19 FEB, 2026 · financial services, legal expenses insurance
AI coverage assessment and case triage in an insurance environment
Dozens of new legal cases a day, 30+ areas of law, 40–45 minutes of manual coverage assessment per case. AI pre-assessment based on the policy terms, with a measurable accuracy threshold, within strict regulatory data protection boundaries.
- target coverage assessment time
- 40–45 min → 5 min
- required accuracy threshold
- ≥90%
- new legal cases per day
- ~30
Speed without giving up professional responsibility
Coverage assessment is expert legal work: each incoming case has to be checked against the terms attached to the policy. Day to day, this takes up a significant share of the legal team's capacity. The goal was not to replace the lawyer but to give them a prepared recommendation backed by cited sources.
Technical implementation and business impact
Terms-based knowledge base and case classification
The system builds a searchable knowledge base from the insurance terms stored per product. It classifies each incoming case by area of law, then gives a coverage recommendation quoting the relevant clauses. When uncertain, it must route the case to a human decision.
Inbox triage and SLA monitoring
The system automatically classifies incoming emails by case type and urgency. For cases bound by strict response times, a deadline alert flags them, and case assignment can be optimised based on each lawyer's workload.
Measurable business impact and ROI
The target is ~5 minutes of expert review per case instead of 40–45, at ~30 cases a day. That frees up the legal team's capacity by an order of magnitude. KPI reporting makes throughput time and accuracy measurable per case, per lawyer and per area of law.
Regulatory compliance and auditability
Because of the financial regulator's cloud rules, data masking and role-based access control are a mandatory layer running beneath every module. Every AI recommendation is logged and retrievable together with the cited source. The solution integrates with the client's case management system, developed over several decades, rather than replacing it.