policy: Insurance "Claim Auto-Approval" Limit Guard

[akarlaraytu]

📘 Context

A claims-processing AI assistant must enforce strict auto-approval limits and
fraud-flag escalation rules to prevent automated approval of suspicious or
out-of-scope claims that would otherwise require human adjuster review.

This policy acts as a deterministic gate before any auto-approval action,
ensuring fraud risk and policy-coverage edge cases get routed to humans.

🎯 The Goal

Write a claim auto-approval policy for an insurance AI assistant.

Variables you can use:

• claim_type (Enum): "AUTO", "HEALTH", "PROPERTY", "LIABILITY", "WORKERS_COMP".
• claim_amount_usd (Float): USD amount being claimed.
• policy_coverage_limit_usd (Float): Coverage cap for this policy.
• policyholder_tenure_years (Integer): Years policyholder has been with the company.
• prior_claims_12mo (Integer): Number of claims in the last 12 months.
• fraud_score (Integer): Fraud risk score 0-100.
• documentation_complete (Boolean): Whether all required docs are submitted.
• claim_within_policy_period (Boolean): Whether incident occurred during active coverage.
• adjuster_review_requested (Boolean): Whether an adjuster has flagged for review.

Requirements:

• BLOCK if claim_within_policy_period is False.
• BLOCK if claim_amount_usd > policy_coverage_limit_usd.
• BLOCK if fraud_score > 80.
• BLOCK if documentation_complete is False.
• BLOCK if claim_amount_usd > 5000 and adjuster_review_requested is False (auto-approval cap).
• ESCALATE if prior_claims_12mo > 3.
• ESCALATE if fraud_score > 50.
• ESCALATE if policyholder_tenure_years < 1 and claim_amount_usd > 1000.

📚 Resources

• Start here: docs/getting-started.md
• Check syntax: quickstart/01_hello_world.csl
• See how examples are structured: examples/community/

✅ Definition of Done

Submit a PR with: examples/community/insurance_claim_auto_approval.csl