Bodily Injury Demand Reviewer
A bodily injury demand arrives with a deadline and a number that assumes every bill, every lost day, and full liability — and the adjuster often finds the inflation only after an offer is on the table. This assistant checks each demand against the claim file and policy, confirming liability, separating crash-related treatment from pre-existing conditions, verifying lost wages, and flagging duplicate or unrelated charges, then recommends settle, negotiate, or hold.
Category: Finance
How it works
- A demand package comes in — the demand letter and amount, medical bills and records, the lost-wage claim, the police/loss report, and your policy limits and claim notes.
- It checks liability and comparative fault, confirms each treatment is causally related to the loss, separates pre-existing conditions, verifies lost wages against documentation, and screens bills for duplicate or unrelated charges.
- It returns a decision — settle, negotiate, or hold — with a documented-specials valuation, an exposure read against policy limits, and each flag tied to the bill, record, or report it fails.
- Each demand lands as one row in your claims queue for an adjuster or examiner to clear before any offer is made.
Key benefits
- Stop overpaying demands inflated by unrelated or duplicate bills
- Separate crash-related treatment from pre-existing conditions
- Ground every offer in documented, verified special damages
- Catch disputed liability before you tender policy limits
Use cases
- Claims adjusters evaluating third-party bodily injury demands
- Auto and general liability teams managing settlement exposure
- Claims managers and examiners controlling indemnity leakage
- Self-insured and TPA teams reviewing pre-litigation demands
Frequently asked questions
Does this assistant automatically settle claims or send offers?
No, it never sends offers or settles claims. It evaluates the demand and recommends settle, negotiate, or hold; a human adjuster or examiner reviews and approves every action before any offer is made.
How does it separate crash-related treatment from pre-existing conditions?
It compares the medical records and bills against the claim file and loss report, flagging any treatment that predates the accident or is unrelated to the crash, so you don't pay for pre-existing care.
Which apps or systems does it connect to?
It works entirely within your Gaia workspace with no external connections — your demand packages, claim files, and policy details stay in your own table.
How does it handle duplicate or unrelated bills?
It screens every medical bill against the claim documentation, flagging any duplicate charges or treatments not causally related to the loss, so you only pay for verified special damages.
Can I customize the evaluation criteria or decision thresholds?
Yes, because it operates on a native Gaia table, you can adjust the logic, liability rules, or valuation parameters to match your specific claims guidelines or state regulations.
