Finds what was paid above what the policy actually required
Claims leakage is the gap between what an insurer paid and what it was liable to pay under the policy. The industry knows the number is material and mostly cannot find it, because the causes are small and procedural rather than dramatic.
A deductible not applied. A sub-limit ignored because it sits in an endorsement rather than the main schedule. Depreciation not taken where the policy is actual cash value. A payment made without pursuing a third party who was clearly liable. A reserve set high and never revisited, distorting every downstream decision. A settlement above the handler's authority without the review that authority level exists to trigger.
None of it is fraud. Each is a handler under volume pressure making a defensible-looking decision without holding the whole policy in mind — which is the real difficulty, because a policy is a schedule plus endorsements plus wording, and the sub-limit that matters is usually in the endorsement.
The commercially serious point is that leakage is a rate, not a pile of individual errors. The pattern is worth more than any single recovery, and recovery is often impossible anyway.
This agent audits closed claims against the governing policy, reports each finding with the clause behind it, and reports the leakage rate by cause and by handling team. It reopens nothing, pays nothing, and never assesses a claimant.
Rather than an industry benchmark you assume applies to you.
Training, checklist or system control — each finding says which.
Where limitation periods have not yet expired.
The sub-limit that was missed is almost always in an endorsement rather than the main schedule.
The two most common leaks, and the two easiest to prove after the fact.
A third party clearly liable and never approached. Usually the largest single amount in the report.
A payment above a handler's limit without the review that the limit exists to force.
Leakage is a recurring percentage. The pattern is worth more than any individual recovery.
It never reopens, adjusts or declines a claim. Every finding goes to a person with the file.
Why Insurance in particular. The sub-limit that was missed is almost always in an endorsement rather than the schedule. Leakage is a recurring rate rather than a pile of errors, and the pattern is worth more than any single recovery.
Runs unattended
Started by you or by an event, and it finishes on its own. Nothing waits for someone to be at a desk.
The same standard every time
The two-hundredth item is held to the bar the first one was. Consistency is the part people cannot sustain.
It cannot act on its own
Claims Leakage Auditor has no path to sending, spending or committing. That limit is why its output is safe to act on.
This agent runs server-side through the PROMIVO runtime. Each run is logged step by step and every tool call is permission-checked before it executes.
Read-only by design. This agent has no path to sending, spending, publishing or committing anything. Where that limit is the product, removing it would remove the reason to trust the output.
Demo dataIllustrative sample output, abridged.
{
"claims": [],
"period": "H1 2026",
"currency": "USD"
}{
"escalate": true,
"findings": [
{
"paid": 41200,
"cause": "sub-limit-missed",
"claim": "CLM-77412",
"clause": "Endorsement 3, clause 2: portable equipment sub-limit of 15,000 per occurrence.",
"difference": 26200,
"recoverable": "Unlikely — settled and paid 14 months ago. The value here is the pattern, not this claim.",
"policyRequired": 15000
},
{
"paid": 88000,
"cause": "recovery-not-pursued",
"claim": "CLM-78330",
"clause": "n/a — third party recorded as at fault in the loss report.",
"difference": 88000,
"recoverable": "Possibly. The loss date is 19 months ago; check the applicable limitation period before anything else.",
"policyRequired": 88000
}
],
"disclaimer": "An audit of the insurer's own handling against its own policies. No claim has been reopened, adjusted or paid, no claimant has been assessed or contacted, no allegation of fraud is made, and no statement is made about what is legally recoverable.",
"unauditable": [
"31 claims — the governing endorsement could not be found, so they are excluded rather than passed."
],
"claimsAudited": 840,
"leakageByTeam": [
{
"note": "Concentrated in sub-limits. A checklist finding, not a training one.",
"team": "Team B",
"ratePercent": 4.8
}
],
"leakageByCause": [
{
"note": "All 47 sat in endorsements rather than the schedule.",
"cause": "sub-limit-missed",
"amount": 612000,
"claims": 47
},
{
"cause": "recovery-not-pursued",
"amount": 411000,
"claims": 12
}
],
"ambiguousWording": [
"The portable equipment definition in Endorsement 3 could exclude the item in CLM-77980. Reported rather than decided."
],
"escalationReason": "Sub-limit leakage is 47 claims across the period, three recoveries expire within 90 days, and 31 claims could not be audited because an endorsement is missing.",
"leakageRatePercent": 2.9,
"recoveriesExpiringSoon": [
"Three recoveries totalling 140,000 have limitation periods expiring within 90 days."
]
}No integrations required.
A sample or the full population, against the policies that governed them.
Whether payments or reserves were the cause.
Patterns by cause, to fix the process rather than the person.
Understanding your own claims cost properly.
$599/month
Billed monthly through your PROMIVO subscription. Cancel at any time.
Runs consume your plan allowance for agent executions and tokens. See plan limits.
No. It has no route to a claims system. Reopening a settled claim has legal, regulatory and customer consequences that belong to a person with the full file.
Never. It audits the insurer's own handling against the insurer's own policy. It makes no assessment of any claimant and never suggests fraud by one.
No, and conflating the two is harmful. Leakage is procedural overpayment by the insurer. Fraud is an allegation about a person, requiring a different process with different safeguards.
It identifies what may be recoverable and whether time limits allow it. Pursuing recovery is a legal and commercial decision.
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