Claims settlement simulator

A claims app proposes a settlement. VeriProof checks the carrier’s rules before payout. Try a sample claim to see what proceeds, stops, or needs an adjuster.

How the simulation works

The website proposes approval. VeriProof checks the rules.

  1. The website simulates the agent

    Every prepared scenario starts with the website acting as an AI agent and proposing approval.

  2. VeriProof enforces the business rules

    VeriProof checks the proposed approval against the rules prepared for this demo.

  3. The website applies the result

    VeriProof returns one of five outcomes: Allow, Warn, Transform, Escalate, or Deny. The website applies that outcome to the simulated action.

In a real integration, your application applies VeriProof's result before the proposed action proceeds.

  1. Choose what the agent approvesEvery prepared scenario starts with simulated agent approval
  2. See VeriProof's decisionPass, escalate, or stop based on the business rules

Choose a scenario

The claim settlement

Each sample claim ends differently. Pick one, or change the claim facts below.

Claim type
Water damage
Claim amount
$18,900
Coverage limit
$100,000
Fraud signal score
0.78
Prior claims in 12 months
1
Change scenario details

The claims app proposes to pay this claim automatically.

The app proposes a payout. VeriProof stops it because the fraud score exceeds the carrier’s limit.

Records created in this public demo can be seen by other visitors, so use the sample data rather than your own.

Configuration details

How this demo is set up

Review the application settings, rules, and evidence fields used in this simulator.

VeriProof setup

Industry
Insurance
Application
Claims Processing Agent
Environment
Public demo workspace
Rule enforcement
Enforce: check rules before payout
Rule set
Claims settlement and fraud guardrails

Related governance frameworks

Insurance context: NAIC Model Bulletin on the Use of AI Systems by Insurers · Unfair claims settlement rules · Colorado SB 21-169

The claims app's own checks

The sample claims app makes the first settlement decision.

  • Deny when the policy is not in force.
  • Send claims above $25,000 or involving injury to an adjuster.
  • Propose settlement for other claims. The app leaves fraud checks to VeriProof.

The company rules VeriProof enforces

VeriProof checks the proposed payout against these sample carrier rules. The carrier sets the thresholds; they are not regulatory limits.

  • Stop an automatic payout when the fraud score is 0.70 or higher.
  • Require review for claims of $10,000 or more when there are at least two prior claims in 12 months.
  • Require review when the proposed amount reaches 90% of the coverage limit or more.
Review the details saved with each run

When saving succeeds, the record keeps the sample claim facts, app proposal, and policy result together.

claimant_name / claim_number

The sample claimant and claim references.

claim_type / claim_amount_usd

The loss type and requested settlement.

coverage_limit_usd / policy_in_force

The coverage facts used in app and rule checks.

fraud_signal_score / prior_claims_12mo

The fraud signal and recent claim count.

injury_involved

Whether the sample claim includes an injury.

local_decision / governance_action / final_decision

The app decision, rule check, and actual outcome as separate facts.