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Vehicle Claims Resolution
Automated decision system for determining optimal insurance claim resolution based on damage severity, vehicle age, and parts availability.
Solution
This decision engine streamlines the vehicle insurance claims process by determining whether to repair, replace, or offer cash settlement for damaged vehicles. The system evaluates the extent of vehicle damage through a percentage assessment, categorizing cases as minor, moderate, severe, or total loss. For vehicles with significant damage but not qualifying as total loss, the solution factors in the vehicle's age and parts availability status.
When dealing with older vehicles that have severe damage and limited parts availability, the system typically recommends cash settlements to avoid lengthy repairs with uncertain outcomes. For newer vehicles with similar damage profiles, it might recommend replacement when parts cannot be sourced. In cases where damage is repairable and necessary parts are available or can be obtained with reasonable delay, the system recommends repair. Each recommendation comes with a clear explanation of the decision factors, helping adjusters communicate effectively with policyholders while ensuring consistent claim handling.
How it works
The decision graph processes vehicle claims through three sequential evaluation steps:
- Damage Assessment: Analyzes the damage percentage to classify severity as minor (under 30%), moderate (30-59%), severe (60-79%), or total loss (80%+).
- Parts Availability Check: Evaluates the availability of replacement parts based on the vehicle's age and reported parts status (available, limited, discontinued).
- Resolution Determination: Combines damage level, parts availability, and vehicle age to recommend the optimal resolution:
- Total loss claims automatically receive cash settlement recommendations
- Severe damage with unavailable parts triggers cash settlement for older vehicles (>8 years) or replacement for newer ones
- Moderate damage with unavailable parts leads to cash settlement for vehicles older than 6 years
- All minor damage and repairable moderate/severe damage with obtainable parts defaults to repair recommendations
Each recommendation includes a detailed explanation of the decision factors.
Where teams use it
- Auto insurance claim processing
- Fleet vehicle management
- Leasing company damage assessments
- Rental car company vehicle evaluations
- Body shop repair vs. replace decisions
- Salvage and total loss determinations
Inside the decision model
Vehicle Claims Resolution ships as a JDM decision graph with 4 nodes, 3 decision tables and 16 rules. Download it, load it into GoRules, and run it as-is on Zen Engine.
Request
inputThree request objects set up the decision: claim.damagePercentage grades the loss, vehicle.ageYears qualifies parts sourcing and settlement choices, and parts.status reports what the supply chain looks like.
Sample requestJSON
{
"claim": {
"id": "CL-20250318-001",
"damagePercentage": 65
},
"vehicle": {
"make": "Toyota",
"model": "Camry",
"year": 2015,
"ageYears": 10
},
"parts": {
"status": "limited"
}
}Assess Damage
tableSeverity grading buckets claim.damagePercentage with a first hit policy: >= 80 marks the file 'total_loss' and flips assessment.isTotalLoss to true, >= 60 grades 'severe', >= 30 'moderate', and the blank fallback row grades 'minor'. Descending thresholds make the overlapping >= conditions unambiguous.
An 80 percent trigger stands in for the total-loss thresholds adjusters really apply, where a vehicle is written off once repair cost plus salvage approaches its actual cash value; many jurisdictions set that trigger somewhere between 60 and 100 percent. Using damage as a percentage rather than a repair estimate keeps the template independent of any particular estimating platform.
| Damage Percentageclaim.damagePercentage | Damage Assessmentassessment.damageLevel | Is Total Lossassessment.isTotalLoss |
|---|---|---|
| >= 80 | 'total_loss' | true |
| >= 60 | 'severe' | false |
| >= 30 | 'moderate' | false |
| - | 'minor' | false |
Check Parts Availability
tableSourcing risk only bites for older vehicles: rows for vehicle.ageYears > 10 translate a parts.status of 'discontinued' into 'unavailable' and 'limited' into 'delayed', while 'available' passes through. Vehicles <= 10 years old and the blank catch-all resolve to 'available' regardless of reported status.
Treating age as the gate matches how the parts market behaves, since OEM production and aftermarket coverage stay dense for roughly the first decade of a model's life and thin out afterward. Downgrading 'limited' to a delay rather than an outright unavailability keeps repair on the table where the wait, not the part, is the real cost.
| Vehicle Agevehicle.ageYears | Parts Statusparts.status | Parts Availabilityparts.availability |
|---|---|---|
| > 10 | 'discontinued' | 'unavailable' |
| > 10 | 'limited' | 'delayed' |
| > 10 | 'available' | 'available' |
| <= 10 | - | 'available' |
| - | - | 'available' |
Determine Repair Method
tableResolution combines all three signals in a first hit table. A 'total_loss' grade goes straight to 'cash_settlement' regardless of the other columns; 'severe' damage with 'unavailable' parts splits on vehicle.ageYears, cash settlement above 8 years and 'replacement' at or below it; 'moderate' damage with unavailable parts settles in cash only past 6 years; and every row where parts are 'delayed' or 'available', plus all 'minor' damage, lands on 'repair' with a matching explanation string.
The ordering encodes standard claims economics: once a car is totaled, cash against actual cash value is the only sensible outcome, and for older vehicles with unsourceable parts a settlement avoids open-ended rental and storage costs during a stalled repair. Offering replacement only for newer vehicles reflects that a like-kind substitute is realistic early in a model's life, while the 8 and 6 year cutoffs are tunable business choices rather than industry rules.
| Damage Levelassessment.damageLevel | Parts Availabilityparts.availability | Vehicle Agevehicle.ageYears | Repair Methodrecommendation.method | Explanationrecommendation.explanation |
|---|---|---|---|---|
| 'total_loss' | - | - | 'cash_settlement' | 'Vehicle is a total loss; cash settlement recommended' |
| 'severe' | 'unavailable' | > 8 | 'cash_settlement' | 'Severe damage with unavailable parts for older vehicle; cash settlement recommended' |
| 'severe' | 'unavailable' | <= 8 | 'replacement' | 'Severe damage with unavailable parts for newer vehicle; replacement recommended' |
| 'severe' | 'delayed', 'available' | - | 'repair' | 'Severe damage with obtainable parts; repair recommended' |
| 'moderate' | 'unavailable' | > 6 | 'cash_settlement' | 'Moderate damage with unavailable parts for older vehicle; cash settlement recommended' |
| 'moderate' | 'delayed', 'available' | - | 'repair' | 'Moderate damage with obtainable parts; repair recommended' |
+1 more row in the downloadable template
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Make this template
your own.
Load Vehicle Claims Resolution into GoRules, adjust the rules to your policy, and ship it behind your own API.