Governance

Why every Case Orientation Report
starts from the same standard.

A report is only worth opening if three things hold on every claim: every applicable requirement is identified consistently, each one is prepared against the standard in force at the time, and the whole preparation can be traced, reproduced and audited.

This page sets out what makes those three things true. Governance is about whether you can trust the preparation. How Outcomer is deployed, and whether you can trust the environment it runs in, is set out separately under Security.

The boundary

What Outcomer prepares, and what your examiner decides.

Outcomer prepares

Selects the requirements the claim engages. Prepares each against the standard in force at the relevant date. Sets the evidence on the file against each one. Records the source authority, the corpus version and the reasoning. Holds the corpus under version control.

Outcomer never reaches a conclusion on the claim.

Your examiner decides

Assesses the evidence prepared against each requirement. Resolves anything marked borderline. Reaches the determination. Owns the judgement, and the accountability for it.

The judgement is your examiner’s, in full.


The corpus

Six properties behind every Case Orientation Report.

  1. Sourced from the issuing authorities.Every requirement traces to the statute, regulation, scheme manual or supervisory guidance it comes from — captured from the authority that issued it, not paraphrased or second-hand. Every requirement on the report names its source, so your examiner can see where the standard originates.
  2. The right requirements, for this claim.Applicability is resolved by explicit rules — jurisdiction, claim type, and the recognised characteristics of the claim — selecting the complete requirement set and nothing outside it. The report shows which authorities were selected and why, so the scope of every preparation is visible and challengeable.
  3. Every authority versioned.Each authority is held under change control with its state at every point in time retained. When a provision changes, the prior version is not overwritten. Each report records the corpus version that applied, so the standard used is never in question.
  4. The same claim, prepared the same way.Requirement selection is deterministic: the same claim characteristics always resolve to the same authorities and the same requirement set. Two examiners opening the same claim open an identical report — which is what removes preparation as a source of drift.
  5. Reproducible at the date it was worked.Because every authority is versioned and selection is deterministic, any preparation can be reproduced exactly as it stood when the claim was worked — not as the standard reads today. A historic report can be regenerated to match the original.
  6. Every preparation accountable.Each requirement, its source, its version, the evidence set against it and the reasoning are all recorded. The report is itself the audit artefact — an examiner, an auditor or a regulator can trace any position back to the standard behind it.

One precision worth stating plainly. Requirement selection is deterministic — the same claim always resolves to the same set. Evidence mapping is recorded and reproducible against a pinned corpus and model version. Different guarantees, both checkable.


Configuration

Three things are agreed before any claim is processed.

  1. The statutory matrix, signed off. Every provision your claim type engages, its source, the version in force and the point at which it applies. You review the whole set and confirm it matches your own reading.
  2. Your internal matrix, signed off. Your handling standards decomposed into requirements. You confirm the rendering faithfully represents your manual — only you can, because the standard is yours.
  3. Maintenance, discussed and approved. How the matrix stays current, how you tell us when your own standards change, and how each update is recorded and versioned.

Sign-off is recorded and dated, and the configuration version is stamped on every report — so “complete against the configuration you approved” is checkable two years later. It is signed by a named person, not a team.


Change control

When a requirement changes, the corpus changes under control.

Requirements are not static. The governance question is not whether the corpus changes, but whether every change is controlled, dated, and leaves historic preparations reproducible. Four steps, and you keep the decision.

  1. We monitor the instruments in your requirement set.
  2. We decompose the change — which requirements are affected, what the new wording requires, and what it replaces.
  3. You sign it off, as you did the original matrix. Until you do, the change is flagged as pending rather than applied.
  4. We apply it from the effective date, so claims before it still resolve against the old requirement and claims after it against the new.

Your own standards change only when you tell us they have, and you certify the new rendering as you did the first. We do not take standing authority over a document that is yours.

An update never changes the answer on a claim already examined. A claim worked in 2021 remains reproducible against the version in force then. That is what lets a determination made two years ago be defended against the standard that applied two years ago — not the one that reads today.


Inspection

None of this is a closed box.

The authorities the corpus holds, their versions, and the applicability rules that select them are open to your inspection.

The standard behind every Case Orientation Report can be verified,
not taken on trust.

Inspect the governance model.

We will walk through the corpus, the applicability rules, the versioning and the sign-off process — before anything is configured.

Teams we support

United StatesWorkers’ comp — indemnity · Workers’ comp — complex & litigated · Auto — PIP & no-fault · Casualty & bodily injury · Complex property & large loss · Claims QA & file audit
United Kingdom · Canada · Australia