NAICOM / Insurance Act 2003

Overview

Field	Value
Pack ID	nigeria/naicom
Full title	Insurance Act 2003 (Cap I17 LFN 2004) + NAICOM Guidelines
Regulator	NAICOM (National Insurance Commission)
Jurisdiction	Nigeria (NG)
Effective date	Insurance Act: 2003; Operational Guidelines: 2021; Market Conduct: 2023

What comply54 enforces

Claims adjudication thresholds (NAICOM Operational Guidelines 2021)

Threshold	Guideline	Rule
≤ ₦500,000	Guideline 15	Auto-approval allowed
₦500,001 – ₦2,000,000	Guideline 15	Human adjuster required; auto-denial prohibited
₦2,000,001 – ₦5,000,000	Guideline 12	Senior adjuster (≥ 5 yrs experience) required
> ₦5,000,000	Guideline 12 + NFIU	Manual review + AML reporting

result = compliance.check(
    action="approve_claim",
    params={"claim_amount": 2_500_000, "claim_type": "motor"},
    context={"human_adjuster_assigned": True, "senior_approval": False},
)
# decision: escalate — NAICOM Guideline 12: senior adjuster required for claims > ₦2,000,000

Life insurance underwriting cap (NAICOM Guideline 18)

AI agents may not autonomously underwrite life insurance policies above ₦5,000,000.

result = compliance.check(
    action="approve_underwriting",
    params={"policy_type": "life", "coverage_amount": 6_000_000},
    context={"human_underwriter": False},
)
# decision: deny — NAICOM Guideline 18: life insurance underwriting above ₦5,000,000
#           requires manual human underwriter

Anti-discrimination in underwriting (Insurance Act §67, NAICOM Market Conduct Rule 6)

The following characteristics are explicitly prohibited as underwriting factors:

Prohibited characteristic
religion
ethnicity
tribe
political_affiliation
gender
disability
hiv_status

result = compliance.check(
    action="generate_quote",
    params={
        "policy_type": "life",
        "coverage_amount": 1_000_000,
        "underwriting_factors": ["age", "smoking_status", "religion"],
    },
    context={"human_underwriter": True},
)
# decision: deny — Insurance Act §67 + NAICOM Market Conduct Rule 6:
#           religion is a prohibited underwriting characteristic

Fraud investigation (NAICOM Market Conduct Rule 11)

AI fraud detection may flag suspicious claims but may not autonomously deny them. Claims with fraud score ≥ 0.65 require human investigation.

Condition	Decision
Fraud score ≥ 0.65, no human investigator	deny
Fraud score ≥ 0.65, human investigator assigned	escalate — investigation in progress
Fraud score < 0.65	Continue standard checks

result = compliance.check(
    action="flag_fraud",
    params={"claim_id": "CLM-001", "fraud_score": 0.78},
    context={"human_investigator_assigned": False},
)
# decision: deny — NAICOM Market Conduct Rule 11: fraud score 0.78 exceeds threshold —
#           human investigation required before any claim decision

Policy modification (Insurance Act §50)

Policy terms may not be modified without notifying the customer.

Condition	Decision
customer_notified = true	allow
customer_notified = false	deny

AML reporting (NFIU / MLPPA 2022)

Premiums or payouts ≥ ₦5,000,000 trigger AML reporting obligations enforced by the nigeria/nfiu-aml pack (also included in NigeriaInsuranceCompliance).

Input fields used

Field	Path in input	Description
Action	input.action	"approve_claim", "deny_claim", "generate_quote", "approve_underwriting", "flag_fraud", "cancel_policy"
Claim amount	input.params.claim_amount	Integer (NGN)
Coverage amount	input.params.coverage_amount	Integer (NGN)
Policy type	input.params.policy_type	"life", "motor", "property", "health"
Underwriting factors	input.params.underwriting_factors	Array of strings
Fraud score	input.params.fraud_score	Float 0–1
Human adjuster assigned	input.context.human_adjuster_assigned	Boolean
Senior approval	input.context.senior_approval	Boolean
Human underwriter	input.context.human_underwriter	Boolean
Human investigator assigned	input.context.human_investigator_assigned	Boolean
Customer notified	input.context.customer_notified	Boolean

Messages returned

NAICOM Guideline 15: Claim of ₦1,500,000 exceeds ₦500,000 auto-denial cap — human adjuster required
NAICOM Guideline 12: Claim of ₦3,000,000 exceeds ₦2,000,000 threshold — senior adjuster required
NAICOM Guideline 18: Life insurance underwriting above ₦5,000,000 requires manual human underwriter
Insurance Act §67 + NAICOM Rule 6: religion is a prohibited underwriting characteristic
NAICOM Market Conduct Rule 11: Fraud score 0.78 exceeds threshold — human investigation required
Insurance Act §50: Policy modification requires customer notification

Regulatory references

• Insurance Act 2003 (Cap I17 LFN 2004) — NAICOM
• NAICOM Operational Guidelines 2021 — Guidelines 12, 15, 18
• NAICOM Market Conduct Guidelines 2023 — Rules 6 (anti-discrimination), 11 (fraud investigation)
• MLPPA 2022 / NFIU AML Guidelines — AML reporting obligations (see also nigeria/nfiu-aml)

Related

• Nigeria Insurance sector pack
• NDPA 2023 policy reference
• NFIU/AML policy reference