Use Case

Automate insurance claims from first notice to final settlement

Claims processors juggle policy documents, medical reports, and adjuster notes across disconnected systems. Docstruct orchestrates the entire lifecycle — intake, extraction, validation, and routing — in one pipeline.

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The end-to-end claims workflow

Exactly how Docstruct handles insurance claims — from first notice to final settlement.

1

Claim Intake & Document Collection

Claimant submits FNOL (First Notice of Loss) via portal, email, or agent upload. Docstruct auto-ingests the claim form, policy document, and any supporting evidence (photos, police reports).

FNOL FormPolicy CertificateIncident Photos
2

AI Field Extraction

Docstruct extracts structured fields from every document: policy number, claimant name, date of loss, claim type, coverage limits, deductible amount, and itemized damages.

Policy NumberClaim AmountCoverage LimitDeductible
3

Rule-Based Validation & Routing

Expressions evaluate extracted data: Is the policy active? Does the claim amount exceed the deductible? Is the loss type covered? Claims are auto-routed — simple claims to auto-approval, complex ones to senior adjusters.

Policy Status CheckCoverage ValidationThreshold Rules
4

Adjuster Review & Verification

Flagged claims land in the Checker UI. The adjuster reviews extracted fields against source documents, verifies damage estimates, and approves or requests additional documentation.

Damage AssessmentMedical ReportAdjuster Notes
5

Settlement & Notification

On approval, Docstruct triggers downstream actions: settlement amount is synced to the claims management system, approval email is sent to the claimant, and the case is archived with a full audit trail.

Settlement LetterPayment InstructionAudit Log

What gets automated

Every Docstruct capability mapped to what it replaces in your claims process.

Docstruct CapabilityWhat It Means for Claims
Document Ingestion
Auto-collect FNOL forms, policy docs, and evidence from email, portal, and agent uploads into one pipeline
AI Field Extraction
Pull policy number, claimant details, loss date, claim amount, and itemized damages — no manual keying
Expression Engine
Evaluate coverage eligibility, deductible thresholds, and fraud indicators before human review
Conditional Routing
Auto-approve simple claims under $2K; escalate high-value or flagged claims to senior adjusters
Checker UI
Adjusters verify extracted data side-by-side with source documents in a single screen
Action Triggers
On approval: sync settlement to CMS, email claimant, archive case. On rejection: notify agent with reason codes
Audit Trail
Every extraction, edit, approval, and rejection is logged with timestamps and user IDs for regulatory compliance

Who uses this workflow

Three roles, one platform — each sees exactly what they need.

Claims Processor

Maker eliminated

Manual data entry and document sorting is fully automated — processors are redeployed to exception handling.

Claims Adjuster

Checker

Reviews pre-extracted, validated claims in the Checker UI — focuses on judgment calls, not paperwork.

Claims Manager

Audit visibility

Full pipeline visibility with audit trails, SLA tracking, and exception dashboards — zero blind spots.

Ready to automate your claims pipeline?

Set up your first claims workflow in under 15 minutes. No template training. No IT dependency.

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