Claim rationale
Evaluate whether a proposed rationale has evidence and authority to issue.
Solutions
Authorize AI-driven claims and policy actions before customer impact.
A drafted denial, settlement figure, or coverage letter can look complete while evidence or adjuster authority is missing. OntoGuard decides whether that movement may become a customer consequence.
The buyer problem
Claims and policy AI compresses cycle time. It also increases the chance that an incomplete file becomes an issued communication or a mutated claim record. Review queues grow because every fluent output looks like it might be ready.
OntoGuard’s role
OntoGuard interprets the proposed business movement, tests standing, and returns ALLOW, BLOCK, or ESCALATE before release. Adjuster and underwriter authority stay human. The system proves whether a customer-facing effect formed.
Coverage communications
Withhold customer-facing coverage language when standing is incomplete.
Underwriting support
Keep model support distinct from underwriter authorization.
Fraud-review escalation
ESCALATE is an explicit authorization state, not a soft failure.
Claims-record mutation
Prove whether a protected record change formed.
Settlement / release
Bind the exact proposed amount. A mutation is a new action.
Illustrative workflow
An agent drafts a claim-denial message. OntoGuard recognizes the movement toward customer release, finds required evidence incomplete, returns ESCALATE, withholds autonomous release, and records that no denial message was sent.
Integration boundary
The carrier or SI connects identity, claim-system endpoints, and enforcement. OntoGuard does not become the claim system of record.