Salesforce / Use Cases / 05 · Adjuster agent declines coverage with a defensible action_ref

05 STANDARD Insurance

Adjuster agent declines coverage with a defensible action_ref

Every coverage denial mints a portable, signed receipt. Bad-faith plaintiffs see the full action_ref trail.

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01Scenario

A carrier's adjuster Agentforce agent updates a Case to Closed Without Pay. State insurance regulators and plaintiff's counsel may later contest the decision; the carrier needs a tamper-evident record of who decided what, when, and on what basis.

claim.deny.with_reason mints a receipt that includes the policy id, loss date, the adjuster agent's credential pill, and a SHA-256 reference to the denial-letter PDF. The receipt is jurisdiction-tagged (e.g. US-CA) so downstream verification respects state-specific bad-faith standards.

The insured or their counsel can pull a JSONL receipt from a regulatory filing and verify it offline. No login, no Salesforce, no callout. The Ed25519 signature is decisive.

02Handles

action_type: claim.deny.with_reason
handle: HiveReceiptMinter + Hive_Config__c jurisdiction
lands on: Case (Claim)
rail: STANDARD $0.50/receipt, Hive-billed

03APEX

Case claim = [SELECT Id, Policy_Id__c, Loss_Date__c, Account.Name,
                       Coverage_Code__c, Denial_Reason_Code__c, Adjuster__c
                FROM Case WHERE Id = :caseId];

Map<String, Object> payload = new Map<String, Object>{
  'policy_id'         => claim.Policy_Id__c,
  'loss_date'         => String.valueOf(claim.Loss_Date__c),
  'coverage_code'     => claim.Coverage_Code__c,
  'denial_reason'     => claim.Denial_Reason_Code__c,
  'denial_letter_hash'=> HiveHash.sha256Pdf(denialLetterAttachmentId),
  'adjuster_did'      => 'did:hive:0xAdjuster' + claim.Adjuster__c,
  'adjuster_license'  => adjusterLicenseNo,
  'state_review_within_days' => 30
};

Id receiptId = HiveReceiptMinter.mint(
  claim.Id,
  'claim.deny.with_reason',
  'did:hive:0xInsuredCounsel',
  'salesforce:case:' + claim.Id,
  payload
);

// receipt.Jurisdiction__c is set from Hive_Config__c (US-CA)

04Flow XML

<Flow xmlns="http://soap.sforce.com/2006/04/metadata">
    <processType>AutoLaunchedFlow</processType>
    <start>
        <object>Case</object>
        <recordTriggerType>UpdatedAndConditionMet</recordTriggerType>
        <filters>
            <field>Status</field>
            <value><stringValue>Closed Without Pay</stringValue></value>
        </filters>
        <triggerType>RecordAfterSave</triggerType>
        <connector><targetReference>mint_denial</targetReference></connector>
    </start>
    <actionCalls>
        <name>mint_denial</name>
        <actionName>HiveReceiptMinter</actionName>
        <actionType>apex</actionType>
    </actionCalls>
    <status>Active</status>
</Flow>

05The receipt that lands in Hive_Receipt__c

{
  "agent_id": "did:hive:0xAdjuster991",
  "counterparty_did": "did:hive:0xInsuredCounsel",
  "action_type": "claim.deny.with_reason",
  "scope": "salesforce:case:5001x000ABCDE",
  "action_ref": "sha256(...)",
  "payload_hash": "sha256:b7e2...0ca1",
  "signature": "ed25519:f3a4...2210",
  "timestamp_ms": 1716334100000,
  "jurisdiction": "US-CA",
  "verification_status": "VERIFIED"
}

06Verification

Plaintiff's counsel verifies the denial receipt offline

curl -sS https://hivemorph.onrender.com/v1/verify \
  -H 'content-type: application/json' \
  --data-binary @denial_receipt.json

# expected:
# {
#   "verified": true,
#   "adjuster_license_present": true,
#   "denial_letter_hash_matches": "sha256:b7e2...0ca1",
#   "jurisdiction": "US-CA"
# }

07Economics

Per-denial fee	$0.50
Free tier	100/mo
Carrier scale	Mid-size carrier ~5k denials/mo → $499/mo (capped)
Bad-faith defense	Each denial = one receipt = one signed, dated, portable record
Regulator pull	State insurance departments verify directly from JSONL

08Compliance and audit shape

Adjuster license number embedded in receipt (state-bar-style credential pill).
Denial letter hash binds the receipt to the exact PDF served to the insured.
Jurisdiction field drives state-specific verification rules (CA, NY, TX, FL).
Receipt survives any change to the underlying Case — the action_ref is immutable.
Unfair Claims Settlement Practices Act exposure: every denial event is now a signed record.

09Trust anchors

Every claim on this page is verifiable against these public constants. No login. No NDA.

Rail	STANDARD — $0.50/receipt, Hive-billed
Hive Ed25519 pubkey	`fd9d10abe60de7510c61ef649c8da598a519468dd2a2b827106d76487a899444`
Canonicalization	RFC 8785 JCS over the JSON receipt body
Signature algorithm	Ed25519 (RFC 8032)
Backend root	https://hivemorph.onrender.com
Verify any receipt	thehiveryiq.com/verify
MIT starter	thehiveryiq.com/salesforce/install
Billing	$0.50/receipt, 100/mo free, $499/mo cap. Square invoice or monthly ACH — buyer picks.
Pricing	thehiveryiq.com/pricing