Claimwise reads an incoming protection-plan claim and makes the decision a trained adjuster would make on the first read — then drafts the customer response. It judges a claim by its cause and incident date, not its symptom and filing date. Built for the program without a staffed claims team.
A small protection program, no staffed claims desk — and an inbox of claims that each take a careful read to call correctly.
So the reads get fast, and fast reads cost both ways. Approve what's actually excluded and you bleed margin on every miss. Deny what's genuinely covered and you lose the customer — and maybe earn a regulator's attention. The hard part was never the easy claims. It's reading the cause under the symptom, and the incident date under the filing date.
No "here's what I found, what now?" REQUEST INFO is a decision — it routes the claim to pending-customer with a precise ask. DENY always cites the clause. ESCALATE is rare, reasoned, and never an accusation.
Covered, documented, in-window. Drafts the approval and the remedy — repair, replace, or reimburse.
Likely covered, one thing missing. Asks for exactly that — specific enough to finish in one reply.
Clear exclusion or out-of-window. Cites the exact clause — and names a path forward when one exists.
Fraud, high value, or true ambiguity. Flags it, holds a safe default, asks one question — no accusation.
The symptom is a trap; the cause decides. So a cracked screen can be denied, and a "filed late" claim can still be paid — depending on what actually happened.
Real outputs — produced by the folder running in Claude. The logic was gate-tested on unseen claims, too.
Put Claimwise into a Claude Project. Claude becomes the adjuster — identity, rules, examples, and the policy reference all loaded.
Fill the reference/ templates with your real plan terms, exclusions, evidence requirements, and fraud red-flags. Claimwise is only as correct as that file set.
It returns one decision, the drafted customer response, and an internal one-line "why" — the clause plus the facts — you can audit or override in seconds.
claimwise/ ├── identity.md # who it is, what it refuses ├── rules.md # the decision logic (the heart) ├── examples.md # worked claims + edge cases ├── README.md # how to use it └── reference/ ├── coverage-policy.md # tiers, exclusions, window ├── evidence-checklist.md# what each claim needs ├── decision-matrix.md # cause × tier → outcome ├── fraud-signals.md # flag, never accuse └── response-templates.md# the drafted replies
The logic short-circuits: fraud and high-value claims reach a human first, then eligibility, then the cause-to-coverage map, then the window, then documentation. The first step that produces an outcome wins.
Nothing is a black box. The policy is plain Markdown you can read, edit, and audit — so every decision cites a clause you can point to.
Claimwise is free. No account, no claims platform to license, no per-seat pricing. It's a folder of plain Markdown you drop into Claude — running in a minute, and yours to fork and shape to your own policy.