Claims Decisioning: claims settled in minutes, not weeks
Claims Decisioning is an automated coverage check, from FNOL to settlement. We check the policy terms against the facts of the case and say whether the claim should be approved or denied. Where it is approved, the amount owed is calculated line by line, and your adjuster makes the final call.
Water damage claim
Claim 62850
A settled claim in under 2 minutes
Same facts, same answer
The amount is calculated from the wording, so it does not vary by adjuster.
A reason on every line
Each amount quotes the clause or rule behind it.
Your team keeps the final decision
Full automation runs only where you and your regulator allow it.
We handle the documents, the data and the calculations
Every document read
Invoices, estimates, policies and photographs become structured data.
Evidence checked first
Signatures, metadata and figures are tested before any amount is calculated.
Each line against the policy
Parts, labour and fees are split out, each with its clause.
The calculations done
Excess, limits, caps, liability and betterment, worked through in order.
Every figure traced
Each number links to the place in the document it came from.
Every change explained
When an adjuster overrides a line, the reason is recorded.
The technology
Calculated, not predicted
Your policy wording, catalogue or rulebook is configured into a deterministic decision tree. Given the facts of the case, the outcome is calculated from the wording. The same facts always give the same answer, and the answer can be explained clause by clause.
Agents do the reading. Photographs, PDFs, handwriting and emails become the facts the decision tree needs. Each agent does one small task, so a fault is easy to find and fix at the step where it happened.
Every claim moving, from FNOL to settlement
Arrives on any channel
One claim record
ClaimantA. Meier
PolicyHOM-2026-8834
IncidentWater damage, kitchen
Documents4 read, 0 missing
ContextualisedEvery party in the loop
Customer
Reference sent, status page live
Broker
Record shared, nothing to re-key
Repairer
Estimate requested, due Friday
Adjuster
Assigned, documents already read
Less admin around every claim
One record per claim
Submission, photographs, policy and system data in one place.
Automatic routing
Claims go to the right adjuster on your rules and live workload.
No chasing by hand
Reminders go out when your triggers say so.
Every party in the loop
Customer, broker and repairer each see the live status.
A full record of every decision
Claim 62850 Record
Water damage
- Received
- Read
- Checked
- Calculated
- Decided
- Settled
- 09:14:02AgentFour documents read and classified#a7f3
- 09:14:19AgentEvidence integrity check passed#4c19
- 09:14:31Rules engineEach line checked against the wording, clause 4.2 applied#b028
- 09:14:33Rules enginePayout calculated: 3'936.33#3f6a
- 09:21:40AdjusterLine 5 confirmed, two nights above the cap set aside#e5d1
- 09:21:41Rules engineRecord sealed, chain verified#c90d
Chain verified, 6 of 6 hashes match
Otus
An AI-powered expert for every team member
Otus sits alongside every person in your team. It explains any decision line by line, drafts the letter or the handover and plans the day, from the claim, the policy and the record.
Adjusters ask in plain language, by voice or text, and get an answer straight away. It has no decision rights: your team decides.
Explore our platform
- Invoice BenchmarkingNever overpay on an invoice again.
- Damage ReportingCompleted damage reports in minutes.
- Otus, True Aim's claims specialistAn AI-powered expert for every team member.
Common questions
Is the outcome predicted by AI?
No. Your policy wording, catalogue or rules are turned into a decision tree. The amount is calculated from the facts, so the same facts always give the same answer.
Where is AI used?
To read the claim. Agents turn photographs, PDFs, handwriting and emails into facts. Each agent is assigned one small task, so each step is clearly visible.
Who makes the final decision?
Your team. By default, True Aim prepares a recommendation with full reasoning for a person to confirm. Full automation is available only where you and your regulator allow it.
What happens when something is wrong?
Every assumption is on screen and can be changed. Every change records its reason. The fault is fixed at the step where it happened.
Can we work from our own rules rather than the policy wording?
Yes. Industry catalogues and your own business rules work the same way as policy wording. One example is fair wear and tear rules for vehicles returned at the end of a lease.
Which regulations is the record mapped against?
DORA, the EU AI Act and national rules including FINMA, BaFin, the NAIC and POPIA. The forensic view of the claim record shows every action by actor, so accountability is visible for every decision.
Does it replace our claims system?
No. True Aim's Claims Decisioning works above the claims system you run, reads the claim from it and writes the recommendation back into it.
What is the Decision Dossier?
The record of every decision: the inputs, the clauses applied, the calculation trace, the evidence links and who confirmed the outcome. It exports as one audit pack.
See the automated coverage check on your own claims
Book a demo with your own claims, or start with your own numbers in the Impact Estimator.