GenAIM Automating the judgment‑heavy work in medical malpractice claims
AI-Operated. Human-Governed.
Workflows
Book a demo

For every accepted claim, the claims handler needs three answers quickly.

1What will it cost?
2How long will it take to close?
3How do you defend it?
Today, answering them is slow, manual work. The file arrives at thousands of pages and the claims handler wades through all of it. Weeks to months before the insurer holds a position, with outside counsel on the clock for much of it.
With GenAIM working the file, the answers arrive in minutes. Yours to verify and approve.
Within minutes. The file is ingested and catalogued, every document summarised.
Against your own claims. Compared with your closed claims, what similar cases settled for, in court or out. A basis for the initial reserve.
The chronology. Clinicians identified, breaches and the causation path called out against accepted standards of care, each traced to its source, for your claims handler to verify and approve.
Locked. Approved, it becomes the locked chronology, the spine of the case. Everything from here builds on it.
Strategy. Defend or settle. Which counsel to instruct. Which medical opinion to seek. The records to chase, already raised as tracked actions.
Days, not months, to the insurer’s own position on the claim, before a dollar goes to panel.
The three answers, from the worked claim below.
What will it cost?
$655,000
median of similar closed claims, range $412,000 to $1,180,000, from your own book.
How long to close?
16 months
median time to close from your similar closed claims. A benchmark from day one.
How do you defend it?
The spine of the case
Built in days. Every finding traced to its source. Yours to build the defence on.

Every figure from the worked example on this page. Illustrative, synthetic data.

The worked claim

One claim, run end to end.

Case Summary · at intake, within minutes
Bile duct injury during laparoscopic cholecystectomy
Admitted 10 Sept 2025 · elective procedure · 14 documents catalogued · 0 required documents missing

Elective laparoscopic cholecystectomy with intraoperative cholangiogram omitted despite documented risk factors. Post-operative deterioration; urgent ultrasound results showing a bile leak remained unreviewed for nearly 24 hours, and the patient was discharged while they stood unreviewed. Emergency readmission and repair followed. The claimant alleges failure to recognise and respond to the post-operative injury.

Medical records ×6Imaging ×2Correspondence ×3Legal ×2Expert ×1
From your closed claims · similar cases
3 similar cases found · outcomes $412,000 to $1,180,000 · median $655,000 · median time to close 16 months
CM-2023-0412Bile duct injury, laparoscopic cholecystectomy
Same procedure, same injury, same severity
Settled out of court
11 months · closed 2023
$412,000
CM-2021-0655Bile duct injury, delayed recognition
Same injury, same delay pattern
Settled at mediation
16 months · closed 2021
$655,000
CM-2019-1180Laparoscopic injury, causation disputed
Same procedure, causation contested
Judgment at trial
34 months · closed 2019
$1,180,000
Surfaced at intake from the insurer’s own closed claims. A basis for the initial reserve. Synthetic data.
Full Chronology · Within minutes
Bile duct injury during laparoscopic cholecystectomy
Wed, 10 Sept 2025 · admitted to Surgical Assessment Unit · loaded from claim file
Total events 28
∿
Critical delays 2
⏱
Care breaches 4
⚠
Clinicians 5
◉
Causation path 9 of 28
→
Clinicians Dr. Helen Ash (Consultant) Dr. Daniel Oak (Consultant Surgeon) Aaron Elm (RN) SHO on-call (name not documented) Dr. Sarah Cedar (Consultant Radiologist)
All Events Causation Path Breaches Delays Critical
Wed, 10 Sept 2025
08:14 Dr. Helen Ash (Consultant)
Patient admitted to Surgical Assessment Unit for elective laparoscopic cholecystectomy.
08:14 Dr. Helen Ash (Consultant)
Initial assessment completed and surgical consent obtained.
14:20 Breach High Causation path Dr. Helen Ash (Consultant)
Discharge while critical investigation results unreviewed. Urgent ultrasound results showing bile leak had been available for nearly 24 hours and remained unreviewed at point of discharge.

And from the chronology, GenAIM produces an accountability matrix, what should have happened, what actually happened, and where the breach sits.

⊙ Accountability Matrix
Event Clinician Expected Actual Severity
Intraoperative cholangiogram omitted during high-risk cholecystectomy Dr. Daniel Oak (Consultant Surgeon) A reasonable practitioner would have performed an intraoperative cholangiogram with risk factors present, dense adhesions, distorted anatomy, 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) A reasonable practitioner would have escalated to the consultant surgeon with post-operative fever, tachycardia, hypotension, and severe pain. SHO assessment only, no consultant escalation despite ongoing critical deterioration. High
The assessment is your deliverable. The locked chronology is the spine of the case. The accountability matrix and the source trail are the audit file. Expert briefs are scoped for counsel, with pre-breach evidence only, breach and causation kept separate, and only checked evidence included.
Illustrative example using synthetic data. No real patient, clinician, or insurer information; names are fictional.
Evidence by design

Checked against the source. Verified where it matters.

Every event GenAIM extracts is checked against its source record for completeness and support. 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 supports 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.

How GenAIM fits

Works alongside your existing claims environment.

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.

Built for how complex claims teams actually work.
How to start

A 4-6 week design partner engagement.
On a live claims workflow. With agreed outcomes.

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.

You bring

  • A live claims workflow with agreed objectives and defined outcomes
  • Your claims handling guidelines and the standards of care your team works against
  • A senior claims analyst or claims operations lead to compose alongside us
  • One or two real (or de-identified) claim files to run against

You keep

  • Your methodology, configured into GenAIM, never shared, your IP
  • A dedicated environment. Claim files and patient records stay on your terms
  • A working setup at the end of the engagement, ready to scale
  • Full audit trail on every workflow run
  • Your claim files, methodology, prompts, and outputs remain isolated to your environment and are never pooled across clients.
Start with one claims workflow. Hit the objectives. Scale from there.

Bring it live with real claims.

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.

Book a demo →
Or join the waitlist if the timing isn't right yet.

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.