Coordinate damage evidence, coverage documents, and repair estimates into an adjuster-owned claim review.
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Illustrative architecture: A property insurer faces storm claims containing photographs, contractor estimates, policy endorsements, and incomplete incident descriptions. Adjusters need a consistent evidence packet while specialist teams handle fraud concerns and disputed coverage. The architecture supports their workflow and makes no automated coverage determination.
Claim packets contain contradictory dates, duplicate invoices, and policy versions that vary by loss date. Unchecked image summaries can turn uncertain visual observations into asserted damage amounts, while automatic correspondence may disclose another claimant's information.
Separate extraction, policy lookup, estimate comparison, and completeness review so each produces traceable findings. A claim orchestrator reconciles their results against the authoritative policy and leaves coverage and payment decisions with authorized staff.
The intended result is a reviewable operational decision with source evidence and explicit ownership. Track preparation time alongside correction burden and unresolved evidence. A shorter packet is useful only if adjusters can still inspect the originals and explain the decision through existing review procedures.
Index photographs and documents by loss event, location, and source; label uncertain extraction.
Cannot infer causation or replace an assessor's inspection.
Find policy wording and endorsements effective on the recorded loss date.
Returns citations and ambiguity; cannot decide coverage.
Compare line items, units, duplicate invoices, and approved repair catalogs.
Cannot set settlement amounts or approve contractors.
Compile conflicts, missing evidence, and a draft request for clarification.
May draft correspondence only for the assigned claim owner.
Owns claim identifiers, assignments, reserves, and signed adjuster decisions.
Provides coverage-period snapshots and effective endorsements with stable document references.
Store original evidence separately from draft summaries; only the payment adapter accepts approved settlement requests.
flowchart LR
N0["Property claim evidence workbench"]
N1["Evidence intake agent"]
N2["Policy retrieval agent"]
N3["Estimate comparison agent"]
N4["Adjuster briefing agent"]
N5["Evidence ledger"]
N6["Human decision"]
N7["Authorized adapter"]
N0 --> N1
N0 --> N2
N1 --> N3
N2 --> N4
N3 --> N4
N4 --> N5
N5 --> N6
N6 --> N7sequenceDiagram
participant O as "Case orchestrator"
participant S as "Claims management system"
participant H as "Accountable reviewer"
O->>S: Load claim evidence manifest
S-->>O: Loss date and policy revision
O->>H: Present draft claim packet
S-->>O: Endorsement revision arrives
O->>H: Invalidate affected policy section
H-->>O: Request refreshed packet
O->>S: Save reviewed replacement revisionAssociate uploads with an authenticated claimant and existing claim; quarantine unsupported files before specialist processing.
Read the claim's recorded date and address, then retrieve policy versions valid at that time rather than the latest document alone.
Process images and invoices independently; retain page coordinates and mark unclear amounts or damage observations for human inspection.
Compare invoice identities and calculate totals deterministically, keeping possible duplicates separate from confirmed duplicate payment evidence.
Show policy citations, disputed facts, missing documents, and proposed correspondence without presenting a model recommendation as a coverage ruling.
Save the reviewed packet and approved communication with its revision; any later evidence invalidates dependent draft conclusions.
Detect: Policy revision and loss-date lookup differ from the packet's recorded manifest.
Recover: Suspend the draft, rebuild affected sections, and notify the adjuster that their prior review is stale.
Detect: Normalized line-item and invoice-reference checks flag a probable overlap.
Recover: Present both originals for comparison; retain uncertainty instead of silently deleting evidence.
Measurement definitions, not promised improvements.
Elapsed time from minimum evidence arrival to an adjuster-ready packet, segmented by claim complexity.
Audited policy references with correct wording and effective date divided by audited references.
Confirmed duplicate evidence findings divided by duplicate alerts reviewed by adjusters.
Material packet corrections per reviewed claim, categorized as extraction, policy, or identity error.
| Decision | Benefit | Cost |
|---|---|---|
| Multimodal extraction | Makes image and document evidence searchable together. | Requires specialist validation and image provenance handling. |
| Separate policy retrieval | Limits unsupported coverage statements. | Adds explicit reconciliation when endorsements conflict. |
| Draft-only correspondence | Keeps judgment and tone with the adjuster. | Human queue capacity limits end-to-end throughput. |
Adjusters verify date-sensitive policy retrieval and estimate calculations across settled, disputed, and incomplete cases.
A bounded adjuster team accepts the packet format after identity, disclosure, and citation tests pass.
Additional claim types launch only with their own evidence rubric and tested escalation owner.