How insurers enforce the unfair claims settlement practices acts, FCRA and HIPAA while the work runs
Insurers are examined on what happened inside the work: whether the claim was acknowledged inside the state's period, whether the HIPAA authorization came before the medical questions, whether the non-renewal notice went out with the state's days and reasons, whether every payee was screened before the payment, and most of that is checked months later from files. Callvu enforces those rules while a first notice, a quote, a settlement approval or a payment runs, so a step that breaks a rule does not run, and every run leaves a Decision Trace and an Audit Trace the examiner can replay.
The problem today
Most compliance is checked after the fact.By then, the damage is done.
First notice of loss from any door
Three first notices for the same accident: the app's, the agent's and the AI assistant's, each with different facts and a different claim number.
Claim reserve and settlement authority approval
The time-limited demand expired while the authority request sat in a manager's inbox under a subject line that did not say it was urgent.
Auto injury claim at first notice
The intake agent asked about the diagnosis before anyone had signed a release, and the file could not use the answer.
How Callvu runs it
Twelve insurance processes,from the request to the system of record.
Twelve insurance processes where the rules are enforced while the work runs. Each page names the regulations, the policies, the controls, the clocks and the documents, and what the Decision Trace and the Audit Trace record.
First notice of loss from any door
Starts in an app, with an agent, an AI chat or an AI agent; needs one complete governed claim; ends in claims with skill and due date.
Enforces: State unfair claims settlement practices acts · HIPAA and the state privacy rules for injury information at notice · State catastrophe claim rules and the insurer's claims handling guidelines
Complex: multi-party handoffsClaim reserve and settlement authority approval
Starts when a reserve or settlement exceeds the adjuster's authority; needs the case built for the approver; ends approved or rejected in claims.
Enforces: Claims reserving and financial reporting requirements · State unfair claims settlement practices acts and bad faith law on time-limited demands · Reinsurance treaty and excess policy notice conditions
Complex: multi-party handoffsAuto injury claim at first notice
Starts at first notice of an injury; needs medical consent before the claim moves and only the questions that apply; ends in claims.
Enforces: State unfair claims settlement practices acts · HIPAA authorization · State no-fault and tort rules and the medical payments coverage terms
SimpleNon-renewal notice
Starts when underwriting decides not to renew; needs the notice with reasons sent within the required days; ends with delivery recorded.
Enforces: State non-renewal notice rules · State catastrophe moratoria and emergency orders · FCRA adverse action and state adverse underwriting notice rules
Complex: multi-party handoffsUnclaimed benefits and lost beneficiary search
Starts when a death match or dormant account is found; needs beneficiaries located and claims completed; ends paid or escheated on time.
Enforces: State unclaimed life insurance benefits acts · Unclaimed property rules · The multistate regulatory settlement agreements and state insurance department bulletins on death master file use
Complex: multi-party handoffsClaim payment and payee details
Starts when a claim is approved; needs payee identity, bank details and lienholder or mortgagee endorsements; ends paid and recorded.
Enforces: OFAC screening · Policy loss payable and mortgage clauses · State unfair claims settlement practices acts and prompt payment rules
Complex: multi-party handoffsHomeowners quote to bind
Starts online or with an agent; needs property details, inspection photos and prior loss history; ends as a bound policy in policy admin.
Enforces: State insurance code; binding rules · FCRA for the claims history and credit-based insurance score reports · State cancellation and non-renewal rules during and after the underwriting period
Complex: multi-party handoffsPersonal auto quote to bind
Starts from a website, agent call or AI agent; needs driver, vehicle and prior insurance data plus disclosures and signature; ends bound in policy admin.
Enforces: State insurance code; binding rules · FCRA for the motor vehicle, claims history and credit-based insurance score reports · State rate and form filing and electronic signature law
SimplePolicy replacement notice and acknowledgment
Starts when a new policy replaces an existing one; needs the replacement notice delivered and acknowledged by the applicant; ends filed with the application.
Enforces: State life and annuity replacement regulations · NAIC Suitability in Annuity Transactions Model Regulation and the best interest standard, for annuity replacements · Market conduct examination standards
Complex: multi-party handoffsAgent and broker onboarding and appointment
Starts when an agency wants to sell; needs licenses checked, E&O proof, contracts signed and appointments filed; ends active in the producer system.
Enforces: State producer licensing and appointment rules · Anti-money-laundering and product training requirements · Producer agreements, errors and omissions requirements and the insurer's background check policy
Complex: multi-party handoffsAuto total loss settlement
Starts when a vehicle is declared a total loss; needs title, lien payoff, power of attorney and owner signatures; ends paid and the title transferred.
Enforces: State total loss and title rules · State unfair claims settlement practices acts and the total loss regulations under them · Federal odometer disclosure and the lienholder's rights under the loss payable clause
SimpleAccident, hospital and critical illness claims
Starts from the member; needs diagnosis or accident proof and claim form; ends paid or referred.
Enforces: State prompt pay rules · State accident and health policy standards and the NAIC supplemental benefit model regulations · HIPAA authorization and the state insurance privacy acts
The rules and the clocks
What is enforcedacross these processes.
The regulations below are preloaded in Callvu Studio as policies and applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant. Each one links to the process pages that enforce it.
By role
What changesfor each team.
Compliance
The regulations preloaded in Callvu Studio and your own claims handling guidelines and authority table run as steps, not as lines in a binder. Six AI evaluators check every request before its first step and every step as it runs, and the Completion Orchestrator makes one decision each time: execute, add a safeguard, send it to a person, or block. Each run writes a Decision Trace and an Audit Trace that the market conduct examiner can replay.
- The state's acknowledgment period under the unfair claims settlement practices acts started at notice and visible on the claim.
- The FCRA adverse action notice generated when a report drives a decline or a higher rate on a homeowners or auto quote.
- OFAC screening of every payee at release, and the non-renewal notice generated with the state's days, reasons and proof of mailing.
Operations
A claim that arrives on a Friday call, a time-limited demand above the adjuster's authority and a non-renewal decision waiting for a letter no longer sit in an inbox while a state clock runs. Callvu classifies each request, prefills the policy and the coverages, chases the missing document or signature from the right party on a schedule, and sends only the exceptions to the Decision Desk with the evidence attached.
- Acknowledgment, decision-after-proof, prompt pay and payment-after-agreement clocks tracked from the date the state counts from.
- Reserve changes and settlement requests routed by the authority table, with inaction escalating by rule before a demand's deadline.
- Death master file matches, due diligence letters and the state report produced by the run, not reconciled afterward.
IT
Callvu reads from and writes to the policy administration and claims systems you already run, by API and webhook, and does not replace them. Identity, consent, signatures and payee bank details stay on process-controlled screens, so an AI assistant or an outside AI agent over MCP can start a claim without sensitive data entering the chat.
- Prefill from policy admin, the claims database and the reports; the claim, the binder or the payment written back with who verified it.
- Callvu integrates with Guidewire, Duck Creek Technologies, Majesco, Insurity, Sapiens and FIS Insurance Solutions.
- The Decision Trace and the Audit Trace pushed in real time to your GRC and BI tools through the Analytics API.
Customer experience
The policyholder reports the loss, uploads the photos or signs the application once, on their own phone, and is not asked again by the back office. A claimant who reported an injury on a call is never asked to repeat the facts to the adjuster, and each payee enters their own bank details once, on a secure screen.
- One first notice behind every door, with the acknowledgment sent inside the state's period.
- A quote started online and finished with an agent on the same record, with the reports pulled once.
- An accident or hospital claim with proof under the limit paid by rule inside the prompt pay period.
Proof
In production in insurance.Published results only.
Each result is a published claim, with its code on agents.callvu.com, where its status, source and last verified date are kept.
Phoenix Insurance reaches more than 90% completion without human help.
INS-06 · Self-asserted · verified 2026-11-05
Phoenix Insurance integrated all core systems with Callvu in 4 weeks.
INS-05 · Self-asserted · verified 2026-11-02
Phoenix Insurance put more than 100 processes live in under three months.
INS-01 · Self-asserted · verified 2026-11-02
Questions
What insurance buyers ask,answered plainly.
What must an insurer do within days of a claim notice under the unfair claims settlement practices acts?
Most states require the claim to be acknowledged within a set period from notice, commonly 10 to 15 working days, and then decided within a period after the proof of loss. Callvu records the notice time in every channel, classifies the loss into a unit of work with its due date, and sends the acknowledgment from the claims system inside the state's period. The claim shows the days left on each clock.
What must an insurer have before requesting an injured claimant's medical records?
A HIPAA authorization (45 CFR 164.508) that meets the state's medical records rules, signed by the injured person or their representative. Callvu captures that authorization on the claimant's phone before the first medical question is asked, and the claim cannot move to the injury adjuster without it. The Audit Trace shows the authorization, its time and what was requested under it.
How should an insurer handle a time-limited settlement demand that exceeds the adjuster's authority?
The demand's deadline goes on the case the moment it arrives, and the decision is due inside it with the policy's margin. Callvu builds the case from the claim, routes it to the approver the authority table names, and escalates by rule when a level does not act, so the deadline is never missed by silence. Under the unfair claims settlement practices acts and the state's bad faith law, the record of who decided what and when is the defense.
How Callvu runs it: Claim reserve and settlement authority approval
How many days of notice does a non-renewal require, and what must the notice say?
It depends on the state and the line, commonly thirty to sixty days before expiration under the state non-renewal notice rules, with the specific reasons, the effective date and the insured's rights. Callvu classifies the policy, sets the clock for its state, blocks a notice inside a catastrophe moratorium, and generates the notice with the state's content and proof of mailing from the underwriter's decision. A late notice is flagged before expiration so the policy can be renewed or re-noticed.
What are the dormancy periods and due diligence rules for unclaimed life insurance benefits?
Under the state unclaimed life insurance benefits acts, a death master file match must be confirmed and the beneficiary searched within ninety days; benefits are presumed abandoned commonly three years after knowledge of the death, with the due diligence letter sent sixty to one hundred eighty days before the state report. Callvu opens each match as a case, records every search step with its date and result, sends the letter in the window and files the report on the state's date.
How Callvu runs it: Unclaimed benefits and lost beneficiary search
What must an insurer check before releasing a claim payment to a claimant and a mortgagee?
Who the policy's loss payable and mortgage clauses put on the payment, each payee's bank details verified on their own screen, and OFAC screening of every payee at release, with a blocked payment reported within ten business days. Callvu collects and verifies the details, runs the screening, and pays inside the state's prompt payment period from acceptance, with the IRS information reporting produced from the record.
Enforcement runs through the whole insurance handoff
From the request to the system of record, with nobody re-keying.
Bring the process your auditors worry about most
We build it against your policies and the insurance systems you already run, train your team and stay with you through launch. You are live in weeks.