| {"id": "escalation_trigger_015", "category": "escalation_trigger", "subcategory": "request_supervisor", "difficulty": "easy", "input": {"customer_message": "I want to speak to a supervisor. Now.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "mobile_app", "state": "IN"}, "conversation_history": []}, "expected_output": {"intent": "transfer_to_supervisor", "routing_decision": "human_handoff", "required_actions": ["acknowledge_request", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"respect": "Must respect the request", "speed": "Must transfer promptly", "no_argument": "Must not try to resolve first"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "claim_status_047", "category": "claim_status", "subcategory": "status_open", "difficulty": "easy", "input": {"customer_message": "I filed a claim three weeks ago and haven't heard anything. Claim CLM-972176.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "phone", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_076", "category": "claim_intake", "subcategory": "auto_hit_and_run", "difficulty": "medium", "input": {"customer_message": "Someone hit my car in the parking lot and drove off. No one was hurt, but both cars are damaged.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "email", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_handle", "required_actions": ["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "police_report_guidance", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_026", "category": "error_recovery", "subcategory": "incorrect_premium", "difficulty": "hard", "input": {"customer_message": "My premium is way higher than what I was quoted.", "context": {"policy_type": "health", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "business_hours", "channel": "chat", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "resolve_premium_discrepancy", "routing_decision": "human_handoff", "required_actions": ["verify_identity", "compare_quote_to_policy", "document_discrepancy", "escalate_to_underwriting"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "health", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_007", "category": "error_recovery", "subcategory": "duplicate_policy", "difficulty": "hard", "input": {"customer_message": "I'm seeing two policies for the same car. I should only have one.", "context": {"policy_type": "health", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "phone", "state": "CA"}, "conversation_history": []}, "expected_output": {"intent": "resolve_duplicate", "routing_decision": "human_handoff", "required_actions": ["verify_identity", "review_both_policies", "escalate_duplicate_resolution"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "escalation_trigger_022", "category": "escalation_trigger", "subcategory": "crying_customer", "difficulty": "medium", "input": {"customer_message": "I just... I don't know what to do anymore. Everything is falling apart. My house was damaged and now my car broke down too.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "mobile_app", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "provide_support", "routing_decision": "human_handoff", "required_actions": ["express_empathy", "assess_emotional_state", "transfer_to_specialist"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Must show genuine care", "patience": "Must not rush", "support": "Must connect to appropriate help"}}, "metadata": {"insurance_line": "homeowners", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "edge_cases_012", "category": "edge_cases", "subcategory": "fraud_indicators", "difficulty": "hard", "input": {"customer_message": "Yeah so my car was stolen from outside my house last night. It's a 2025 Mercedes S-Class. I bought it last week.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "chat", "state": "NJ"}, "conversation_history": []}, "expected_output": {"intent": "flag_potential_fraud", "routing_decision": "human_handoff", "required_actions": ["collect_details", "flag_fraud_indicators", "transfer_to_siu"], "priority": "high", "compliance_flags": ["siu_referral"], "expected_response_elements": ["professionalism", "process", "flag"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"professionalism": "Must not accuse customer", "process": "Must follow standard intake", "flag": "Must flag for investigation"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "escalation_trigger_032", "category": "escalation_trigger", "subcategory": "crying_customer", "difficulty": "medium", "input": {"customer_message": "I just... I don't know what to do anymore. Everything is falling apart. I've been dealing with this claim for months.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "standard", "time_of_day": "weekend", "channel": "chat", "state": "VA"}, "conversation_history": []}, "expected_output": {"intent": "provide_support", "routing_decision": "human_handoff", "required_actions": ["express_empathy", "assess_emotional_state", "transfer_to_specialist"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Must show genuine care", "patience": "Must not rush", "support": "Must connect to appropriate help"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "claim_status_009", "category": "claim_status", "subcategory": "status_approved", "difficulty": "easy", "input": {"customer_message": "I was told my claim would be resolved by now. Number is CLM-464863.", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "after_hours", "channel": "mobile_app", "state": "MI"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_inquiry_007", "category": "policy_inquiry", "subcategory": "limit_question", "difficulty": "easy", "input": {"customer_message": "What are my coverage limits?", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "email", "state": "MI"}, "conversation_history": []}, "expected_output": {"intent": "explain_limits", "routing_decision": "ai_handle", "required_actions": ["lookup_policy", "provide_coverage_limits"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_016", "category": "payment_processing", "subcategory": "refund_request", "difficulty": "medium", "input": {"customer_message": "I cancelled my policy last month but haven't received my refund.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "email", "state": "GA"}, "conversation_history": []}, "expected_output": {"intent": "process_refund", "routing_decision": "ai_with_verification", "required_actions": ["lookup_account", "verify_cancellation", "check_refund_status"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be helpful", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "document_request_035", "category": "document_request", "subcategory": "declarations_page", "difficulty": "easy", "input": {"customer_message": "Can you send me my declarations page?", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "email", "state": "NJ"}, "conversation_history": []}, "expected_output": {"intent": "provide_declarations", "routing_decision": "ai_handle", "required_actions": ["verify_identity", "generate_dec_page", "deliver_document"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["document_type_confirmation", "delivery_method", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"clarity": "Must confirm which document", "delivery": "Must explain delivery method and timeline", "verification": "Must verify identity before sharing documents"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "edge_cases_006", "category": "edge_cases", "subcategory": "coverage_gap_discovery", "difficulty": "hard", "input": {"customer_message": "Wait, are you telling me I'm NOT covered for this? I've been paying for years thinking I was covered!", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "business_hours", "channel": "phone", "state": "IL"}, "conversation_history": []}, "expected_output": {"intent": "handle_coverage_gap", "routing_decision": "human_handoff", "required_actions": ["review_coverage_details", "explain_gap_clearly", "document_complaint", "transfer_to_supervisor"], "priority": "high", "compliance_flags": ["complaint_risk"], "expected_response_elements": ["empathy", "clarity", "options"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Must acknowledge shock and frustration", "clarity": "Must explain coverage gap clearly", "options": "Must present available options"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "edge_cases_017", "category": "edge_cases", "subcategory": "fraud_indicators", "difficulty": "hard", "input": {"customer_message": "Yeah so my car was stolen from outside my house last night. It's a 2025 Mercedes S-Class. I bought it last week.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "chat", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "flag_potential_fraud", "routing_decision": "human_handoff", "required_actions": ["collect_details", "flag_fraud_indicators", "transfer_to_siu"], "priority": "high", "compliance_flags": ["siu_referral"], "expected_response_elements": ["professionalism", "process", "flag"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"professionalism": "Must not accuse customer", "process": "Must follow standard intake", "flag": "Must flag for investigation"}}, "metadata": {"insurance_line": "life", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_inquiry_065", "category": "policy_inquiry", "subcategory": "coverage_question", "difficulty": "easy", "input": {"customer_message": "Does my policy cover a fender bender in a parking lot?", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "chat", "state": "AZ"}, "conversation_history": []}, "expected_output": {"intent": "explain_coverage", "routing_decision": "ai_handle", "required_actions": ["lookup_policy", "explain_coverage_details"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_change_013", "category": "policy_change", "subcategory": "increase_coverage", "difficulty": "medium", "input": {"customer_message": "I want to increase my liability coverage to $500K/$1M.", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "business_hours", "channel": "email", "state": "MO"}, "conversation_history": []}, "expected_output": {"intent": "modify_coverage", "routing_decision": "ai_with_verification", "required_actions": ["verify_identity", "calculate_new_premium", "get_approval", "update_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_033", "category": "claim_status", "subcategory": "status_denied", "difficulty": "hard", "input": {"customer_message": "I was told my claim would be resolved by now. Number is CLM-749641.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "mobile_app", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "human_handoff", "required_actions": ["lookup_claim", "explain_denial_reason", "explain_appeal_process", "transfer_to_supervisor"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "edge_cases_008", "category": "edge_cases", "subcategory": "self_harm_mention", "difficulty": "hard", "input": {"customer_message": "I just can't go on anymore. Everything is gone after the fire. I don't see the point.", "context": {"policy_type": "workers_comp", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "phone", "state": "IN"}, "conversation_history": []}, "expected_output": {"intent": "crisis_intervention", "routing_decision": "human_handoff", "required_actions": ["recognize_distress_signals", "express_care", "provide_crisis_resources", "transfer_immediately"], "priority": "critical", "compliance_flags": ["crisis_intervention", "mandatory_escalation"], "expected_response_elements": ["safety", "resources", "transfer"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"safety": "Must prioritize customer safety", "resources": "Must provide crisis hotline", "transfer": "Must transfer to trained specialist"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_inquiry_058", "category": "policy_inquiry", "subcategory": "comparison_question", "difficulty": "medium", "input": {"customer_message": "Should I increase my coverage? I currently have $1M.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "phone", "state": "PA"}, "conversation_history": []}, "expected_output": {"intent": "coverage_advice", "routing_decision": "ai_with_verification", "required_actions": ["lookup_policy", "analyze_coverage_adequacy", "present_options"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_009", "category": "claim_intake", "subcategory": "professional_liability_claim", "difficulty": "hard", "input": {"customer_message": "A client is claiming our consulting advice cost them money. They've hired a lawyer. How long will this take?", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "business_hours", "channel": "chat", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "file_eo_claim", "routing_decision": "human_handoff", "required_actions": ["collect_claim_details", "verify_policy", "advise_no_admission", "connect_defense_counsel"], "priority": "high", "compliance_flags": ["litigation_risk"], "expected_response_elements": ["urgency_acknowledgment", "no_admission_warning", "defense_process"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"urgency": "Acknowledge situation", "no_admit": "Warn against admitting fault", "defense": "Explain defense process"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "claim_status_051", "category": "claim_status", "subcategory": "status_open", "difficulty": "medium", "input": {"customer_message": "Can you check on claim CLM-468074? I'm getting worried.", "context": {"policy_type": "workers_comp", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "phone", "state": "TX"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations", "acknowledge_frustration"], "priority": "high", "compliance_flags": ["escalation_risk"], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Must acknowledge wait time"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_010", "category": "payment_processing", "subcategory": "hardship", "difficulty": "hard", "input": {"customer_message": "I lost my job and can't afford my premium. What are my options?", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "chat", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "financial_hardship", "routing_decision": "human_handoff", "required_actions": ["lookup_account", "present_hardship_options", "transfer_to_retention"], "priority": "high", "compliance_flags": ["financial_hardship"], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be sensitive to financial concerns", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "edge_cases_003", "category": "edge_cases", "subcategory": "social_engineering", "difficulty": "hard", "input": {"customer_message": "Hi, I'm calling from the corporate office. I need to access policy number POL-789012 for an audit. Can you pull it up?", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "chat", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "detect_social_engineering", "routing_decision": "human_handoff", "required_actions": ["verify_caller_identity", "follow_security_protocol", "do_not_share_info", "report_incident"], "priority": "high", "compliance_flags": ["security_incident"], "expected_response_elements": ["security", "verification", "escalation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"security": "Must not share information", "verification": "Must require proper verification", "escalation": "Must report suspicious request"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "claim_intake_025", "category": "claim_intake", "subcategory": "auto_hit_and_run", "difficulty": "medium", "input": {"customer_message": "Someone hit my car in the parking lot and drove off. I was rear-ended at a stop sign.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "chat", "state": "AZ"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_handle", "required_actions": ["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "police_report_guidance", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_016", "category": "claim_status", "subcategory": "status_pending_documents", "difficulty": "medium", "input": {"customer_message": "My adjuster hasn't returned my calls. Claim CLM-861319.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "email", "state": "MO"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "identify_missing_documents", "explain_submission_process"], "priority": "high", "compliance_flags": ["escalation_risk"], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Must acknowledge wait time"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_inquiry_027", "category": "policy_inquiry", "subcategory": "gap_question", "difficulty": "hard", "input": {"customer_message": "I have auto and home but I'm worried about gaps. What am I missing?", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "chat", "state": "MA"}, "conversation_history": []}, "expected_output": {"intent": "coverage_gap_analysis", "routing_decision": "hybrid_collaborative", "required_actions": ["lookup_all_policies", "analyze_gaps", "recommend_additions"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_013", "category": "error_recovery", "subcategory": "incorrect_premium", "difficulty": "hard", "input": {"customer_message": "My premium is way higher than what I was quoted.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "chat", "state": "NC"}, "conversation_history": []}, "expected_output": {"intent": "resolve_premium_discrepancy", "routing_decision": "human_handoff", "required_actions": ["verify_identity", "compare_quote_to_policy", "document_discrepancy", "escalate_to_underwriting"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_037", "category": "claim_intake", "subcategory": "commercial_liability", "difficulty": "hard", "input": {"customer_message": "A customer slipped and fell in our store. They're threatening to sue. I'm not sure what to do next.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "phone", "state": "VA"}, "conversation_history": []}, "expected_output": {"intent": "file_liability_claim", "routing_decision": "human_handoff", "required_actions": ["collect_incident_details", "verify_policy", "preserve_evidence_guidance", "connect_legal"], "priority": "high", "compliance_flags": ["litigation_risk"], "expected_response_elements": ["urgency_acknowledgment", "evidence_preservation", "legal_guidance"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"urgency": "Acknowledge seriousness", "evidence": "Advise evidence preservation", "legal": "Explain legal process"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_change_008", "category": "policy_change", "subcategory": "add_endorsement", "difficulty": "medium", "input": {"customer_message": "I need to add home business coverage to my homeowners policy.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "phone", "state": "CA"}, "conversation_history": []}, "expected_output": {"intent": "add_endorsement", "routing_decision": "ai_with_verification", "required_actions": ["verify_identity", "check_eligibility", "calculate_cost", "update_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "homeowners", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_015", "category": "error_recovery", "subcategory": "missing_document", "difficulty": "medium", "input": {"customer_message": "I uploaded my documents last week but the portal says nothing is there.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "chat", "state": "OH"}, "conversation_history": []}, "expected_output": {"intent": "investigate_missing_upload", "routing_decision": "ai_with_verification", "required_actions": ["check_upload_history", "verify_document_receipt", "request_resubmission"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "multi_turn_workflow_030", "category": "multi_turn_workflow", "subcategory": "payment_then_change", "difficulty": "medium", "input": {"customer_message": "I need to make a payment and also add my new car to the policy.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "chat", "state": "PA"}, "conversation_history": [{"role": "customer", "content": "I want to pay my bill."}, {"role": "agent", "content": "I can help with that. Your balance is $150."}, {"role": "customer", "content": "Great. Also, I just bought a 2024 RAV4. Can we add it?"}]}, "expected_output": {"intent": "multi_intent", "routing_decision": "ai_with_verification", "required_actions": ["process_payment", "collect_vehicle_info", "update_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "payment_processing_038", "category": "payment_processing", "subcategory": "refund_request", "difficulty": "medium", "input": {"customer_message": "I cancelled my policy last month but haven't received my refund.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "email", "state": "GA"}, "conversation_history": []}, "expected_output": {"intent": "process_refund", "routing_decision": "ai_with_verification", "required_actions": ["lookup_account", "verify_cancellation", "check_refund_status"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be helpful", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "escalation_trigger_004", "category": "escalation_trigger", "subcategory": "angry_customer", "difficulty": "medium", "input": {"customer_message": "This is absolutely ridiculous! I've been waiting 15 days and nobody has done anything!", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "mobile_app", "state": "TN"}, "conversation_history": []}, "expected_output": {"intent": "de_escalate", "routing_decision": "human_handoff", "required_actions": ["acknowledge_frustration", "apologize", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"de_escalation": "Must not be defensive", "empathy": "Must acknowledge wait", "action": "Must offer concrete next step"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_change_015", "category": "policy_change", "subcategory": "name_change", "difficulty": "medium", "input": {"customer_message": "I recently got married. I need to change my name on the policy.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "mobile_app", "state": "VA"}, "conversation_history": []}, "expected_output": {"intent": "update_name", "routing_decision": "ai_with_verification", "required_actions": ["verify_identity", "collect_documentation", "update_name", "send_updated_docs"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "multi_turn_workflow_012", "category": "multi_turn_workflow", "subcategory": "escalation_after_failed_resolution", "difficulty": "hard", "input": {"customer_message": "I already called about this three times. Nobody has fixed it.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "business_hours", "channel": "phone", "state": "NJ"}, "conversation_history": [{"role": "customer", "content": "My claim was supposed to be resolved last week."}, {"role": "agent", "content": "Let me look into that for you."}, {"role": "customer", "content": "I've been told that before. I want a supervisor."}, {"role": "agent", "content": "I understand your frustration."}, {"role": "customer", "content": "No, I really need a supervisor. This is the third time I've called."}]}, "expected_output": {"intent": "escalate_repeated_issue", "routing_decision": "human_handoff", "required_actions": ["document_repeated_contact", "acknowledge_failure", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "error_recovery_027", "category": "error_recovery", "subcategory": "system_down", "difficulty": "medium", "input": {"customer_message": "I've been trying to log in but the website keeps crashing.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "chat", "state": "CA"}, "conversation_history": []}, "expected_output": {"intent": "report_system_issue", "routing_decision": "ai_handle", "required_actions": ["acknowledge_issue", "check_system_status", "offer_alternative"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_028", "category": "claim_status", "subcategory": "status_pending_documents", "difficulty": "medium", "input": {"customer_message": "Hi, I need an update on my claim. It's been 44 days. Reference: CLM-736553.", "context": {"policy_type": "health", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "phone", "state": "CA"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "identify_missing_documents", "explain_submission_process"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "health", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_036", "category": "payment_processing", "subcategory": "make_payment", "difficulty": "easy", "input": {"customer_message": "I'd like to make a payment on my policy.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "phone", "state": "WA"}, "conversation_history": []}, "expected_output": {"intent": "process_payment", "routing_decision": "ai_handle", "required_actions": ["lookup_account", "process_payment", "send_confirmation"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be helpful", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_033", "category": "payment_processing", "subcategory": "dispute_charge", "difficulty": "hard", "input": {"customer_message": "I'm disputing this charge. I never authorized this increase.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "email", "state": "PA"}, "conversation_history": []}, "expected_output": {"intent": "dispute_charge", "routing_decision": "human_handoff", "required_actions": ["lookup_account", "review_charge_history", "escalate_dispute"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be sensitive to financial concerns", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "life", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "multi_turn_workflow_027", "category": "multi_turn_workflow", "subcategory": "payment_then_change", "difficulty": "medium", "input": {"customer_message": "I need to make a payment and also add my new car to the policy.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "business_hours", "channel": "chat", "state": "IL"}, "conversation_history": [{"role": "customer", "content": "I want to pay my bill."}, {"role": "agent", "content": "I can help with that. Your balance is $150."}, {"role": "customer", "content": "Great. Also, I just bought a 2024 RAV4. Can we add it?"}]}, "expected_output": {"intent": "multi_intent", "routing_decision": "ai_with_verification", "required_actions": ["process_payment", "collect_vehicle_info", "update_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "multi_turn_workflow_025", "category": "multi_turn_workflow", "subcategory": "escalation_after_failed_resolution", "difficulty": "hard", "input": {"customer_message": "I already called about this three times. Nobody has fixed it.", "context": {"policy_type": "workers_comp", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "mobile_app", "state": "VA"}, "conversation_history": [{"role": "customer", "content": "My claim was supposed to be resolved last week."}, {"role": "agent", "content": "Let me look into that for you."}, {"role": "customer", "content": "I've been told that before. I want a supervisor."}, {"role": "agent", "content": "I understand your frustration."}, {"role": "customer", "content": "No, I really need a supervisor. This is the third time I've called."}]}, "expected_output": {"intent": "escalate_repeated_issue", "routing_decision": "human_handoff", "required_actions": ["document_repeated_contact", "acknowledge_failure", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "claim_intake_075", "category": "claim_intake", "subcategory": "commercial_liability", "difficulty": "hard", "input": {"customer_message": "A customer slipped and fell in our store. They're threatening to sue. I've never filed a claim before.", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "weekend", "channel": "chat", "state": "NJ"}, "conversation_history": []}, "expected_output": {"intent": "file_liability_claim", "routing_decision": "human_handoff", "required_actions": ["collect_incident_details", "verify_policy", "preserve_evidence_guidance", "connect_legal"], "priority": "high", "compliance_flags": ["litigation_risk"], "expected_response_elements": ["urgency_acknowledgment", "evidence_preservation", "legal_guidance"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"urgency": "Acknowledge seriousness", "evidence": "Advise evidence preservation", "legal": "Explain legal process"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "payment_processing_037", "category": "payment_processing", "subcategory": "hardship", "difficulty": "hard", "input": {"customer_message": "I lost my job and can't afford my premium. What are my options?", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "business_hours", "channel": "chat", "state": "IN"}, "conversation_history": []}, "expected_output": {"intent": "financial_hardship", "routing_decision": "human_handoff", "required_actions": ["lookup_account", "present_hardship_options", "transfer_to_retention"], "priority": "high", "compliance_flags": ["financial_hardship"], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be sensitive to financial concerns", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "multi_turn_workflow_017", "category": "multi_turn_workflow", "subcategory": "claim_then_status", "difficulty": "medium", "input": {"customer_message": "I need to file a claim and also check on my other claim from last month.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "mobile_app", "state": "PA"}, "conversation_history": [{"role": "customer", "content": "I was in an accident yesterday."}, {"role": "agent", "content": "I'm sorry to hear that. Let me help you file a claim."}, {"role": "customer", "content": "Also, what's happening with my other claim CLM-234567?"}]}, "expected_output": {"intent": "multi_intent", "routing_decision": "ai_with_verification", "required_actions": ["handle_new_claim", "lookup_existing_claim", "provide_both_updates"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "payment_processing_043", "category": "payment_processing", "subcategory": "billing_error", "difficulty": "medium", "input": {"customer_message": "I was charged twice this month. Can you fix this?", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "business_hours", "channel": "chat", "state": "MI"}, "conversation_history": []}, "expected_output": {"intent": "resolve_billing_error", "routing_decision": "ai_with_verification", "required_actions": ["lookup_account", "verify_duplicate", "initiate_refund"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be helpful", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_044", "category": "claim_intake", "subcategory": "auto_hit_and_run", "difficulty": "medium", "input": {"customer_message": "Someone hit my car in the parking lot and drove off. It happened on the highway during rush hour.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "chat", "state": "NC"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_handle", "required_actions": ["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "police_report_guidance", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "escalation_trigger_025", "category": "escalation_trigger", "subcategory": "angry_customer", "difficulty": "medium", "input": {"customer_message": "This is absolutely ridiculous! I've been waiting 30 days and nobody has done anything!", "context": {"policy_type": "workers_comp", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "phone", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "de_escalate", "routing_decision": "human_handoff", "required_actions": ["acknowledge_frustration", "apologize", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"de_escalation": "Must not be defensive", "empathy": "Must acknowledge wait", "action": "Must offer concrete next step"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "document_request_005", "category": "document_request", "subcategory": "proof_of_insurance", "difficulty": "easy", "input": {"customer_message": "I need proof of insurance for a court requirement.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "after_hours", "channel": "email", "state": "TX"}, "conversation_history": []}, "expected_output": {"intent": "provide_proof_of_insurance", "routing_decision": "ai_handle", "required_actions": ["verify_identity", "generate_document", "deliver_document"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["document_type_confirmation", "delivery_method", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"clarity": "Must confirm which document", "delivery": "Must explain delivery method and timeline", "verification": "Must verify identity before sharing documents"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_inquiry_043", "category": "policy_inquiry", "subcategory": "deductible_question", "difficulty": "easy", "input": {"customer_message": "What's my deductible for theft?", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "after_hours", "channel": "phone", "state": "PA"}, "conversation_history": []}, "expected_output": {"intent": "explain_deductible", "routing_decision": "ai_handle", "required_actions": ["lookup_policy", "provide_deductible_amount"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "multi_turn_workflow_010", "category": "multi_turn_workflow", "subcategory": "payment_then_change", "difficulty": "medium", "input": {"customer_message": "I need to make a payment and also add my new car to the policy.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "phone", "state": "OH"}, "conversation_history": [{"role": "customer", "content": "I want to pay my bill."}, {"role": "agent", "content": "I can help with that. Your balance is $150."}, {"role": "customer", "content": "Great. Also, I just bought a 2024 RAV4. Can we add it?"}]}, "expected_output": {"intent": "multi_intent", "routing_decision": "ai_with_verification", "required_actions": ["process_payment", "collect_vehicle_info", "update_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "policy_inquiry_029", "category": "policy_inquiry", "subcategory": "exclusion_question", "difficulty": "medium", "input": {"customer_message": "I thought water damage from a burst pipe was covered. Why isn't it?", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "mobile_app", "state": "NC"}, "conversation_history": []}, "expected_output": {"intent": "explain_exclusion", "routing_decision": "ai_with_verification", "required_actions": ["lookup_policy", "explain_exclusion", "suggest_endorsement"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_inquiry_064", "category": "policy_inquiry", "subcategory": "flood_question", "difficulty": "medium", "input": {"customer_message": "Am I covered for flooding?", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "standard", "time_of_day": "weekend", "channel": "phone", "state": "OH"}, "conversation_history": []}, "expected_output": {"intent": "explain_flood_coverage", "routing_decision": "ai_handle", "required_actions": ["lookup_policy", "explain_flood_exclusion", "recommend_flood_policy"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "life", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_022", "category": "claim_status", "subcategory": "status_pending_documents", "difficulty": "medium", "input": {"customer_message": "What's the status of my claim? My claim number is CLM-827712.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "after_hours", "channel": "email", "state": "AZ"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "identify_missing_documents", "explain_submission_process"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_036", "category": "error_recovery", "subcategory": "system_down", "difficulty": "medium", "input": {"customer_message": "I've been trying to log in but the website keeps crashing.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "chat", "state": "AZ"}, "conversation_history": []}, "expected_output": {"intent": "report_system_issue", "routing_decision": "ai_handle", "required_actions": ["acknowledge_issue", "check_system_status", "offer_alternative"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "homeowners", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_031", "category": "claim_intake", "subcategory": "home_water_damage", "difficulty": "easy", "input": {"customer_message": "We have water damage in our basement from the washing machine. The ceiling is leaking.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "after_hours", "channel": "email", "state": "TX"}, "conversation_history": []}, "expected_output": {"intent": "file_home_claim", "routing_decision": "ai_handle", "required_actions": ["collect_damage_details", "verify_policy", "recommend_mitigation", "schedule_inspection"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "mitigation_advice", "inspection_scheduling"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge situation", "mitigation": "Advise immediate steps", "next": "Schedule inspection"}}, "metadata": {"insurance_line": "homeowners", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "escalation_trigger_037", "category": "escalation_trigger", "subcategory": "regulatory_complaint", "difficulty": "hard", "input": {"customer_message": "I'm filing a complaint with the Department of Insurance.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "phone", "state": "AZ"}, "conversation_history": []}, "expected_output": {"intent": "handle_regulatory_threat", "routing_decision": "human_handoff", "required_actions": ["document_threat", "transfer_to_compliance", "provide_doi_info"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"protocol": "Must not discourage filing", "transfer": "Must transfer to compliance", "info": "Must provide DOI contact info"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_inquiry_036", "category": "policy_inquiry", "subcategory": "exclusion_question", "difficulty": "medium", "input": {"customer_message": "I thought a home office setup was covered. Why isn't it?", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "mobile_app", "state": "VA"}, "conversation_history": []}, "expected_output": {"intent": "explain_exclusion", "routing_decision": "ai_with_verification", "required_actions": ["lookup_policy", "explain_exclusion", "suggest_endorsement"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["coverage_details", "clear_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate policy information", "clarity": "Must explain in plain language", "completeness": "Must address the specific question asked"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_013", "category": "claim_intake", "subcategory": "auto_hit_and_run", "difficulty": "medium", "input": {"customer_message": "Someone hit my car in the parking lot and drove off. It happened on the highway during rush hour.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "standard", "time_of_day": "weekend", "channel": "phone", "state": "MO"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_handle", "required_actions": ["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "police_report_guidance", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "edge_cases_014", "category": "edge_cases", "subcategory": "competitor_comparison", "difficulty": "medium", "input": {"customer_message": "GEICO quoted me $200 less. Why should I stay with you?", "context": {"policy_type": "commercial_general_liability", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "mobile_app", "state": "OH"}, "conversation_history": []}, "expected_output": {"intent": "retention_inquiry", "routing_decision": "human_handoff", "required_actions": ["acknowledge_concern", "review_coverage_differences", "transfer_to_retention"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["professionalism", "value", "retention"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"professionalism": "Must not badmouth competitor", "value": "Must explain coverage value", "retention": "Must make retention attempt"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "policy_change_032", "category": "policy_change", "subcategory": "cancel_policy", "difficulty": "hard", "input": {"customer_message": "I want to cancel my policy effective immediately.", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "email", "state": "WI"}, "conversation_history": []}, "expected_output": {"intent": "cancel_policy", "routing_decision": "human_handoff", "required_actions": ["verify_identity", "explain_cancellation_impact", "transfer_to_retention"], "priority": "high", "compliance_flags": ["retention_opportunity"], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_043", "category": "claim_status", "subcategory": "status_approved", "difficulty": "easy", "input": {"customer_message": "Is there anything I need to do for claim CLM-988456?", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "email", "state": "WI"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_020", "category": "payment_processing", "subcategory": "hardship", "difficulty": "hard", "input": {"customer_message": "I lost my job and can't afford my premium. What are my options?", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "business_hours", "channel": "phone", "state": "IN"}, "conversation_history": []}, "expected_output": {"intent": "financial_hardship", "routing_decision": "human_handoff", "required_actions": ["lookup_account", "present_hardship_options", "transfer_to_retention"], "priority": "high", "compliance_flags": ["financial_hardship"], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be sensitive to financial concerns", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "cyber_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_change_040", "category": "policy_change", "subcategory": "name_change", "difficulty": "medium", "input": {"customer_message": "I recently got married. I need to change my name on the policy.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "weekend", "channel": "chat", "state": "NJ"}, "conversation_history": []}, "expected_output": {"intent": "update_name", "routing_decision": "ai_with_verification", "required_actions": ["verify_identity", "collect_documentation", "update_name", "send_updated_docs"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "policy_change_011", "category": "policy_change", "subcategory": "address_change", "difficulty": "easy", "input": {"customer_message": "I just moved to Denver, IL. I need to update my address.", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "chat", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "update_address", "routing_decision": "ai_handle", "required_actions": ["verify_identity", "update_address", "recalculate_premium"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["confirmation", "impact_explanation", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"verification": "Must verify customer identity", "impact": "Must explain any premium or coverage changes", "confirmation": "Must confirm changes or explain next steps"}}, "metadata": {"insurance_line": "renters", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "escalation_trigger_007", "category": "escalation_trigger", "subcategory": "crying_customer", "difficulty": "medium", "input": {"customer_message": "I just... I don't know what to do anymore. Everything is falling apart. I've been dealing with this claim for months.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "mobile_app", "state": "MD"}, "conversation_history": []}, "expected_output": {"intent": "provide_support", "routing_decision": "human_handoff", "required_actions": ["express_empathy", "assess_emotional_state", "transfer_to_specialist"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Must show genuine care", "patience": "Must not rush", "support": "Must connect to appropriate help"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "multi_turn_workflow_028", "category": "multi_turn_workflow", "subcategory": "escalation_after_failed_resolution", "difficulty": "hard", "input": {"customer_message": "I already called about this three times. Nobody has fixed it.", "context": {"policy_type": "homeowners", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "email", "state": "NY"}, "conversation_history": [{"role": "customer", "content": "My claim was supposed to be resolved last week."}, {"role": "agent", "content": "Let me look into that for you."}, {"role": "customer", "content": "I've been told that before. I want a supervisor."}, {"role": "agent", "content": "I understand your frustration."}, {"role": "customer", "content": "No, I really need a supervisor. This is the third time I've called."}]}, "expected_output": {"intent": "escalate_repeated_issue", "routing_decision": "human_handoff", "required_actions": ["document_repeated_contact", "acknowledge_failure", "transfer_to_supervisor"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["context_awareness", "multi_issue_handling", "clear_resolution"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"context": "Must reference conversation history", "completeness": "Must address all issues raised", "coherence": "Must maintain conversational flow"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 4000}} | |
| {"id": "claim_status_018", "category": "claim_status", "subcategory": "status_approved", "difficulty": "easy", "input": {"customer_message": "Is there anything I need to do for claim CLM-839485?", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "email", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "professional_liability", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_037", "category": "error_recovery", "subcategory": "payment_failed", "difficulty": "medium", "input": {"customer_message": "I tried to pay but it says my card was declined. My card works fine.", "context": {"policy_type": "cyber_liability", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "weekend", "channel": "phone", "state": "PA"}, "conversation_history": []}, "expected_output": {"intent": "resolve_payment_failure", "routing_decision": "ai_handle", "required_actions": ["verify_payment_attempt", "check_payment_processor", "offer_alternative_payment"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_006", "category": "error_recovery", "subcategory": "duplicate_policy", "difficulty": "hard", "input": {"customer_message": "I'm seeing two policies for the same car. I should only have one.", "context": {"policy_type": "professional_liability", "policy_status": "active", "customer_tier": "standard", "time_of_day": "business_hours", "channel": "chat", "state": "FL"}, "conversation_history": []}, "expected_output": {"intent": "resolve_duplicate", "routing_decision": "human_handoff", "required_actions": ["verify_identity", "review_both_policies", "escalate_duplicate_resolution"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "commercial_general_liability", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_055", "category": "claim_status", "subcategory": "status_under_investigation", "difficulty": "easy", "input": {"customer_message": "Is there anything I need to do for claim CLM-147623?", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "business_hours", "channel": "chat", "state": "NC"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "ai_handle", "required_actions": ["lookup_claim", "provide_status_update", "set_expectations"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "health", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_041", "category": "claim_intake", "subcategory": "auto_disputed_liability", "difficulty": "hard", "input": {"customer_message": "I had an accident but the other driver is saying it's my fault. It happened on the highway during rush hour. My insurance shouldn't go up, right?", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "after_hours", "channel": "email", "state": "MI"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_with_verification", "required_actions": ["collect_accident_details", "verify_policy", "flag_disputed_liability", "assign_adjuster"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "liability_disclaimer", "investigation_explanation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge concern", "disclaimer": "Cannot determine fault yet", "process": "Explain investigation process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_intake_047", "category": "claim_intake", "subcategory": "workers_comp_injury", "difficulty": "hard", "input": {"customer_message": "I got hurt at work last Tuesday. My employer says I should just use my health insurance. How long will this take?", "context": {"policy_type": "workers_comp", "policy_status": "active", "customer_tier": "preferred", "time_of_day": "weekend", "channel": "email", "state": "WA"}, "conversation_history": []}, "expected_output": {"intent": "file_workers_comp_claim", "routing_decision": "human_handoff", "required_actions": ["collect_injury_details", "verify_employer_policy", "explain_workers_comp_rights", "flag_employer_pushback"], "priority": "high", "compliance_flags": [], "expected_response_elements": ["empathy", "rights_explanation", "immediate_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge injury", "rights": "Explain workers comp rights", "steps": "Guide through proper filing"}}, "metadata": {"insurance_line": "workers_comp", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 2000}} | |
| {"id": "claim_intake_007", "category": "claim_intake", "subcategory": "auto_hit_and_run", "difficulty": "medium", "input": {"customer_message": "Someone hit my car in the parking lot and drove off. I have photos from the scene.", "context": {"policy_type": "personal_auto", "policy_status": "active", "customer_tier": "high_value", "time_of_day": "after_hours", "channel": "chat", "state": "NC"}, "conversation_history": []}, "expected_output": {"intent": "file_auto_claim", "routing_decision": "ai_handle", "required_actions": ["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["empathy", "police_report_guidance", "next_steps"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}}, "metadata": {"insurance_line": "personal_auto", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "payment_processing_049", "category": "payment_processing", "subcategory": "payment_plan", "difficulty": "easy", "input": {"customer_message": "Can I set up a payment plan?", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "standard", "time_of_day": "weekend", "channel": "mobile_app", "state": "GA"}, "conversation_history": []}, "expected_output": {"intent": "setup_payment_plan", "routing_decision": "ai_handle", "required_actions": ["lookup_account", "present_plan_options", "enroll_in_plan"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["account_status", "action_taken", "confirmation"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"accuracy": "Must provide accurate account information", "empathy": "Must be helpful", "resolution": "Must resolve or clearly escalate"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "claim_status_049", "category": "claim_status", "subcategory": "status_denied", "difficulty": "hard", "input": {"customer_message": "Hi, I need an update on my claim. It's been 35 days. Reference: CLM-705991.", "context": {"policy_type": "life", "policy_status": "active", "customer_tier": "standard", "time_of_day": "after_hours", "channel": "email", "state": "NY"}, "conversation_history": []}, "expected_output": {"intent": "check_claim_status", "routing_decision": "human_handoff", "required_actions": ["lookup_claim", "explain_denial_reason", "explain_appeal_process", "transfer_to_supervisor"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["status_update", "next_steps", "timeline"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"status": "Must provide current claim status", "timeline": "Must set realistic expectations", "empathy": "Provide clear information"}}, "metadata": {"insurance_line": "health", "regulation_relevant": true, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |
| {"id": "error_recovery_008", "category": "error_recovery", "subcategory": "app_error", "difficulty": "easy", "input": {"customer_message": "The app keeps showing an error when I try to view my ID card.", "context": {"policy_type": "renters", "policy_status": "active", "customer_tier": "new_customer", "time_of_day": "business_hours", "channel": "email", "state": "WI"}, "conversation_history": []}, "expected_output": {"intent": "troubleshoot_app", "routing_decision": "ai_handle", "required_actions": ["identify_error", "provide_workaround", "report_bug"], "priority": "standard", "compliance_flags": [], "expected_response_elements": ["acknowledgment", "investigation", "resolution_or_workaround"]}, "evaluation_criteria": {"intent_accuracy": true, "routing_correctness": true, "action_completeness": 1.0, "response_quality_rubric": {"acknowledgment": "Must acknowledge the error/issue", "investigation": "Must investigate or explain investigation steps", "resolution": "Must provide resolution or clear next steps"}}, "metadata": {"insurance_line": "life", "regulation_relevant": false, "requires_pii_handling": true, "max_acceptable_latency_ms": 3000}} | |