Veterans Benefits Claims Automator

Principal workflows

• Digitize: Service treatment records, personnel files, private medical records and claim forms are scanned or received electronically, read with optical character recognition, and indexed by document type, date and source.
• Map: Each claimed condition is compared with the veteran's service history using rule logic for presumptive provisions, so the claim file shows which conditions may meet a presumption and which need further development.
• Develop: Where evidence is missing, the system prepares development tasks such as records requests and examination requests, and tracks them until the evidence arrives or the request is closed.
• Decide: The rater reviews the evidence summary and the rule results, decides service connection and evaluation for each condition, and records the reasons. Quality reviewers sample decisions against the same evidence.

Who uses it

• Agencies and offices that adjudicate veterans' disability compensation claims
• Veterans service representatives who develop claims and gather evidence
• Rating specialists who decide service connection and evaluations
• Policy and procedures staff who maintain presumptive rules as law changes
• Quality assurance staff and oversight bodies who review decisions

Reporting

• Claims by stage, age and station
• Development requests outstanding and overdue
• Proposed findings accepted, changed or rejected by raters, by rule
• Quality review results by team and condition type
• Presumptive rule versions in effect and their change history
• Documents needing records technician review

Features

• Record digitization: Scanned and electronic records are read, classified by document type and indexed, with each extracted fact linked back to its page.
• Service timeline: Periods of service, units, locations and duties from personnel records shown on one timeline, with the source of each entry.
• Presumptive rule library: Rules for presumptive provisions, each documented with its legal citation, effective dates, conditions and service criteria.
• Explained rule results: Every possible presumptive match shows the rule applied, the service facts and diagnoses it relied on, and the pages they came from.
• Rule versioning: When law or regulation changes, policy staff add a new rule version with its effective date, test it and approve it before it is used.
• Evidence summary: A per-condition summary of the diagnoses, treatment and in-service events found in the file, for the rater to verify.
• Development tracking: Records and examination requests proposed from evidence gaps, with status and follow-up dates tracked on the claim.
• Rater decision record: The rater's decision on each condition and the reasons, recorded beside the proposal so any difference is visible.
• Quality review sampling: Sample completed claims for second review, record findings, and see where reviewers and raters disagree.
• Workload queues: Claims queued by stage, priority indicators your agency sets and age, with assignment rules by team or station.
• Claim file search: Search the full claim file by term, date, document type or condition, with results linked to the page.
• Audit trail: Every view, extraction correction, proposal, decision and export recorded with the person and time.

Integrations

• Claims and case management: Claim establishment data and status exchanged with your agency's claims processing system, mapped during implementation.
• Document repositories and scanning: Documents received from your mail scanning vendor or electronic folder, by scheduled transfer or API.
• Service personnel and treatment records: Service records available to your agency through its existing exchanges with the military services, received as documents or structured data.
• Examination scheduling: Examination requests approved by a veterans service representative passed to your examination scheduling process.
• Single sign-on: Staff sign in through your agency's identity provider, including PIV-based authentication where your provider supports it.
• Work API: Claim, development and decision data available to your agency's data warehouse and reporting tools through the Moraph Work API.

Deployment

• Moraph cloud, United States: Hosted in the United States region, with records kept in the US.
• Dedicated environment: A single-tenant environment for agencies that require isolation, scoped in the proposal.
• With a managed service: Optionally run alongside a Moraph managed service for administration, integration support and rule library maintenance support.

Security and privacy

• Records kept in the United States: Claim files and decision data are hosted in the United States region.
• Cleared support lane: Support tickets from federal clients are routed only to US citizens with active security clearances.
• Access by role and station: Staff see only the claims for their role, team or station; access to sensitive files can be limited further.
• Encryption under controlled keys: Client data is encrypted with keys our staff cannot access without explicit, time-bound authorization.
• Complete audit trail: Every view, correction, proposal, decision and export is recorded with the user and time, and cannot be edited.
• Independent audits: Moraph's controls are covered by its SOC 2 Type II report and ISO/IEC 27001 certification, available through the Trust Center.

Limitations

• It proposes; it never decides. Service connection, evaluations and every other finding are made by your rating staff, and the system does not issue decisions or notices.
• Presumptive rules reflect law and regulation as reviewed and approved by your policy staff. Moraph does not interpret the law for your agency, and rule changes take effect only when you approve them.
• Extraction from scanned records can miss or misread information, especially handwriting and poor-quality scans. Low-confidence pages are flagged, and staff remain responsible for reviewing the evidence.
• It does not assign disability percentages on its own. It can show the rating schedule criteria and evidence, but the evaluation is the rater's decision.
• Moraph holds no FedRAMP authorization for this product. We provide control documentation to support your agency's own authorization decision.
• It is not a replacement for your agency's system of record for claims, payments or notices; it works alongside them.
• Appeals processing is not included beyond making the claim file and decision record available.
• Coverage starts with the claim types and presumptive provisions agreed during implementation; others are added by agreement.

Next steps

Book a demonstration or a technical briefing at www.moraph.com/solutions/veterans-benefits-claims-automator. Purchasing routes and company information: www.moraph.com/how-to-buy.