First notice of loss
Turn first notice of loss into a complete, correctly routed claim
A claim that arrives incomplete costs more than one that arrives late. Claimants retell a stressful event across three handoffs, evidence is requested in the wrong order, and the file reaches an adjuster missing the fields that determine routing. This blueprint captures the event once, calmly, and hands over a structured file — while every coverage and liability judgement stays with your licensed handler.
- The team
- 4 AI worker roles escalating into 1 human decision owner.
- The process
- 6 orchestrated stages, each with a named decision owner.
- The channels
- Voice, Web chat, WhatsApp, Email on one shared context.
The shift
What breaks today, and what changes
The challenge
- Claimants repeat distressing details at each handoff because intake is not structured or shared.
- Incomplete first notice creates a rework loop of callbacks and document chases before triage can even start.
- Peak events — storms, floods, multi-vehicle incidents — arrive as a volume spike your intake team cannot staff for.
What changes
- The event is captured once, in a consistent structure, whatever channel the claimant used.
- Injury and emergency language reaches a person immediately rather than continuing through an intake script.
- Handlers open a file that already has the policy match, evidence, and routing rationale attached.
The team
Every seat has one job and a defined level of autonomy
This is what gets configured in Team Canvas: role-scoped AI workers, the humans they escalate into, and a trust level on each connection that sets what a worker may do on its own. Trust starts tight and widens on evidence.
AI workers
Intake worker
Guides the claimant through first notice of loss at their pace, in their language.
- Owns
- Event narrative capture
- Trust level
- Acts within policy — never comments on coverage or liability
Policy verification worker
Matches the caller to a policy and confirms it was in force at the time of loss.
- Owns
- Policy match and identity confidence
- Trust level
- Acts within policy — read-only against the policy system
Evidence worker
Requests the documents and media that this claim type actually requires, and chases what is missing.
- Owns
- Evidence completeness
- Trust level
- Acts within policy — request and receive only
Triage worker
Classifies claim type, severity, and urgency, and records why.
- Owns
- Routing recommendation
- Trust level
- Suggest only — routing is a recommendation with a rationale
Human decision owners
Claims handler
Owns coverage, liability, reserving, and settlement from a complete file.
Owns: All regulated claim decisions
The process
The conversation starts the work. The workflow finishes it.
Each stage records the decision that was made and the role accountable for it — which is what makes the run reviewable afterwards rather than a black box. Where the platform executes a stage rather than a person or agent performing it, that is named too, and accountability still sits with the role.
- 1
Identify policy
Does the caller match a policy that was in force at the date of loss?
Policy verification worker
- 2
Capture the event
Is anyone injured or at risk, or is urgent mitigation needed right now?
Intake worker
- 3
Classify
What claim type and severity band does this fall into, and on what evidence?
Triage worker
- 4
Collect evidence
Which documents does this specific claim type require, and what is still outstanding?
Evidence worker
- 5
Route
Specialist queue, standard queue, or immediate human takeover?
Triage worker
Run by workflow
- 6
Keep informed
Has the claim state changed in a way the claimant should hear about proactively?
Intake worker
Run by workflow
Decision rules
The non-negotiables encoded in the workflow, not left to a prompt.
- Injury, emergency, and safety language triggers immediate human takeover — intake does not continue.
- No worker states or implies whether a loss is covered; coverage language is out of scope by design.
- Triage classification is always a recommendation with recorded rationale, never an automatic determination.
- Potential fraud indicators are recorded as private signals for specialist review and never raised with the claimant.
Controls & guardrails
What makes this safe to run in production, and provable afterwards.
- Coverage, liability, and settlement decisions are structurally reserved for licensed handlers.
- Sensitive personal and medical detail is captured under least-privilege access.
- Every routing recommendation carries the signals that produced it.
- Emergency intent bypasses the intake flow entirely.
Platform capabilities
What this blueprint runs on
Nothing here is bespoke. Each blueprint is a configuration of the same platform, which is why the second one you launch reuses the governance you already reviewed.
Channels
- Voice
- Web chat
Systems it reads and writes
- Policy administration system
- Claims management platform
- Document & media store
- CRM
Measurement
What we instrument from day one
These are the measurements the pilot puts in place, not benchmark results. You set the targets against your own baseline — and the same instrumentation is what decides whether a worker's trust level widens.
- First-notice completeness
- Measures how much of the required intake structure is present before a human opens the file, which is what removes the callback loop.
- Time to correct queue
- Tracks how long a claim takes to reach the right specialist queue, and how often it is re-routed afterwards.
- Explainable routing
- Every routing suggestion records the signals behind it, so a re-route is a reviewable decision rather than a mystery.
Fields captured on contact one
Intake to assignment
Rationale per claim
Rollout
How this one goes live
A deliberately narrow start, supervised, with autonomy widened per role once the record supports it.
Weeks 1–2
One claim type, one channel
Start with your highest-volume, lowest-complexity claim type. The worker captures and structures; a human reviews every file before it moves.
Weeks 3–5
Add evidence chase and triage
Evidence collection and triage recommendations come online. Handlers still confirm routing, which is what builds the rationale baseline.
Week 6+
Extend claim types and surge cover
Broaden to further claim types and enable the blueprint as surge capacity for peak events, where consistent intake matters most.
Questions we get asked
First notice of loss, in practice
- Does the AI decide whether a claim is covered?
- No. Coverage, liability, reserving, and settlement are reserved for your licensed handlers. The workers capture the event, verify the policy match, collect evidence, and recommend a routing queue with recorded rationale. Coverage language is excluded from their scope by design, not by prompt discipline alone.
- How does intake handle a claimant who is distressed or injured?
- Injury, emergency, and safety language triggers immediate human takeover on the turn it appears. The intake script does not continue, and the transcript plus policy context transfers with the call so the person picking up does not restart the conversation.
- What happens during a catastrophe event when volume spikes?
- The same blueprint absorbs surge volume across voice, chat, and messaging simultaneously, so first notice is captured consistently rather than queued. Handlers then work from complete, structured files instead of triaging a backlog of partial notes.
What changes in Insurance
Intake gets structured and complete on first contact, while coverage, liability, and settlement stay with the licensed handler.
Read the full Insurance analysisRelated blueprints
Teams that run next to this one
Next step
Build this team around one measurable win.
We map your version of this process, compose the worker roles, connect your systems, and agree the escalation points with the people who own them — then run it supervised.