Claim intelligence
Every insurer in the world reads documents, reconciles evidence and decides claims. What differs - completely, and in ways that do not generalise - is what the regulator requires, what the customer is owed, and what a defensible decision has to look like. We build the engine once and the obligations per market.
Six markets encoded, 142 obligation rules across 24 jurisdictions, six statutory benefit schemes, 207 tests, zero dependencies. Every rule ships unverified until a named person has checked it against the primary instrument.
The thesis
A system that reads a medical certificate works anywhere. A system that knows the certificate is a statutory instrument with a review cycle, that the clock it starts runs in business days under one state's calendar, and that stopping payments on it requires notice - that system only works where it was built.
Document understanding. Evidence anchoring. Cross-document reconciliation. Provenance and replay. Entity resolution. The architecture of an explainable decision.
Built once
Obligation timeframes and their units. Benefit formulas and indexed caps. What evidence a decision requires. Dispute pathways. Public holidays, of all things, which change the answer.
Built per market
Findings are never decisions. No assertion without two sources. Protected attributes firewalled from assessment. No opaque score anywhere in the product.
Everywhere, in code
The uncomfortable consequence is that entering a market is not a configuration exercise. It is reading the instruments, encoding them as data with citations, and having a person verify each one against the primary source. That is slow, and it is the moat.
Platform
Each answers one question well. The facts that decide whether a claim ends well sit between them, which is where a single-purpose tool cannot look.
An example of the last one: you are about to stop weekly payments on a claim that has been underpaid for ninety-seven weeks. The obligation engine does not know about the underpayment. The entitlement engine does not know about the cessation. Nobody in the process sees both.
Markets
"Live" means the obligations are encoded with citations and, where the market has statutory benefits, the arithmetic is modelled and tested. "Encoded" means the rules are in and the market is missing something named - a benefit scheme, most states, a revised code. Every market publishes its own gaps rather than leaving you to discover them.
71 rules, 8 jurisdictions, 4 benefit schemes. General Insurance Code, Life Code, RG 271, APRA CPS 230 and 234, Privacy Act APP 1 and 11, state workers compensation and CTP schemes with their weekly benefit arithmetic.
See the Australian product →14 rules, 4 regions, 1 benefit scheme. Fair Insurance Code, the CoFI conduct regime, and accident compensation - including the flat 80 per cent weekly compensation with no step-down, which is the structural opposite of every Australian scheme.
14 rules, 3 nations. The DISP complaints timetable, ICOBS claims handling, the Insurance Act late-payment remedy. No statutory benefit scheme to model - UK income protection is contractual. Where ICOBS says "promptly" rather than a number, our own interval is used and labelled as ours.
12 rules, 4 provinces, 1 benefit scheme. Ontario's Statutory Accident Benefits Schedule in depth, including the income replacement benefit and the weekly cap fixed in the regulation and never indexed. Quebec complaints and the AMF transfer right.
13 rules. Consumer Protection Code timeframes, the Consumer Insurance Contracts Act duty to give a specific reason, and the EU AI Act obligations carried as horizon rules. The strictest transparency regime modelled here, and the one this architecture was designed for.
18 rules, 3 states of fifty. The NAIC baseline plus California, New York and Texas, whose day counts genuinely differ, and the federal ERISA timetable that overrides state law for group disability and health. A fifty-state book needs the other forty-seven before this is fit for use, and the platform says so rather than implying national coverage.
If your market is not listed and you have the regulatory problem this solves, that is worth a conversation - the order we build in should be set by who actually needs it. [email protected]
What we will not do
No accuracy, detection-rate or time-saved figure appears anywhere on this site, because no pilot has produced one under a methodology we would publish beside it. When one has, the number and the method arrive together.
All 142 obligation rules across six markets, and every indexed rate, carry
verified: false until a named person has checked them against the primary
instrument. The count appears in every position and every report rather than in a footnote.
A claim in a market whose rules are not encoded refuses to evaluate rather than returning zero breaches. Zero applicable rules and zero breaches look identical in every report, and an insurer reading the second would reasonably conclude they were compliant.
There is no risk score, no ranking of claimants, and no composite figure spanning compliance and evidence. The only number attached to a person is how many independent documents corroborate a fact about them.
The Australian product is live, documented and demonstrable on synthetic claim files. It is the fastest way to judge whether the architecture is right for your market.