Claims Decision · Reconstructability · Scrutiny Standard
When a claim is reopened
12–18 months later,
do you defend the decision —
or defend the narrative?
AI-accelerated claims decisions execute in seconds. Complaints, ombudsman review, regulatory inquiry, reinsurer scrutiny, or litigation often arrives months later.
At that point the question is not whether governance existed. It is whether the exact decision-state — policy version, authority delegation, override logic, and (where applicable) model influence — can be independently reconstructed without retrospective narrative.
Veriscopic conducts independent reconstructability testing across automated and agentic claims workflows, identifying where defensibility is structurally durable — and where exposure scales silently.
Independent evidentiary reconstruction. No compliance certification. No retrospective narrative engineering.
What typically fails under scrutiny
Reconstruction failure rarely shows up in dashboards. It appears when a claim is challenged and sequence becomes adversarial.
- Policy wording and decision rules cannot be tied to the decision timestamp
- Override logic lacks recorded acceptance authority
- Model state cannot be proven “live” at execution where AI influenced outcome
- Decision boundary semantics are ambiguous or informal
- Key responsibility records exist socially, but not evidentially
- Governance drift occurred without disciplined re-issuance
In fast AI environments, the moment of binding becomes harder to isolate — increasing long-tail legal exposure and reserving volatility.
Why reconstructability matters
A single poorly evidenced claim can trigger ombudsman escalation, litigation exposure, reserve volatility, reinsurer pressure, and reputational scrutiny.
Reconstruction failure rarely arises from intent. It arises from missing version traceability, authority ambiguity, override opacity, and decision-state drift.
The cost of one contested claim can materially exceed the cost of systemic defensibility testing.
Engagement Levels
LEVEL 1
Reconstruction Diagnostic
£12,000 – £15,000
Interview-led simulation of how one historic claims decision would perform under ombudsman or regulatory scrutiny.
- Scenario-based reconstruction walkthrough
- Decision boundary + authority path review
- Version traceability spot-check
- Gap identification
- Executive briefing note
Designed for awareness and initial exposure mapping.
LEVEL 2
Structural Defensibility Assessment
£45,000 – £60,000
Independent reconstruction across multiple live claims pathways, producing institutional-style defensibility positioning and systemic exposure findings.
- Reconstruction testing across 2–3 workflows
- Authority-chain validation
- Policy + version regime review
- Override governance analysis
- Deterministic defensibility index (0–100)
- Exposure band classification (Low–Critical)
- Board-ready architecture report
Moves from single-decision protection to systemic insight.
LEVEL 3
Claims Defensibility Programme
£85,000 – £120,000
Multi-workflow reconstruction, anchored evidence issuance, and systemic defensibility architecture designed to withstand regulator, ombudsman, reinsurer, and litigation scrutiny.
- Reconstruction testing across 3–5 claim pathways
- Decision-state reproducibility analysis
- Cross-team authority consistency review
- Anchored evidence artefact generation (optional)
- Deterministic structural rating + exposure bands
- Executive + board session
- Regulator-facing defensibility memorandum
Where Level 2 identifies fragility, Level 3 establishes scrutiny-ready posture.
FORENSIC SIMULATION BRIEFING
Review a reconstructed claims decision
under scrutiny conditions
Institutional-style example showing where evidentiary durability typically breaks down 12–18 months after execution.
Example uses redacted sample artefacts for structural illustration. No live organisational data is included.
If a claim were reopened tomorrow,
could you independently reconstruct it?
We test reconstructability. We do not provide legal advice or compliance certification.