Determines compensability, computes benefits and files the EDI claim — a licensed claims adjuster signs the determination.
Workers'-comp claims handling is high-volume AOE/COE compensability + AWW/benefit computation under 50 state acts, where a wrong denial or benefit termination denies an injured worker statutory benefits and is actionable as bad-faith claims handling.
Injuries intaken, compensability determined and benefits computed straight-through; the licensed claims adjuster signs the compensability determination before the EDI claim is filed with the state.
Intake to outcome. 🤖 steps run automatically; 🧑⚖️ steps are where a named human signs off the judgment calls.
Connectors run as sandbox stubs today — flip to the real provider to go live.
The autopilot escalates the judgment calls to a qualified human — the rest is straight-through.
Every autonomous decision is logged — who · what · confidence. Signed human checkpoints and a built-in compliance reviewer enforce the rails, so the outcome holds up to an audit, not just a demo. Every irreversible action runs only after a human signs — the autopilot does the volume, never the point of no return on its own.
🧑 Accountable owner: Licensed workers'-comp claims adjuster — one person answers for what this autopilot does.
Same buyer, adjacent function — the connectors and compliance packs are shared.