Afrexai Insurance Claims

# Insurance Claims Processor

Process, analyze, and optimize insurance claims. Covers property, liability, workers' comp, auto, and professional indemnity.

## What This Does

Takes raw claim details and produces:
- Structured claim summary with policy coverage mapping
- Liability assessment with supporting/weakening factors
- Reserve estimate with confidence range
- Subrogation opportunity analysis
- Red flag detection (fraud indicators, coverage gaps)
- Settlement recommendation with negotiation range
- Regulatory compliance checklist by jurisdiction

## Usage

Provide claim details in any format — adjuster notes, policyholder statement, incident report, photos, or free text. The agent structures everything.

### Quick Claim Analysis
```
Analyze this claim: [paste details]
```

### Full Processing
```
Process claim for:
- Policy type: [commercial general liability / property / WC / auto / PI]
- Incident date: [date]
- Reported date: [date]
- Claimant: [name/entity]
- Description: [what happened]
- Claimed amount: [if known]
- Policy limits: [if known]
- Jurisdiction: [state/country]
```

## Claim Analysis Framework

### 1. Coverage Determination
- Map incident to policy provisions
- Identify applicable endorsements and exclusions
- Flag coverage disputes early
- Check occurrence vs claims-made triggers

### 2. Liability Assessment
Score 1-10 on insured liability exposure:
- **1-3**: Strong defense position, deny or minimal settlement
- **4-6**: Mixed liability, negotiate
- **7-10**: Clear insured liability, reserve and settle

Factors evaluated:
- Comparative/contributory negligence (jurisdiction-specific)
- Statutory obligations
- Contractual indemnity provisions
- Prior loss history pattern

### 3. Reserve Estimation
Three-point estimate:
- **Low**: Best case with strong defense
- **Mid**: Most likely outcome
- **High**: Worst case including litigation costs

Include:
- Indemnity reserve
- Defense costs (inside/outside limits)
- Allocated loss adjustment expense...

# Insurance Claims Processor

Turn raw claim data into structured analysis with liability scoring, reserve estimates, fraud detection, and settlement strategy.

Covers property, liability, workers' comp, auto, and professional indemnity claims across US and UK jurisdictions.

## Install

```
clawhub install afrexai-insurance-claims
```

## What You Get

- **Coverage mapping** — matches incidents to policy provisions, endorsements, exclusions
- **Liability scoring** — 1-10 scale with comparative negligence analysis
- **Reserve estimates** — three-point (low/mid/high) with ALAE/ULAE breakdown
- **Fraud detection** — pattern-based red flag scoring
- **Subrogation analysis** — recovery potential and cost-benefit
- **Settlement strategy** — opening position, authority range, mediation vs litigation
- **Compliance timeline** — jurisdiction-specific deadlines and bad faith triggers

## Who This Is For

- Claims adjusters processing high volume
- Insurance operations managers automating triage
- Risk managers handling self-insured retentions
- TPAs standardizing claim handling procedures
- InsurTech teams building claims automation

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