Most of the work in a claim is assembly: finding the clauses that apply, checking an estimate against schedule rates, noticing the three things that do not fit. That is work an agent does well and an adjuster resents doing. Authorising the payment is the opposite — and the platform keeps the two on different sides of a line somebody drew.
Assigning the Insurance Operations pack brings 103 terminology overrides and 4 measured definitions with it, along with the governance defaults that decide which actions wait for a person. Everything below is what that configuration contains, not an illustration of what it could contain.The useful question is never “can it do this” — it is “what does it do without asking, and what does it bring to a person”. Each card answers both.
governedThe assistant: Structures what was reported, identifies the policy in force on the date of loss, and lists the coverage sections that could apply along with what each needs to be proven.
The person: Nobody yet. Opening a file commits nothing; the assistant is doing the reading.
governedThe assistant: Compares line items against schedule rates and coverage limits, applies deductible and any sub-limits, and raises the exceptions rather than smoothing them.
The person: The adjuster, on anything the assistant flagged — and the flags are the product, not the total.
governedThe assistant: Assembles the file: clauses relied on, the figures with their inputs, the correspondence, and what a reviewer would want to see first.
The person: A senior adjuster authorises the payment, at the quorum the authority chain sets. Separation of duties refuses the vote of whoever prepared it.
Every label resolves company override → industry default → canonical, and a region filters rather than ranks — so a label added for one market cannot change what another one reads. The same resolved words assemble the agent’s prompt.
overlayThe same label in every region this pack covers.
overlayUnderwriting Approval in US · Claim Sanction in IN
overlayThe same label in every region this pack covers.
overlayThe same label in every region this pack covers.
overlayThe same label in every region this pack covers.
overlayInsurance Catalogue in IN
Each measure carries a definition, the formula it is computed by and the source that defines it. That is what makes the figure defensible in a review — and what stops a model producing a plausible one instead.
kpi mapThe share of earned premium consumed by incurred losses, including movement in incurred-but-not-reported reserves and loss adjustment expense.
loss_ratio = incurred_losses / earned_premium × 100
kpi mapTotal underwriting cost as a share of earned premium. Below 100% the book is profitable before investment income — which is why the denominator matters as much as the number.
combined = loss_ratio + expense_ratio, each on its declared basis
kpi mapAvailable solvency margin as a multiple of the required margin, with the statutory floor an Indian insurer must hold.
solvency = available_solvency_margin / required_solvency_margin
kpi mapPremium returned when a policy is cancelled mid-term on a pro-rata basis, where the insurer keeps only the premium for the period actually on risk.
refund = annual_premium × unexpired_days / policy_days
Every deployment in this industry fails the same few ways. These are the ones the platform is built to make impossible rather than discouraged.
enforcedThe assistant states what it relied on and which facts do not reconcile. It does not produce a confidence number about a person, because an adjuster cannot defend one and a regulator will ask them to.
enforcedWho may authorise, and how many of them, is configured as an authority chain — and it replaces whatever the requester nominated, because a requester choosing their own approver is not an approval.
enforcedDeclining a claim is recorded the same way an authorisation is: who, when, on what basis. A platform that treats refusal as a failure state teaches everyone to approve.
Everything on this page is configuration on top of one runtime. The controls underneath it are the same for every client, and they are written out in full on the platform page.
The first scope that works is a process somebody already owns, with a decision worth keeping human. Bring that, and we will map the agents, the integrations and the approval roles around it.
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