They stay human. The agent works upstream, on preparation and checks.
Health data is a special category under the GDPR. Whether an agent may process it is decided during scoping: legal basis, minimisation, hosting, and access rights limited to what is strictly needed.
Action log, sources consulted, model version: every file the agent touches can be reconstructed for internal audit, the supervisor or a complaint.
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