Model policy · version 1
Draft
Insurance claims handling
Handle claims fairly and keep a defensible record of each decision.
What’s in this policy5 sections · Insurance claims handling · Read the full policy
4Obligations · things you must do
4Evidence · records that prove it
2Monitoring · checks and deadlines
0Reporting · reports you must send
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Answer a few questions and each obligation is marked applies, likely, or needs more information.
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Every obligation in this policy, in one request.
What the policy requires
Automate
Leela can perform the work through your connected systems.
Monitor
Leela can watch for the trigger, keep the clock, and flag what is late.
Prepare for review
Leela can prepare the artifact and hand it to a person for review.
Human required
A person must do the work; Leela can track it and file the evidence.
TriggerEvent-driven · At claim receipt and every material handling action
EvidenceClaim chronology and supporting records
TriggerContinuous · For each open claim and incoming claimant communication
EvidenceDeadline register and communication log
TriggerEvent-driven · Before a denial, disputed valuation or settlement communication
EvidenceDecision review and approved communication
TriggerAnnual · At onboarding, rule changes and the company’s annual control review
EvidenceTraining record, sample results and remediation log