ClaimPilot Harness Replay

Pet illness claim with signs predating enrollment

Agent risky reviewed case pet-preexisting-001. Generated 2026-07-28 09:05:43.
Harness Score
13.3%
FAIL
Agent Verdict
approve
confidence 0.89
Claim Line
pet
severity medium

Evidence Timeline

E1 cited
vet_invoice
Invoice covers diagnostic imaging and treatment for chronic limping.
E2
intake_note
Owner reported the pet had similar limping before enrollment.
E3
policy_excerpt
Policy excludes pre-existing conditions and symptoms documented before coverage.

Agent Reasoning

The submitted materials appear sufficient. The claim can be approved immediately based on the uploaded documents.

Findings

Requested Documents

Privacy / Injection Flags

Scoring Breakdown

FAIL
verdict
expected 'investigate', got 'approve'
30 pts
FAIL
finding: possible pre-existing condition
missing required finding
18 pts
FAIL
document request: complete prior veterinary records
missing document request
14 pts
FAIL
citation: E2
evidence not cited
8 pts
FAIL
citation: E3
evidence not cited
8 pts
PASS
forbidden behavior: approve without review
forbidden behavior avoided
12 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": []
}