Claims decisioning as reports arrive

A claim takes weeks and changes as reports arrive. Decisimo runs your written policy across the case, with an adjuster reviewing it.

Start free See the claim stages

Claims policy follows evidence across the case

Claim as a case

Each task runs when its evidence is on file

Updated review

Changed values rerun tasks and send a new review to the same role

Recorded basis

The claims team’s rows write the basis and reason to the case

Policy changes

The team edits rules, tables and scorecards

Named fraud flags

Rules write named flags for the adjuster to review

Standard risk

The underwriting team edits the decision flow for one-call decisions

A motor claim, from first notice to settlement letter

  1. First notification

  2. Policy and value

  3. Engineer’s report

  4. Fraud indicators

  5. Settlement basis

  6. Adjuster review

  7. Settlement letter

A claim as a case that follows its evidence

  • No fixed orderEach task runs when its conditions hold.
  • Flow viewIt links each value's writer to every task that reads it
  • Six task kindsHuman review, memo, decision logic, AI extraction, document reading and external call

How case work runs

Flow view for Motor claim, repair or total loss, showing tasks linked by evidence dependencies
Motor claim, repair or total loss connects ten tasks through the values each task reads.

Repair or total loss, by rows the claims team edits

  • Two conditionsRepair to value and engineer's finding form four rows
  • Total lossAbove 0.7 means total loss, as does an engineer’s finding
  • Plain reasonsEach row writes its reason onto the case for review and letter
Settlement basis task shows four decision-table rows using repair ratio and engineer’s finding to set the basis and reason
The Settlement basis task opens on the table it runs and the four rows it decides.

A late report and what runs again

  • Changed valueThe task that read it runs again on its own
  • Logic, letter rerunCalls, document reading, AI extraction use the case type’s budget
  • New review taskSame role gets current values. Earlier review and decision stay on file.

Fraud indicators as named flags for the adjuster

  • Claim timingWithin 30 days of inception or reported over 14 days after the incident
  • Claim historyThree or more claims in three years, or no third party identified
  • Flags for reviewRules raise flags for the adjuster. None declines a claim.

Fraud decisioning

Standard risk in one call, edited by underwriters

  • Portal editingThe team edits sources, rules, tables, scorecards and functions
  • Release nameEndpoint responses name the release. An endpoint can require sign-off.
  • Shared logicA case task can use the same rules, tables, scorecards and functions

Life underwriting scorecards

The obligation stays with the insurer

  • EU AI ActLife and health risk assessment and pricing are high-risk from 2 December 2027
  • GDPR Article 22It applies to automated decisions today
  • Decision recordsInputs and outputs can be written to the insurer’s own Postgres

Governance obligations

What stays with the insurer

  • Demo caseScreenshots use demo values from a sample case
  • Insurer’s policyThe insurer's policy runs on data the insurer supplies
  • Adjuster decisionThe adjuster reviews flags and makes the claim decision

Questions we get asked

Can policy handle part of a claim and send the rest to an adjuster?

The settlement basis table writes repair or total loss and its reason to the case. An adjuster reviews the case in Decisimo.

What happens when an engineer’s report changes an authorised repair?

Tasks that read changed values run again. The same role gets a new review task with current values, and the earlier review stays on the case.

Where is the record of each decision kept?

For standard risk, each decision's input and output can be written to the insurer's own Postgres database.

Put your claims policy into a case

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