How insurance lawyers use Justis AI

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.

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.

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.

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.

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.

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.

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.