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AI agent for insurance claims managers

Subrogation Opportunity Agent

Recover payments from at-fault parties before time limits run out.

AutomationOperationsInsurance
See how it worksGet access
Subrogation Opportunity Agent: what goes in, what the agent does and what you get

What it does

Insurers pay a claim and then forget that someone else may have caused the loss. This agent reviews open and recently closed claims for signs of third-party fault, such as a rear-end collision, a faulty product or a contractor error. It checks the evidence in the file, the time limits for recovery in that state, and the other party's insurer. It assembles a demand package with the payment records, reports and photos. After the adjuster approves, it sends the demand and tracks responses, drafting follow-ups. Edge case: a claim near the end of the time limit is moved to the top and flagged for legal review.

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, continueApprovedYes, continueNoNo 1 STARTS WHEN Weekly claim review 2 USES A TOOL Search open and closed claims for third-party faultsigns 3 DOES Check the evidence in the file 4 CHECKS THE RESULT Is the evidence enough to support a demand? If not: Request missing reports or statements. Back tostep 3. 5 DOES Check the time limit and the other party's insurer 6 DOES Assemble the demand package 7 YOU APPROVE Adjuster approves the demand 8 USES A TOOL Send the demand 9 USES A TOOL Track the response and payment 10 CHECKS THE RESULT Has the other insurer replied within the time limit? If not: Draft a follow-up and flag the file. Back tostep 8. 11 RESULT Recovery received or claim closed
Read the steps as a list
  1. Weekly claim review
  2. Search open and closed claims for third-party fault signs
  3. Check the evidence in the file
  4. Is the evidence enough to support a demand?If not: Request missing reports or statements. Back to step 3.
  5. Check the time limit and the other party's insurer
  6. Assemble the demand package
  7. Adjuster approves the demandThe agent waits here for your OK.
  8. Send the demand
  9. Track the response and payment
  10. Has the other insurer replied within the time limit?If not: Draft a follow-up and flag the file. Back to step 8.
  11. Recovery received or claim closed

How it decides

It pursues a claim when fault evidence is strong and the potential recovery exceeds the cost, and prioritizes by deadline.

  • Pursue claims with recoverable amounts above the set minimum
  • Move claims within 90 days of the time limit to the top
  • Include every payment and the proof of loss
  • Send follow-ups every 21 days

Make it yours

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

  • Minimum recovery worth pursuing
  • Follow-up interval (default 21 days)
  • Time limit table by state
  • Claim types to review

What keeps you in control

It always asks you first

  • Adjuster approves each demand

Hard limits

  • Never send a demand without adjuster approval
  • Never include a payment not in the file

It stops when

  • Done: the recovery is received or closed
  • Stop: the time limit passes or legal takes over

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 closed auto claim shows a rear-end collision and $9,300 paid. The agent finds the police report naming the other driver, but there is no repair invoice for the rental. It requests it, then assembles the demand for $9,950. The adjuster approves it. The other insurer replies after 30 days offering 80 percent, which the agent logs for review.

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