01 / Operational model
Who acts, and what changes?
Principal and authority origin
A claims-handling agent assigned to a policyholder claim. Claim assignment, policy authority and adjuster delegation.
Consequential action
Approve payment or deny coverage.
02 / Action-time control
Make the requested effect testable.
Policy terms, claim amount, fraud flag and human review threshold. Permit routine document gathering; bind any payment approval to claim, payee and amount.
OriginClaim assignment, policy authority and adjuster delegation
RequestApprove payment or deny coverage
DecisionEvaluate and enforce before effect
03 / Evidence and responsibility
Permission, execution, and outcome are separate.
Claim evidence, policy version, reviewer, payment decision and carrier ledger.
Coverage interpretation and regulated claims decisions remain insurer responsibilities.
Primary source