Humans in the loop
Where the state says licensed
A reserved act never runs in software. It reaches a licensed professional with the file already prepared, and the record comes back on your webhook.
The reserved act
- 01Run the open work
- 02Stop at the reserved act
- 03Check the license
- 04Review the prepared file
- 05Decide in their own judgment
- 06Receive the record
- 01Run the open work
Intake, acknowledgment, file assembly, coverage and estimate review, at API speed.
- 02Stop at the reserved act
The claim answers PENDING_ADJUSTER and names the license the act requires.
- 03Check the license
Verified at call time against the state registry, per state and line of authority.
- 04Review the prepared file
A licensed adjuster on the network reviews it under authority your carrier delegates.
- 05Decide in their own judgment
Approve, deny with reasons, or send it back for more.
- 06Receive the record
decision.issued brings the decision and attestation, and claim.paid the payment record.
No platform process can commit past an adjuster's refusal, and their flat fee never moves with the outcome. A decision your regulator can trust is a decision your product can ship.
Coverage runs the same way: a bind answers PENDING_PRODUCER, and a licensed producer reviews and binds before policy.bound arrives.
Every clock has an owner
Each state's claim deadlines run as code from the moment of notice. In Texas a claim is acknowledged within 15 days of notice, decided within 15 business days of a complete file, and paid within 5 business days of acceptance. A clock closes only on evidence, the final window takes a daily human acknowledgment, and no setting can extend a statutory deadline.
Texas Insurance Code ยงยง542.055 to 542.057. State timers are built in.