Solutions · Insurance

Every claim handled consistently, every decision explained.

Exceptions surface early, and each decision carries the rule, the evidence and the person behind it.

The work

Similar claims get different outcomes depending on who handles them, and decisions can't be reconstructed when challenged.

A claim arrives as a phone call, a form or an email with photos. It needs coverage confirmed, severity judged, documents gathered, a reserve set, perhaps an adjuster sent, and a settlement decided. Handlers apply guidelines differently, and the reasons often live only in their heads.

Same claim, same decision

Two similar water-damage claims arrive.

C-4410 and C-4417: a burst pipe, photos and a plumber’s invoice in each.

Step 1 of 5

C-4410In

C-4417In

Both go through the same steps.

Coverage is checked, the AI reads the photos and invoice, and a model suited to the task scores severity inside the guideline.

Step 2 of 5

CoverageCovered

SeverityModerate · both

ReserveSet by rule

Each decision shows its reasons.

The rule, the evidence and who decided. C-4417 goes straight through because it is below the handler-review amount.

Step 3 of 5

RuleSudden escape of water

EvidenceInvoice $6,850 · photos · clause 4.2

C-4410Confirmed by handler

C-4417Straight through

A third claim doesn’t add up.

C-4423’s invoice doesn’t match its photos. Momor doesn’t decide: it asks a senior handler, with both pieces side by side.

Step 4 of 5

C-4423Invoice vs photos

The question, as the person sees itC-4423: the invoice doesn’t match the photos. Review before settlement?

Months later, any decision can be explained.

Which rule applied, what evidence it stood on, and who decided.

Step 5 of 5

RecordComplete

Illustrative.

Step 1 of 5

C-4410In

C-4417In

Step 2 of 5

CoverageCovered

SeverityModerate · both

ReserveSet by rule

Step 3 of 5

RuleSudden escape of water

EvidenceInvoice $6,850 · photos · clause 4.2

C-4410Confirmed by handler

C-4417Straight through

Step 4 of 5

C-4423Invoice vs photos

The question, as the person sees itC-4423: the invoice doesn’t match the photos. Review before settlement?

Step 5 of 5

RecordComplete

Who does what

Rules, AI and people, each in their place.

Rules and systemsCoverage rules, authority limits, reserve rules, connections to policy, claims and payment systems.
AI, within a roleRead photos, invoices and reports; extract the facts; compare them with the policy wording; draft the decision note.
Decision modelsScore severity and route, always inside the guideline.
PeopleDecisions above authority, any exception, all disputes and denials.

What stays

A record you can follow.

Every claim keeps its decision trail. Patterns across claims (for example invoices from one supplier that keep disagreeing with photos) can be raised as notices to the claims manager without stopping individual claims. Suspicious patterns go to Investigations.

How the knowledge graph works →

First deployment

First notice of loss to settlement for one claim type.

You receive intake from your channels, the claims workflow with your guidelines and authority limits, the handler and senior handler queues, and decision records. Broker version: renewal and coverage review for one book of commercial clients.

Start with one process.

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