UM/UIM Coverage Logic Engine

Part III decision logic — the funnel, mapped

The analysis runs the funnel you use: Level I insuring agreement and the definitions it incorporates, Level II the nine Part III exclusions, then Level III conditions and limitations. Each node is one auditable rule tied to a specific provision of Form 5980 TX, so the logic can be reviewed clause-by-clause rather than buried in code.

Continue / element satisfied Coverage-defeating → Denial Undetermined → Reservation of Rights Screens out a provision Limit / offset / deductible

Prototype — illustrative. Logic is modeled on Form 5980 TX (08/17), Part III, plus controlling Texas authority. It is a demonstration aid, not legal advice, and should be verified by an attorney against the issued policy (and declarations) before any production use.

Guided claim analysis

Not started0 provisions screened

⚙ AI Document Review CONCEPT

In production, Claude reads the demand letter, recorded statements, and file materials and proposes each answer with a citation back to the source document — the handler only verifies. Load a sample UIM claim to see the funnel populate:

Provisions in play

Live conclusions & audit trace

Answer questions to build the analysis.

Coverage correspondence

Drafted in your format: a concise opening determination, then I. facts, II. policy information, III. coverage analysis with each issue in IRAC, IV. additional information needed (fed by every "undetermined" answer), and V. conclusion. Standard I.A.1.a.i. outlining. Click into the letter to edit.

Document

[brackets] are merge fields from the claim record.