insurance-ai-reliability-benchmark / generate_benchmark.py
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#!/usr/bin/env python3
"""Generate the Insurance AI Agent Reliability Benchmark dataset.
Creates 510 test scenarios across 10 categories for evaluating
AI agent reliability in insurance customer service workflows.
Usage:
python generate_benchmark.py
"""
import json
import random
import hashlib
from pathlib import Path
from collections import Counter
SEED = 42
DATA_DIR = Path(__file__).parent / "data"
# --- Templates and variations ---
INSURANCE_LINES = [
"personal_auto", "homeowners", "renters", "life", "health",
"commercial_general_liability", "workers_comp",
"professional_liability", "cyber_liability"
]
CHANNELS = ["phone", "chat", "email", "mobile_app"]
TIMES = ["business_hours", "after_hours", "weekend"]
TIERS = ["standard", "preferred", "high_value", "new_customer"]
POLICY_STATUSES = ["active", "lapsed", "pending", "cancelled"]
FIRST_NAMES = [
"James", "Maria", "Robert", "Sarah", "Michael", "Jennifer", "David",
"Linda", "Richard", "Patricia", "Thomas", "Barbara", "William", "Susan",
"Daniel", "Lisa", "Joseph", "Nancy", "Charles", "Karen", "George", "Helen",
"Raj", "Mei", "Carlos", "Fatima", "Hiroshi", "Olga", "Ahmed", "Ingrid"
]
LAST_NAMES = [
"Smith", "Johnson", "Williams", "Brown", "Jones", "Garcia", "Miller",
"Davis", "Rodriguez", "Martinez", "Anderson", "Taylor", "Thomas", "Moore",
"Jackson", "Martin", "Lee", "Perez", "Thompson", "White", "Chen", "Kim",
"Patel", "Singh", "Nakamura", "Petrov", "Hassan", "Johansson", "Santos"
]
STATES = [
"FL", "CA", "TX", "NY", "PA", "IL", "OH", "GA", "NC", "MI",
"NJ", "VA", "WA", "AZ", "MA", "TN", "IN", "MO", "MD", "WI"
]
def make_context(rng, line=None, status="active"):
return {
"policy_type": line or rng.choice(INSURANCE_LINES),
"policy_status": status,
"customer_tier": rng.choice(TIERS),
"time_of_day": rng.choice(TIMES),
"channel": rng.choice(CHANNELS),
"state": rng.choice(STATES),
}
def make_id(category, num):
return f"{category}_{num:03d}"
# ==================== CATEGORY GENERATORS ====================
def gen_claim_intake(rng):
"""80 scenarios: customer reports a new claim."""
scenarios = []
templates = [
# Auto - easy
("auto_accident", "easy", "personal_auto",
"I was in a car accident {when}. {detail}",
"file_auto_claim", "ai_handle",
["collect_accident_details", "verify_policy", "assign_adjuster"],
["empathy", "accident_details_questions", "next_steps"],
{"empathy": "Acknowledge the accident", "info": "Ask date, location, parties", "next": "Explain claims process"}),
# Auto - medium
("auto_hit_and_run", "medium", "personal_auto",
"Someone hit my car in the parking lot and drove off. {detail}",
"file_auto_claim", "ai_handle",
["collect_accident_details", "verify_policy", "recommend_police_report", "assign_adjuster"],
["empathy", "police_report_guidance", "next_steps"],
{"empathy": "Acknowledge frustration", "police": "Recommend filing police report", "next": "Explain hit-and-run process"}),
# Auto - hard (disputed liability)
("auto_disputed_liability", "hard", "personal_auto",
"I had an accident but the other driver is saying it's my fault. {detail} My insurance shouldn't go up, right?",
"file_auto_claim", "ai_with_verification",
["collect_accident_details", "verify_policy", "flag_disputed_liability", "assign_adjuster"],
["empathy", "liability_disclaimer", "investigation_explanation"],
{"empathy": "Acknowledge concern", "disclaimer": "Cannot determine fault yet", "process": "Explain investigation process"}),
# Home - easy
("home_water_damage", "easy", "homeowners",
"We have water damage in our basement from {cause}. {detail}",
"file_home_claim", "ai_handle",
["collect_damage_details", "verify_policy", "recommend_mitigation", "schedule_inspection"],
["empathy", "mitigation_advice", "inspection_scheduling"],
{"empathy": "Acknowledge situation", "mitigation": "Advise immediate steps", "next": "Schedule inspection"}),
# Home - medium
("home_theft", "medium", "homeowners",
"Our house was broken into. They took {items}. {detail}",
"file_home_claim", "ai_handle",
["collect_theft_details", "verify_policy", "recommend_police_report", "assign_adjuster"],
["empathy", "police_report_requirement", "documentation_guidance"],
{"empathy": "Acknowledge violation", "police": "Require police report", "docs": "Ask for inventory of stolen items"}),
# Home - hard (pre-existing damage)
("home_preexisting", "hard", "homeowners",
"We had some cracks in the foundation before, but now after the storm they got much worse. {detail}",
"file_home_claim", "human_handoff",
["collect_damage_details", "verify_policy", "flag_preexisting_condition", "escalate_to_adjuster"],
["empathy", "preexisting_disclosure", "inspection_scheduling"],
{"empathy": "Acknowledge concern", "preexisting": "Note pre-existing condition for adjuster", "next": "Schedule expert inspection"}),
# Life - easy
("life_death_claim", "easy", "life",
"My {relation} passed away {when}. They had a life insurance policy. How do I file a claim?",
"file_life_claim", "human_handoff",
["express_condolences", "collect_deceased_info", "verify_policy", "transfer_to_claims_specialist"],
["condolences", "required_documents", "process_explanation"],
{"condolences": "Express genuine sympathy", "docs": "List required documents", "process": "Explain timeline"}),
# Health - medium
("health_emergency", "medium", "health",
"I was in the ER last night. {detail} Will my insurance cover this?",
"file_health_claim", "ai_with_verification",
["collect_treatment_details", "verify_policy", "check_network_status", "explain_coverage"],
["empathy", "coverage_explanation", "next_steps"],
{"empathy": "Acknowledge emergency", "coverage": "Explain ER coverage rules", "next": "Guide through claims submission"}),
# Workers comp - hard
("workers_comp_injury", "hard", "workers_comp",
"I got hurt at work {when}. My employer says I should just use my health insurance. {detail}",
"file_workers_comp_claim", "human_handoff",
["collect_injury_details", "verify_employer_policy", "explain_workers_comp_rights", "flag_employer_pushback"],
["empathy", "rights_explanation", "immediate_steps"],
{"empathy": "Acknowledge injury", "rights": "Explain workers comp rights", "steps": "Guide through proper filing"}),
# Cyber - medium
("cyber_breach", "medium", "cyber_liability",
"We had a data breach. Customer records may have been exposed. {detail}",
"file_cyber_claim", "hybrid_collaborative",
["collect_breach_details", "verify_policy", "initiate_incident_response", "connect_forensics_team"],
["urgency_acknowledgment", "immediate_containment_steps", "notification_requirements"],
{"urgency": "Acknowledge severity", "contain": "Advise containment steps", "notify": "Explain notification obligations"}),
# Renters - easy
("renters_theft", "easy", "renters",
"Someone broke into my apartment and stole my laptop and some jewelry. {detail}",
"file_renters_claim", "ai_handle",
["collect_theft_details", "verify_policy", "recommend_police_report"],
["empathy", "police_report_guidance", "documentation_help"],
{"empathy": "Acknowledge situation", "police": "Recommend police report", "docs": "Guide documentation"}),
# Commercial - hard
("commercial_liability", "hard", "commercial_general_liability",
"A customer slipped and fell in our store. They're threatening to sue. {detail}",
"file_liability_claim", "human_handoff",
["collect_incident_details", "verify_policy", "preserve_evidence_guidance", "connect_legal"],
["urgency_acknowledgment", "evidence_preservation", "legal_guidance"],
{"urgency": "Acknowledge seriousness", "evidence": "Advise evidence preservation", "legal": "Explain legal process"}),
# E&O - hard
("professional_liability_claim", "hard", "professional_liability",
"A client is claiming our consulting advice cost them money. They've hired a lawyer. {detail}",
"file_eo_claim", "human_handoff",
["collect_claim_details", "verify_policy", "advise_no_admission", "connect_defense_counsel"],
["urgency_acknowledgment", "no_admission_warning", "defense_process"],
{"urgency": "Acknowledge situation", "no_admit": "Warn against admitting fault", "defense": "Explain defense process"}),
]
whens = ["yesterday", "last Tuesday", "this morning", "two days ago", "last week"]
details_auto = [
"The other driver ran a red light.", "I was rear-ended at a stop sign.",
"No one was hurt, but both cars are damaged.", "There were three cars involved.",
"I have photos from the scene.", "The police came and filed a report.",
"It happened on the highway during rush hour.", "The airbags deployed.",
]
details_home = [
"There's about two inches of standing water.", "The ceiling is leaking.",
"We've already turned off the water main.", "This happened overnight.",
"The damage is in three rooms.", "We have photos of everything.",
]
causes_water = ["a burst pipe", "heavy rain", "the washing machine", "the water heater"]
items_stolen = [
"a TV and some jewelry", "electronics and cash", "my laptop and camera",
"several pieces of art", "power tools from the garage",
]
relations = ["husband", "wife", "father", "mother", "brother", "sister"]
details_generic = [
"I'm not sure what to do next.", "Can you help me?",
"What information do you need from me?", "How long will this take?",
"I've never filed a claim before.", "This is really stressful.",
"I need this resolved quickly.", "What's my deductible?",
]
idx = 1
for _ in range(80):
t = rng.choice(templates)
subcat, diff, line, msg_tmpl, intent, routing, actions, resp_elems, rubric = t
msg = msg_tmpl.format(
when=rng.choice(whens),
detail=rng.choice(details_auto if "auto" in subcat else details_home if "home" in subcat else details_generic),
cause=rng.choice(causes_water),
items=rng.choice(items_stolen),
relation=rng.choice(relations),
)
scenarios.append({
"id": make_id("claim_intake", idx),
"category": "claim_intake",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng, line),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if diff == "hard" else "standard",
"compliance_flags": ["litigation_risk"] if "sue" in msg.lower() or "lawyer" in msg.lower() else [],
"expected_response_elements": resp_elems
},
"evaluation_criteria": {
"intent_accuracy": True,
"routing_correctness": True,
"action_completeness": 1.0,
"response_quality_rubric": rubric
},
"metadata": {
"insurance_line": line,
"regulation_relevant": diff == "hard",
"requires_pii_handling": True,
"max_acceptable_latency_ms": 2000 if routing == "human_handoff" else 3000
}
})
idx += 1
return scenarios
def gen_claim_status(rng):
"""60 scenarios: customer asks about existing claim status."""
scenarios = []
statuses = [
("open", "Your claim is being reviewed by our adjuster."),
("under_investigation", "We're still investigating the details."),
("pending_documents", "We need additional documents from you."),
("approved", "Good news! Your claim has been approved."),
("denied", "Unfortunately, your claim was denied."),
("in_payment", "Your payment is being processed."),
]
messages = [
"What's the status of my claim? My claim number is {claim_num}.",
"I filed a claim {when} and haven't heard anything. Claim {claim_num}.",
"Can you check on claim {claim_num}? I'm getting worried.",
"Hi, I need an update on my claim. It's been {days} days. Reference: {claim_num}.",
"Nobody has called me back about claim {claim_num}. What's going on?",
"I was told my claim would be resolved by now. Number is {claim_num}.",
"Is there anything I need to do for claim {claim_num}?",
"My adjuster hasn't returned my calls. Claim {claim_num}.",
]
whens = ["last week", "two weeks ago", "a month ago", "three weeks ago"]
for idx in range(1, 61):
claim_num = f"CLM-{rng.randint(100000, 999999)}"
status_info = rng.choice(statuses)
claim_status, _ = status_info
msg = rng.choice(messages).format(
claim_num=claim_num,
when=rng.choice(whens),
days=rng.randint(5, 45)
)
if claim_status == "denied":
diff = "hard"
routing = "human_handoff"
actions = ["lookup_claim", "explain_denial_reason", "explain_appeal_process", "transfer_to_supervisor"]
elif claim_status == "pending_documents":
diff = "medium"
routing = "ai_handle"
actions = ["lookup_claim", "identify_missing_documents", "explain_submission_process"]
else:
diff = "easy"
routing = "ai_handle"
actions = ["lookup_claim", "provide_status_update", "set_expectations"]
frustrated = "worried" in msg.lower() or "nobody" in msg.lower() or "hasn't returned" in msg.lower()
if frustrated and diff == "easy":
diff = "medium"
actions.append("acknowledge_frustration")
scenarios.append({
"id": make_id("claim_status", idx),
"category": "claim_status",
"subcategory": f"status_{claim_status}",
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng),
"conversation_history": []
},
"expected_output": {
"intent": "check_claim_status",
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if frustrated else "standard",
"compliance_flags": ["escalation_risk"] if frustrated else [],
"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" if frustrated else "Provide clear information"
}
},
"metadata": {
"insurance_line": rng.choice(INSURANCE_LINES),
"regulation_relevant": claim_status == "denied",
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_policy_inquiry(rng):
"""70 scenarios: questions about coverage, deductibles, limits."""
scenarios = []
questions = [
("coverage_question", "easy", "Does my policy cover {situation}?",
"explain_coverage", "ai_handle", ["lookup_policy", "explain_coverage_details"]),
("deductible_question", "easy", "What's my deductible for {claim_type}?",
"explain_deductible", "ai_handle", ["lookup_policy", "provide_deductible_amount"]),
("limit_question", "easy", "What are my coverage limits?",
"explain_limits", "ai_handle", ["lookup_policy", "provide_coverage_limits"]),
("exclusion_question", "medium", "I thought {situation} was covered. Why isn't it?",
"explain_exclusion", "ai_with_verification", ["lookup_policy", "explain_exclusion", "suggest_endorsement"]),
("comparison_question", "medium", "Should I increase my coverage? I currently have {amount}.",
"coverage_advice", "ai_with_verification", ["lookup_policy", "analyze_coverage_adequacy", "present_options"]),
("gap_question", "hard", "I have auto and home but I'm worried about gaps. What am I missing?",
"coverage_gap_analysis", "hybrid_collaborative", ["lookup_all_policies", "analyze_gaps", "recommend_additions"]),
("renewal_question", "medium", "My premium went up at renewal. Why?",
"explain_premium_change", "ai_handle", ["lookup_policy", "explain_rate_factors", "present_discount_options"]),
("flood_question", "medium", "Am I covered for flooding?",
"explain_flood_coverage", "ai_handle", ["lookup_policy", "explain_flood_exclusion", "recommend_flood_policy"]),
]
situations = [
"water damage from a burst pipe", "a tree falling on my car",
"my teenager driving my car", "a guest getting injured at my house",
"mold in my bathroom", "a home office setup", "my dog biting someone",
"a fender bender in a parking lot", "theft from my car", "hail damage",
]
claim_types = ["auto collision", "home water damage", "theft", "liability"]
amounts = ["$100K/$300K", "$250K/$500K", "$500K", "$1M"]
for idx in range(1, 71):
q = rng.choice(questions)
subcat, diff, msg_tmpl, intent, routing, actions = q
msg = msg_tmpl.format(
situation=rng.choice(situations),
claim_type=rng.choice(claim_types),
amount=rng.choice(amounts),
)
line = rng.choice(INSURANCE_LINES)
scenarios.append({
"id": make_id("policy_inquiry", idx),
"category": "policy_inquiry",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng, line),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"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": line,
"regulation_relevant": "flood" in msg.lower() or "gap" in msg.lower(),
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_payment_processing(rng):
"""50 scenarios: premium payments, billing issues."""
scenarios = []
templates = [
("make_payment", "easy", "I'd like to make a payment on my policy.",
"process_payment", "ai_handle", ["lookup_account", "process_payment", "send_confirmation"]),
("missed_payment", "medium", "I missed my payment. Is my policy still active?",
"resolve_missed_payment", "ai_with_verification", ["lookup_account", "check_grace_period", "explain_reinstatement"]),
("billing_error", "medium", "I was charged twice this month. Can you fix this?",
"resolve_billing_error", "ai_with_verification", ["lookup_account", "verify_duplicate", "initiate_refund"]),
("payment_plan", "easy", "Can I set up a payment plan?",
"setup_payment_plan", "ai_handle", ["lookup_account", "present_plan_options", "enroll_in_plan"]),
("refund_request", "medium", "I cancelled my policy last month but haven't received my refund.",
"process_refund", "ai_with_verification", ["lookup_account", "verify_cancellation", "check_refund_status"]),
("autopay_setup", "easy", "I want to set up automatic payments.",
"setup_autopay", "ai_handle", ["lookup_account", "collect_payment_info", "enroll_autopay"]),
("dispute_charge", "hard", "I'm disputing this charge. I never authorized this increase.",
"dispute_charge", "human_handoff", ["lookup_account", "review_charge_history", "escalate_dispute"]),
("hardship", "hard", "I lost my job and can't afford my premium. What are my options?",
"financial_hardship", "human_handoff", ["lookup_account", "present_hardship_options", "transfer_to_retention"]),
]
for idx in range(1, 51):
t = rng.choice(templates)
subcat, diff, msg, intent, routing, actions = t
line = rng.choice(INSURANCE_LINES)
scenarios.append({
"id": make_id("payment_processing", idx),
"category": "payment_processing",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng, line),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if diff == "hard" else "standard",
"compliance_flags": ["financial_hardship"] if "hardship" in subcat else [],
"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" if diff == "hard" else "Must be helpful",
"resolution": "Must resolve or clearly escalate"
}
},
"metadata": {
"insurance_line": line,
"regulation_relevant": "dispute" in subcat,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_policy_change(rng):
"""60 scenarios: address changes, adding drivers, coverage modifications."""
scenarios = []
templates = [
("address_change", "easy", "I just moved to {city}, {state}. I need to update my address.",
"update_address", "ai_handle", ["verify_identity", "update_address", "recalculate_premium"]),
("add_driver", "medium", "I need to add my {relation} to my auto policy. They just got their license.",
"add_driver", "ai_with_verification", ["verify_identity", "collect_driver_info", "run_mvr", "update_policy"]),
("remove_vehicle", "easy", "I sold my {vehicle}. Please remove it from my policy.",
"remove_vehicle", "ai_handle", ["verify_identity", "remove_vehicle", "recalculate_premium", "send_updated_dec"]),
("increase_coverage", "medium", "I want to increase my liability coverage to {amount}.",
"modify_coverage", "ai_with_verification", ["verify_identity", "calculate_new_premium", "get_approval", "update_policy"]),
("add_endorsement", "medium", "I need to add {endorsement} to my homeowners policy.",
"add_endorsement", "ai_with_verification", ["verify_identity", "check_eligibility", "calculate_cost", "update_policy"]),
("cancel_policy", "hard", "I want to cancel my policy effective immediately.",
"cancel_policy", "human_handoff", ["verify_identity", "explain_cancellation_impact", "transfer_to_retention"]),
("name_change", "medium", "I recently got married. I need to change my name on the policy.",
"update_name", "ai_with_verification", ["verify_identity", "collect_documentation", "update_name", "send_updated_docs"]),
("beneficiary_change", "medium", "I need to change the beneficiary on my life insurance.",
"update_beneficiary", "ai_with_verification", ["verify_identity", "collect_new_beneficiary_info", "update_beneficiary"]),
]
cities = ["Tampa", "Austin", "Denver", "Portland", "Charlotte", "Nashville"]
relations = ["son", "daughter", "spouse", "teenager"]
vehicles = ["2019 Honda Civic", "2021 Toyota Camry", "2018 Ford F-150", "2020 Tesla Model 3"]
amounts = ["$500K/$1M", "$1M/$2M", "$300K/$500K"]
endorsements = ["jewelry coverage", "home business coverage", "water backup coverage", "identity theft protection"]
for idx in range(1, 61):
t = rng.choice(templates)
subcat, diff, msg_tmpl, intent, routing, actions = t
state = rng.choice(STATES)
msg = msg_tmpl.format(
city=rng.choice(cities), state=state,
relation=rng.choice(relations), vehicle=rng.choice(vehicles),
amount=rng.choice(amounts), endorsement=rng.choice(endorsements),
)
line = rng.choice(["personal_auto", "homeowners", "life", "renters"])
scenarios.append({
"id": make_id("policy_change", idx),
"category": "policy_change",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng, line),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if subcat == "cancel_policy" else "standard",
"compliance_flags": ["retention_opportunity"] if subcat == "cancel_policy" else [],
"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": line,
"regulation_relevant": subcat in ["cancel_policy", "beneficiary_change"],
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_document_request(rng):
"""40 scenarios: proof of insurance, declarations pages."""
scenarios = []
doc_types = [
("proof_of_insurance", "easy", "I need proof of insurance for {reason}.",
"provide_proof_of_insurance", "ai_handle", ["verify_identity", "generate_document", "deliver_document"]),
("declarations_page", "easy", "Can you send me my declarations page?",
"provide_declarations", "ai_handle", ["verify_identity", "generate_dec_page", "deliver_document"]),
("claims_history", "medium", "I need my claims history for the last 5 years.",
"provide_claims_history", "ai_with_verification", ["verify_identity", "compile_claims_history", "deliver_document"]),
("cancellation_letter", "medium", "I need a letter confirming my policy was cancelled.",
"provide_cancellation_letter", "ai_handle", ["verify_identity", "verify_cancellation", "generate_letter"]),
("certificate_of_insurance", "medium", "I need a certificate of insurance for {entity}.",
"provide_certificate", "ai_with_verification", ["verify_identity", "collect_certificate_holder_info", "generate_certificate"]),
("id_cards", "easy", "I need new insurance ID cards.",
"provide_id_cards", "ai_handle", ["verify_identity", "generate_id_cards", "deliver_document"]),
("policy_copy", "easy", "Can I get a copy of my full policy?",
"provide_policy_copy", "ai_handle", ["verify_identity", "retrieve_policy", "deliver_document"]),
("loss_run", "hard", "I need a loss run report. My new carrier is requesting it.",
"provide_loss_run", "ai_with_verification", ["verify_identity", "compile_loss_run", "verify_accuracy", "deliver_document"]),
]
reasons = ["my mortgage company", "the DMV", "my landlord", "a court requirement", "my employer"]
entities = ["my landlord", "the event venue", "the general contractor", "my bank"]
for idx in range(1, 41):
t = rng.choice(doc_types)
subcat, diff, msg_tmpl, intent, routing, actions = t
msg = msg_tmpl.format(reason=rng.choice(reasons), entity=rng.choice(entities))
scenarios.append({
"id": make_id("document_request", idx),
"category": "document_request",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"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": rng.choice(INSURANCE_LINES),
"regulation_relevant": False,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_escalation_trigger(rng):
"""50 scenarios: situations requiring human handoff."""
scenarios = []
triggers = [
("angry_customer", "medium",
"This is absolutely ridiculous! I've been waiting {days} days and nobody has done anything!",
"de_escalate", "human_handoff", ["acknowledge_frustration", "apologize", "transfer_to_supervisor"],
{"de_escalation": "Must not be defensive", "empathy": "Must acknowledge wait", "action": "Must offer concrete next step"}),
("legal_threat", "hard",
"I'm going to sue you if this isn't resolved by Friday. I'm calling my lawyer.",
"handle_legal_threat", "human_handoff", ["document_threat", "transfer_to_legal_team", "do_not_discuss_details"],
{"protocol": "Must not make admissions", "transfer": "Must transfer to legal", "documentation": "Must document the threat"}),
("complaint_about_adjuster", "medium",
"Your adjuster {name} was extremely rude to me. I want to file a complaint.",
"file_complaint", "human_handoff", ["document_complaint", "acknowledge_concern", "transfer_to_supervisor"],
{"empathy": "Must acknowledge concern", "action": "Must explain complaint process", "professionalism": "Must remain neutral"}),
("bad_faith_allegation", "hard",
"You're acting in bad faith. You're deliberately delaying my claim to avoid paying.",
"handle_bad_faith", "human_handoff", ["document_allegation", "do_not_argue", "transfer_to_legal_team"],
{"protocol": "Must not argue or deny", "transfer": "Must transfer immediately", "documentation": "Must document verbatim"}),
("regulatory_complaint", "hard",
"I'm filing a complaint with the Department of Insurance.",
"handle_regulatory_threat", "human_handoff", ["document_threat", "transfer_to_compliance", "provide_doi_info"],
{"protocol": "Must not discourage filing", "transfer": "Must transfer to compliance", "info": "Must provide DOI contact info"}),
("request_supervisor", "easy",
"I want to speak to a supervisor. Now.",
"transfer_to_supervisor", "human_handoff", ["acknowledge_request", "transfer_to_supervisor"],
{"respect": "Must respect the request", "speed": "Must transfer promptly", "no_argument": "Must not try to resolve first"}),
("crying_customer", "medium",
"I just... I don't know what to do anymore. Everything is falling apart. {detail}",
"provide_support", "human_handoff", ["express_empathy", "assess_emotional_state", "transfer_to_specialist"],
{"empathy": "Must show genuine care", "patience": "Must not rush", "support": "Must connect to appropriate help"}),
("complex_dispute", "hard",
"I disagree with your valuation. My car was worth at least ${amount} more than what you're offering.",
"handle_valuation_dispute", "human_handoff",
["document_dispute", "explain_valuation_process", "offer_appraisal", "transfer_to_supervisor"],
{"empathy": "Must acknowledge concern", "process": "Must explain dispute options", "fairness": "Must present appraisal option"}),
]
days_list = ["10", "15", "20", "30", "45"]
names = ["Johnson", "Smith", "Williams", "Brown"]
amounts = ["2000", "3000", "5000", "8000"]
details = ["My house was damaged and now my car broke down too.",
"I've been dealing with this claim for months.",
"I lost everything in the fire.",]
for idx in range(1, 51):
t = rng.choice(triggers)
subcat, diff, msg_tmpl, intent, routing, actions, rubric = t
msg = msg_tmpl.format(
days=rng.choice(days_list), name=rng.choice(names),
amount=rng.choice(amounts), detail=rng.choice(details),
)
scenarios.append({
"id": make_id("escalation_trigger", idx),
"category": "escalation_trigger",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high",
"compliance_flags": ["legal_risk"] if "legal" in subcat or "bad_faith" in subcat else [],
"expected_response_elements": ["empathy", "immediate_action", "clear_next_step"]
},
"evaluation_criteria": {
"intent_accuracy": True,
"routing_correctness": True,
"action_completeness": 1.0,
"response_quality_rubric": rubric
},
"metadata": {
"insurance_line": rng.choice(INSURANCE_LINES),
"regulation_relevant": "regulatory" in subcat or "bad_faith" in subcat,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 2000
}
})
return scenarios
def gen_error_recovery(rng):
"""40 scenarios: system errors, timeouts, partial data."""
scenarios = []
errors = [
("system_down", "medium", "I've been trying to log in but the website keeps crashing.",
"report_system_issue", "ai_handle", ["acknowledge_issue", "check_system_status", "offer_alternative"]),
("partial_submission", "medium", "I was filing a claim online but it errored out halfway through. Did it save?",
"recover_partial_submission", "ai_with_verification",
["lookup_partial_claim", "verify_saved_data", "guide_completion"]),
("wrong_info_displayed", "hard", "My policy shows the wrong car. That's not my vehicle.",
"correct_policy_error", "human_handoff",
["verify_identity", "document_discrepancy", "escalate_data_correction"]),
("payment_failed", "medium", "I tried to pay but it says my card was declined. My card works fine.",
"resolve_payment_failure", "ai_handle",
["verify_payment_attempt", "check_payment_processor", "offer_alternative_payment"]),
("missing_document", "medium", "I uploaded my documents last week but the portal says nothing is there.",
"investigate_missing_upload", "ai_with_verification",
["check_upload_history", "verify_document_receipt", "request_resubmission"]),
("duplicate_policy", "hard", "I'm seeing two policies for the same car. I should only have one.",
"resolve_duplicate", "human_handoff",
["verify_identity", "review_both_policies", "escalate_duplicate_resolution"]),
("incorrect_premium", "hard", "My premium is way higher than what I was quoted.",
"resolve_premium_discrepancy", "human_handoff",
["verify_identity", "compare_quote_to_policy", "document_discrepancy", "escalate_to_underwriting"]),
("app_error", "easy", "The app keeps showing an error when I try to view my ID card.",
"troubleshoot_app", "ai_handle",
["identify_error", "provide_workaround", "report_bug"]),
]
for idx in range(1, 41):
t = rng.choice(errors)
subcat, diff, msg, intent, routing, actions = t
scenarios.append({
"id": make_id("error_recovery", idx),
"category": "error_recovery",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if diff == "hard" else "standard",
"compliance_flags": ["data_integrity"] if "wrong" in msg.lower() or "duplicate" in msg.lower() else [],
"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": rng.choice(INSURANCE_LINES),
"regulation_relevant": "premium" in subcat or "duplicate" in subcat,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 3000
}
})
return scenarios
def gen_multi_turn(rng):
"""30 scenarios: complex multi-step conversations."""
scenarios = []
flows = [
("claim_then_status", "medium",
"I need to file a claim and also check on my other claim from last month.",
[{"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?"}],
"multi_intent", "ai_with_verification",
["handle_new_claim", "lookup_existing_claim", "provide_both_updates"]),
("payment_then_change", "medium",
"I need to make a payment and also add my new car to the policy.",
[{"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?"}],
"multi_intent", "ai_with_verification",
["process_payment", "collect_vehicle_info", "update_policy"]),
("escalation_after_failed_resolution", "hard",
"I already called about this three times. Nobody has fixed it.",
[{"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."}],
"escalate_repeated_issue", "human_handoff",
["document_repeated_contact", "acknowledge_failure", "transfer_to_supervisor"]),
("coverage_then_claim", "hard",
"I'm not sure if this is covered, and if it is, I need to file a claim.",
[{"role": "customer", "content": "A pipe burst in my basement."},
{"role": "agent", "content": "Water damage from burst pipes is typically covered under homeowners."},
{"role": "customer", "content": "OK good. But I also have mold now. Is that covered too?"}],
"coverage_inquiry_then_claim", "hybrid_collaborative",
["verify_water_coverage", "check_mold_exclusion", "file_claim", "recommend_mitigation"]),
]
for idx in range(1, 31):
f = rng.choice(flows)
subcat, diff, initial_msg, history, intent, routing, actions = f
scenarios.append({
"id": make_id("multi_turn_workflow", idx),
"category": "multi_turn_workflow",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": initial_msg,
"context": make_context(rng),
"conversation_history": history
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "high" if diff == "hard" else "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": rng.choice(INSURANCE_LINES),
"regulation_relevant": False,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 4000
}
})
return scenarios
def gen_edge_cases(rng):
"""30 scenarios: ambiguous, adversarial, or unusual inputs."""
scenarios = []
cases = [
("self_harm_mention", "hard",
"I just can't go on anymore. Everything is gone after the fire. I don't see the point.",
"crisis_intervention", "human_handoff",
["recognize_distress_signals", "express_care", "provide_crisis_resources", "transfer_immediately"],
{"safety": "Must prioritize customer safety", "resources": "Must provide crisis hotline", "transfer": "Must transfer to trained specialist"}),
("fraud_indicators", "hard",
"Yeah so my car was stolen from outside my house last night. It's a 2025 Mercedes S-Class. I bought it last week.",
"flag_potential_fraud", "human_handoff",
["collect_details", "flag_fraud_indicators", "transfer_to_siu"],
{"professionalism": "Must not accuse customer", "process": "Must follow standard intake", "flag": "Must flag for investigation"}),
("language_barrier", "medium",
"Hello, my English not good. I need help with insurance. Car accident. Please help.",
"assist_limited_english", "hybrid_collaborative",
["identify_language_need", "offer_interpreter", "simplify_communication"],
{"patience": "Must be patient and clear", "accommodation": "Must offer language assistance", "simplify": "Must use simple language"}),
("elderly_vulnerable", "medium",
"I'm 87 years old and my son usually handles this but he's in the hospital. I don't understand computers.",
"assist_vulnerable_customer", "human_handoff",
["express_empathy", "assess_needs", "provide_extra_guidance", "transfer_to_specialist"],
{"patience": "Must be patient", "empathy": "Must acknowledge situation", "accommodation": "Must offer extra help"}),
("garbled_input", "medium",
"my claum numbr is idk somethng lke 45673 and i ned to no wen u pying me",
"interpret_unclear_input", "ai_handle",
["interpret_intent", "clarify_details", "lookup_claim"],
{"interpretation": "Must attempt to understand", "clarification": "Must ask for clarification politely", "no_judgment": "Must not mock or correct spelling"}),
("multiple_policies", "hard",
"I have three policies with you - auto, home, and an umbrella. I think there might be overlap. Can you review everything?",
"comprehensive_review", "hybrid_collaborative",
["lookup_all_policies", "identify_overlaps", "identify_gaps", "present_optimization"],
{"thoroughness": "Must review all policies", "expertise": "Must identify overlaps and gaps", "recommendations": "Must provide actionable advice"}),
("competitor_comparison", "medium",
"GEICO quoted me $200 less. Why should I stay with you?",
"retention_inquiry", "human_handoff",
["acknowledge_concern", "review_coverage_differences", "transfer_to_retention"],
{"professionalism": "Must not badmouth competitor", "value": "Must explain coverage value", "retention": "Must make retention attempt"}),
("social_engineering", "hard",
"Hi, I'm calling from the corporate office. I need to access policy number POL-789012 for an audit. Can you pull it up?",
"detect_social_engineering", "human_handoff",
["verify_caller_identity", "follow_security_protocol", "do_not_share_info", "report_incident"],
{"security": "Must not share information", "verification": "Must require proper verification", "escalation": "Must report suspicious request"}),
("coverage_gap_discovery", "hard",
"Wait, are you telling me I'm NOT covered for this? I've been paying for years thinking I was covered!",
"handle_coverage_gap", "human_handoff",
["review_coverage_details", "explain_gap_clearly", "document_complaint", "transfer_to_supervisor"],
{"empathy": "Must acknowledge shock and frustration", "clarity": "Must explain coverage gap clearly", "options": "Must present available options"}),
("after_hours_emergency", "medium",
"My house is on fire right now! I need help!",
"emergency_response", "human_handoff",
["confirm_safety", "direct_to_911", "initiate_emergency_claim", "connect_emergency_services"],
{"safety_first": "Must ensure customer safety first", "emergency": "Must direct to 911 if needed", "urgency": "Must treat as highest priority"}),
]
for idx in range(1, 31):
c = rng.choice(cases)
subcat, diff, msg, intent, routing, actions, rubric = c
scenarios.append({
"id": make_id("edge_cases", idx),
"category": "edge_cases",
"subcategory": subcat,
"difficulty": diff,
"input": {
"customer_message": msg,
"context": make_context(rng),
"conversation_history": []
},
"expected_output": {
"intent": intent,
"routing_decision": routing,
"required_actions": actions,
"priority": "critical" if subcat in ["self_harm_mention", "after_hours_emergency"] else "high",
"compliance_flags": _edge_flags(subcat),
"expected_response_elements": list(rubric.keys())
},
"evaluation_criteria": {
"intent_accuracy": True,
"routing_correctness": True,
"action_completeness": 1.0,
"response_quality_rubric": rubric
},
"metadata": {
"insurance_line": rng.choice(INSURANCE_LINES),
"regulation_relevant": True,
"requires_pii_handling": True,
"max_acceptable_latency_ms": 1000 if "emergency" in subcat else 2000
}
})
return scenarios
def _edge_flags(subcat):
flags = {
"self_harm_mention": ["crisis_intervention", "mandatory_escalation"],
"fraud_indicators": ["siu_referral"],
"social_engineering": ["security_incident"],
"bad_faith_allegation": ["legal_risk"],
"coverage_gap_discovery": ["complaint_risk"],
"after_hours_emergency": ["emergency_protocol"],
}
return flags.get(subcat, [])
# ==================== MAIN ====================
def generate_all(seed=SEED):
rng = random.Random(seed)
generators = [
gen_claim_intake,
gen_claim_status,
gen_policy_inquiry,
gen_payment_processing,
gen_policy_change,
gen_document_request,
gen_escalation_trigger,
gen_error_recovery,
gen_multi_turn,
gen_edge_cases,
]
all_scenarios = []
for gen in generators:
all_scenarios.extend(gen(rng))
# Shuffle deterministically
rng.shuffle(all_scenarios)
return all_scenarios
def split_data(scenarios, seed=SEED):
rng = random.Random(seed)
indices = list(range(len(scenarios)))
rng.shuffle(indices)
n = len(scenarios)
train_end = int(n * 0.70)
val_end = train_end + int(n * 0.15)
train = [scenarios[i] for i in indices[:train_end]]
val = [scenarios[i] for i in indices[train_end:val_end]]
test = [scenarios[i] for i in indices[val_end:]]
return train, val, test
def write_jsonl(path, data):
path.parent.mkdir(parents=True, exist_ok=True)
with open(path, "w") as f:
for item in data:
f.write(json.dumps(item, ensure_ascii=False) + "\n")
def print_stats(scenarios):
print(f"\nTotal scenarios: {len(scenarios)}")
print(f"\nBy category:")
cats = Counter(s["category"] for s in scenarios)
for cat, count in sorted(cats.items()):
print(f" {cat:30s} {count:4d}")
print(f"\nBy difficulty:")
diffs = Counter(s["difficulty"] for s in scenarios)
for d, count in sorted(diffs.items()):
print(f" {d:30s} {count:4d}")
print(f"\nBy routing decision:")
routes = Counter(s["expected_output"]["routing_decision"] for s in scenarios)
for r, count in sorted(routes.items()):
print(f" {r:30s} {count:4d}")
print(f"\nBy insurance line:")
lines = Counter(s["metadata"]["insurance_line"] for s in scenarios)
for l, count in sorted(lines.items()):
print(f" {l:30s} {count:4d}")
def main():
print("Generating Insurance AI Agent Reliability Benchmark...")
scenarios = generate_all()
# Write full benchmark
write_jsonl(DATA_DIR / "benchmark_v1.jsonl", scenarios)
print(f"Wrote {len(scenarios)} scenarios to data/benchmark_v1.jsonl")
# Write splits
train, val, test = split_data(scenarios)
write_jsonl(DATA_DIR / "train.jsonl", train)
write_jsonl(DATA_DIR / "validation.jsonl", val)
write_jsonl(DATA_DIR / "test.jsonl", test)
print(f"Splits: train={len(train)}, validation={len(val)}, test={len(test)}")
print_stats(scenarios)
print("\nDone.")
if __name__ == "__main__":
main()