How insurance lawyers use Justis AI
Insurance work rarely turns on a big question of law. It turns on the wording of one clause, one answer in a proposal form signed years ago, and a date that decides whether the insurer can still question the policy at all. The facts are spread across a policy schedule, three endorsements, a surveyor's report, hospital records and a repudiation letter, and the answer is in how they read together.
Justis reads the whole file with you, whichever side you act for. You upload the claim once, and it reads every page, scans included, then sets each ground the insurer relies on against the wording, the dates, the Insurance Act 1938 and IRDAI's rules. Every fact carries the document and page it came from, and anything it could not confirm is marked, not guessed.
01
Death claims repudiated for non-disclosure
The problem
A death claim is repudiated for suppression of a medical history in the proposal form. Whether that holds depends first on dates: under section 45 of the Insurance Act, a life policy cannot be called in question on any ground after three years from the date of the policy, the date risk commenced, the date of revival or the date of a rider, whichever is later.
Within those three years the insurer can still repudiate, but it has to show the fact was material to the expectancy of life, that it was suppressed or misstated, and it has to communicate the grounds in writing. The answer usually sits in the medical records: when the condition was first diagnosed, and whether the proposer could have known of it when the form was signed.
How Justis handles it
Justis reads the policy, the proposal form, the medical records, the investigation report and the repudiation letter together. It works out the relevant three-year date from the policy's own dates, then tests each ground: what the proposal asked, what was answered, what the records show and when.
It separates fraud from innocent misstatement, notes where premiums fall to be refunded, and drafts the reply to the repudiation or the insurer's defence, each point cited to the page and the provision.
| What comes back | Example |
|---|---|
| Policy | Term life, ₹75 lakh, issued 10.06.2023; death on 02.04.2026 |
| Section 45 date | Three years from issue ends 10.06.2026: death and repudiation both fall inside, so the policy can still be questioned |
| Ground relied on | Non-disclosure of diabetes (repudiation letter of 15.07.2026, p. 2) |
| What the records show | First diagnosis recorded on 22.01.2024, seven months after the proposal was signed (Hospital records, p. 14) |
| Assessment | No fact to suppress on the proposal date; the ground does not hold on the insurer's own records |
| Deliverable | Reply to the repudiation in Word, cited to 9 pages and section 45 |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the policy, the proposal form, the medical records and the repudiation letter. Work out whether section 45 of the Insurance Act bars the repudiation, test each ground the insurer relies on against what the proposal asked and when each condition was first recorded, and draft the reply.
02
Health claims: pre-existing disease and waiting periods
The problem
Health claims are rejected on a short list of grounds: a pre-existing disease, a waiting period not yet served, an exclusion, or a document not produced. Each depends on dates across several policy years, and often across a portability from another insurer, so the continuity of cover has to be rebuilt before the ground can be tested.
IRDAI's rules set limits the rejection letter rarely mentions: the maximum waiting period for pre-existing diseases, the moratorium after which a health policy cannot be contested except for proven fraud and the policy's permanent exclusions, and the credit a ported policyholder carries with them.
How Justis handles it
Justis reads every schedule and renewal notice, the portability papers, the discharge summary and the rejection, and builds the continuity of cover year by year. It then sets the ground against the policy wording and the IRDAI health insurance rules current when it answers, citing the version it relied on.
It drafts the grievance to the insurer and, if that fails, the complaint to the Insurance Ombudsman or the consumer commission, with the timeline and the documents annexed in order.
| Step | Example |
|---|---|
| Cover | Family floater since 01.04.2019, ported on 01.04.2023 with continuity; renewed each year without a break |
| Claim | Knee replacement, ₹4.6 lakh, rejected for pre-existing osteoarthritis |
| Continuity | Over seven years of continuous cover on the admission date, counting the ported years |
| Moratorium | Continuous cover beyond the five-year moratorium: contestable only for proven fraud or a permanent exclusion, neither alleged |
| Next forum | Grievance to the insurer first; Ombudsman complaint within one year of its final reply |
| Deliverable | Grievance letter and draft Ombudsman complaint with an annexure index |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the policy schedules, renewal notices, portability papers and the rejection letter. Build the continuity of cover year by year, test the rejection ground against the wording and IRDAI's current health insurance rules on waiting periods and the moratorium, and draft the grievance to the insurer.
03
Motor accident claims before the tribunal
The problem
A claim petition before the Motor Accidents Claims Tribunal is decided on two things: whether the insurer can escape liability and how much compensation is due. The insurer's defences under section 149 of the Motor Vehicles Act 1988 are narrow, such as no valid driving licence or use outside the permit, and proving one often still leaves the insurer paying the third party and recovering from the owner.
The compensation is arithmetic on the record: income, age, future prospects, dependants and the multiplier. Get the income proof or the age wrong and the award moves by lakhs, in either direction.
How Justis handles it
Justis reads the FIR, the charge sheet, the driving licence, the permit, the policy and the claimant's income papers, including scans in Hindi, and sets each defence against the documents that prove or defeat it. It checks the limitation for the claim petition under section 166(3).
It computes compensation on the multiplier method with every step shown, so both sides can argue the inputs rather than the total, and drafts the written statement for the insurer or the claim petition for the claimant.
| What comes back | Example |
|---|---|
| Accident | 14.05.2026, Nashik; claim petition to be filed within six months, by 14.11.2026 |
| Licence defence | Driver's licence expired 03.03.2026 and not renewed on the accident date (Licence extract, p. 3) |
| Likely outcome | Insurer pays the third party and recovers from the owner |
| Income | Salaried, age 34, ₹40,000 a month on the salary slips; permanent job |
| Computation | ₹4.8 lakh a year, plus 50% future prospects, less one quarter for personal expenses, times multiplier 16: ₹86.4 lakh before conventional heads |
| Deliverable | Written statement for the insurer, with the computation as an annexure |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the claim petition, the FIR, the driving licence, the permit and the policy. Set out the insurer's defences under section 149 of the Motor Vehicles Act with the document behind each, compute compensation on the multiplier method with every step shown, and draft the written statement.
04
Fire and property losses: the surveyor's report
The problem
In a fire or burglary loss, liability is often admitted and the fight is over quantum. The surveyor's report cuts the claim with depreciation, salvage, an average clause for under-insurance and items said to fall outside the policy, and each deduction sits on a different page of a long report.
The policy's arbitration clause may cover only disputes on quantum where liability is admitted, so whether the dispute goes to arbitration or to a commission depends on how the insurer framed its response.
How Justis handles it
Justis reads the policy, the schedule and endorsements, the surveyor's report and the claim bill, and puts every deduction in a table: the amount, the reason given, the clause relied on and whether the wording supports it.
It checks the average clause arithmetic against the declared sum insured, identifies whether the insurer has admitted liability, and says which forum the dispute belongs in, then drafts the objection to the survey report or the notice invoking arbitration.
| What comes back | Example |
|---|---|
| Loss | Warehouse fire; claim for stock of ₹1.5 crore under a fire and special perils policy |
| Survey assessment | ₹88 lakh after 7 deductions, each tied to a page of the report |
| Average clause | Sum insured ₹4 crore against value at risk of ₹5 crore: loss scaled by four fifths, ₹1.2 crore before other deductions |
| Deductions challenged | 3 of 7 not supported by the wording, including salvage valued twice (Survey report, pp. 18 and 26) |
| Forum | Liability admitted in the insurer's letter of 24.09.2026, so the quantum-only arbitration clause applies |
| Deliverable | Objections to the survey report and a draft notice invoking arbitration |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the policy, the endorsements, the surveyor's report and our claim bill. Put every deduction in a table with the amount, the reason given, the clause relied on and whether the wording supports it, check the average clause arithmetic, and tell me whether the arbitration clause applies.
05
Coverage opinions on liability and D&O policies
The problem
A director receives a show cause notice from SEBI, or a company is served with a professional negligence claim, and the first question is whether the policy responds. Claims-made wordings turn on definitions: what counts as a claim, when it was first made, whether notice was given in time, and whether the facts were known before the retroactive date.
The exclusions interact with each other and with the endorsements, and a coverage opinion that misses one endorsement is wrong from the start.
How Justis handles it
Justis reads the policy wording, the schedule and every endorsement together, then the notice or claim, and walks through cover in order: insuring clause, definitions, period and notice, retroactive date, exclusions, then the limits and retention.
It quotes each operative clause with the page, marks where the wording is ambiguous and the reading that favours each side, and drafts the coverage opinion or the notification to insurers.
| Step | Example |
|---|---|
| Event | SEBI show cause notice to two independent directors, received 02.09.2026 |
| Is it a claim | Definition includes a formal regulatory proceeding against an insured person (Wording, cl. 2.3, p. 6) |
| Notice | Must be given as soon as practicable within the policy period; period ends 31.03.2027 |
| Exclusions | Conduct exclusion applies only on a final adjudication; prior notice exclusion not triggered on the file |
| Endorsement | Endorsement 4 sub-limits regulatory defence costs to ₹2 crore |
| Deliverable | Coverage opinion and a draft notification to insurers |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the D&O policy wording, the schedule, every endorsement and the SEBI show cause notice. Walk through cover in order: insuring clause, definition of claim, notice, retroactive date, exclusions and limits, quoting each clause with its page, and draft a coverage opinion.
06
Consumer commission complaints and defences
The problem
Most insurance disputes end up before a consumer commission, and the first objections are procedural. Pecuniary jurisdiction under the Consumer Protection Act 2019 turns on the consideration paid, which for a policy is the premium, not the amount claimed, and complaints filed on the claim value go to the wrong forum.
The complaint has to be filed within two years of the cause of action, and the insurer's reply has to meet the allegation of deficiency in service head on, with the policy clause and the claim papers, not a general denial.
How Justis handles it
Justis identifies the forum from the premium paid, computes the limitation date from the rejection, and builds the complaint or the reply paragraph by paragraph, each point tied to a page of the claim file and the clause of the policy.
It lists the preliminary objections the record supports, such as limitation, a pending Ombudsman complaint on the same facts or a quantum dispute covered by arbitration, and drafts the evidence affidavit with the documents in order.
| What comes back | Example |
|---|---|
| Claim | Health claim of ₹18 lakh rejected on 20.08.2025 |
| Forum | Premium paid ₹62,000: District Commission, although the claim is ₹18 lakh |
| Limitation | Two years under section 69: complaint by 20.08.2027 |
| Deficiency alleged | Rejection without reasons, and claim decided 94 days after the last document |
| Preliminary objections | None supported for the insurer on the file; Ombudsman complaint withdrawn before filing |
| Deliverable | Consumer complaint, evidence affidavit and index of documents in Word |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the policy, the claim papers and the rejection letter. Tell me which consumer commission has jurisdiction on the premium paid, compute the limitation date under section 69 of the Consumer Protection Act, and draft the complaint with each allegation tied to a page of the file.
07
Reviewing a book of claims and litigation
The problem
An insurer's legal team carries hundreds of pending matters across tribunals, commissions and courts, and the panel advocates report in different formats. Knowing which files share a losing ground, which are close to a hearing and where the exposure sits means opening every file.
The same is true when a reinsurer, a new panel counsel or an internal audit asks for a view of the book by the end of the week.
How Justis handles it
Upload the claim files and tabular review asks the same questions of every one at once: forum, stage, amount claimed, ground of repudiation, next date and the defence taken. Every cell cites the page it came from.
Justis then groups the book by ground and outcome, marks the files where the defence looks weak on the insurer's own papers, and exports the grid to Excel or a short summary deck for the review meeting.
| What comes back | Example |
|---|---|
| Files read | 312 matters, 41,000 pages, 58 of them scanned |
| Grid | 12 questions per file, each answer cited to the document and page |
| Pattern | 47 life claims repudiated for non-disclosure after the three-year date in section 45 |
| Exposure | ₹38.6 crore claimed in matters listed in the next 60 days |
| Flag | 19 files where the investigation report does not support the ground relied on |
| Deliverable | Excel grid, a note on settlement candidates and a six-slide summary |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Review every claim file in this matter. For each, give the forum, the stage, the amount claimed, the ground of repudiation, the next date and the defence taken, with the page for each answer. Then group the files by ground and flag those where our own papers do not support the ground.
08
A claim file read into a settlement or repudiation note
The problem
A theft or loss claim reaches the claims manager as a file: the policy and endorsements, the claim form, the police papers, the surveyor's documents and an investigator's report that ends in a recommendation. The recommendation is often where the file is weakest, and a repudiation on a ground the file does not support comes back as a consumer complaint with interest and costs.
Whoever signs the decision needs the grounds tested against the documents and the case law, the amount worked out, and a list of what is still missing before payment.
How Justis handles it
Justis reads the whole file, scans included, and takes each ground the investigator relies on in turn: what the policy condition says, what the documents show, and what the Supreme Court has said about that ground. Where two documents disagree it puts them side by side with the page for each.
It computes the amount payable under the policy, splits it between the financier and the insured, lists the documents to call for, and drafts the settlement or repudiation note for the claims manager to decide on.
| What comes back | Example |
|---|---|
| Delay ground | Insurer told 41 days after the theft, but FIR registered at 08:30 the same morning; Gurshinder Singh (SC, 2020) says late intimation alone does not defeat a theft claim where the police were told at once |
| Key ground | Investigator says one key produced (report p. 3); the surveyor's receipt of 28.08.2026 records both keys (claim file p. 3) |
| Investigator's own findings | Theft genuine on the police record and CCTV; no financial distress |
| Amount | IDV ₹9,40,000 less ₹1,000 deductible: ₹9,39,000, of which ₹4,12,600 to the bank as on 04.09.2026 and ₹5,26,400 to the insured |
| Before payment | Magistrate's order accepting the untraced report (listed 21.10.2026), subrogation letter, bank NOC |
| Deliverable | Settlement note recommending payment, in Word, each point cited to the page |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the whole theft claim file: the policy and endorsements, the claim form, the police papers, the surveyor's documents and the investigation report. Test each ground the investigator gives for repudiation against the documents and the Supreme Court's decisions on late intimation in theft claims, compute the amount payable and its split between the financier and the insured, list what must be on file before payment, and draft a settlement or repudiation note.
09
An appeal to the State Commission: both sides argued
The problem
A District Commission allows a repudiated claim with interest, compensation and costs. The insurer has 45 days from the order to appeal to the State Commission under section 41 of the Consumer Protection Act 2019, and the appeal is not entertained without a deposit of half the amount ordered.
Management asks two questions: can the order be set aside, and is it worth the deposit. The answer depends on the order's errors and on the weak points in the insurer's own file, which the other side will find.
How Justis handles it
Justis reads the order and the record together and sets out the argument for each side, ground by ground, with the authorities from the Supreme Court corpus and the page of the record behind each point. It marks the order's errors of fact and law and the documents that cut against the insurer.
It computes the limitation date and the deposit, gives a candid view of which grounds are strong, weak or uncertain, and drafts the memorandum of appeal on the grounds you choose to run.
| What comes back | Example |
|---|---|
| Order | District Commission, Ahmedabad, 08.09.2026: ₹7,85,000 with 9% interest, ₹50,000 compensation, ₹10,000 costs |
| Error of fact | Para 9 says the proposal form was not produced; para 5 records it filed as Annexure R-2 |
| Error of law | Para 11 applies the five-year moratorium to a policy issued 20.11.2021, about 26 months before the claim |
| Weak point for the insurer | Its own pre-policy medical report shows HbA1c 8.9% and the underwriter accepted with a loading; Manmohan Nanda (SC, 2021) against Satwant Kaur Sandhu (SC, 2009) |
| Time and deposit | Appeal by 23.10.2026; 50% deposit ₹4,22,500 on the sums ordered, interest to be confirmed |
| Deliverables | Argument note with both sides' grounds and authorities, and a draft memorandum of appeal in Word |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Read the District Commission's order and the insurer's record in this matter. Set out the grounds of appeal and the complainant's likely answer to each, with the Supreme Court authorities on each side and the page of the record behind every point, mark the order's errors of fact and law and the documents that weaken our case, rate each ground strong, weak or uncertain, compute the limitation date and the deposit under section 41 of the Consumer Protection Act 2019, and draft a memorandum of appeal.
10
Filling an Insurance Ombudsman complaint
The problem
For a claim within the Ombudsman's limit, a complaint under the Insurance Ombudsman Rules 2017 is often quicker and cheaper than a consumer case. The form asks for exact particulars: the policy number, the date of the grievance and of the insurer's reply, whether any other proceeding is pending, the porting history of a health policy, and the relief sought.
The client's own account usually has the figure wrong and sometimes the policy number too, and the form is filed with whatever the intake sheet says.
How Justis handles it
Upload the blank Annexure VI-A in Word, the intake sheet and the claim papers. Justis fills every item from the documents, notes the source of each answer, and marks where the intake and the papers disagree.
It recomputes the relief from the policy wording and the bill, checks the one-year limit and the monetary ceiling, and drafts the brief statement of the case for item 4. Signing and filing stay with the client.
| What comes back | Example |
|---|---|
| Form filled | Annexure VI-A, items 1 to 12 and the porting details, as a completed Word document |
| Policy number | Intake says PGI/HF/2025/PNQ/0047179; the schedule and the settlement letter say …0047719 |
| The deduction | Insurer applied the 50% room-rent proportion to the whole bill; clause 4.6 excludes pharmacy, implants and diagnostics |
| Relief | ₹1,91,400 payable on the wording (₹5,18,800 less ₹3,27,400 paid), not the client's ₹3,57,600, which includes non-payables and the room difference |
| Time and limit | Insurer's reply 08.07.2026: complaint by 08.07.2027; well within the ₹50 lakh limit |
| Porting | Ported 01.02.2022 from Vasundhara Health; cover since 01.02.2020 |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Fill the blank Insurance Ombudsman complaint form (Annexure VI-A) from the intake sheet and the claim papers, as a completed Word document. Take each particular from the documents and note its source, flag every point where the intake and the papers disagree, recompute the amount due under the policy's proportionate deduction clause with the working shown, confirm the one-year time limit, and write the brief details of the case for item 4.
11
Redlining a renewal wording for the policyholder
The problem
Renewal terms arrive a few weeks before expiry with a premium change and what the broker calls wording clean-up. In a claims-made cyber or liability policy the clean-up is where cover goes: a retroactive date reset to inception, a sub-limit on the risk that matters most, a notice condition made a condition precedent, an exclusion that lets the insurer decide what it applies to.
The risk committee needs to know what changed against the expiring policy and what to ask for before it binds.
How Justis handles it
Upload the proposed wording and your instructions with the expiring terms. Justis compares them clause by clause, marks every change from the expiring cover as a tracked change in the renewal wording with a comment the broker can forward, and drafts your position where it differs.
It sets out what each change means for a real claim, and separates what you can accept from what you cannot.
| What comes back | Example |
|---|---|
| Retroactive date | Reset from 01.04.2021 to 01.11.2026 and the continuity clause 8.5 deleted: prior acts lose cover |
| Ransomware | Sub-limited to ₹5 crore of the ₹20 crore limit; expiring cover was the full limit |
| Notice | Clause 8.1: within 48 hours of discovery by any employee, as a condition precedent; expiring was 30 days and prejudice-based |
| War exclusion | Clause 6.14 adds state-backed cyber operations, with attribution decided by the insurer |
| Fines and new exclusions | Fines 'where insurable by law' dropped; new unencrypted device exclusion 6.19 |
| Deliverable | Tracked-change wording in Word with a comment on each change, and a one-page note for the risk committee |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Compare the insurer's proposed renewal schedule and wording with the expiring terms and our positions in the instructions note. For every change from the expiring cover, quote the clause, explain its effect on a claim, say whether our positions allow it, and redline the wording as tracked changes with a comment for the broker on each. Then write a one-page note for the risk committee.
12
A batch of motor own-damage claims
The problem
A divisional office clears motor own-damage claims in batches, each with a policy schedule, a claim intimation, a licence extract and a survey report. Most are routine, and the few that are not look like the routine ones: an accident the night before a break-in policy began, a surveyor recommending repudiation on a licence ground the Supreme Court has rejected, depreciation deducted on a zero-depreciation policy.
Reading each file in full is the only way to catch them, and the batch is due by Friday.
How Justis handles it
Tabular review asks the same questions of every file: policy period against the accident date, the licence against the vehicle's class, the delay in intimation and its explanation, the survey assessment and its deductions, and the red flags. Every cell cites the page.
Justis then sorts the batch into files to pay as assessed, to pay at a corrected figure and to decide on liability, and exports the grid to Excel.
| What comes back | Example |
|---|---|
| Files read | 5 claim files from the Nashik office |
| Not covered | MC-1101: accident at 23:40 on 17.06.2026; the break-in policy started at 00:00 on 18.06.2026 |
| Licence ground fails | MC-1102: LMV licence on a 3,490 kg goods carrier; covered under the Constitution Bench ruling of 6 November 2024 affirming Mukund Dewangan |
| Delay explained | MC-1103: 23 days, insured in hospital, vehicle kept unrepaired; survey not prejudiced |
| Wrong assessment | MC-1104: ₹38,700 depreciation deducted despite the zero-depreciation add-on; payable ₹1,40,100, not ₹1,01,400 |
| Routine | MC-1105: pay as assessed, ₹49,800 |
Illustrative example. Names, figures and dates are invented; the provisions are real.
Run a tabular review of every motor own-damage claim file in this matter. For each, check the accident date against the policy period, the driver's licence against the vehicle's class and weight, the delay in intimation and its explanation, the survey assessment and every deduction against the add-ons, and any red flag. Then sort the files into pay as assessed, pay at a corrected figure, and decide liability.
Make it repeatable
A claim stays in its matter workspace from intimation to award. Every document you add, the surveyor's final report, the Ombudsman's notice, the other side's evidence, is read the moment it lands, so the question you ask a year later is answered across the whole file.
When the same work comes back, save it once. A workflow carries the exact steps your team runs on a repudiated claim; a playbook carries your positions on policy wordings, such as the exclusions you accept and the ones you push back on; and a skill carries the method, such as the order in which you test a coverage question. Attach any of them to a message with an @-mention.
- A section 45 check on every life claim, with the dates shown
- A continuity of cover table for every health claim rejection
- A multiplier computation for every motor claim, step by step
- A deduction table for every surveyor's report
- Claimant interviews and hearings, in English or Hindi, transcribed into the claim
