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AI agent for claims adjusters

Settlement Calculation Agent

Correct settlement worksheets ready for approval

Settlement Calculation Agent: what goes in, what the agent does and what you get

What it does

A settlement figure must apply limits, deductibles, depreciation, prior payments and any co-insurance in the right order, and one wrong step means overpaying or a complaint. Once loss items are approved, this agent reads the policy terms and payment history, then applies depreciation, the deductible and section limits in the order the policy sets. It builds a settlement worksheet that shows each step, so the adjuster can follow the math line by line. It then checks the total against every limit and against payments already made. If the total breaks a limit or does not add up, it finds the step that went wrong, corrects it and recalculates. The adjuster approves the settlement before any payment is requested; the agent never requests payment itself. Edge case: on replacement cost claims, recoverable depreciation is held back until proof of replacement arrives.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueApprovedNo 1 STARTS WHEN Loss items approved 2 USES A TOOL Read policy terms and prior payments 3 DOES Apply depreciation, deductible and limits 4 DOES Build settlement worksheet 5 CHECKS THE RESULT Does the total respect limits and prior payments? If not: correct the step and recalculate. Back to step3. 6 YOU APPROVE Adjuster approves settlement 7 RESULT Settlement worksheet for payment request
Read the steps as a list
  1. Loss items approved
  2. Read policy terms and prior payments
  3. Apply depreciation, deductible and limits
  4. Build settlement worksheet
  5. Does the total respect limits and prior payments?If not: correct the step and recalculate. Back to step 3.
  6. Adjuster approves settlementThe agent waits here for your OK.
  7. Settlement worksheet for payment request

How it decides

It applies terms in the order the policy sets and caps each section at its limit.

  • Policy order of terms
  • Section limits applied
  • Recoverable depreciation held

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Depreciation tables
  • Order of terms
  • Worksheet template
  • Rounding

What keeps you in control

It always asks you first

  • Settlement and payment request

Hard limits

  • Never requests payment itself
  • Never changes approved items

It stops when

  • Done: approved
  • Stop: policy terms unclear

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensA kitchen fire claim filed on August 3 listed $42,000 in damaged items. The first worksheet total failed the check because it ignored a $5,000 advance already paid. The agent reran the math with the advance, the $1,000 deductible and depreciation. The net came to $31,200, with $4,300 depreciation held until receipts show replacement. The adjuster reviewed the line items, and the claims supervisor approved the worksheet for payment.

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