Transforming Medical Malpractice Claims with AI-Powered Solutions

The amaise agenticAI Platform and Product Suite revolutionizes the management of medical malpractice claims, delivering measurable improvements in efficiency, accuracy, and transparency:

84%

Increase in Efficiency

Streamline claims workflows with AI-driven automation, reducing time-consuming manual tasks.

Enhanced Understanding

Empower adjusters with precise insights into medical, legal, and financial complexities.

10%

Reduction in Claim Payouts

Optimize settlements while ensuring fairness and defensibility.

The Challenges of Long-Term Care Claims Management

Managing medical malpractice claims presents a range of unique and complex challenges:

Highly Complex Claims

Claims often involve intricate medical histories, negligence allegations, and multi-layered liability issues requiring deep expertise.

Extensive Documentation

Handling large volumes of medical records, legal filings, expert opinions, and patient care data is resource-intensive.

Unstructured Data Formats

Data inconsistencies, including handwritten notes, scanned documents, and varying terminologies, complicate processing.

Subjective Evaluations

Determining negligence, causation, and damages involves subjective judgments, creating variability in assessments.

Fraudulent Claims

Identifying falsified records, misrepresented injuries, or exaggerated claims is critical to cost containment.

Litigation Risks

Disputes over liability or settlement amounts often result in costly and time-intensive legal proceedings.

Medical Malpractice – Navigating Complexity with Confidence

Medical malpractice claims stem from alleged failures in the clinical responsibilities of hospitals, physicians, nurses, and other healthcare professionals. Common issues include misdiagnosis, delayed diagnosis, surgical errors, childbirth injuries, and medication-related harm. These cases often require comprehensive analysis of complex medical records and other unstructured documents—making the discovery process both time-intensive and resource-heavy.

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Claims most frequently requiring structured medical analysis include:

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Hospital negligence claims
Wrongful death cases
Radiology interpretation errors
Nursing home wrongful death
Birth-related injuries
Traumatic brain injuries
Spinal cord injuries
Medication prescribing and administration errors
Infection-related complications
Stroke mismanagement
Post-treatment deformities
Sepsis-related harm
Nerve damage cases

our solution

The amaise agenticAI Platform and Product Suite

The amaise agenticAI Platform addresses these challenges with a comprehensive, AI-driven approach to medical malpractice claims management:

Automatic Document Organization

Effortlessly organizes all claim-related files, including medical records, legal documents, and expert reports, while removing duplicates for streamlined workflows.

Key Fact Extraction

Highlights critical details such as patient outcomes, provider negligence indicators, legal exposures, and policy coverage, ensuring adjusters have actionable information at their fingertips.

AI-Powered Insights and Recommendations

Provides actionable insights for decision-making, including negligence assessments, causation analysis, and settlement recommendations. Multiple perspectives—pro-insurance, pro-claimant, and neutral—ensure balanced and defensible outcomes.

Preconfigured Question Sets

Customizable templates ensure each claim is thoroughly evaluated, covering key criteria such as standard of care breaches, liability allocation, and damages assessment.

Key Benefits

Optimized Claim Settlements

Ensures fair and accurate settlements while reducing overpayments or underpayments. Proven to achieve a 10% reduction in claim payouts, leading to significant cost savings for insurers.

Accelerated Claims Processing

Enhanced Fraud Detection

Litigation Risk Reduction