Clinical records, multiple providers, a defended standard of care. The chronology, breach, and causation work that decides how the file settles.
GenAIM reads every record in the claim file, applies your claims methodology, and produces the chronology and assessment your team reviews and approves. The judgment engine has spent two years on real, contested matters, the same evidence-to-judgment work your files demand, with expert reviewers on every call. The medical malpractice reference workflow is built. We compose it with your team to fit your claims methodology, then run real or de-identified claim files together.
GenAIM doesn't replace your claims process. It operates the work that sits between the records arriving and the adjuster's reserve decision. GenAIM comes with a medical malpractice reference workflow. We compose it with your team into the one your claims line actually runs. Reviewed by your team at gates you control.
Your insurer's claims handling guidelines and the standards of care your team works against loaded in. Different methodologies for different lines: hospital vs. individual practitioner, surgical vs. diagnostic. GenAIM connects to your claims system, pulling claim documents from the system that already holds them, or runs standalone; the finished assessment flows back to your system.
Every record in the claim file read end to end: clinical notes, EHR exports, third-party records, imaging reports. Clinical events extracted with timestamps and source citations. A unified chronology built across all source documents. Breach issues and severity identified against your methodology. The key issues surfaced for human review and approval.
Adjusters refine findings, confirm breach assessments, and trace causation through human-governance gates.
Chronology and breach assessment generated in your team's templates, ready for roundtable, defence counsel briefing, or reserve review. Senior analyst review precedes Head of Claims sign-off. The reserve recommendation is supported by an assessment the team can stand behind.
The output of a GenAIM claim review isn't a summary or a dashboard. It's a unified clinical chronology, every event, every actor, every record reference, sitting alongside a structured breach-and-causation assessment, traceable to the source line in the source record that earned each finding.
| Event | Clinician | Expected | Actual | Severity |
|---|---|---|---|---|
| Intraoperative cholangiogram omitted during high-risk cholecystectomy | Dr. Daniel Oak (Consultant Surgeon) | Perform intraoperative cholangiogram when risk factors present including dense adhesions, distorted anatomy, and bile staining. | Cholangiogram considered but not performed due to time constraints and unstable pneumoperitoneum. | High |
| Failure to escalate critically deteriorated patient to consultant | SHO on-call (name not documented, covering for Dr. Daniel Oak) | Escalate to consultant surgeon when post-operative patient shows fever, tachycardia, hypotension, and severe pain. | SHO assessment only, no consultant escalation despite ongoing critical deterioration. | High |
Illustrative example using synthetic data. No real patient or clinician information.
Your methodology is loaded once and applied to every claim. Your team approves each judgment before the work moves on.
Your claims handling guidelines and the relevant standards of care load once. Different protocols for hospital claims vs. individual practitioner claims, surgical vs. diagnostic, applied automatically based on claim type and policy line.
Tighter breach thresholds for high-severity exposures. Specialty-specific protocols for high-frequency claim types. Methodology variations are configuration, not engineering work.
Approved users, typically senior claims analysts or claims operations leads who own the insurer's methodology, can compose workflows directly through GenAIM's workflow and agent builders, with changes reviewed before execution. Use our team if you want, not because you have to.
Every event GenAIM extracts is checked against its source record and scored for coverage. Your team reviews the exceptions, the partial matches and the gaps, not every record from scratch. Every finding traces back to the source line that earned it, and the causation chain shows how the events connect: who knew what, and when. GenAIM doesn't replace professional judgment. It replaces the manual execution that sits underneath it.
GenAIM is the judgment layer over your existing claims systems, adding the judgment those core platforms don't provide, without replacing them. Your system of record stays where it is: claim documents flow in by API or upload, and the finished result flows back, or GenAIM runs standalone. For the complex-claims work, GenAIM is where your team works, building the case on the chronology, correcting findings, and approving each judgment, with every action and sign-off tracked.
We are looking for the medical indemnity partner to bring the chronology, breach, and causation workflow live with real claims. The engagement is structured, time-boxed, and built around real or de-identified claim files.
Bring a claim file or your assessment methodology. A 30-minute working session, and we'll show how GenAIM would run it end to end.
GenAIM is led by Jonathan Birch. 25 years building enterprise automation, including 4 years as CSO in London at an insurance technology company, automating claims processing for a major UK motor insurer. Full track record on the homepage.