Short answer
AI claims document triage is a workflow where a model identifies each incoming claim document, such as photos, repair quotes, invoices, police reports or medical certificates, attaches it to the right claim, extracts key details, and checks it against the documents that claim type needs. Handlers see what is missing on day one. In New Zealand it supports Fair Insurance Code timeframes, and every claim decision stays with a person.
- The model files and checks documents; it never accepts, declines or scores a claim for fraud.
- The Fair Insurance Code asks members to decide within 10 business days of having all needed information.
- Knowing exactly what is missing starts that clock sooner.
- Health insurers are covered by the Health Information Privacy Code.
What claims document triage does
AI claims document triage handles the paperwork stream that follows a claim: photos of damage, builders’ and panel beaters’ quotes, invoices, police reports, valuations, assessor reports, travel receipts and medical certificates. They arrive by email, portal upload and post, often unlabelled and sometimes for the wrong claim. Today a person opens each one, works out what it is, attaches it, and ticks a checklist.
The model does that sorting. It identifies the document type, matches it to the claim using claim number, policyholder and address, extracts the key details (date of loss, amounts, provider, registration), updates the required-documents checklist for the claim type, and drafts a request for anything missing. The handler starts from a complete picture.
| Claim type | Documents the checklist expects | Common gap |
|---|---|---|
| Motor collision | Claim form, photos, repair quote, other party details | Other party details |
| House water damage | Photos, plumber’s report, repair quote | Cause of leak report |
| Contents theft | Police report reference, proof of ownership, receipts | Proof of ownership |
| Travel medical | Medical certificate, invoices, travel itinerary | Itemised invoice |
How the workflow runs
- Inputs
- Documents from claims email, portal uploads and scanned post; the claims system’s open claims; checklists by claim type; and letter templates.
- Systems
- The claims management system (create attachments and tasks only), document storage, a vision-capable model API, and a handler review queue.
- Steps
- Identify document type; match to a claim with confidence; extract key fields; update the checklist; detect duplicates; flag possible vulnerability cues for the handler; draft acknowledgement or missing-information requests; log every action.
- Human review
- Claims support staff confirm uncertain matches and review drafts before sending. Handlers make every coverage, settlement and decline decision. A team leader samples filed documents weekly.
- Outputs
- Documents filed to claims with extracted fields, updated checklists, drafted requests, and a daily list of claims now complete and ready for a decision.
- Measures
- Days from first notification to complete information, documents misfiled, acknowledgement within 5 business days, and handler time per claim.
- Risks
- Misfiling to the wrong claim, misread amounts, missed vulnerability, and inconsistency flags biasing decisions.
The NZ timeframes this supports
The Insurance Council’s Fair Insurance Code 2020 commits members to acknowledge a claim within 5 business days and decide whether to accept it within 10 business days of having all the information they need. If they cannot, they must explain why and update the customer at least every 20 business days. A precise, current list of what is missing is what makes the 10-day clock meaningful.
From 15 November 2027, when the FMA says the Contracts of Insurance Act 2024 takes effect, section 66 of the Act implies a term in every insurance contract that the insurer pays sums due within a reasonable time, including time to investigate and gather information. Under the CoFI regime, the fair conduct principle already covers handling a claim. Health insurers also fall under the Health Information Privacy Code 2020.
Illustrative example: a regional insurer’s home and motor team
Illustrative example, synthetic numbers: a claims team with 1,200 open claims receives about 3,900 documents a month. Assumptions: sorting and filing takes 3 minutes per document today; after the pilot, 80% are filed with high confidence and checked in 1 minute, and 20% need 4 minutes.
- Before: 3,900 x 3 minutes = about 195 hours a month.
- After: 3,120 minutes + 3,120 minutes = about 104 hours, so roughly 90 hours back for handlers.
- Model fees: at 3,000 input and 400 output tokens per document on Gemini 3.8 Flash, US$0.75 and US$3.75 per million tokens until 31 December 2026 (Google, updated 16 October 2026), about US$15 a month, rising to about US$29 when the listed rates double on 1 January 2027.
What stays with people
Handlers decide cover, settlement, declines and how to explain them. Assessors judge damage. Specialist teams decide on fraud referrals. Staff decide how to support a customer showing signs of vulnerability. Nothing is sent to a customer about the outcome of a claim without a person writing or approving it.
Where claims triage goes wrong
- Wrong claim. Two claims at the same address, or a common surname. Below a match threshold, a person files it.
- Misread amounts. A quote total read as GST exclusive. Check totals against line items and flag mismatches.
- Suspicion by default. Inconsistency flags shown to the decision-maker colour judgement. Send them to a separate review.
- Surge failure. After a storm, queue designs that worked at normal volume collapse. Load-test at five times normal; see human review queues.
Related workflows are policy document comparison support and broker client communication drafting. We build these as AI document processing with workflow automation around the claims system. See the insurance overview.
Sources
- Fair Insurance Code 2020, Insurance Council of New Zealand, effective 1 April 2020
- Contracts of Insurance Act 2024, New Zealand Legislation, accessed 19 October 2026
- FMA letter to insurers outlining expectations regarding Contracts of Insurance Act, Financial Markets Authority, updated 18 May 2026
- CoFI legislation, Financial Markets Authority, accessed 19 October 2026
- Health Information Privacy Code 2020, Office of the Privacy Commissioner, accessed 19 October 2026
- Gemini API pricing, Google, updated 16 October 2026
Written by the Levy Street team in Wellington. Last updated 19 October 2026.