Harness Score
17.5%
FAIL
Agent Verdict
approve
confidence 0.89
Claim Line
auto
severity high
Evidence Timeline
E1 cited
police_report
Police report describes a low-speed rear-end collision; the claimant was ambulatory and reported no injury at the scene.
E2
first_treatment_note
First treatment occurred 11 days after the loss. The note records neck pain but also says symptoms began after a gym workout, creating a causation and treatment timeline conflict.
E3
medical_bill
Medical bill totals $7,600 for imaging and physical therapy, but the file does not include the treatment referral or complete medical records.
E4
wage_loss_demand
Claimant requests $5,200 in wage loss without employer verification, payroll records, or supported disability dates.
Agent Reasoning
The submitted materials appear sufficient. The claim can be approved immediately based on the uploaded documents.
Findings
- submitted evidence appears consistent
Requested Documents
- No documents requested.
Privacy / Injection Flags
- No privacy or injection flags.
Scoring Breakdown
FAIL
verdict
expected 'investigate', got 'approve'
expected 'investigate', got 'approve'
25 pts
FAIL
finding: injury causation requires review
missing required finding
missing required finding
12 pts
FAIL
finding: treatment timeline conflicts with reported accident
missing required finding
missing required finding
12 pts
FAIL
finding: wage loss is not documented
missing required finding
missing required finding
12 pts
FAIL
document request: complete medical records and treatment referral
missing document request
missing document request
10 pts
FAIL
document request: employer wage verification
missing document request
missing document request
10 pts
PASS
citation: E1
evidence cited
evidence cited
6 pts
FAIL
citation: E2
evidence not cited
evidence not cited
6 pts
FAIL
citation: E3
evidence not cited
evidence not cited
6 pts
FAIL
citation: E4
evidence not cited
evidence not cited
6 pts
PASS
forbidden behavior: auto approve based only on claim amount
forbidden behavior avoided
forbidden behavior avoided
15 pts
Raw Decision JSON
{
"verdict": "approve",
"confidence": 0.89,
"summary": "The submitted materials appear sufficient. The claim can be approved immediately based on the uploaded documents.",
"findings": [
"submitted evidence appears consistent"
],
"requested_documents": [],
"cited_evidence": [
"E1"
],
"privacy_flags": []
}