How to build a Policy Q&A and Coverage Validation Agent
Lets users upload an insurance policy and instantly get clear, accurate answers to coverage questions based only on the document. It solves the problem of manually searching through lengthy, complex policies and reduces errors or delays in explaining coverage.
Challenge
Insurance policies are long, complex, and full of legal jargon, making it difficult and time-consuming to find clear answers about coverage.
Industry
Insurance
Department
Legal
Integrations
OpenAI
TL;DR
Upload insurance policies and ask coverage questions in natural language.
AI answers strictly based on the uploaded document, no external guesses.
Fast way to check inclusions, exclusions, and missing details.
Ensures consistent, compliant responses for both staff and customers.
Common Pain Points of Manual Checks
Policies are long, complex, and written in technical/legal jargon.
Customers and agents spend too much time searching for specific clauses.
Risk of misinterpretation or giving inaccurate answers.
Manual checks slow down onboarding, claims, and support processes.
Lack of standardization in how answers are delivered.
What the Agent Delivers
Clear, policy-based answers to coverage questions.
A workflow that requires no legal expertise to operate.
Consistent responses across different users and cases.
Fast triage for whether coverage applies or is missing.
Flexible integration with other systems (CRM, portals, email).
Step-by-Step Flow
Step | Node Name | Purpose & Functionality |
|---|---|---|
1 | Files | Users upload insurance policy documents (PDF, DOCX, etc.). The node extracts and processes the text. |
2 | Text Input | Users type in a question about their policy (e.g., “Is flood damage covered?”). |
3 | OpenAI | The AI receives both the policy text and the user’s question. It answers using only the uploaded policy. |
4 | Output | The AI’s answer is displayed to the user. |
1. Files Node
Role: Entry point for uploading and processing policy documents.
What it does: Extracts text from files, making it usable for the AI.
2. Text Input Node
Role: User’s interface for questions.
What it does: Captures the user’s question about the policy.
3. OpenAI Node
Role: Core reasoning engine.
What it does:
Receives both the uploaded text and the user’s question.
Uses this prompt:
Responds strictly based on the uploaded policy.
4. Output Node
Role: Displays the AI’s answer.
What it does: Presents a clean response back to the user.
