Phase 4 - Autonomous Claims Administration & Management

An autonomous claims processing platform based on AI & Machine Learning which acts as a third-party claims management platform for insurance companies. PolkaCover will change how claims are processed by making it easy for insurance companies to make payouts a seamless process for their customers.

Claims Management Process

The following diagram illustrates the information flow from Policy Creation right through to Claims Servicing:

Features and benefits of the Claims Management process are as follows:

  1. Policy Claims Management: The use of smart contracts in combination with trusted third-party data sources allows for policy claims to be processed automatically, significantly cutting down on the handling time synonymous with traditional insurance models.

  2. Claims Prevention and management: Alongside big data, mobile and digital technologies, blockchain is essential to establishing an efficient, transparent and customer-focused claims model based on higher degrees of trust.. A distributed ledger can enable the insurer and various third parties to easily and instantly access and update relevant information

  3. Fraud detection and risk prevention: Thanks to its ability to provide a public ledger across multiple untrusted parties, blockchain has the potential to eliminate errors and detect fraudulent activity. A decentralized digital repository can independently verify the authenticity of customers, policies and transactions (such as claims) by providing a complete historical record. As such, insurers would be able to identify duplicate transactions or those involving suspicious parties

With the advent of blockchain technology, the transparency of data removes any uncertainty that can arise from data corruption from service providers and addresses the important issue of trust on the platform. You can see below how Polkacover is a part of this process:

What does a real life claim request look like?

There are 2 kind of products which are available for users:

  • High payout value (Above USDT 1000) - the insurer would need to review the claim offline

  • Low payout value (Below USDT 1000) - the payout would be run through a smart contract

At a high-level the process will follow these steps:

  1. The claimant would raise a claim request through the platform

  2. Depending on the type of product / claim scenario, a set of predefined questions & documents are requested.

  3. Once the document/questions have been fulfilled by the claimant, through the smart contract, a direct payout is made to the claimant into their address which can paid out is CVR/DAI/USDT

When it comes to low payout values, the administration work that goes into validating a claim would end up financially costing more to the insurer than the claim payout value. In such scenarios, when there is significant claims data, we are able to expect & program the claims platform to allow a direct payout (in low payout cases) to the claimant without the intervention of a third party based on documentation provided. These claims are then reviewed on a monthly basis to further refine the automated claims payment engine.

A similar functionality will be built into the P2P platform as well and as we gather more claim data , the payout allowance through this method would increase over time.