Check every claim before it is decided
Check a claim is complete, covered and clean before an assessor spends time on it. Anything that doesn't fit the policy goes to a person, and every decision keeps a record a regulator can follow.
The playbook in 54 seconds
What each agent checks and who decides the exceptions. All videos
What you can build for insurance claims
Claim intake check
Claim intake check reads the claim form, policy schedule and supporting documents. It checks the policy numbers match, the loss is in the policy period, the claimant is the named insured and no required document is missing, then sends gaps to the claims officer.
Tested: clean set completed; 3 of 3 planted errors flagged.
View on the Docy AI marketplace →See the brief
Build an agent that checks a new property or motor insurance claim at lodgement. From the claim form, policy schedule and supporting documents, extract the claim number, claimant, policy number on each, loss date, date reported, type of loss, claimed amount, documents supplied, named insured and policy period. Also have the extractor state whether the policy numbers match, whether the loss date is within the policy period, whether the claimant is the named insured, and list required documents that are missing (or None): photos, a repair quote or invoice, and a police report for theft or malicious damage. Check all of these. If any check fails, send it to the claims officer to request information or decide. Then write a short intake record.
Policy coverage check
Policy coverage check reads the claim with the policy schedule and wording. It checks the item is insured, the amount is within the sum insured, no listed exclusion applies and the loss is in cover, then sends doubts to the claims assessor with the excess noted.
Tested: clean set completed; 3 of 3 planted errors flagged.
View on the Docy AI marketplace →See the brief
Build an agent that checks whether a claim falls within the policy before it is assessed. From the claim form, policy schedule and policy wording, extract the cause of loss, item damaged, loss date, claimed amount, insured items, sum insured, excess, period of cover and listed exclusions. Also have the extractor state whether the item is insured, whether the claimed amount is within the sum insured, whether the cause of loss matches a listed exclusion and which one (or None), and whether the loss date is within cover. Check the item is insured, the amount is within the sum insured, no exclusion matches and the loss is in cover. If any check fails, send it to the claims assessor to decide on cover. Then write a short coverage note stating the excess.
Claim fraud red flags
Claim fraud red flags screens a claim for late reporting, a new policy, invoices dated before the loss and repeat claims. Flagged claims go to the investigations team to clear or refer. Flags prompt review; they are not findings of fraud.
Tested: clean set completed; 3 of 3 planted errors flagged.
View on the Docy AI marketplace →See the brief
Build an agent that screens an insurance claim for common red flags before payment. From the claim form, policy schedule, invoices or quotes and the claimant's prior claims list, extract the loss date, date reported, policy start date, claimed amount, each invoice with supplier and date, and each prior claim date. Also have the extractor work out the days from loss to report, the days from policy start to loss, whether any invoice is dated before the loss, and the number of prior claims in the 12 months before the loss. Check the claim was reported within 30 days, the policy had started at least 60 days before the loss, no invoice predates the loss and there are fewer than 2 prior claims in 12 months. If any check fails, send it to the investigations team to clear or refer. Then write a short screening record.
The brief is what you type into the Docy AI assistant. Agents tagged Open Docy can also be built by hand on the open-source canvas. Agents tagged Docy AI may need custom code, a knowledge list or a policy node, which Open Docy does not include.
Your rules. A person's decision. A record.
Send the claim file
Upload the claim form, policy schedule and wording, invoices, photos and the claimant's prior claims list.
Apply your rules
Required documents, cover terms and red-flag thresholds are checked the same way on every claim. Anything that fails goes to a named person.
Keep the record
Each run records what was checked, the values found and who decided, so you can show how a claim was handled.
Be clear about the limits
- They don't decide claims or pay them. Claims officers and assessors make every decision.
- Red flags are prompts for review, not findings of fraud. Check thresholds against your own guidelines and claims handling obligations.
- They don't connect to your claims or policy administration system. They check the documents you give them.
- These agents check documents against rules you set. They do not replace the people who make the decision.
- We have tested these: each completed a clean test set and flagged the errors we planted in a flawed one. Test on your own files before relying on them.
Want to try one on your own insurance claims documents?
Tell us which documents you work with and which check would save you the most time.