Unauthorized Practice of Law is not a policy preference — it is a hard legal requirement. AdjudiCLAIMS was built from the ground up to ensure that AI output to claims examiners never crosses the line into legal analysis.
517
Total UPL test fixtures
100%
RED zone queries blocked (126/126)
0%
False positive block rate (126 GREEN queries)
46
Prohibited output patterns in validator
The Green/Yellow/Red Framework
Every query a claims examiner submits is classified into one of three zones before the AI responds. The zone determines what the AI is permitted to say — and what it is required to block.
What GREEN zone covers:
Example GREEN zone responses:
Test result: 126 GREEN zone queries — 0% false positive block rate
Factual guidance is never incorrectly blocked. Examiners get answers to legitimate procedural questions without false-positive friction.
What YELLOW zone covers:
Required disclaimer (non-negotiable):
Test result: 62 YELLOW zone queries — 100% include mandatory disclaimer
What RED zone blocks:
Standard RED zone response:
Test result: 126 RED zone queries — 100% blocked. Zero legal advice delivered.
Enforcement Architecture
Each layer operates independently. If one fails, the next catches it. 46 prohibited output patterns are tested against 203 response variations to ensure the validator catches what the prompt and classifier miss.
Pre-generation
Every examiner query is classified GREEN/YELLOW/RED using a lightweight LLM call before the main AI responds. RED zone queries never reach the generation model. The classifier is the first gate.
Generation
Claims examiner system prompts are calibrated to GREEN zone output. YELLOW statistical context permitted with mandatory disclaimer. RED zone language explicitly prohibited. The prompt is the second gate.
Post-generation
46 prohibited patterns are scanned in every AI response before delivery. Legal conclusions that slip through the prompt are caught here. 203 response variations tested — 100% detection rate. The validator is the third gate.