CaseC-0479

Life benefit, paid alone

The largest claim the recommended version settles with no person: the kind of decision an audit exists for.

life claim · $47,024

What the claimant wrote

Life insurance claim. I am the named beneficiary on the final expense policy of my late spouse, who passed away from natural causes in Savannah, GA on 2026-04-27. I have attached the certified death certificate and my identification. The benefit amount is $47,024. — Ruth Adeyemi

At a glanceEvery version

This claim through all ten versions

0Today

By hand

The claim joins one queue with every other claim and waits about 5.0 days for an adjuster to read it, check the policy and decide.

W0 to W3: turning the answers into a decision

W0 · Trust the one big answer

Sent to a person: nothing allowed it to go ahead alone. The right call
The steps it went through
1. Code R-HV-50K not fired: Claims over $50,000 require mandatory human review
2. Code R-INJECTION not fired: Suspected manipulation of automated processing quarantines the claim
3. Code R-FRAUD not fired: Claims with fraud indicators require investigation
4. Code R-POLICY not fired: Claims on a policy that is not in force go to a human (denials are never automatic)
5. Code R-TYPE-CONFIDENCE not fired: Uncertain claim type cannot be routed automatically
6. Code R-SPECIALIST not fired: Claims needing domain expertise are assigned to a specialist
7. Code R-DENY-NEEDS-HUMAN not fired: A recommended denial is always reviewed by a person
8. Code R-INCOMPLETE-CONFLICT not fired: Approval recommended on a submission judged incomplete
9. Code R-AUTO-APPROVE not fired: Auto-approval: approve recommended with sufficient confidence, low fraud risk, adequate documentation, value within limit
10. Code R-AUTO-RMI not fired: Automatic request for missing information
11. Code R-DEFAULT-HUMAN FIRED: No automatic rule applied: route to human review Decided here
12. Person Disposition human_review by R-DEFAULT-HUMAN
W1 · Combine the small answers

Sent to a person: not certain enough for the amount at stake. The right call
The steps it went through
1. Code Claim C-0479: $47,024, policy active.
2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
3. Code Claims over $50,000 require mandatory human review
4. Code Suspected manipulation of automated processing quarantines the claim
5. Code Claims with fraud indicators require investigation
6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
7. Code Claims needing domain expertise are assigned to a specialist
8. Code Code combines the narrow answers and acts on the least certain one: 40.0% confidence.
9. Code Not certain enough for a claim this size, so it goes to a person. Decided here
10. Person Sent to a person: below the confidence cut-off.
W2 · Learn how much to trust each answer

Paid automatically. The right call
The steps it went through
1. Code Claim C-0479: $47,024, policy active.
2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
3. Code Claims over $50,000 require mandatory human review
4. Code Suspected manipulation of automated processing quarantines the claim
5. Code Claims with fraud indicators require investigation
6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
7. Code Fourteen learned weights score approval at 99.0% and a request for information at 0.3%; the higher one is proposed.
8. Code Certain enough, so it is handled with no person. Decided here
9. Code Handled with no person: paid.
W3 · Be stricter as amounts rise

Paid automatically. The right call
The steps it went through
1. Code Claim C-0479: $47,024, policy active.
2. Decision model The model answers fourteen typed questions about completeness, evidence and fraud; code decides, it never does.
3. Code Claims over $50,000 require mandatory human review
4. Code Suspected manipulation of automated processing quarantines the claim
5. Code Claims with fraud indicators require investigation
6. Code Claims on a policy that is not in force go to a human (denials are never automatic)
7. Code Fourteen learned weights score approval at 99.0% and a request for information at 0.3%; the higher one is proposed.
8. Code The certainty needed grows with the amount at stake: doubt is scaled by the claim's value against a $5,000 reference, giving 91.0% confidence.
9. Code Certain enough, so it is handled with no person. Decided here
10. Code Handled with no person: paid.

Around W3: the work people still do, and what else was tried

+ A quick confirmation for near-certain claims (now for requests only)

Paid automatically. The right call
The steps it went through
1. Code The fitted workflow handles this claim with no person; no lane is needed.
2. Code Handled automatically; this claim never reaches a lane.
+ Grade the fraud response

Paid automatically. The right call
The steps it went through
1. Code The fitted workflow handles this claim with no person; no lane is needed.
2. Code Handled automatically; this claim never reaches a lane.
+ A second vote on near-misses (a negative result)

Paid automatically. The right call
The steps it went through
1. Code The fitted workflow handles this claim with no person; no lane is needed.
2. Code Handled automatically; this claim never reaches a lane.
+ Ask the customer one question

Paid automatically. The right call
The steps it went through
1. Code The fitted workflow handles this claim with no person; no lane is needed.
2. Code Handled automatically; this claim never reaches a lane.
+ Watch after the decision

Paid automatically. The right call
The steps it went through
1. Code The fitted workflow handles this claim with no person; no lane is needed.
2. Code Handled automatically; this claim never reaches a lane.