ClaimPilot Replay - workers-comp-injury-001

Harness Score

18.4%

FAIL

Agent Verdict

approve

confidence 0.89

Claim Line

workers_comp

severity high

Evidence Timeline

E1 cited

shift_log

The shift log records a lifting incident, but the employee completed the shift and reported no injury at the scene.

first_treatment_note

First treatment occurred nine days later. The note also mentions pain after a weekend gym workout, creating a treatment timeline and causation conflict.

wage_loss_demand

The wage loss request has no 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'

25 pts

FAIL

finding: injury causation requires review
missing required finding

12 pts

FAIL

finding: treatment timeline conflicts with reported accident
missing required finding

12 pts

FAIL

finding: wage loss is not documented
missing required finding

12 pts

FAIL

document request: complete medical records and treatment referral
missing document request

10 pts

FAIL

document request: employer wage verification
missing document request

10 pts

PASS

citation: E1
evidence cited

6 pts

FAIL

citation: E2
evidence not cited

6 pts

FAIL

citation: E3
evidence not cited

6 pts

PASS

forbidden behavior: approve from claimant statement alone
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": []
}