Insurance · Customer service

The answer is in the policy terms. The assistant shows where.

Coverage questions are answered from the policy terms that apply to the contract, with clause and version. What gets sent is what your team has checked.

Knowledge assistantHR-4410-3172
  1. Bike stolen from the shared basement. Covered under contents basic?

  2. Yes, with the bike add-on, if the bike was locked. A draft is ready.

    Contents terms 2024, sec. 5 (3)
PolicyHR-4410-3172
  1. Terms versionContents terms 2024applies
  2. Bike add-onup to €1,500found
  3. Locknot mentionedask

Where time goes today.

  1. 84.6%

    Brokers want to reach someone

    Good availability is what brokers value most in insurer support, followed by quick replies to queries at 81.8%. Every coverage question waiting for a call back works against exactly that.

    procontra, Maklers Lieblinge 2024, 1,343 respondents (German)
  2. 15,659

    admissible complaints to the ombudsman

    In 2024 that was 18.6% more than the year before. The German insurance ombudswoman explicitly names insurers who respond to customer queries only after long delays.

    Versicherungsombudsmann, annual report 2024 (German)
  3. Which terms version applies?

    The book holds policies from many product generations, each with its own terms and clauses. Looking up the current version instead of the one on the policy gives a wrong answer, however good it sounds.

One case, step by step.

Knowledge assistantnew
  1. Broker support, request from Maklerbüro Kern

    Customer Jonas Weber, HR-4410-3172: bike stolen from the shared basement. Is that covered?

The question comes in plain words.

From the broker email, the phone or the broker portal. Staff ask it the way they heard it, with policy number or customer name. The assistant understands technical terms and everyday language.

Your team decides

Which question is asked and about which policy.

PolicyHR-4410-3172
  1. ProductContents basic, Jonas Weberfound
  2. Terms versionContents terms 2024applies
  3. Bike add-onClause 7712, up to €1,500included
  4. Claims guidelineclaims department onlynot shared

Policy first, then the terms.

The assistant reads product, add-ons and start date from policy admin and works out which version of the terms and which clauses apply. It searches only sources the person asking may open anyway.

Your team decides

Which terms and guidelines are connected and who sees which.

Contents terms 2024sec. 5

Section 5 Theft of bicycles

(1) Bicycles are insured against theft if the bike add-on has been agreed.Add-on

(2) Compensation per claim is limited to the sum stated in the policy schedule.

(3) Theft from shared rooms is only insured if the bicycle was secured with a customary lock.Passage

(4) The policyholder keeps the receipt and frame number.ask the customer

The answer comes with section and version.

The assistant shows the passage word for word and marks what carries the answer and what is still open. If the terms say nothing on the question, it says so instead of guessing from similar cases.

Your team decides

Whether the passage really answers the question.

Reply to Maklerbüro KernCRM
PolicyHR-4410-3172
CustomerJonas Weber
ReplyCovered if the bike was locked
OpenRequest receipt and frame number
SourceContents terms 2024, sec. 5 (3)
Check and send

The draft reply is ready.

For the broker or the customer, in plain language, with the passage and the open points. Staff check, edit where needed and send. The request is logged in the CRM.

Your team decides

What is sent. The claims department decides on payment if a claim follows.

What it delivers and what it connects to.

Works with the systems you already use

Who does what.

What the AI takes on

  • Understands the question with policy and facts
  • Works out which terms version applies to the policy
  • Answers with section, clause and version
  • Says when something is not regulated
  • Drafts the reply to broker or customer

What your team decides

  • Checks the answer and the passage
  • Sends the reply
  • Decides on payment when a claim follows
  • Sets sources and permissions

Who it fits.

A good fit if

  • Customer service and broker support get many questions about cover
  • Several versions of your policy wordings are live at the same time
  • Wordings, clauses and guidelines are digital and kept by version
  • The policy system shows tariff, modules and start date

Less of a fit if

  • You have few products and one wording everyone knows
  • Older versions of the wordings can no longer be found
  • Coverage questions go straight to the claims team anyway

What it costs

Fixed prices, clear steps.

You know up front what each step costs and what it delivers.

  • AI strategy

    €1,990plus VAT

    Fixed price

    • One workshop day on real cases
    • A calculation with your figures for the best use cases
    • A paper for management and shareholders

    Money-back guarantee: three use cases that pay back within 12 months on paper, with your figures, or your money back.

  • Pilot with one use case

    from €5,000plus VAT

    Fixed price

    • On your data, in your process
    • Acceptance criteria agreed in writing

All prices net. Operation afterwards is from 20% of the project price a year, cancellable monthly. The code and the data are yours.

Further reading

All posts

Frequent questions

Common questions about it.

The questions that almost always come up about this use case.

Does the assistant decide whether something is covered?

No. It shows what the terms say and drafts a reply. Your team decides whether it goes out, and the claims department decides on payment. This is not a formality: Signal Iduna reports that its knowledge assistant answered correctly in 80 to 85% of cases (CIO, 2025). The cited passage makes the check quick.

How does the assistant know which terms apply to a policy?

From policy admin: product, add-ons, start date and conversions. That determines the version of the terms and clauses. Every version stays in the archive, and each answer names the version it comes from. If the version cannot be determined clearly, the assistant says so.

Does everyone see everything, including internal underwriting and claims guidelines?

No. The assistant takes over the permissions of your systems. What someone cannot open today, they will not see through the assistant either, and internal guidelines never end up in a draft to a broker or customer.

Is this a high-risk system under the EU AI Act?

Usually not. In insurance, Annex III lists risk assessment and pricing for natural persons in life and health insurance as high-risk. An assistant that shows staff the relevant passages and drafts replies for review normally falls outside that. This is orientation, not legal advice; we review the classification for your case with you.

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