Example processinsurance

Workers compensation claims automation software

An example of workers compensation claims as a governed process: agents do the 8 steps, and a person signs the gate before anything irreversible happens. Download it, import it into your workspace, and adapt it to your systems.

Download example · JSONImport into Minctrl →

minctrl.process/v1 · hash ce0723e58891…316c

The graph8 agent steps1 human gatesigns: Licensed workers'-comp claims adjuster

Workers'-comp claims autopilot

Workers'-comp claims handling is high-volume AOE/COE compensability + AWW/benefit computation under 50 state acts, where a wrong denial or benefit termination denies an injured worker statutory benefits and is actionable as bad-faith claims handling. Injuries intaken, compensability determined and benefits computed straight-through; the licensed claims adjuster signs the compensability determination before the EDI claim is filed with the state.

The governed flow · branches, parallel work & a human on the irreversible step
clear / acceptedcontested / denial / red flagdeficient — recompute AWW / pull recordssound — proceed to file
Start
agent · low risk
Intake the First Report of Injury (FROI) and the medical records
parallel · fan-out / join
Run compensability computation and treatment/deadline screening concurrently
agent · low risk
Determine compensability (AOE/COE) and compute the AWW and TTD/PPD benefits
agent · low risk
Screen utilization review / treatment guidelines and statutory deadlines — apply state-mandated medical treatment guidelines (CA: MTUS per Title 8 §9792.20–9792.27.23; other states: ACOEM, ODG, or jurisdiction-specific schedule) and verify UR compliance with state UR procedures
parallel · fan-out / join
Both the benefit computation and the UR / deadline screen are complete
decision
Compensability clear and accepted, or contested / denial?
agent · low risk
Auto-draft the acceptance and benefit-payment notice with the computed AWW / TTD
agent · low risk
Schedule the first benefit payment to meet state timeliness requirements (e.g., within 14 days of first disability in CA; failure to pay within 30 days triggers 10% penalty — CA Labor Code § 5814). Record the scheduled payment date on the acceptance notice.
agent · medium risk
Build the contested / denial dossier — AOE/COE dispute, fraud or red-flag indicators, missing-records gaps
gate · human sign-off
A licensed claims adjuster signs the compensability determination before state filing. Note: pre-filing adjuster signoff requirements are jurisdiction-specific (e.g., mandatory for some self-insured employers in AZ; carrier/TPA policy in CA; check state DOI rules).signs: Licensed claims adjuster
decision
Determination sound and defensible — or send back for rework? For denials: confirm the decision has a reasonably debatable basis to avoid bad-faith liability (penalties up to 200% of withheld benefits — CA Labor Code § 5814; state bad-faith statutes). For acceptances: confirm AWW/TTD computation and payment schedule are complete.
agent · high riskirreversible
File the FROI/SROI to the state via IAIABC EDI Claims Release R3.1 (electronic submission to the state workers-comp authority per state DOI EDI requirements)
agent · low risk
Monitor the claim status, benefit-payment timeliness and reserves
Done
low riskmedium riskhigh riskbranch / reworkgate · human sign-off
Use this example
01

Download the file

A minctrl.process/v1 document: the graph and the hash of the process it becomes.

02

Import it in Processes

Import into Minctrl opens this example in your workspace; one click stores it as your first version. Import JSON does the same with the file, and a file changed after download is refused.

03

Connect your systems

Every connector starts in shadow: steps run, nothing leaves Minctrl until you configure a connector and switch it live.

04

Adapt it

Change signers, time limits and steps on the canvas. Each save is a new version; a running case stays on the version it started with.

Questions
How do I automate workers compensation claims with Minctrl?

Start from this example. Import the file in Processes, connect your own systems, and adapt the steps on the canvas. Agents run the reversible steps; every irreversible step waits at a gate for the role you choose. The example has 8 steps and 1 gate; you can change any of them.

Is workers compensation claims in Minctrl auditable?

Every run start, signature and change to the process is written to a hash-chained audit log your auditor can verify and export. A run is pinned to the exact graph it started on.

Does the AI decide everything?

No. Minctrl will not make a process runnable while an irreversible step can be reached without a human gate, and one person cannot sign two gates of the same run.

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