{
  "title": "Insurance claim intake examples for evaluating AI routing",
  "source_page": "https://fiund.com/industries/insurance-claim-intake-data",
  "authorship": "Original fictional Fiund editorial exercise. No actual operating records or third-party source assets are included.",
  "example": {
    "title": "Routing follows the stated missing-document rule and its effective version",
    "context": "Two fabricated intake files use a deliberately simple original queue rubric. It is a documentation benchmark with no real claim, policyholder or insurer workflow.",
    "records": [
      [
        "IR1",
        "Practice routing rubric",
        "v1 before day 10: missing event form goes to DOCUMENTS. v2 from day 10: missing event form plus an identity-reference conflict goes to REVIEW; missing form alone stays DOCUMENTS."
      ],
      [
        "IR2",
        "File A",
        "Intake day 12, event form missing, identity references consistent. No other disposition record."
      ],
      [
        "IR3",
        "File B",
        "Intake day 12, event form missing, identity alias on cover differs from the attachment. No authoritative resolution supplied."
      ]
    ],
    "question": "Which practice queue follows for each file under the supplied rubric, and what decisions remain outside that routing output?",
    "answer": "IR1's v2 controls both day-12 files. IR2 has only a missing event form, so A routes to DOCUMENTS. IR3 combines the missing form with an unresolved identity-reference conflict, so B routes to REVIEW. Cite the exact rule and evidence for each referral. These are synthetic human-queue assignments, not determinations of identity, fraud, coverage, claim value, eligibility or entitlement to payment.",
    "failureModes": [
      "Repeating the older missing-form route after the effective rubric has changed.",
      "Resolving an identity conflict by assumption instead of following the stated review rule."
    ],
    "fields": [
      [
        "Intake date and rubric version",
        "Selects the applicable practice rule."
      ],
      [
        "Document gap and conflict evidence",
        "Supports the route."
      ],
      [
        "Queue, reason and handoff boundary",
        "Keeps routing distinct from final disposition."
      ]
    ],
    "holdout": "Move B's intake to day 8. Require the v1 route with an explicit conflict note, preserving the distinction between the rubric's output and unresolved evidence.",
    "boundary": "Use original fictional referrals and reviewer keys. Actual operational use requires separate authorization; exclude medical, financial, identity and privileged claim materials."
  }
}