From 2f3696252450c148fa58ddd0f0d48bb9a38ab1f3 Mon Sep 17 00:00:00 2001 From: Risper8 Date: Sun, 11 Jan 2026 15:25:59 +0300 Subject: [PATCH 1/2] Add claims domain and README for TauBench --- .env.example | 2 - claims_pydantic.json | 17490 ++++++++++++++++ data/tau2/domains/claims/db.json | 17490 ++++++++++++++++ data/tau2/domains/claims/policy.md | 331 + data/tau2/domains/claims/split_tasks.json | 108 + data/tau2/domains/claims/tasks.json | 1710 ++ src/tau2/domains/claims/README.md | 92 + src/tau2/domains/claims/__init__.py | 0 src/tau2/domains/claims/data_model.py | 230 + src/tau2/domains/claims/environment.py | 56 + src/tau2/domains/claims/test.py | 295 + src/tau2/domains/claims/tools.py | 771 + src/tau2/domains/claims/utils.py | 12 + src/tau2/registry.py | 18 + tests/test_domains/test_claims/__init__.py | 0 .../test_claims/test_tools_claims.py | 528 + 16 files changed, 39131 insertions(+), 2 deletions(-) delete mode 100644 .env.example create mode 100644 claims_pydantic.json create mode 100644 data/tau2/domains/claims/db.json create mode 100644 data/tau2/domains/claims/policy.md create mode 100644 data/tau2/domains/claims/split_tasks.json create mode 100644 data/tau2/domains/claims/tasks.json create mode 100644 src/tau2/domains/claims/README.md create mode 100644 src/tau2/domains/claims/__init__.py create mode 100644 src/tau2/domains/claims/data_model.py create mode 100644 src/tau2/domains/claims/environment.py create mode 100644 src/tau2/domains/claims/test.py create mode 100644 src/tau2/domains/claims/tools.py create mode 100644 src/tau2/domains/claims/utils.py create mode 100644 tests/test_domains/test_claims/__init__.py create mode 100644 tests/test_domains/test_claims/test_tools_claims.py diff --git a/.env.example b/.env.example deleted file mode 100644 index 1e6489d2..00000000 --- a/.env.example +++ /dev/null @@ -1,2 +0,0 @@ -ANTHROPIC_API_KEY= -OPENAI_API_KEY= \ No newline at end of file diff --git a/claims_pydantic.json b/claims_pydantic.json new file mode 100644 index 00000000..f16d69ea --- /dev/null +++ b/claims_pydantic.json @@ -0,0 +1,17490 @@ +{ + "HOME-ET-2024-00001": { + "claim_id": "HOME-ET-2024-00001", + "policy": { + "policy_id": "HOME-ET-2024-00001", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Danielle", + "last_name": "Johnson" + }, + "policyholder_dob": "1969-11-12", + "policyholder_address": { + "line1": "908 Jennifer Squares", + "line2": null, + "city": "Robinsonshire", + "state": "Louisiana", + "country": "Ethiopia", + "postal_code": "01352" + }, + "policyholder_contact": "001-626-254-2351x16155", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 1751.86, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****7924", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Joshua", + "last_name": "Walker" + }, + "dob": "2004-08-23", + "address": { + "line1": "161 Calderon River Suite 931", + "line2": null, + "city": "Lake Jeremyport", + "state": "Colorado", + "country": "Ethiopia", + "postal_code": "31013" + }, + "contact": "664-375-2553", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "92OS832764", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "Angela", + "last_name": "Cohen" + }, + "dob": "2007-04-09", + "address": { + "line1": "05641 Robin Port", + "line2": null, + "city": "Jasonfort", + "state": "Montana", + "country": "Ethiopia", + "postal_code": "84760" + }, + "contact": "724.523.8849x696", + "identity_documents": [], + "relationship_to_policyholder": "relative" + }, + { + "role": "third_party", + "name": { + "first_name": "Wendy", + "last_name": "Taylor" + }, + "dob": "1988-07-27", + "address": { + "line1": "12269 Paul Ranch", + "line2": null, + "city": "Riceside", + "state": "Alabama", + "country": "Ethiopia", + "postal_code": "89667" + }, + "contact": "001-418-345-1462x7048", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-05-20", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "Meaganhaven", + "estimated_loss_amount": 450305.42, + "currency": "EBT" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-05-27", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-10T20:05:57": "Document proof_of_ownership received", + "2024-02-19T13:04:12": "Claim created", + "2024-06-25T21:58:51": "Document claim_form received", + "2024-07-10T18:59:14": "Document proof_of_ownership verified", + "2024-08-23T19:31:24": "Document repair_quotes received", + "2024-08-31T23:33:46": "Document claim_form verified", + "2024-09-24T09:18:19": "Document repair_quotes verified", + "2024-11-12T13:10:00": "Document photos received", + "2024-12-18T20:10:03": "Document photos verified", + "2024-12-26T02:31:56": "Claim status updated to awaiting_documents" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Megan", + "last_name": "Mcclain" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Javier", + "last_name": "Johnson" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-08-17T21:27:16" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-KE-2024-00002": { + "claim_id": "HOME-KE-2024-00002", + "policy": { + "policy_id": "HOME-KE-2024-00002", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Chelsea", + "last_name": "Hernandez" + }, + "policyholder_dob": "1975-11-30", + "policyholder_address": { + "line1": "39117 Tiffany Place", + "line2": null, + "city": "East Donna", + "state": "Oklahoma", + "country": "Kenya", + "postal_code": "22144" + }, + "policyholder_contact": "989-363-8346x578", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 4122.71, + "currency": "KES", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****2084", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****4483", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Kathryn", + "last_name": "Ryan" + }, + "dob": "1971-11-09", + "address": { + "line1": "50983 Adrian Station", + "line2": null, + "city": "East Carloston", + "state": "Michigan", + "country": "Kenya", + "postal_code": "09788" + }, + "contact": "334.373.8299x73763", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "65zU667010", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-04-29", + "cause_of_loss": "fence/wall destroyed", + "description": "Reported insured loss event", + "location": "Laurenville", + "estimated_loss_amount": 763351.82, + "currency": "KES" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-05-02", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 187632.05, + "currency": "KES", + "payment_date": "2024-08-24T13:48:55", + "payment_method": "mobile_money", + "recipient_name": "Kathryn Ryan", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 755364.93, + "currency": "KES", + "payment_date": "2024-11-23T20:16:40", + "payment_method": "bank_transfer", + "recipient_name": "Kathryn Ryan", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-16T01:42:55": "Payment of 187632.05 KES initiated via mobile_money", + "2024-02-26T05:33:53": "Payment of 755364.93 KES initiated via bank_transfer", + "2024-03-12T08:58:45": "Claim created", + "2024-05-14T21:17:02": "Document fire_report received", + "2024-07-23T13:10:47": "Document photos received", + "2024-08-07T21:14:44": "Document proof_of_ownership received", + "2024-09-17T17:58:06": "Claim status updated to awaiting_documents", + "2024-09-17T18:12:58": "Document photos verified", + "2024-10-14T19:37:24": "Document claim_form received" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Kerry", + "last_name": "Smith" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Alec", + "last_name": "Hickman" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-04-27T01:10:07" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-ET-2024-00003": { + "claim_id": "HOME-ET-2024-00003", + "policy": { + "policy_id": "HOME-ET-2024-00003", + "insurance_type": "property", + "policyholder_name": { + "first_name": "John", + "last_name": "Lee" + }, + "policyholder_dob": "1958-06-06", + "policyholder_address": { + "line1": "32677 Michelle Circle", + "line2": null, + "city": "South Aaron", + "state": "Missouri", + "country": "Ethiopia", + "postal_code": "35261" + }, + "policyholder_contact": "246.787.2343x098", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 3928.83, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****5889", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****7126", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "credit_card", + "masked_reference": "****6310", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Shane", + "last_name": "Henderson" + }, + "dob": "1958-11-16", + "address": { + "line1": "788 Brian Pass", + "line2": null, + "city": "Port Jacobland", + "state": "Utah", + "country": "Ethiopia", + "postal_code": "31329" + }, + "contact": "(719)639-9091x6998", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "35uW346247", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Shari", + "last_name": "Smith" + }, + "dob": "1997-04-03", + "address": { + "line1": "83842 Ibarra Gardens", + "line2": null, + "city": "Justinmouth", + "state": "Ohio", + "country": "Ethiopia", + "postal_code": "92715" + }, + "contact": "698-608-4124x1182", + "identity_documents": [], + "relationship_to_policyholder": "relative" + }, + { + "role": "third_party", + "name": { + "first_name": "Cassandra", + "last_name": "Robbins" + }, + "dob": "1968-11-03", + "address": { + "line1": "740 Cynthia Village Suite 005", + "line2": null, + "city": "Lake Tina", + "state": "Hawaii", + "country": "Ethiopia", + "postal_code": "97655" + }, + "contact": "486.880.1128x059", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-11-01", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "North Kyle", + "estimated_loss_amount": 772610.79, + "currency": "EBT" + }, + "claim_status": "new", + "reported_date": "2024-11-03", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": {}, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-ZA-2024-00004": { + "claim_id": "HOME-ZA-2024-00004", + "policy": { + "policy_id": "HOME-ZA-2024-00004", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Rachel", + "last_name": "Flynn" + }, + "policyholder_dob": "1997-03-22", + "policyholder_address": { + "line1": "22602 Patton Loop", + "line2": null, + "city": "West Erik", + "state": "Vermont", + "country": "Zambia", + "postal_code": "14669" + }, + "policyholder_contact": "(707)633-7543x3036", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 3685.28, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****2104", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Michelle", + "last_name": "Nolan" + }, + "dob": "1959-09-17", + "address": { + "line1": "8685 Darrell Green Apt. 940", + "line2": null, + "city": "New Ryanmouth", + "state": "Nevada", + "country": "Zambia", + "postal_code": "79958" + }, + "contact": "316.793.4060x88356", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "95zS148465", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Kenneth", + "last_name": "Martinez" + }, + "dob": "1983-08-07", + "address": { + "line1": "299 Sullivan Village Apt. 443", + "line2": null, + "city": "Floydmouth", + "state": "New Jersey", + "country": "Zambia", + "postal_code": "58406" + }, + "contact": "638.572.1489x513", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-12-19", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "East Andrew", + "estimated_loss_amount": 1427333.2, + "currency": "ZMW" + }, + "claim_status": "under_review", + "reported_date": "2024-12-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-03-08T20:47:27": "Document claim_form received", + "2024-04-19T19:37:58": "Claim created", + "2024-07-27T06:55:57": "Document photos received", + "2024-08-20T10:27:41": "Document photos verified", + "2024-10-22T17:12:33": "Document proof_of_ownership received", + "2024-11-23T10:25:46": "Document proof_of_ownership verified", + "2024-12-03T15:41:38": "Claim status updated to under_review" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Property Team", + "claims_adjuster": { + "first_name": "David", + "last_name": "Garcia" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Stacey", + "last_name": "Russell" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-01-04T02:35:05" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-SO-2024-00005": { + "claim_id": "HOME-SO-2024-00005", + "policy": { + "policy_id": "HOME-SO-2024-00005", + "insurance_type": "property", + "policyholder_name": { + "first_name": "John", + "last_name": "Alvarez" + }, + "policyholder_dob": "1999-08-19", + "policyholder_address": { + "line1": "63287 Angela Vista", + "line2": null, + "city": "South Dennismouth", + "state": "Texas", + "country": "South Africa", + "postal_code": "70117" + }, + "policyholder_contact": "+1-495-979-8687", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 940.59, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****2528", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****7658", + "verified": false + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****4502", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Melissa", + "last_name": "Jones" + }, + "dob": "1985-08-12", + "address": { + "line1": "48734 Jones Heights Apt. 455", + "line2": null, + "city": "East Edwardfurt", + "state": "Vermont", + "country": "South Africa", + "postal_code": "20529" + }, + "contact": "001-831-266-5876x036", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "96IV705466", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-01-28", + "cause_of_loss": "guest injury", + "description": "Reported insured loss event", + "location": "South Andrewside", + "estimated_loss_amount": 1968409.6, + "currency": "ZAR" + }, + "claim_status": "under_review", + "reported_date": "2024-02-17", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "no witness statements" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": {}, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Health Team", + "claims_adjuster": { + "first_name": "Mark", + "last_name": "Lee" + }, + "adjuster_role": "Junior Claims Analyst", + 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1509695.24, + "currency": "ZAR" + }, + "claim_status": "under_review", + "reported_date": "2024-11-30", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "duplicate_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 387593.65, + "currency": "ZAR", + "payment_date": "2024-07-07T06:06:32", + "payment_method": "credit_card", + "recipient_name": "Russell Campbell", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 1174450.92, + "currency": "ZAR", + "payment_date": "2024-03-24T11:19:28", + "payment_method": "credit_card", + "recipient_name": "Russell Campbell", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-14T10:09:19": "Claim status updated to under_review", + "2024-07-04T23:08:27": "Claim created", + "2024-08-18T08:52:43": "Payment of 387593.65 ZAR initiated via credit_card", + "2024-08-23T05:34:12": "Document claim_form received", + "2024-08-25T20:44:51": "Payment of 1174450.92 ZAR initiated via credit_card", + 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"2024-02-28T02:22:44": "Document proof_of_ownership received", + "2024-03-18T05:25:55": "Payment of 496697.47 ZAR initiated via bank_transfer", + "2024-04-04T01:52:14": "Document repair_quotes received", + "2024-08-11T19:15:50": "Document repair_quotes verified", + "2024-08-28T17:25:46": "Document claim_form received", + "2024-09-20T20:16:58": "Document proof_of_ownership verified", + "2024-10-20T10:21:08": "Claim created", + "2024-10-24T05:50:03": "Document claim_form verified", + "2024-11-18T01:57:06": "Payment of 299065.85 ZAR initiated via mobile_money" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Raven", + "last_name": "Taylor" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Ronald", + "last_name": "Horton" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-06-03T00:30:54" + }, + "assignment_history": [] + }, + "recoveries": 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"real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 950590.94, + "currency": "ZMW", + "payment_date": "2024-11-08T03:36:46", + "payment_method": "bank_transfer", + "recipient_name": "Lisa Kennedy", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 957452.93, + "currency": "ZMW", + "payment_date": "2024-05-15T02:57:21", + "payment_method": "bank_transfer", + "recipient_name": "Lisa Kennedy", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-06T08:29:55": "Claim created", + "2024-05-15T22:45:27": "Document claim_form received", + "2024-08-05T04:10:43": "Payment of 950590.94 ZMW initiated via bank_transfer", + "2024-10-05T08:11:06": "Payment of 957452.93 ZMW initiated via bank_transfer", + "2024-10-28T07:12:08": "Claim status updated to expired" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Property Team", + "claims_adjuster": { + "first_name": "Matthew", + "last_name": "Mitchell" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "", + "last_name": "" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-10-09T02:43:58" + }, + "assignment_history": [] + }, 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"line2": null, + "city": "Foxchester", + "state": "Oregon", + "country": "Ethiopia", + "postal_code": "10167" + }, + "contact": "(451)477-8528", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "68ku018242", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-02-06", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "West Stacey", + "estimated_loss_amount": 336015.96, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-02-07", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "inflated_loss", + "duplicate_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 181902.44, + "currency": "EBT", + "payment_date": "2024-08-12T02:55:43", + "payment_method": "credit_card", + "recipient_name": "April Mcintyre", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 298970.86, + "currency": "EBT", + "payment_date": 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"assignment_history": [] + }, + "recoveries": [] + }, + "HOME-UG-2024-00017": { + "claim_id": "HOME-UG-2024-00017", + "policy": { + "policy_id": "HOME-UG-2024-00017", + "insurance_type": "property", + "policyholder_name": { + "first_name": "April", + "last_name": "Campbell" + }, + "policyholder_dob": "1995-04-05", + "policyholder_address": { + "line1": "99590 Christopher Row", + "line2": null, + "city": "Debrashire", + "state": "Nebraska", + "country": "Uganda", + "postal_code": "81517" + }, + "policyholder_contact": "+1-407-984-4736x4710", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 3314.34, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5375", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Christian", + "last_name": "Gonzalez" + }, + "dob": "1983-04-09", + "address": { + "line1": "3592 Hensley Island Suite 625", + "line2": null, + "city": "West Johnville", + "state": "Louisiana", + "country": "Uganda", + "postal_code": "59430" + }, + "contact": "421.704.6963", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "95tF327877", + "verified": false + } + ], + "relationship_to_policyholder": "relative" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-07-24", + "cause_of_loss": "emergency hospitalization abroad", + "description": "Reported insured loss event", + "location": "North Sierrahaven", + "estimated_loss_amount": 78210.77, + "currency": "UGX" + }, + "claim_status": "under_review", + "reported_date": "2024-08-10", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "travel_cover", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-08T20:06:24": "Document photos received", + "2024-05-02T05:45:58": "Document claim_form received", + "2024-06-08T20:03:19": "Document proof_of_ownership received", + "2024-07-27T03:23:37": "Claim status 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"policyholder_contact": "+1-891-221-6558x52398", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 3858.32, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****5526", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Brandy", + "last_name": "Williams" + }, + "dob": "1958-01-26", + "address": { + "line1": "57872 Mark Ridge", + "line2": null, + "city": "Franciscoport", + "state": "Pennsylvania", + "country": "Nigeria", + "postal_code": "44590" + }, + "contact": "288.979.4705x51694", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "49HO930972", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-27", + "cause_of_loss": "storm damage", + "description": 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"verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "duplicate_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-03-17T16:15:29": "Document photos received", + "2024-06-01T21:22:11": "Claim created", + "2024-10-02T17:38:03": "Claim status updated to awaiting_documents", + "2024-10-23T17:49:38": "Document claim_form received" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Kyle", + "last_name": "Cameron" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Donna", + "last_name": "Smith" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-11-02T18:30:16" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-SO-2024-00019": { 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"dob": "2005-01-22", + "address": { + "line1": "283 Bolton Neck", + "line2": null, + "city": "Edwardsburgh", + "state": "New Jersey", + "country": "South Africa", + "postal_code": "70379" + }, + "contact": "585-949-7334x84344", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "08TE330165", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-07-12", + "cause_of_loss": "Househelp injured", + "description": "Reported insured loss event", + "location": "Lake Kellitown", + "estimated_loss_amount": 1866040.25, + "currency": "ZAR" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-07-26", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "medical_report", + "real_document_type": "medical_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-05-15T12:19:35": "Claim created", + "2024-07-13T11:31:45": "Document proof_of_ownership received", + "2024-11-15T14:28:18": "Document claim_form received", + 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"Document proofs_of_death_form verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Melissa", + "last_name": "Fowler" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Holly", + "last_name": "Walker" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-08-13T01:12:53" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-TA-2024-00002": { + "claim_id": "LIFE-TA-2024-00002", + "policy": { + "policy_id": "LIFE-TA-2024-00002", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Darlene", + "last_name": "Daniel" + }, + "policyholder_dob": "1991-09-08", + "policyholder_address": { + "line1": "512 Rice Stream", + "line2": null, + "city": "Port Adam", + "state": "Alaska", + "country": "Tanzania", + "postal_code": "39608" + }, + "policyholder_contact": "386.286.3375x243", + "effective_date": "2024-01-01", 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null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-04-20T15:39:30": "Document insured_id_or_surrender_letter received", + "2024-07-30T12:20:24": "Document birth_certificate received", + "2024-07-30T12:20:48": "Document guardianship_order not received", + "2024-07-31T03:27:43": "Claim status updated to awaiting_documents", + "2024-08-08T03:36:39": "Document death_certificate received", + "2024-08-13T23:58:39": "Document 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"line1": "961 Yates Station", + "line2": null, + "city": "North Josephfurt", + "state": "Virginia", + "country": "South Africa", + "postal_code": "83587" + }, + "policyholder_contact": "(765)651-1047", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 2075.51, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****2882", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****8030", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****1474", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Stephanie", + "last_name": "Sanders" + }, + "dob": "2007-12-10", + "address": { + "line1": "26788 Garcia Corners", + "line2": null, + "city": "Angelamouth", + "state": "Missouri", + "country": "South Africa", + "postal_code": "02118" + }, + "contact": "666-618-3982x6224", + "identity_documents": [ + { + "doc_type": "birth_certificate", + "doc_number": "72EY126464", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-02-04", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "West Johnathanbury", + "estimated_loss_amount": 1664384.92, + "currency": "ZAR" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-02-06", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + 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"2024-12-04T19:45:26": "Document death_certificate verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Alyssa", + "last_name": "Nelson" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Katherine", + "last_name": "Kelly DVM" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-04-24T03:56:24" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ET-2024-00005": { + "claim_id": "LIFE-ET-2024-00005", + "policy": { + "policy_id": "LIFE-ET-2024-00005", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Jennifer", + "last_name": "Simpson" + }, + "policyholder_dob": "1984-12-10", + "policyholder_address": { + "line1": "9245 Timothy Fall Suite 547", + "line2": null, + "city": "West Nicholas", + "state": "Montana", + "country": "Ethiopia", + "postal_code": "48344" + }, + "policyholder_contact": 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"document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + 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"first_name": "Janice", + "last_name": "Evans" + }, + "dob": "1996-10-20", + "address": { + "line1": "251 Kevin Falls", + "line2": null, + "city": "Heatherhaven", + "state": "Missouri", + "country": "Zambia", + "postal_code": "55320" + }, + "contact": "+1-629-466-2782x827", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-08-23", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "West Megan", + "estimated_loss_amount": 1724909.48, + "currency": "ZMW" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-08-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-20T02:04:16": "Payment of 691339.23 ZMW initiated via mobile_money", + "2024-02-04T17:04:22": "Document insured_id_or_surrender_letter received", + "2024-03-18T16:00:40": "Document death_certificate received", + "2024-06-04T10:00:02": "Document birth_certificate_or_guardianship_order received", + "2024-06-29T18:28:17": "Document police_abstract_or_post_mortem_if_accident received", + "2024-07-07T10:27:07": "Payment of 1286700.01 ZMW initiated via bank_transfer", + "2024-07-18T05:46:22": "Document 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"status": "active", + "premium_amount": 2339.46, + "currency": "KES", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****6482", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****2548", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Stephanie", + "last_name": "Washington" + }, + "dob": "1961-12-15", + "address": { + "line1": "0745 Scott Crest", + "line2": null, + "city": "East Lisa", + "state": "Pennsylvania", + "country": "Kenya", + "postal_code": "90827" + }, + "contact": "(696)429-2330x958", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "54WY494812", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-09-16", + "cause_of_loss": "car accident", + "description": "Reported insured loss event", + "location": "Sellersview", + "estimated_loss_amount": 928109.76, + "currency": "KES" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-09-28", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "no original policy document" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-06-07T23:53:10": "Claim created", + "2024-06-17T04:39:10": "Document letters_of_administration received", + "2024-07-04T00:39:49": "Claim status updated to awaiting_documents", + "2024-07-11T23:25:43": "Document affidavits_if_applicable received", + "2024-12-05T23:49:05": "Document letters_of_administration verified", + "2024-12-23T14:16:14": "Document death_certificate received", + "2024-12-26T11:56:07": "Document death_certificate verified", + "2024-12-28T03:05:04": "Document proofs_of_death_form received", + "2024-12-29T23:26:03": "Document proofs_of_death_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "James", + "last_name": "Hoffman" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Jennifer", + "last_name": "Vasquez" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-05-24T14:06:19" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-NI-2024-00008": { + "claim_id": "LIFE-NI-2024-00008", + "policy": { + "policy_id": "LIFE-NI-2024-00008", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Michelle", + "last_name": "Martinez" + }, + "policyholder_dob": "1973-04-10", + "policyholder_address": { + "line1": "7116 Neal Wells Suite 775", + "line2": null, + "city": "Port Kimland", + "state": "Washington", + "country": "Nigeria", + "postal_code": "60590" + }, + "policyholder_contact": "+1-451-986-3637x4545", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 3552.38, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8564", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****9239", + "verified": 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"(942)762-2178x092", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "36i5610371", + "verified": true + } + ], + "relationship_to_policyholder": "sister" + }, + { + "role": "beneficiary", + "name": { + "first_name": "Jeremy", + "last_name": "Frazier" + }, + "dob": "1955-08-14", + "address": { + "line1": "516 Tim Forks", + "line2": null, + "city": "Davisville", + "state": "Connecticut", + "country": "Nigeria", + "postal_code": "41572" + }, + "contact": "(942)762-2189x092", + "identity_documents": [], + "relationship_to_policyholder": "relative" + }, + { + "role": "third_party", + "name": { + "first_name": "Jennifer", + "last_name": "Fuller" + }, + "dob": "1965-04-15", + "address": { + "line1": "731 Donald Crossing Suite 565", + "line2": null, + "city": "East Joshua", + "state": "Colorado", + "country": "Nigeria", + "postal_code": "33028" + }, + "contact": "+1-599-894-0438", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "36i5665371", + "verified": true + } + ], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-04-08", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Debbiebury", + "estimated_loss_amount": 1999953.36, + "currency": "NGN" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-04-15", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "beneficiary_dispute" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-14T15:06:21": "Document claimant_id received", + "2024-01-28T14:26:04": "Document insured_id_or_surrender_letter received", + "2024-02-11T13:39:00": "Document birth_certificate_or_guardianship_order received", + "2024-02-16T08:05:02": "Document death_certificate received", + "2024-03-16T15:55:40": "Document policy_document received", + "2024-06-04T14:40:34": "Document birth_certificate_or_guardianship_order verified", + "2024-06-12T03:36:27": "Document letters_of_administration received", + "2024-08-18T18:41:26": "Claim created", + "2024-09-14T13:36:55": "Document proofs_of_death_form received", + "2024-10-03T20:48:42": "Document death_certificate verified", + "2024-10-15T03:40:30": "Document proofs_of_death_form verified", + "2024-12-31T23:39:51": "Claim status updated to awaiting_documents" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Sandra", + "last_name": "Juarez" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "", + "last_name": "" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-04-09T13:23:33" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-SO-2024-00009": { + "claim_id": "LIFE-SO-2024-00009", + "policy": { + "policy_id": "LIFE-SO-2024-00009", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Troy", + "last_name": "Rodriguez" + }, + "policyholder_dob": "1993-08-31", + "policyholder_address": { + "line1": "8271 Brenda Bridge Suite 300", + "line2": null, + "city": "Hunterhaven", + "state": "Wyoming", + "country": "South Africa", + "postal_code": "54952" + }, + "policyholder_contact": "(761)888-9241x41832", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 3087.71, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5772", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****6780", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****4068", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Victor", + "last_name": "Wheeler" + }, + "dob": "1994-11-22", + "address": { + "line1": "6303 Sandy Crescent", + "line2": null, + "city": "Salazarton", + "state": "Maryland", + "country": "South Africa", + "postal_code": "87805" + }, + "contact": "001-721-402-0275x8842", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "41qT056481", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Theresa", + "last_name": "Burton" + }, + "dob": "1988-09-30", + "address": { + "line1": "507 Michael Glens Apt. 913", + "line2": null, + "city": "North Micheletown", + "state": "Kansas", + "country": "South Africa", + "postal_code": "06527" + }, + "contact": "656.322.0863x5365", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-12-27", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Davidton", + "estimated_loss_amount": 899959.94, + "currency": "ZAR" + }, + "claim_status": "new", + "reported_date": "2025-01-11", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "beneficiary_dispute" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-09T13:00:05": "Document policy_document received", + "2024-02-13T01:33:18": "Document policy_document verified", + "2024-03-09T01:36:51": "Document proofs_of_death_form received", + "2024-05-03T23:55:27": "Document death_certificate received", + "2024-06-22T23:24:12": "Document affidavits_if_applicable received", + "2024-06-29T19:52:47": "Document birth_certificate_or_guardianship_order received", + "2024-07-10T09:14:06": "Claim created", + "2024-08-06T16:19:11": "Document affidavits_if_applicable verified", + "2024-11-17T03:46:27": "Document claimant_id received", + "2024-11-19T06:38:11": "Claim status updated to new", + "2024-12-22T17:25:22": "Document letters_of_administration received", + "2024-12-24T15:52:50": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Vanessa", + "last_name": "Hatfield" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Bonnie", + "last_name": "Valencia" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-11-19T18:45:51" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00010": { + "claim_id": "LIFE-ZA-2024-00010", + "policy": { + "policy_id": "LIFE-ZA-2024-00010", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Harry", + "last_name": "Brock" + }, + "policyholder_dob": "1955-07-13", + "policyholder_address": { + "line1": "49493 Richardson Park Apt. 832", + "line2": null, + "city": "South Andrewside", + "state": "Minnesota", + "country": "Zambia", + "postal_code": "83855" + }, + "policyholder_contact": "001-205-406-4138x367", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 2153.06, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****2353", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****8055", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****6262", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Tina", + "last_name": "Finley" + }, + "dob": "2003-06-01", + "address": { + "line1": "03865 Villegas Corner Apt. 826", + "line2": null, + "city": "New Ashleychester", + "state": "Texas", + "country": "Zambia", + "postal_code": "17633" + }, + "contact": "544.356.5574", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "32Du912127", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-22", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Martinezstad", + "estimated_loss_amount": 590417.93, + "currency": "ZMW" + }, + "claim_status": "under_review", + "reported_date": "2024-08-23", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-06-29T22:23:09": "Document affidavits_if_applicable received", + "2024-08-06T06:04:02": "Document policy_document received", + "2024-08-16T01:32:31": "Document death_certificate received", + "2024-08-16T21:56:26": "Claim created", + "2024-10-19T08:22:55": "Document affidavits_if_applicable verified", + "2024-11-23T02:05:18": "Claim status updated to under_review", + "2024-11-27T18:51:59": "Document policy_document verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-TA-2024-00011": { + "claim_id": "LIFE-TA-2024-00011", + "policy": { + "policy_id": "LIFE-TA-2024-00011", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Tami", + "last_name": "Clark" + }, + "policyholder_dob": "1977-04-17", + "policyholder_address": { + "line1": "35680 Green Extensions", + "line2": null, + "city": "South Melissaside", + "state": "West Virginia", + "country": "Tanzania", + "postal_code": "72606" + }, + "policyholder_contact": "417.512.1003", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 2829.85, + "currency": "TZS", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****5288", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****4515", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****4279", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Kyle", + "last_name": "Baker" + }, + "dob": "1982-03-31", + "address": { + "line1": "199 Lowery Club Apt. 137", + "line2": null, + "city": "North Rebecca", + "state": "Michigan", + "country": "Tanzania", + "postal_code": "16560" + }, + "contact": "8708296670", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "25cN324472", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-07", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Lake Kenneth", + "estimated_loss_amount": 74423.94, + "currency": "TZS" + }, + "claim_status": "under_review", + "reported_date": "2024-11-21", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-02-14T11:38:09": "Document policy_document received", + "2024-03-21T23:13:04": "Document police_abstract_or_post_mortem_if_accident received", + "2024-06-19T12:22:45": "Document police_abstract_or_post_mortem_if_accident verified", + "2024-09-17T08:09:51": "Claim status updated to under_review", + "2024-12-07T12:38:57": "Document death_certificate received", + "2024-12-29T02:21:51": "Document insured_id_or_surrender_letter received", + "2024-12-30T13:17:06": "Document insured_id_or_surrender_letter verified", + "2024-12-31T16:12:21": "Claim created" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Christopher", + "last_name": "Parks" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Melissa", + "last_name": "Williams" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-04-05T18:10:10" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00012": { + "claim_id": "LIFE-ZA-2024-00012", + "policy": { + "policy_id": "LIFE-ZA-2024-00012", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Robert", + "last_name": "Pierce" + }, + "policyholder_dob": "1956-04-25", + "policyholder_address": { + "line1": "578 Cooper Port Suite 642", + "line2": null, + "city": "West Carlatown", + "state": "Wyoming", + "country": "Zambia", + "postal_code": "37323" + }, + "policyholder_contact": "5786593213", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 4241.26, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5982", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****6286", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****9501", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Bruce", + "last_name": "Ramirez" + }, + "dob": "1991-04-21", + "address": { + "line1": "96522 Brittany Valley", + "line2": null, + "city": "Robintown", + "state": "Virginia", + "country": "Zambia", + "postal_code": "92324" + }, + "contact": "(399)229-3784x270", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "39Nm308705", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-01-14", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "West Jennifer", + "estimated_loss_amount": 1110272.77, + "currency": "ZMW" + }, + "claim_status": "settled", + "reported_date": "2024-01-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 83269.24, + "currency": "ZMW", + "payment_date": "2024-08-26T18:50:11", + "payment_method": "mobile_money", + "recipient_name": "Bruce Ramirez", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 143358.09, + "currency": "ZMW", + "payment_date": "2024-10-09T23:17:39", + "payment_method": "bank_transfer", + "recipient_name": "Bruce Ramirez", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { 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"first_name": "Samantha", + "last_name": "Richard" + }, + "policyholder_dob": "1980-05-29", + "policyholder_address": { + "line1": "154 Taylor Estate Suite 752", + "line2": null, + "city": "Jeffreyshire", + "state": "Idaho", + "country": "Ethiopia", + "postal_code": "50096" + }, + "policyholder_contact": "542-320-9690x2959", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 1088.45, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****6228", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****3007", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Marcus", + "last_name": "Johnson" + }, + "dob": "1988-10-01", + "address": { + "line1": "1355 Daisy Corners", + "line2": null, + "city": "Seanview", + "state": "Indiana", + "country": "Ethiopia", + "postal_code": "33208" + }, + "contact": "001-915-841-0067x626", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "58Ce617932", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "Lauren", + "last_name": "Johnson" + }, + "dob": "1956-05-09", + "address": { + "line1": "1152 Martin Club Apt. 599", + "line2": null, + "city": "Bushchester", + "state": "Tennessee", + "country": "Ethiopia", + "postal_code": "22127" + }, + "contact": "+1-662-601-5336x884", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-10-19", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "North Brandon", + "estimated_loss_amount": 1238126.31, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-11-01", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "identity_mismatch" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-12T03:16:42": "Claim status updated to under_review", + "2024-03-22T11:55:17": "Claim created", + "2024-04-07T05:48:05": "Document proofs_of_death_form received", + "2024-06-06T18:06:31": "Document police_abstract_or_post_mortem_if_accident received", + "2024-07-20T18:24:09": "Payment of 575573.61 EBT initiated via bank_transfer", + "2024-09-12T18:44:26": "Document letters_of_administration received", + "2024-10-22T11:23:08": "Document death_certificate received", + "2024-11-11T12:53:59": "Document letters_of_administration verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Sylvia", + "last_name": "Schroeder" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Shannon", + "last_name": "Yu" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-06-25T14:31:00" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00014": { + "claim_id": "LIFE-UG-2024-00014", + "policy": { + "policy_id": "LIFE-UG-2024-00014", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Ashley", + "last_name": "Larsen" + }, + "policyholder_dob": "1984-02-01", + "policyholder_address": { + "line1": "9731 Jamie Route", + "line2": null, + "city": "Tiffanyfort", + "state": "Delaware", + "country": "Uganda", + "postal_code": "40917" + }, + "policyholder_contact": "(277)641-8625x6527", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 4213.9, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****3108", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****7114", + "verified": false + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****3363", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Eric", + "last_name": "Ward" + }, + "dob": "1984-11-28", + "address": { + "line1": "3490 Karen Shores Apt. 158", + "line2": null, + "city": "Arellanoshire", + "state": "Iowa", + "country": "Uganda", + "postal_code": "73062" + }, + "contact": "6683687937", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "60hW898992", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-06-29", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Thompsonburgh", + "estimated_loss_amount": 105828.11, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-06-30", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 59894.2, + "currency": "UGX", + "payment_date": "2024-07-04T20:08:32", + "payment_method": "mobile_money", + "recipient_name": "Eric Ward", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 8708.19, + "currency": "UGX", + "payment_date": "2024-09-15T16:23:48", + "payment_method": "mobile_money", + "recipient_name": "Eric Ward", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-03-11T12:07:32": "Claim created", + "2024-06-02T21:37:00": "Payment of 59894.2 UGX initiated via mobile_money", + "2024-06-12T05:54:59": "Document police_abstract_or_post_mortem_if_accident received", + "2024-06-16T22:19:16": "Document proofs_of_death_form received", + "2024-06-21T18:28:14": "Payment of 8708.19 UGX initiated via mobile_money", + "2024-07-20T22:26:45": "Claim status updated to new", + "2024-08-21T05:25:21": "Document claimant_id received", + "2024-08-30T18:54:29": "Document death_certificate received", + "2024-12-30T10:30:42": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00015": { + "claim_id": "LIFE-ZA-2024-00015", + "policy": { + "policy_id": "LIFE-ZA-2024-00015", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Teresa", + "last_name": "Stokes" + }, + "policyholder_dob": "1959-07-19", + "policyholder_address": { + "line1": "8685 Stone Well", + "line2": null, + "city": "Port Isabellashire", + "state": "North Dakota", + "country": "Zambia", + "postal_code": "55498" + }, + "policyholder_contact": "362-629-9911", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 3987.38, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****3262", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****8837", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "David", + "last_name": "Henderson" + }, + "dob": "1991-06-09", + "address": { + "line1": "4679 Johnson Harbor Suite 299", + "line2": null, + "city": "Williamsmouth", + "state": "Vermont", + "country": "Zambia", + "postal_code": "31640" + }, + "contact": "9743505444", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "32Pf475469", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-06-02", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "South Jason", + "estimated_loss_amount": 1632418.92, + "currency": "ZMW" + }, + "claim_status": "new", + "reported_date": "2024-06-17", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "identity_mismatch", + "beneficiary_dispute", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 396124.05, + "currency": "ZMW", + "payment_date": "2024-10-20T04:00:04", + "payment_method": "bank_transfer", + "recipient_name": "David Henderson", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 31894.78, + "currency": "ZMW", + "payment_date": "2024-06-09T15:14:50", + "payment_method": "bank_transfer", + "recipient_name": "David Henderson", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-04-08T08:58:31": "Claim created", + "2024-05-22T20:19:09": "Document death_certificate received", + "2024-05-27T04:26:14": "Payment of 396124.05 ZMW initiated via bank_transfer", + "2024-06-01T10:31:20": "Document proofs_of_death_form received", + "2024-08-07T04:30:22": "Document death_certificate verified", + "2024-09-02T12:41:58": "Document police_abstract_or_post_mortem_if_accident received", + "2024-10-13T09:57:22": "Claim status updated to new", + "2024-10-20T19:46:37": "Payment of 31894.78 ZMW initiated via bank_transfer", + "2024-12-26T07:32:48": "Document affidavits_if_applicable received", + "2024-12-29T19:05:23": "Document affidavits_if_applicable verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Jessica", + "last_name": "Osborn DDS" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Deanna", + "last_name": "Bartlett" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-07-29T18:16:14" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00016": { + "claim_id": "LIFE-UG-2024-00016", + "policy": { + "policy_id": "LIFE-UG-2024-00016", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Madison", + "last_name": "Figueroa" + }, + "policyholder_dob": "1990-08-31", + "policyholder_address": { + "line1": "33030 Williams Lake", + "line2": null, + "city": "West Micheal", + "state": "New Jersey", + "country": "Uganda", + "postal_code": "66708" + }, + "policyholder_contact": "(710)435-7972x7985", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 4900.6, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8793", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Katherine", + "last_name": "Camacho" + }, + "dob": "1972-08-03", + "address": { + "line1": "0602 Mercedes Rue", + "line2": null, + "city": "Lake Jamie", + "state": "Tennessee", + "country": "Uganda", + "postal_code": "54175" + }, + "contact": "800.772.2903x49446", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "74Lg374896", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-05-28", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "New Yvonnestad", + "estimated_loss_amount": 578822.53, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-05-29", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "identity_mismatch", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 524035.82, + "currency": "UGX", + "payment_date": "2024-04-25T23:13:36", + "payment_method": "bank_transfer", + "recipient_name": "Katherine Camacho", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 31330.54, + "currency": "UGX", + "payment_date": "2024-07-30T12:01:32", + "payment_method": "cheque", + "recipient_name": "Katherine Camacho", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-19T14:27:14": "Document letters_of_administration received", + "2024-01-20T06:22:26": "Document proofs_of_death_form received", + "2024-02-24T12:11:54": "Payment of 524035.82 UGX initiated via bank_transfer", + "2024-04-28T19:29:03": "Document death_certificate received", + "2024-05-25T16:32:32": "Payment of 31330.54 UGX initiated via cheque", + "2024-05-28T01:21:50": "Document police_abstract_or_post_mortem_if_accident received", + "2024-05-30T12:13:40": "Document police_abstract_or_post_mortem_if_accident verified", + "2024-08-20T12:46:26": "Document proofs_of_death_form verified", + "2024-09-28T21:14:14": "Document letters_of_administration verified", + "2024-10-17T21:56:47": "Claim status updated to new", + "2024-11-29T20:54:12": "Claim created" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Kaylee", + "last_name": "Moore" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Jonathon", + "last_name": "Taylor" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-01-03T20:02:15" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ET-2024-00017": { + "claim_id": "LIFE-ET-2024-00017", + "policy": { + "policy_id": "LIFE-ET-2024-00017", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Anna", + "last_name": "Wheeler" + }, + "policyholder_dob": "1999-04-27", + "policyholder_address": { + "line1": "28309 Guerrero Springs Apt. 074", + "line2": null, + "city": "Rebeccafurt", + "state": "Missouri", + "country": "Ethiopia", + "postal_code": "97065" + }, + "policyholder_contact": "6994353875", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 2510.31, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****5947", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****6890", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Justin", + "last_name": "Cohen" + }, + "dob": "1999-09-27", + "address": { + "line1": "1724 Stacey Isle", + "line2": null, + "city": "East Michaelport", + "state": "Nebraska", + "country": "Ethiopia", + "postal_code": "43927" + }, + "contact": "(949)547-1709x991", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "81im684602", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-27", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Robertshire", + "estimated_loss_amount": 389658.74, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-09-04", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 128451.56, + "currency": "EBT", + "payment_date": "2024-07-24T03:28:22", + "payment_method": "bank_transfer", + "recipient_name": "Justin Cohen", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 382540.53, + "currency": "EBT", + "payment_date": "2024-09-01T11:46:55", + "payment_method": "bank_transfer", + "recipient_name": "Justin Cohen", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-03-09T17:24:36": "Claim status updated to under_review", + "2024-03-19T16:33:54": "Payment of 128451.56 EBT initiated via bank_transfer", + "2024-03-22T14:45:38": "Claim created", + "2024-07-07T22:22:40": "Document letters_of_administration received", + "2024-09-02T06:21:21": "Document letters_of_administration verified", + "2024-11-06T13:36:11": "Payment of 382540.53 EBT initiated via bank_transfer", + "2024-12-17T18:17:46": "Document death_certificate received", + "2024-12-19T04:16:29": "Document proofs_of_death_form received", + "2024-12-29T05:37:06": "Document death_certificate verified", + "2024-12-29T15:01:00": "Document proofs_of_death_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Mr.", + "last_name": "Donald Nguyen" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Matthew", + "last_name": "Farley" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-07-15T08:34:30" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00018": { + "claim_id": "LIFE-UG-2024-00018", + "policy": { + "policy_id": "LIFE-UG-2024-00018", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Patricia", + "last_name": "Hatfield" + }, + "policyholder_dob": "1969-03-27", + "policyholder_address": { + "line1": "271 Christina Roads", + "line2": null, + "city": "Powellfort", + "state": "Missouri", + "country": "Uganda", + "postal_code": "01112" + }, + "policyholder_contact": "2835505830", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 1645.06, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****2196", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Douglas", + "last_name": "Huffman" + }, + "dob": "1970-05-20", + "address": { + "line1": "2168 Jackson View Apt. 447", + "line2": null, + "city": "Ryanberg", + "state": "Michigan", + "country": "Uganda", + "postal_code": "64749" + }, + "contact": "(432)360-3323x098", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "50dQ648909", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-04-21", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Lake Maryton", + "estimated_loss_amount": 1362282.13, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-04-28", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "false_claim", + "beneficiary_dispute", + "identity_mismatch" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 607427.63, + "currency": "UGX", + "payment_date": "2024-01-29T16:30:32", + "payment_method": "bank_transfer", + "recipient_name": "Douglas Huffman", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 699675.12, + "currency": "UGX", + "payment_date": "2024-08-21T20:31:52", + "payment_method": "credit_card", + "recipient_name": "Douglas Huffman", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-02T00:49:39": "Payment of 699675.12 UGX initiated via credit_card", + "2024-02-11T19:38:07": "Document proofs_of_death_form received", + "2024-03-06T08:06:28": "Payment of 607427.63 UGX initiated via bank_transfer", + "2024-04-02T04:55:50": "Document death_certificate received", + "2024-04-20T19:25:47": "Document proofs_of_death_form verified", + "2024-05-26T14:53:11": "Claim created", + "2024-06-27T04:19:09": "Document letters_of_administration received", + "2024-07-14T16:19:50": "Document insured_id_or_surrender_letter received", + "2024-07-20T19:15:16": "Claim status updated to new", + "2024-08-11T23:52:48": "Document letters_of_administration verified", + "2024-10-19T06:00:26": "Document insured_id_or_surrender_letter verified", + "2024-11-24T23:30:56": "Document claimant_id received", + "2024-12-21T13:08:57": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Bobby", + "last_name": "Cook" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Mrs.", + "last_name": "Amy Hayes" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-01-12T14:24:57" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-SO-2024-00019": { + "claim_id": "LIFE-SO-2024-00019", + "policy": { + "policy_id": "LIFE-SO-2024-00019", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Hannah", + "last_name": "Butler" + }, + "policyholder_dob": "2000-01-26", + "policyholder_address": { + "line1": "926 William River Apt. 411", + "line2": null, + "city": "Gonzalezborough", + "state": "Wyoming", + "country": "South Africa", + "postal_code": "34972" + }, + "policyholder_contact": "235.364.2087x37530", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 1553.73, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****6253", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****3347", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****5923", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Omar", + "last_name": "Kelley" + }, + "dob": "1962-07-02", + "address": { + "line1": "18114 Stephen Hill Suite 701", + "line2": null, + "city": "Port Benjamin", + "state": "Maine", + "country": "South Africa", + "postal_code": "47715" + }, + "contact": "+1-356-711-0022x55794", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "52SE166746", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-05", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Banksburgh", + "estimated_loss_amount": 1066207.55, + "currency": "ZAR" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-10-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "beneficiary_dispute", + "identity_mismatch", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 750145.84, + "currency": "ZAR", + "payment_date": "2024-01-25T08:54:37", + "payment_method": "credit_card", + "recipient_name": "Omar Kelley", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 429496.09, + "currency": "ZAR", + "payment_date": "2024-04-29T19:39:07", + "payment_method": "bank_transfer", + "recipient_name": "Omar Kelley", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-30T20:28:33": "Document letters_of_administration received", + "2024-03-09T14:08:30": "Payment of 750145.84 ZAR initiated via credit_card", + "2024-04-04T19:35:07": "Document proofs_of_death_form received", + "2024-05-04T09:17:02": "Payment of 429496.09 ZAR initiated via bank_transfer", + "2024-06-02T05:15:20": "Document affidavits_if_applicable received", + "2024-06-25T23:25:20": "Claim created", + "2024-07-28T05:25:58": "Document insured_id_or_surrender_letter received", + "2024-08-29T11:38:25": "Document letters_of_administration verified", + "2024-08-30T08:46:24": "Document birth_certificate_or_guardianship_order received", + "2024-09-25T11:36:17": "Document death_certificate received", + "2024-10-12T19:08:21": "Document insured_id_or_surrender_letter verified", + "2024-10-12T19:17:47": "Claim status updated to awaiting_documents", + "2024-12-09T13:52:38": "Document policy_document received", + "2024-12-16T16:58:40": "Document birth_certificate_or_guardianship_order verified", + "2024-12-22T15:09:28": "Document claimant_id received", + "2024-12-25T22:06:49": "Document affidavits_if_applicable verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Christian", + "last_name": "Neal" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Elizabeth", + "last_name": "Stanley" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-09-14T10:31:54" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-NI-2024-00020": { + "claim_id": "LIFE-NI-2024-00020", + "policy": { + "policy_id": "LIFE-NI-2024-00020", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Daniel", + "last_name": "Horton" + }, + "policyholder_dob": "1980-10-29", + "policyholder_address": { + "line1": "027 Rodriguez Loop Suite 014", + "line2": null, + "city": "Alexanderhaven", + "state": "Wyoming", + "country": "Nigeria", + "postal_code": "97969" + }, + "policyholder_contact": "001-593-958-8916", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 3989.81, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****9743", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****5285", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Brian", + "last_name": "Dunlap" + }, + "dob": "1978-07-07", + "address": { + "line1": "89002 Christian Ways Apt. 175", + "line2": null, + "city": "West Tara", + "state": "Arkansas", + "country": "Nigeria", + "postal_code": "66945" + }, + "contact": "986.363.1779", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "77Ac517016", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-18", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Port Christopherport", + "estimated_loss_amount": 189465.67, + "currency": "NGN" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-08-29", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + 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"MT-UG-2024-00005", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "Gabrielle", + "last_name": "Serrano" + }, + "policyholder_dob": "1999-11-10", + "policyholder_address": { + "line1": "806 Wood Cape", + "line2": null, + "city": "Perezfort", + "state": "Wyoming", + "country": "Uganda", + "postal_code": "50470" + }, + "policyholder_contact": "(899)616-2473x149", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 1126.31, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5139", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****7176", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Catherine", + "last_name": "Thompson" + }, + "dob": "1967-11-07", + "address": { + "line1": "098 April Lane", + "line2": null, + "city": "Lake Linda", + "state": "Nebraska", + "country": "Uganda", + "postal_code": "47984" + }, + "contact": "726-694-4869", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "63JJ688725", + "verified": false + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-06-12", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "Kingport", + "estimated_loss_amount": 1471074.36, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-06-21", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": 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"recipient_name": "Catherine Thompson", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-07-03T19:32:53": "Payment of 1401987.64 UGX initiated via cheque", + "2024-09-30T18:26:42": "Document motor_accident_claim_form received", + "2024-10-05T01:20:18": "Payment of 294720.93 UGX initiated via credit_card", + "2024-10-25T14:35:34": "Claim created", + "2024-12-20T15:13:47": "Claim status updated to new" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Motor Team", + "claims_adjuster": { + "first_name": "Linda", + "last_name": "Rich" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Nicole", + "last_name": "Davis" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-07-28T18:10:44" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-TA-2024-00006": { + "claim_id": "MT-TA-2024-00006", + "policy": { + 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"Claim created", + "2024-11-16T18:40:32": "Document motor_accident_claim_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Deanna", + "last_name": "Medina" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Danielle", + "last_name": "Ramos" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-07-21T01:03:46" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-ET-2024-00008": { + "claim_id": "MT-ET-2024-00008", + "policy": { + "policy_id": "MT-ET-2024-00008", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "Stephen", + "last_name": "Martinez" + }, + "policyholder_dob": "1967-09-21", + "policyholder_address": { + "line1": "47955 Victor Fords Suite 556", + "line2": null, + "city": "Shannonshire", + "state": "Florida", + "country": "Ethiopia", + "postal_code": "75984" + }, + 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"credit_card", + "masked_reference": "****5389", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Crystal", + "last_name": "Duncan" + }, + "dob": "1971-10-28", + "address": { + "line1": "2282 Austin Knolls Suite 778", + "line2": null, + "city": "Amyberg", + "state": "Vermont", + "country": "Nigeria", + "postal_code": "71186" + }, + "contact": "(799)979-6884", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "83jt174564", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-30", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "North Alexandraberg", + "estimated_loss_amount": 821223.02, + "currency": "NGN" + }, + "claim_status": "under_review", + "reported_date": "2024-12-15", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "duplicate_claim", + "late_notification", + "suspicious_documents" + ], + "notes": "Fraud review required" + }, + 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[] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Thomas", + "last_name": "Maldonado" + }, + "dob": "1989-01-02", + "address": { + "line1": "950 Michael Drives", + "line2": null, + "city": "East Tonymouth", + "state": "Oklahoma", + "country": "Uganda", + "postal_code": "84996" + }, + "contact": "001-957-530-6524x07784", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "92Jk855749", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-09-10", + "cause_of_loss": "Car accident", + "description": "Reported insured loss event", + "location": "New Ericport", + "estimated_loss_amount": 649115.97, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-09-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, 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"city": "West Wayne", + "state": "Iowa", + "country": "Tanzania", + "postal_code": "20580" + }, + "contact": "6678998136", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "22zq517908", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-05-31", + "cause_of_loss": "Vehicle damage", + "description": "Reported insured loss event", + "location": "South Warrenberg", + "estimated_loss_amount": 113865.42, + "currency": "TZS" + }, + "claim_status": "new", + "reported_date": "2024-06-20", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-12T23:19:16": "Document driver_license received", + "2024-06-07T02:52:37": "Claim status updated to new", + "2024-11-11T05:33:32": "Document repair_estimate received", + "2024-12-25T14:38:47": "Claim created" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-ZA-2024-00014": { + "claim_id": "MT-ZA-2024-00014", + "policy": { + "policy_id": "MT-ZA-2024-00014", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "Kathleen", + "last_name": "Castillo" + }, + "policyholder_dob": "1984-04-02", + "policyholder_address": { + "line1": "911 Henderson Keys Apt. 559", + "line2": null, + "city": "Port Kevinstad", + "state": "South Carolina", + "country": "Zambia", + "postal_code": "58462" + }, + "policyholder_contact": "+1-427-603-3521x103", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 3656.75, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****6680", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "James", + "last_name": "Foster" + }, + "dob": "1955-12-03", + "address": { + "line1": "147 Johnson Fords Apt. 388", + "line2": null, + "city": "Anaberg", + "state": "Vermont", + "country": "Zambia", + "postal_code": "92088" + }, + "contact": "+1-906-298-0420x43940", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "16oy451046", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-07-19", + "cause_of_loss": "theft of vehicle", + "description": "Reported insured loss event", + "location": "West Toddside", + "estimated_loss_amount": 1270417.02, + "currency": "ZMW" + }, + "claim_status": "new", + "reported_date": "2024-08-06", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-16T12:11:50": "Claim created", + "2024-09-11T16:34:23": "Claim status updated to new" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + 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], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Kayla", + "last_name": "Morris" + }, + "dob": "1996-06-15", + "address": { + "line1": "430 Andrew Road", + "line2": null, + "city": "Lake Melaniechester", + "state": "Nebraska", + "country": "Nigeria", + "postal_code": "06463" + }, + "contact": "258-330-3441x44885", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "55vv699023", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-18", + "cause_of_loss": "collision with another vehicle", + "description": "Reported insured loss event", + "location": "Hendrickston", + "estimated_loss_amount": 172658.65, + "currency": "NGN" + }, + "claim_status": "new", + "reported_date": "2024-12-08", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + 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"claimant": { + "role": "third_party", + "name": { + "first_name": "Thomas", + "last_name": "Ford" + }, + "dob": "1987-08-21", + "address": { + "line1": "79907 Ingram Well Suite 257", + "line2": null, + "city": "Port Courtneyfurt", + "state": "Vermont", + "country": "Tanzania", + "postal_code": "44135" + }, + "contact": "704.264.9893x19508", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "16lP579055", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-12", + "cause_of_loss": "lab tests", + "description": "Reported insured loss event", + "location": "New Jennaborough", + "estimated_loss_amount": 591099.19, + "currency": "TZS" + }, + "claim_status": "new", + "reported_date": "2024-10-17", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + 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null + }, + { + "document_id": "DOC_2", + "document_type": "doctor_signed_form", + "real_document_type": "doctor_signed_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "original_receipts", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "prescription", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "bank_details", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "unverified_identity", + "overbilling", + "duplicate_receipt" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 44635.84, + "currency": "TZS", + "payment_date": 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"document_type": "other", + "real_document_type": "insurance_policy_copy", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-04-08T19:09:29": "Document claim_form received", + "2024-07-16T06:53:52": "Claim created", + "2024-10-12T15:06:59": "Document itinerary received", + "2024-10-18T22:46:02": "Document medical_bills received", + "2024-10-22T13:01:58": "Claim status updated to reviewed", + "2024-10-26T14:22:04": "Document itinerary verified", + "2024-11-10T19:05:55": "Document medical_bills verified", + "2024-12-02T09:03:25": "Document passport_copy received", + "2024-12-11T16:42:05": "Payment of 162015.75 ZMW initiated via cheque" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "TR-ET-2024-00017": { + "claim_id": "TR-ET-2024-00017", + "policy": { + "policy_id": "TR-ET-2024-00017", + "insurance_type": "travel", + "policyholder_name": { + "first_name": "Karen", + "last_name": "Perez" + }, + "policyholder_dob": "1980-12-11", + "policyholder_address": { + "line1": "70171 Brett Divide Apt. 212", + "line2": null, + "city": "East William", + "state": "Nevada", + "country": "Ethiopia", + "postal_code": "95526" + }, + "policyholder_contact": "942.533.6293x449", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 500.88, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****1267", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Jessica", + "last_name": "Cooper" + }, + "dob": "1973-06-27", + "address": { + "line1": "56627 Henderson 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"EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-04-19", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "medical_bills", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "itinerary", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": 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claim_form received", + "2024-10-19T05:37:58": "Claim status updated to under_review", + "2024-12-21T15:23:31": "Document claim_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Travel Team", + "claims_adjuster": { + "first_name": "Anthony", + "last_name": "Hardin" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Rebecca", + "last_name": "Horton MD" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-08-17T14:27:27" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "TR-NI-2024-00018": { + "claim_id": "TR-NI-2024-00018", + "policy": { + "policy_id": "TR-NI-2024-00018", + "insurance_type": "travel", + "policyholder_name": { + "first_name": "Sheryl", + "last_name": "Hernandez" + }, + "policyholder_dob": "2003-01-13", + "policyholder_address": { + "line1": "362 King Hollow", + "line2": null, + "city": "Willischester", + "state": "Wisconsin", + "country": 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"line2": null, + "city": "Toniland", + "state": "North Carolina", + "country": "South Africa", + "postal_code": "85190" + }, + "contact": "(703)777-8892", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-11-29", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "Paulmouth", + "estimated_loss_amount": 1509695.24, + "currency": "ZAR" + }, + "claim_status": "under_review", + "reported_date": "2024-11-30", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + 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"verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Crystal", + "last_name": "Cook" + }, + "dob": "1968-01-20", + "address": { + "line1": "21418 Ebony Wells", + "line2": null, + "city": "New Nicholas", + "state": "Hawaii", + "country": "Tanzania", + "postal_code": "24204" + }, + "contact": "001-592-570-6537x947", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "47Xy359774", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Wesley", + "last_name": "Barnes" + }, + "dob": "1966-01-05", + "address": { + "line1": "240 Sawyer Plaza", + "line2": null, + "city": "Lake Meghanville", + "state": "Maine", + "country": "Tanzania", + "postal_code": "11494" + }, + "contact": "001-824-778-2613x75060", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": 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"document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "unverified_ownership", + "duplicate_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-08-05T20:02:20": "Claim status updated to awaiting_documents", + "2024-08-30T20:09:04": "Claim created", + "2024-09-28T12:30:56": "Document claim_form received" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Justin", + "last_name": "Hughes" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Samuel", + "last_name": "Brandt" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-05-03T14:47:51" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-SO-2024-00014": { + "claim_id": "HOME-SO-2024-00014", + "policy": { + "policy_id": "HOME-SO-2024-00014", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Nicholas", + "last_name": "Johnson" + }, + "policyholder_dob": "1964-06-06", + "policyholder_address": { + "line1": "9010 Lewis Drive Suite 143", + "line2": null, + "city": "Davidbury", + "state": "Nebraska", + "country": "South Africa", + "postal_code": "84249" + }, + "policyholder_contact": "+1-671-817-9808x932", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 3686.08, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****1745", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Sarah", + "last_name": "Combs" + }, + "dob": "1955-02-03", + "address": { + "line1": 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"handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Raven", + "last_name": "Taylor" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Ronald", + "last_name": "Horton" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-06-03T00:30:54" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-ZA-2024-00015": { + "claim_id": "HOME-ZA-2024-00015", + "policy": { + "policy_id": "HOME-ZA-2024-00015", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Kyle", + "last_name": "Sanders" + }, + "policyholder_dob": "1973-07-30", + "policyholder_address": { + "line1": "6676 Beltran Parks", + "line2": null, + "city": "Richardsonhaven", + "state": "Louisiana", + "country": "Zambia", + "postal_code": "11329" + }, + "policyholder_contact": "001-661-969-2845x1154", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 1204.4, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8699", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****4792", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Lisa", + "last_name": "Kennedy" + }, + "dob": "1995-12-30", + "address": { + "line1": "75705 Hill Turnpike Apt. 165", + "line2": null, + "city": "North Douglas", + "state": "Rhode Island", + "country": "Zambia", + "postal_code": "89379" + }, + "contact": "902.713.5569x092", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "57uP192856", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-03-01", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "Johnville", + "estimated_loss_amount": 1530064.67, + "currency": "ZMW" + }, + "claim_status": "under_review", + "reported_date": "2024-03-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 950590.94, + "currency": "ZMW", + "payment_date": "2024-11-08T03:36:46", + "payment_method": "bank_transfer", + "recipient_name": "Lisa Kennedy", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 957452.93, + "currency": "ZMW", + "payment_date": "2024-05-15T02:57:21", + "payment_method": "bank_transfer", + "recipient_name": "Lisa Kennedy", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-06T08:29:55": "Claim created", + "2024-05-15T22:45:27": "Document claim_form received", + "2024-08-05T04:10:43": "Payment of 950590.94 ZMW initiated via bank_transfer", + "2024-10-05T08:11:06": "Payment of 957452.93 ZMW initiated via bank_transfer", + "2024-10-28T07:12:08": "Claim status updated to expired" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Property Team", + "claims_adjuster": { + "first_name": "Matthew", + "last_name": "Mitchell" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "", + "last_name": "" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-10-09T02:43:58" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "HOME-ET-2024-00016": { + "claim_id": "HOME-ET-2024-00016", + "policy": { + "policy_id": "HOME-ET-2024-00016", + "insurance_type": "property", + "policyholder_name": { + "first_name": "Anthony", + "last_name": "Lopez" + }, + "policyholder_dob": "1988-05-30", + "policyholder_address": { + "line1": "21727 Lisa Vista", + "line2": null, + "city": "Elizabethland", + "state": "Oklahoma", + "country": "Ethiopia", + "postal_code": "71564" + }, + "policyholder_contact": "742-725-8313x2370", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 3142.05, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****1659", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "April", + "last_name": "Mcintyre" + }, + "dob": "1986-10-17", + "address": { + "line1": "114 Key Stravenue", + "line2": null, + "city": "Foxchester", + "state": "Oregon", + "country": "Ethiopia", + "postal_code": "10167" + }, + "contact": "(451)477-8528", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "68ku018242", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-02-06", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "West Stacey", + "estimated_loss_amount": 336015.96, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-02-07", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "real_document_type": "fire_report", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "real_document_type": "repair_quotes", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "proof_of_ownership", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "photos", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "inflated_loss", + "duplicate_claim" + ], + "notes": 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"recoveries": [] + }, + "LIFE-ZA-2024-00006": { + "claim_id": "LIFE-ZA-2024-00006", + "policy": { + "policy_id": "LIFE-ZA-2024-00006", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Angela", + "last_name": "Watts" + }, + "policyholder_dob": "1975-02-03", + "policyholder_address": { + "line1": "12545 Mueller Pike Suite 571", + "line2": null, + "city": "Bowenmouth", + "state": "Massachusetts", + "country": "Zambia", + "postal_code": "09305" + }, + "policyholder_contact": "801-905-1238x2825", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 1372.57, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****3419", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****3399", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Angela", + "last_name": "Watts" + }, + "dob": "1975-02-03", + "address": { + "line1": "12545 Mueller Pike Suite 571", + "line2": null, + "city": "Bowenmouth", + "state": "Massachusetts", + "country": "Zambia", + "postal_code": "09305" + }, + "contact": "801-905-1238x2825", + "identity_documents": [], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "Janice", + "last_name": "Evans" + }, + "dob": "1996-10-20", + "address": { + "line1": "251 Kevin Falls", + "line2": null, + "city": "Heatherhaven", + "state": "Missouri", + "country": "Zambia", + "postal_code": "55320" + }, + "contact": "+1-629-466-2782x827", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-08-23", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "West Megan", + "estimated_loss_amount": 1724909.48, + "currency": "ZMW" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-08-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-20T02:04:16": "Payment of 691339.23 ZMW initiated via mobile_money", + "2024-02-04T17:04:22": "Document insured_id_or_surrender_letter received", + "2024-03-18T16:00:40": "Document death_certificate received", + "2024-06-04T10:00:02": "Document birth_certificate_or_guardianship_order received", + "2024-06-29T18:28:17": "Document police_abstract_or_post_mortem_if_accident received", + "2024-07-07T10:27:07": "Payment of 1286700.01 ZMW initiated via bank_transfer", + "2024-07-18T05:46:22": "Document police_abstract_or_post_mortem_if_accident verified", + "2024-08-14T22:59:16": "Document proofs_of_death_form received", + "2024-08-24T16:27:13": "Claim status updated to under_review", + "2024-10-29T02:02:42": "Document letters_of_administration received", + "2024-11-17T11:30:36": "Claim created" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-KE-2024-00007": { + "claim_id": "LIFE-KE-2024-00007", + "policy": { + "policy_id": "LIFE-KE-2024-00007", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Christine", + "last_name": "Glenn" + }, + "policyholder_dob": "2003-04-24", + "policyholder_address": { + "line1": "2190 Kelly Harbor Apt. 842", + "line2": null, + "city": "Cunninghamfort", + "state": "Oklahoma", + "country": "Kenya", + "postal_code": "67453" + }, + "policyholder_contact": "591-848-5807", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 2339.46, + "currency": "KES", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****6482", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****2548", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Stephanie", + "last_name": "Washington" + }, + "dob": "1961-12-15", + "address": { + "line1": "0745 Scott Crest", + "line2": null, + "city": "East Lisa", + "state": "Pennsylvania", + "country": "Kenya", + "postal_code": "90827" + }, + "contact": "(696)429-2330x958", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "54WY494812", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-09-16", + "cause_of_loss": "car accident", + "description": "Reported insured loss event", + "location": "Sellersview", + "estimated_loss_amount": 928109.76, + "currency": "KES" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-09-28", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "no original policy document" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-06-07T23:53:10": "Claim created", + "2024-06-17T04:39:10": "Document letters_of_administration received", + "2024-07-04T00:39:49": "Claim status updated to awaiting_documents", + "2024-07-11T23:25:43": "Document affidavits_if_applicable received", + "2024-12-05T23:49:05": "Document letters_of_administration verified", + "2024-12-23T14:16:14": "Document death_certificate received", + "2024-12-26T11:56:07": "Document death_certificate verified", + "2024-12-28T03:05:04": "Document proofs_of_death_form received", + "2024-12-29T23:26:03": "Document proofs_of_death_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "James", + "last_name": "Hoffman" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Jennifer", + "last_name": "Vasquez" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-05-24T14:06:19" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-NI-2024-00008": { + "claim_id": "LIFE-NI-2024-00008", + "policy": { + "policy_id": "LIFE-NI-2024-00008", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Michelle", + "last_name": "Martinez" + }, + "policyholder_dob": "1973-04-10", + "policyholder_address": { + "line1": "7116 Neal Wells Suite 775", + "line2": null, + "city": "Port Kimland", + "state": "Washington", + "country": "Nigeria", + "postal_code": "60590" + }, + "policyholder_contact": "+1-451-986-3637x4545", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 3552.38, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8564", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****9239", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "bank_transfer", + "masked_reference": "****4271", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Michelle", + "last_name": "Wright" + }, + "dob": "1978-05-18", + "address": { + "line1": "17012 Bryant Meadow", + "line2": null, + "city": "Lake Regina", + "state": "Tennessee", + "country": "Nigeria", + "postal_code": "40067" + }, + "contact": "(841)654-1520", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "36iL110371", + "verified": false + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Jemimah", + "last_name": "Wright" + }, + "dob": "1970-08-14", + "address": { + "line1": "516 Tim Forks", + "line2": null, + "city": "Davisville", + "state": "Connecticut", + "country": "Nigeria", + "postal_code": "41572" + }, + "contact": "(942)762-2178x092", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "36i5610371", + "verified": true + } + ], + "relationship_to_policyholder": "sister" + }, + { + "role": "beneficiary", + "name": { + "first_name": "Jeremy", + "last_name": "Frazier" + }, + "dob": "1955-08-14", + "address": { + "line1": "516 Tim Forks", + "line2": null, + "city": "Davisville", + "state": "Connecticut", + "country": "Nigeria", + "postal_code": "41572" + }, + "contact": "(942)762-2189x092", + "identity_documents": [], + "relationship_to_policyholder": "relative" + }, + { + "role": "third_party", + "name": { + "first_name": "Jennifer", + "last_name": "Fuller" + }, + "dob": "1965-04-15", + "address": { + "line1": "731 Donald Crossing Suite 565", + "line2": null, + "city": "East Joshua", + "state": "Colorado", + "country": "Nigeria", + "postal_code": "33028" + }, + "contact": "+1-599-894-0438", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "36i5665371", + "verified": true + } + ], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-04-08", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Debbiebury", + "estimated_loss_amount": 1999953.36, + "currency": "NGN" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-04-15", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "beneficiary_dispute" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-14T15:06:21": "Document claimant_id received", + "2024-01-28T14:26:04": "Document insured_id_or_surrender_letter received", + "2024-02-11T13:39:00": "Document birth_certificate_or_guardianship_order received", + "2024-02-16T08:05:02": "Document death_certificate received", + "2024-03-16T15:55:40": "Document policy_document received", + "2024-06-04T14:40:34": "Document birth_certificate_or_guardianship_order verified", + "2024-06-12T03:36:27": "Document letters_of_administration received", + "2024-08-18T18:41:26": "Claim created", + "2024-09-14T13:36:55": "Document proofs_of_death_form received", + "2024-10-03T20:48:42": "Document death_certificate verified", + "2024-10-15T03:40:30": "Document proofs_of_death_form verified", + "2024-12-31T23:39:51": "Claim status updated to awaiting_documents" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Sandra", + "last_name": "Juarez" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "", + "last_name": "" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-04-09T13:23:33" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-SO-2024-00009": { + "claim_id": "LIFE-SO-2024-00009", + "policy": { + "policy_id": "LIFE-SO-2024-00009", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Troy", + "last_name": "Rodriguez" + }, + "policyholder_dob": "1993-08-31", + "policyholder_address": { + "line1": "8271 Brenda Bridge Suite 300", + "line2": null, + "city": "Hunterhaven", + "state": "Wyoming", + "country": "South Africa", + "postal_code": "54952" + }, + "policyholder_contact": "(761)888-9241x41832", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 3087.71, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5772", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****6780", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****4068", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Victor", + "last_name": "Wheeler" + }, + "dob": "1994-11-22", + "address": { + "line1": "6303 Sandy Crescent", + "line2": null, + "city": "Salazarton", + "state": "Maryland", + "country": "South Africa", + "postal_code": "87805" + }, + "contact": "001-721-402-0275x8842", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "41qT056481", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "beneficiary", + "name": { + "first_name": "Theresa", + "last_name": "Burton" + }, + "dob": "1988-09-30", + "address": { + "line1": "507 Michael Glens Apt. 913", + "line2": null, + "city": "North Micheletown", + "state": "Kansas", + "country": "South Africa", + "postal_code": "06527" + }, + "contact": "656.322.0863x5365", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-12-27", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Davidton", + "estimated_loss_amount": 899959.94, + "currency": "ZAR" + }, + "claim_status": "new", + "reported_date": "2025-01-11", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "beneficiary_dispute" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-09T13:00:05": "Document policy_document received", + "2024-02-13T01:33:18": "Document policy_document verified", + "2024-03-09T01:36:51": "Document proofs_of_death_form received", + "2024-05-03T23:55:27": "Document death_certificate received", + "2024-06-22T23:24:12": "Document affidavits_if_applicable received", + "2024-06-29T19:52:47": "Document birth_certificate_or_guardianship_order received", + "2024-07-10T09:14:06": "Claim created", + "2024-08-06T16:19:11": "Document affidavits_if_applicable verified", + "2024-11-17T03:46:27": "Document claimant_id received", + "2024-11-19T06:38:11": "Claim status updated to new", + "2024-12-22T17:25:22": "Document letters_of_administration received", + "2024-12-24T15:52:50": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Vanessa", + "last_name": "Hatfield" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Bonnie", + "last_name": "Valencia" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-11-19T18:45:51" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00010": { + "claim_id": "LIFE-ZA-2024-00010", + "policy": { + "policy_id": "LIFE-ZA-2024-00010", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Harry", + "last_name": "Brock" + }, + "policyholder_dob": "1955-07-13", + "policyholder_address": { + "line1": "49493 Richardson Park Apt. 832", + "line2": null, + "city": "South Andrewside", + "state": "Minnesota", + "country": "Zambia", + "postal_code": "83855" + }, + "policyholder_contact": "001-205-406-4138x367", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 2153.06, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****2353", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****8055", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****6262", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Tina", + "last_name": "Finley" + }, + "dob": "2003-06-01", + "address": { + "line1": "03865 Villegas Corner Apt. 826", + "line2": null, + "city": "New Ashleychester", + "state": "Texas", + "country": "Zambia", + "postal_code": "17633" + }, + "contact": "544.356.5574", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "32Du912127", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-22", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Martinezstad", + "estimated_loss_amount": 590417.93, + "currency": "ZMW" + }, + "claim_status": "under_review", + "reported_date": "2024-08-23", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-06-29T22:23:09": "Document affidavits_if_applicable received", + "2024-08-06T06:04:02": "Document policy_document received", + "2024-08-16T01:32:31": "Document death_certificate received", + "2024-08-16T21:56:26": "Claim created", + "2024-10-19T08:22:55": "Document affidavits_if_applicable verified", + "2024-11-23T02:05:18": "Claim status updated to under_review", + "2024-11-27T18:51:59": "Document policy_document verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-TA-2024-00011": { + "claim_id": "LIFE-TA-2024-00011", + "policy": { + "policy_id": "LIFE-TA-2024-00011", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Tami", + "last_name": "Clark" + }, + "policyholder_dob": "1977-04-17", + "policyholder_address": { + "line1": "35680 Green Extensions", + "line2": null, + "city": "South Melissaside", + "state": "West Virginia", + "country": "Tanzania", + "postal_code": "72606" + }, + "policyholder_contact": "417.512.1003", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 2829.85, + "currency": "TZS", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****5288", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****4515", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****4279", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Kyle", + "last_name": "Baker" + }, + "dob": "1982-03-31", + "address": { + "line1": "199 Lowery Club Apt. 137", + "line2": null, + "city": "North Rebecca", + "state": "Michigan", + "country": "Tanzania", + "postal_code": "16560" + }, + "contact": "8708296670", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "25cN324472", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-07", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Lake Kenneth", + "estimated_loss_amount": 74423.94, + "currency": "TZS" + }, + "claim_status": "under_review", + "reported_date": "2024-11-21", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-02-14T11:38:09": "Document policy_document received", + "2024-03-21T23:13:04": "Document police_abstract_or_post_mortem_if_accident received", + "2024-06-19T12:22:45": "Document police_abstract_or_post_mortem_if_accident verified", + "2024-09-17T08:09:51": "Claim status updated to under_review", + "2024-12-07T12:38:57": "Document death_certificate received", + "2024-12-29T02:21:51": "Document insured_id_or_surrender_letter received", + "2024-12-30T13:17:06": "Document insured_id_or_surrender_letter verified", + "2024-12-31T16:12:21": "Claim created" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Christopher", + "last_name": "Parks" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Melissa", + "last_name": "Williams" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-04-05T18:10:10" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00012": { + "claim_id": "LIFE-ZA-2024-00012", + "policy": { + "policy_id": "LIFE-ZA-2024-00012", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Robert", + "last_name": "Pierce" + }, + "policyholder_dob": "1956-04-25", + "policyholder_address": { + "line1": "578 Cooper Port Suite 642", + "line2": null, + "city": "West Carlatown", + "state": "Wyoming", + "country": "Zambia", + "postal_code": "37323" + }, + "policyholder_contact": "5786593213", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 4241.26, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****5982", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****6286", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****9501", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Bruce", + "last_name": "Ramirez" + }, + "dob": "1991-04-21", + "address": { + "line1": "96522 Brittany Valley", + "line2": null, + "city": "Robintown", + "state": "Virginia", + "country": "Zambia", + "postal_code": "92324" + }, + "contact": "(399)229-3784x270", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "39Nm308705", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-01-14", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "West Jennifer", + "estimated_loss_amount": 1110272.77, + "currency": "ZMW" + }, + "claim_status": "settled", + "reported_date": "2024-01-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 83269.24, + "currency": "ZMW", + "payment_date": "2024-08-26T18:50:11", + "payment_method": "mobile_money", + "recipient_name": "Bruce Ramirez", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 143358.09, + "currency": "ZMW", + "payment_date": "2024-10-09T23:17:39", + "payment_method": "bank_transfer", + "recipient_name": "Bruce Ramirez", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-22T01:01:58": "Payment of 83269.24 ZMW initiated via mobile_money", + "2024-02-11T01:39:18": "Payment of 143358.09 ZMW initiated via bank_transfer", + "2024-06-21T20:31:14": "Claim status updated to settled", + "2024-11-10T19:25:24": "Document death_certificate received", + "2024-11-16T11:01:31": "Claim created", + "2024-11-16T13:43:17": "Document death_certificate verified", + "2024-11-24T06:08:23": "Document claimant_id received", + "2024-12-03T12:22:22": "Document claimant_id verified", + "2024-12-03T22:44:11": "Document police_abstract_or_post_mortem_if_accident received", + "2024-12-27T20:46:07": "Document police_abstract_or_post_mortem_if_accident verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ET-2024-00013": { + "claim_id": "LIFE-ET-2024-00013", + "policy": { + "policy_id": "LIFE-ET-2024-00013", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Samantha", + "last_name": "Richard" + }, + "policyholder_dob": "1980-05-29", + "policyholder_address": { + "line1": "154 Taylor Estate Suite 752", + "line2": null, + "city": "Jeffreyshire", + "state": "Idaho", + "country": "Ethiopia", + "postal_code": "50096" + }, + "policyholder_contact": "542-320-9690x2959", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 1088.45, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****6228", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****3007", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Marcus", + "last_name": "Johnson" + }, + "dob": "1988-10-01", + "address": { + "line1": "1355 Daisy Corners", + "line2": null, + "city": "Seanview", + "state": "Indiana", + "country": "Ethiopia", + "postal_code": "33208" + }, + "contact": "001-915-841-0067x626", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "58Ce617932", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "Lauren", + "last_name": "Johnson" + }, + "dob": "1956-05-09", + "address": { + "line1": "1152 Martin Club Apt. 599", + "line2": null, + "city": "Bushchester", + "state": "Tennessee", + "country": "Ethiopia", + "postal_code": "22127" + }, + "contact": "+1-662-601-5336x884", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-10-19", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "North Brandon", + "estimated_loss_amount": 1238126.31, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-11-01", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "identity_mismatch" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-12T03:16:42": "Claim status updated to under_review", + "2024-03-22T11:55:17": "Claim created", + "2024-04-07T05:48:05": "Document proofs_of_death_form received", + "2024-06-06T18:06:31": "Document police_abstract_or_post_mortem_if_accident received", + "2024-07-20T18:24:09": "Payment of 575573.61 EBT initiated via bank_transfer", + "2024-09-12T18:44:26": "Document letters_of_administration received", + "2024-10-22T11:23:08": "Document death_certificate received", + "2024-11-11T12:53:59": "Document letters_of_administration verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Life Team", + "claims_adjuster": { + "first_name": "Sylvia", + "last_name": "Schroeder" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Shannon", + "last_name": "Yu" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-06-25T14:31:00" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00014": { + "claim_id": "LIFE-UG-2024-00014", + "policy": { + "policy_id": "LIFE-UG-2024-00014", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Ashley", + "last_name": "Larsen" + }, + "policyholder_dob": "1984-02-01", + "policyholder_address": { + "line1": "9731 Jamie Route", + "line2": null, + "city": "Tiffanyfort", + "state": "Delaware", + "country": "Uganda", + "postal_code": "40917" + }, + "policyholder_contact": "(277)641-8625x6527", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 4213.9, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****3108", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "cheque", + "masked_reference": "****7114", + "verified": false + }, + { + "method_id": "PM_3", + "method_type": "mobile_money", + "masked_reference": "****3363", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Eric", + "last_name": "Ward" + }, + "dob": "1984-11-28", + "address": { + "line1": "3490 Karen Shores Apt. 158", + "line2": null, + "city": "Arellanoshire", + "state": "Iowa", + "country": "Uganda", + "postal_code": "73062" + }, + "contact": "6683687937", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "60hW898992", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-06-29", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Thompsonburgh", + "estimated_loss_amount": 105828.11, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-06-30", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 59894.2, + "currency": "UGX", + "payment_date": "2024-07-04T20:08:32", + "payment_method": "mobile_money", + "recipient_name": "Eric Ward", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 8708.19, + "currency": "UGX", + "payment_date": "2024-09-15T16:23:48", + "payment_method": "mobile_money", + "recipient_name": "Eric Ward", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-03-11T12:07:32": "Claim created", + "2024-06-02T21:37:00": "Payment of 59894.2 UGX initiated via mobile_money", + "2024-06-12T05:54:59": "Document police_abstract_or_post_mortem_if_accident received", + "2024-06-16T22:19:16": "Document proofs_of_death_form received", + "2024-06-21T18:28:14": "Payment of 8708.19 UGX initiated via mobile_money", + "2024-07-20T22:26:45": "Claim status updated to new", + "2024-08-21T05:25:21": "Document claimant_id received", + "2024-08-30T18:54:29": "Document death_certificate received", + "2024-12-30T10:30:42": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ZA-2024-00015": { + "claim_id": "LIFE-ZA-2024-00015", + "policy": { + "policy_id": "LIFE-ZA-2024-00015", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Teresa", + "last_name": "Stokes" + }, + "policyholder_dob": "1959-07-19", + "policyholder_address": { + "line1": "8685 Stone Well", + "line2": null, + "city": "Port Isabellashire", + "state": "North Dakota", + "country": "Zambia", + "postal_code": "55498" + }, + "policyholder_contact": "362-629-9911", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 3987.38, + "currency": "ZMW", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****3262", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****8837", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "David", + "last_name": "Henderson" + }, + "dob": "1991-06-09", + "address": { + "line1": "4679 Johnson Harbor Suite 299", + "line2": null, + "city": "Williamsmouth", + "state": "Vermont", + "country": "Zambia", + "postal_code": "31640" + }, + "contact": "9743505444", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "32Pf475469", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-06-02", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "South Jason", + "estimated_loss_amount": 1632418.92, + "currency": "ZMW" + }, + "claim_status": "new", + "reported_date": "2024-06-17", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "identity_mismatch", + "beneficiary_dispute", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 396124.05, + "currency": "ZMW", + "payment_date": "2024-10-20T04:00:04", + "payment_method": "bank_transfer", + "recipient_name": "David Henderson", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 31894.78, + "currency": "ZMW", + "payment_date": "2024-06-09T15:14:50", + "payment_method": "bank_transfer", + "recipient_name": "David Henderson", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-04-08T08:58:31": "Claim created", + "2024-05-22T20:19:09": "Document death_certificate received", + "2024-05-27T04:26:14": "Payment of 396124.05 ZMW initiated via bank_transfer", + "2024-06-01T10:31:20": "Document proofs_of_death_form received", + "2024-08-07T04:30:22": "Document death_certificate verified", + "2024-09-02T12:41:58": "Document police_abstract_or_post_mortem_if_accident received", + "2024-10-13T09:57:22": "Claim status updated to new", + "2024-10-20T19:46:37": "Payment of 31894.78 ZMW initiated via bank_transfer", + "2024-12-26T07:32:48": "Document affidavits_if_applicable received", + "2024-12-29T19:05:23": "Document affidavits_if_applicable verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Jessica", + "last_name": "Osborn DDS" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Deanna", + "last_name": "Bartlett" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-07-29T18:16:14" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00016": { + "claim_id": "LIFE-UG-2024-00016", + "policy": { + "policy_id": "LIFE-UG-2024-00016", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Madison", + "last_name": "Figueroa" + }, + "policyholder_dob": "1990-08-31", + "policyholder_address": { + "line1": "33030 Williams Lake", + "line2": null, + "city": "West Micheal", + "state": "New Jersey", + "country": "Uganda", + "postal_code": "66708" + }, + "policyholder_contact": "(710)435-7972x7985", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 4900.6, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8793", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Katherine", + "last_name": "Camacho" + }, + "dob": "1972-08-03", + "address": { + "line1": "0602 Mercedes Rue", + "line2": null, + "city": "Lake Jamie", + "state": "Tennessee", + "country": "Uganda", + "postal_code": "54175" + }, + "contact": "800.772.2903x49446", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "74Lg374896", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-05-28", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "New Yvonnestad", + "estimated_loss_amount": 578822.53, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-05-29", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "identity_mismatch", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 524035.82, + "currency": "UGX", + "payment_date": "2024-04-25T23:13:36", + "payment_method": "bank_transfer", + "recipient_name": "Katherine Camacho", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 31330.54, + "currency": "UGX", + "payment_date": "2024-07-30T12:01:32", + "payment_method": "cheque", + "recipient_name": "Katherine Camacho", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-19T14:27:14": "Document letters_of_administration received", + "2024-01-20T06:22:26": "Document proofs_of_death_form received", + "2024-02-24T12:11:54": "Payment of 524035.82 UGX initiated via bank_transfer", + "2024-04-28T19:29:03": "Document death_certificate received", + "2024-05-25T16:32:32": "Payment of 31330.54 UGX initiated via cheque", + "2024-05-28T01:21:50": "Document police_abstract_or_post_mortem_if_accident received", + "2024-05-30T12:13:40": "Document police_abstract_or_post_mortem_if_accident verified", + "2024-08-20T12:46:26": "Document proofs_of_death_form verified", + "2024-09-28T21:14:14": "Document letters_of_administration verified", + "2024-10-17T21:56:47": "Claim status updated to new", + "2024-11-29T20:54:12": "Claim created" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Kaylee", + "last_name": "Moore" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Jonathon", + "last_name": "Taylor" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-01-03T20:02:15" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-ET-2024-00017": { + "claim_id": "LIFE-ET-2024-00017", + "policy": { + "policy_id": "LIFE-ET-2024-00017", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Anna", + "last_name": "Wheeler" + }, + "policyholder_dob": "1999-04-27", + "policyholder_address": { + "line1": "28309 Guerrero Springs Apt. 074", + "line2": null, + "city": "Rebeccafurt", + "state": "Missouri", + "country": "Ethiopia", + "postal_code": "97065" + }, + "policyholder_contact": "6994353875", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 2510.31, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****5947", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****6890", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Justin", + "last_name": "Cohen" + }, + "dob": "1999-09-27", + "address": { + "line1": "1724 Stacey Isle", + "line2": null, + "city": "East Michaelport", + "state": "Nebraska", + "country": "Ethiopia", + "postal_code": "43927" + }, + "contact": "(949)547-1709x991", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "81im684602", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-27", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Robertshire", + "estimated_loss_amount": 389658.74, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-09-04", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 128451.56, + "currency": "EBT", + "payment_date": "2024-07-24T03:28:22", + "payment_method": "bank_transfer", + "recipient_name": "Justin Cohen", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 382540.53, + "currency": "EBT", + "payment_date": "2024-09-01T11:46:55", + "payment_method": "bank_transfer", + "recipient_name": "Justin Cohen", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-03-09T17:24:36": "Claim status updated to under_review", + "2024-03-19T16:33:54": "Payment of 128451.56 EBT initiated via bank_transfer", + "2024-03-22T14:45:38": "Claim created", + "2024-07-07T22:22:40": "Document letters_of_administration received", + "2024-09-02T06:21:21": "Document letters_of_administration verified", + "2024-11-06T13:36:11": "Payment of 382540.53 EBT initiated via bank_transfer", + "2024-12-17T18:17:46": "Document death_certificate received", + "2024-12-19T04:16:29": "Document proofs_of_death_form received", + "2024-12-29T05:37:06": "Document death_certificate verified", + "2024-12-29T15:01:00": "Document proofs_of_death_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Mr.", + "last_name": "Donald Nguyen" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Matthew", + "last_name": "Farley" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-07-15T08:34:30" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-UG-2024-00018": { + "claim_id": "LIFE-UG-2024-00018", + "policy": { + "policy_id": "LIFE-UG-2024-00018", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Patricia", + "last_name": "Hatfield" + }, + "policyholder_dob": "1969-03-27", + "policyholder_address": { + "line1": "271 Christina Roads", + "line2": null, + "city": "Powellfort", + "state": "Missouri", + "country": "Uganda", + "postal_code": "01112" + }, + "policyholder_contact": "2835505830", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 1645.06, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****2196", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Douglas", + "last_name": "Huffman" + }, + "dob": "1970-05-20", + "address": { + "line1": "2168 Jackson View Apt. 447", + "line2": null, + "city": "Ryanberg", + "state": "Michigan", + "country": "Uganda", + "postal_code": "64749" + }, + "contact": "(432)360-3323x098", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "50dQ648909", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-04-21", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Lake Maryton", + "estimated_loss_amount": 1362282.13, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-04-28", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "false_claim", + "beneficiary_dispute", + "identity_mismatch" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 607427.63, + "currency": "UGX", + "payment_date": "2024-01-29T16:30:32", + "payment_method": "bank_transfer", + "recipient_name": "Douglas Huffman", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 699675.12, + "currency": "UGX", + "payment_date": "2024-08-21T20:31:52", + "payment_method": "credit_card", + "recipient_name": "Douglas Huffman", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-02T00:49:39": "Payment of 699675.12 UGX initiated via credit_card", + "2024-02-11T19:38:07": "Document proofs_of_death_form received", + "2024-03-06T08:06:28": "Payment of 607427.63 UGX initiated via bank_transfer", + "2024-04-02T04:55:50": "Document death_certificate received", + "2024-04-20T19:25:47": "Document proofs_of_death_form verified", + "2024-05-26T14:53:11": "Claim created", + "2024-06-27T04:19:09": "Document letters_of_administration received", + "2024-07-14T16:19:50": "Document insured_id_or_surrender_letter received", + "2024-07-20T19:15:16": "Claim status updated to new", + "2024-08-11T23:52:48": "Document letters_of_administration verified", + "2024-10-19T06:00:26": "Document insured_id_or_surrender_letter verified", + "2024-11-24T23:30:56": "Document claimant_id received", + "2024-12-21T13:08:57": "Document claimant_id verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Bobby", + "last_name": "Cook" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Mrs.", + "last_name": "Amy Hayes" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-01-12T14:24:57" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-SO-2024-00019": { + "claim_id": "LIFE-SO-2024-00019", + "policy": { + "policy_id": "LIFE-SO-2024-00019", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Hannah", + "last_name": "Butler" + }, + "policyholder_dob": "2000-01-26", + "policyholder_address": { + "line1": "926 William River Apt. 411", + "line2": null, + "city": "Gonzalezborough", + "state": "Wyoming", + "country": "South Africa", + "postal_code": "34972" + }, + "policyholder_contact": "235.364.2087x37530", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "cancelled", + "premium_amount": 1553.73, + "currency": "ZAR", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "mobile_money", + "masked_reference": "****6253", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****3347", + "verified": true + }, + { + "method_id": "PM_3", + "method_type": "cheque", + "masked_reference": "****5923", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Omar", + "last_name": "Kelley" + }, + "dob": "1962-07-02", + "address": { + "line1": "18114 Stephen Hill Suite 701", + "line2": null, + "city": "Port Benjamin", + "state": "Maine", + "country": "South Africa", + "postal_code": "47715" + }, + "contact": "+1-356-711-0022x55794", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "52SE166746", + "verified": true + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-05", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "Banksburgh", + "estimated_loss_amount": 1066207.55, + "currency": "ZAR" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-10-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "beneficiary_dispute", + "identity_mismatch", + "false_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 750145.84, + "currency": "ZAR", + "payment_date": "2024-01-25T08:54:37", + "payment_method": "credit_card", + "recipient_name": "Omar Kelley", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 429496.09, + "currency": "ZAR", + "payment_date": "2024-04-29T19:39:07", + "payment_method": "bank_transfer", + "recipient_name": "Omar Kelley", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-01-30T20:28:33": "Document letters_of_administration received", + "2024-03-09T14:08:30": "Payment of 750145.84 ZAR initiated via credit_card", + "2024-04-04T19:35:07": "Document proofs_of_death_form received", + "2024-05-04T09:17:02": "Payment of 429496.09 ZAR initiated via bank_transfer", + "2024-06-02T05:15:20": "Document affidavits_if_applicable received", + "2024-06-25T23:25:20": "Claim created", + "2024-07-28T05:25:58": "Document insured_id_or_surrender_letter received", + "2024-08-29T11:38:25": "Document letters_of_administration verified", + "2024-08-30T08:46:24": "Document birth_certificate_or_guardianship_order received", + "2024-09-25T11:36:17": "Document death_certificate received", + "2024-10-12T19:08:21": "Document insured_id_or_surrender_letter verified", + "2024-10-12T19:17:47": "Claim status updated to awaiting_documents", + "2024-12-09T13:52:38": "Document policy_document received", + "2024-12-16T16:58:40": "Document birth_certificate_or_guardianship_order verified", + "2024-12-22T15:09:28": "Document claimant_id received", + "2024-12-25T22:06:49": "Document affidavits_if_applicable verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Christian", + "last_name": "Neal" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Elizabeth", + "last_name": "Stanley" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-09-14T10:31:54" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "LIFE-NI-2024-00020": { + "claim_id": "LIFE-NI-2024-00020", + "policy": { + "policy_id": "LIFE-NI-2024-00020", + "insurance_type": "life", + "policyholder_name": { + "first_name": "Daniel", + "last_name": "Horton" + }, + "policyholder_dob": "1980-10-29", + "policyholder_address": { + "line1": "027 Rodriguez Loop Suite 014", + "line2": null, + "city": "Alexanderhaven", + "state": "Wyoming", + "country": "Nigeria", + "postal_code": "97969" + }, + "policyholder_contact": "001-593-958-8916", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 3989.81, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****9743", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****5285", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Brian", + "last_name": "Dunlap" + }, + "dob": "1978-07-07", + "address": { + "line1": "89002 Christian Ways Apt. 175", + "line2": null, + "city": "West Tara", + "state": "Arkansas", + "country": "Nigeria", + "postal_code": "66945" + }, + "contact": "986.363.1779", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "77Ac517016", + "verified": false + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-18", + "cause_of_loss": "accidental death", + "description": "Reported insured loss event", + "location": "Port Christopherport", + "estimated_loss_amount": 189465.67, + "currency": "NGN" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-08-29", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "policy_document", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "claimant_id", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "insured_id_or_surrender_letter", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "proofs_of_death_form", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "birth_certificate_or_guardianship_order", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_7", + "document_type": "other", + "real_document_type": "affidavits_if_applicable", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_8", + "document_type": "other", + "real_document_type": "letters_of_administration", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_9", + "document_type": "other", + "real_document_type": "police_abstract_or_post_mortem_if_accident", + "received": true, + "verified": true, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "confirmed", + "indicators": [ + "false_claim", + "identity_mismatch" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 173340.79, + "currency": "NGN", + "payment_date": "2024-12-22T22:00:20", + "payment_method": "bank_transfer", + "recipient_name": "Brian Dunlap", + "reason": "Claim settlement" + } + ], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-03-15T00:35:25": "Document death_certificate received", + "2024-05-13T20:08:43": "Document claimant_id received", + "2024-06-17T08:22:29": "Document birth_certificate_or_guardianship_order received", + "2024-07-13T20:44:43": "Document letters_of_administration received", + "2024-07-30T01:39:52": "Claim created", + "2024-08-01T10:44:51": "Document insured_id_or_surrender_letter received", + "2024-09-07T23:21:48": "Claim status updated to awaiting_documents", + "2024-09-08T16:46:41": "Payment of 173340.79 NGN initiated via bank_transfer", + "2024-09-09T17:53:26": "Document insured_id_or_surrender_letter verified", + "2024-09-14T14:55:27": "Document letters_of_administration verified", + "2024-10-08T23:50:00": "Document police_abstract_or_post_mortem_if_accident received", + "2024-10-10T17:13:52": "Document claimant_id verified", + "2024-10-15T08:03:22": "Document policy_document received", + "2024-11-21T09:12:08": "Document police_abstract_or_post_mortem_if_accident verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Jason", + "last_name": "Garza" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Meghan", + "last_name": "White" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-10-09T11:42:34" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-NI-2024-00001": { + "claim_id": "MT-NI-2024-00001", + "policy": { + "policy_id": "MT-NI-2024-00001", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "Pamela", + "last_name": "Hart" + }, + "policyholder_dob": "1995-10-24", + "policyholder_address": { + "line1": "571 Katherine Forges Apt. 554", + "line2": null, + "city": "Jacquelineton", + "state": "Hawaii", + "country": "Nigeria", + "postal_code": "65043" + }, + "policyholder_contact": "(561)949-3316", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 3369.78, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "cheque", + "masked_reference": "****8993", + "verified": true + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****9719", + "verified": false + }, + { + "method_id": "PM_3", + "method_type": "credit_card", + "masked_reference": "****1274", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Diamond", + "last_name": "Bryant" + }, + "dob": "1967-12-15", + "address": { + "line1": "60917 Barrett Parkways Apt. 708", + "line2": null, + "city": "New Savannahshire", + "state": "New Mexico", + "country": "Nigeria", + "postal_code": "67129" + }, + "contact": "001-529-622-1699x58669", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "65SV472269", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "William", + "last_name": "Cameron" + }, + "dob": "1992-04-06", + "address": { + "line1": "833 Claudia Highway Suite 228", + "line2": null, + "city": "Jenniferstad", + "state": "Oklahoma", + "country": "Nigeria", + "postal_code": "63464" + }, + "contact": "001-296-884-6081", + "identity_documents": [], + "relationship_to_policyholder": "third_party" + }, + { + "role": "third_party", + "name": { + "first_name": "Dustin", + "last_name": "Santiago" + }, + "dob": "1968-08-03", + "address": { + "line1": "44204 Karen Bypass Suite 719", + "line2": null, + "city": "Lake Deborah", + "state": "Missouri", + "country": "Nigeria", + "postal_code": "31643" + }, + "contact": "540.766.6580x04397", + "identity_documents": [], + "relationship_to_policyholder": "third_party" + } + ], + "loss_details": { + "date_of_loss": "2024-10-06", + "cause_of_loss": "collision with another vehicle", + "description": "Reported insured loss event", + "location": "Port Jenny", + "estimated_loss_amount": 372175.31, + "currency": "NGN" + }, + "claim_status": "under_review", + "reported_date": "2024-10-21", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-10T13:34:56": "Document logbook received", + "2024-05-03T06:59:16": "Document motor_accident_claim_form received", + "2024-05-09T12:54:17": "Document police_abstract received", + "2024-09-25T05:25:16": "Claim created", + "2024-10-16T08:51:17": "Document repair_estimate received", + "2024-12-16T02:56:06": "Claim status updated to under_review" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Roger", + "last_name": "Velasquez" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Evelyn", + "last_name": "Saunders" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-01-31T22:29:40" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-ET-2024-00002": { + "claim_id": "MT-ET-2024-00002", + "policy": { + "policy_id": "MT-ET-2024-00002", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "James", + "last_name": "Cole" + }, + 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"document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + 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"date_of_loss": "2024-11-30", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "North Alexandraberg", + "estimated_loss_amount": 821223.02, + "currency": "NGN" + }, + "claim_status": "under_review", + "reported_date": "2024-12-15", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": 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], + "coverages": [] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Alan", + "last_name": "Weeks" + }, + "dob": "1973-07-03", + "address": { + "line1": "50208 Jacob Cove Suite 427", + "line2": null, + "city": "East Christophertown", + "state": "New York", + "country": "Zambia", + "postal_code": "28968" + }, + "contact": "964-475-7051x20461", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "34pV601367", + "verified": false + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-11-19", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "East Stevenville", + "estimated_loss_amount": 336133.33, + "currency": "ZMW" + }, + "claim_status": "under_review", + "reported_date": "2024-12-02", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", 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"currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****3161", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "bank_transfer", + "masked_reference": "****5489", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "policyholder", + "name": { + "first_name": "Thomas", + "last_name": "Maldonado" + }, + "dob": "1989-01-02", + "address": { + "line1": "950 Michael Drives", + "line2": null, + "city": "East Tonymouth", + "state": "Oklahoma", + "country": "Uganda", + "postal_code": "84996" + }, + "contact": "001-957-530-6524x07784", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "92Jk855749", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-09-10", + "cause_of_loss": "Car accident", + "description": "Reported insured loss event", + "location": "New Ericport", + "estimated_loss_amount": 649115.97, + "currency": "UGX" + }, + "claim_status": "new", + "reported_date": "2024-09-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "other", + "real_document_type": "motor_accident_claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "police_abstract", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "driver_license", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "logbook", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "real_document_type": "repair_estimate", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-01T07:46:13": "Document repair_estimate received", + "2024-06-05T08:31:29": "Document police_abstract received", + "2024-07-21T22:46:39": "Claim created", + "2024-08-07T23:51:55": "Document logbook received", + "2024-08-31T03:19:50": "Document logbook verified", + "2024-09-01T02:50:15": "Claim status updated to new" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] + }, + "MT-NI-2024-00012": { + "claim_id": "MT-NI-2024-00012", + "policy": { + "policy_id": "MT-NI-2024-00012", + "insurance_type": "motor", + "policyholder_name": { + "first_name": "Lori", + "last_name": "Weaver" + }, + "policyholder_dob": "1976-10-22", + "policyholder_address": { + "line1": "863 Cannon Drives", + "line2": null, + 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"last_name": "Thomas" + }, + "policyholder_dob": "2002-04-23", + "policyholder_address": { + "line1": "278 Arnold Mission Suite 532", + "line2": null, + "city": "Jacobsshire", + "state": "New York", + "country": "Uganda", + "postal_code": "96303" + }, + "policyholder_contact": "984.768.9500", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 1224.07, + "currency": "UGX", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****6536", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Nicole", + "last_name": "Barrett" + }, + "dob": "1962-09-08", + "address": { + "line1": "128 Marshall Common Apt. 371", + "line2": null, + "city": "Chloemouth", + "state": "Ohio", + "country": "Uganda", + "postal_code": "01914" + }, + "contact": "678.679.5654x4209", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "07bs929049", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-06", + "cause_of_loss": "outpatient treatment ", + "description": "Reported insured loss event", + "location": "Millerhaven", + "estimated_loss_amount": 207349.98, + "currency": "UGX" + }, + "claim_status": "under_review", + "reported_date": "2024-10-18", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "doctor_signed_form", + "real_document_type": "doctor_signed_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "original_receipts", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "prescription", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "bank_details", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-28T03:41:12": "Document claim_form received", + "2024-04-07T14:54:05": "Document doctor_signed_form received", + "2024-06-01T08:38:55": "Claim status updated to under_review", + "2024-08-10T05:43:11": "Claim created", + "2024-12-04T10:14:59": "Document bank_details received", + "2024-12-22T20:10:28": "Document original_receipts received" + }, + "assignments": { + "taken_to_human_agent": false, + "current_assignment": null, + "assignment_history": [] + }, + "recoveries": [] 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"country": "Nigeria", + "postal_code": "64803" + }, + "contact": "2494478730", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "44SP714627", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-05-31", + "cause_of_loss": "death of insured", + "description": "Reported insured loss event", + "location": "North David", + "estimated_loss_amount": 83614.39, + "currency": "NGN" + }, + "claim_status": "new", + "reported_date": "2024-06-05", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "doctor_signed_form", + "real_document_type": "doctor_signed_form", + "received": true, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "original_receipts", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "prescription", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "bank_details", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "death_certificate", + "real_document_type": "death_certificate", + "received": false, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-05T05:02:19": "Claim created", + "2024-02-17T13:34:00": "Document bank_details received", + "2024-02-28T14:35:30": "Claim status updated to new", + "2024-07-02T15:56:12": "Document prescription received", + "2024-08-10T20:13:29": "Document bank_details verified", + "2024-12-05T23:33:49": "Document claim_form received", + "2024-12-09T01:42:19": "Document prescription verified", + "2024-12-11T11:31:47": "Document claim_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Health Team", + "claims_adjuster": { + "first_name": "Cheyenne", + "last_name": "Stewart" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Terri", + "last_name": "Kerr" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-05-15T16:54:13" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "MC-ET-2024-00012": { + "claim_id": "MC-ET-2024-00012", + "policy": { + "policy_id": "MC-ET-2024-00012", + "insurance_type": "health_inpatient", + "policyholder_name": { + "first_name": "Joshua", + "last_name": "Gamble" + }, + "policyholder_dob": "1963-02-15", 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"31485" + }, + "contact": "001-563-291-0257x4326", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "39HY752450", + "verified": true + } + ], + "relationship_to_policyholder": "self" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-09-05", + "cause_of_loss": "emergency hospitalization abroad", + "description": "Reported insured loss event", + "location": "Wongport", + "estimated_loss_amount": 202013.41, + "currency": "ZMW" + }, + "claim_status": "reviewed", + "reported_date": "2024-09-11", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + 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"city": "Frederickburgh", + "state": "Illinois", + "country": "Ethiopia", + "postal_code": "57687" + }, + "contact": "758-275-0663x370", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-04-02", + "cause_of_loss": "lost baggage", + "description": "Reported insured loss event", + "location": "West Catherine", + "estimated_loss_amount": 806106.56, + "currency": "EBT" + }, + "claim_status": "under_review", + "reported_date": "2024-04-19", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + "received": false, + "verified": false, + 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"payment_method": "mobile_money", + "recipient_name": "Jessica Cooper", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-12T10:02:50": "Claim created", + "2024-02-18T01:22:26": "Payment of 347669.28 EBT initiated via bank_transfer", + "2024-08-23T12:56:56": "Payment of 454391.49 EBT initiated via mobile_money", + "2024-10-10T18:36:53": "Document claim_form received", + "2024-10-19T05:37:58": "Claim status updated to under_review", + "2024-12-21T15:23:31": "Document claim_form verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Travel Team", + "claims_adjuster": { + "first_name": "Anthony", + "last_name": "Hardin" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Rebecca", + "last_name": "Horton MD" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-08-17T14:27:27" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "TR-NI-2024-00018": { + "claim_id": "TR-NI-2024-00018", + "policy": { + "policy_id": "TR-NI-2024-00018", + "insurance_type": "travel", + "policyholder_name": { + "first_name": "Sheryl", + "last_name": "Hernandez" + }, + "policyholder_dob": "2003-01-13", + "policyholder_address": { + "line1": "362 King Hollow", + "line2": null, + "city": "Willischester", + "state": "Wisconsin", + "country": "Nigeria", + "postal_code": "95875" + }, + "policyholder_contact": "219-452-4364", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "lapsed", + "premium_amount": 2374.35, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****1187", + "verified": false + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "John", + "last_name": "Lane" + }, + "dob": "1988-06-12", + "address": { + "line1": "16864 Jackson Landing", + "line2": null, + "city": "Lake Dennis", + "state": "New York", + "country": "Nigeria", + "postal_code": "24354" + }, + "contact": "317.493.2302x34679", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "14bL161415", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-25", + "cause_of_loss": "trip cancellation", + "description": "Reported insured loss event", + "location": "South Todd", + "estimated_loss_amount": 469823.33, + "currency": "NGN" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-11-01", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "medical_bills", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "itinerary", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "insurance_policy_copy", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "overstated_loss", + "duplicate_claim" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 271151.22, + "currency": "NGN", + "payment_date": "2024-02-18T21:40:18", + "payment_method": "mobile_money", + "recipient_name": "John Lane", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 18520.68, + "currency": "NGN", + "payment_date": "2024-10-22T13:53:30", + "payment_method": "credit_card", + "recipient_name": "John Lane", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-02-16T08:05:09": "Claim status updated to awaiting_documents", + "2024-06-16T18:17:30": "Claim created", + "2024-07-20T05:23:20": "Payment of 18520.68 NGN initiated via credit_card", + "2024-08-09T10:33:02": "Payment of 271151.22 NGN initiated via mobile_money", + "2024-10-21T18:22:35": "Document insurance_policy_copy received", + "2024-12-10T14:18:15": "Document passport_copy received", + "2024-12-23T08:02:20": "Document claim_form received", + "2024-12-25T09:52:41": "Document claim_form verified", + "2024-12-25T11:58:20": "Document passport_copy verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Candice", + "last_name": "Wilson" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Michael", + "last_name": "Cruz" + }, + "assessor_role": "Medical Assessor", + "assigned_date": "2024-06-27T15:48:45" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "TR-NI-2024-00019": { + "claim_id": "TR-NI-2024-00019", + "policy": { + "policy_id": "TR-NI-2024-00019", + "insurance_type": "travel", + "policyholder_name": { + "first_name": "Kathleen", + "last_name": "Smith" + }, + "policyholder_dob": "1990-05-18", + "policyholder_address": { + "line1": "7596 Wood Junctions Suite 356", + "line2": null, + "city": "Bishopstad", + "state": "Michigan", + "country": "Nigeria", + "postal_code": "13631" + }, + "policyholder_contact": "5767209184", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "expired", + "premium_amount": 2405.93, + "currency": "NGN", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****6254", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****5994", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Joseph", + "last_name": "Moses" + }, + "dob": "1985-09-27", + "address": { + "line1": "630 Smith Lake Apt. 573", + "line2": null, + "city": "Rossland", + "state": "Minnesota", + "country": "Nigeria", + "postal_code": "56588" + }, + "contact": "316.649.3289x8027", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "87pn271783", + "verified": false + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-10-19", + "cause_of_loss": "lost baggage", + "description": "Reported insured loss event", + "location": "Port Sheryl", + "estimated_loss_amount": 1098564.05, + "currency": "NGN" + }, + "claim_status": "under_review", + "reported_date": "2024-10-20", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "medical_bills", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "itinerary", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "insurance_policy_copy", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": null + }, + "beneficiary_dispute": null, + "payments": [ + { + "payment_id": "PAY_1", + "amount": 628072.02, + "currency": "NGN", + "payment_date": "2024-10-14T22:25:39", + "payment_method": "bank_transfer", + "recipient_name": "Joseph Moses", + "reason": "Claim settlement" + }, + { + "payment_id": "PAY_2", + "amount": 266956.33, + "currency": "NGN", + "payment_date": "2024-05-16T15:39:29", + "payment_method": "mobile_money", + "recipient_name": "Joseph Moses", + "reason": "Claim settlement" + } + ], + "subrogation_possible": false, + "subrogation_notes": null, + "audit_trail": { + "2024-01-08T12:29:53": "Payment of 266956.33 NGN initiated via mobile_money", + "2024-02-27T01:59:08": "Document insurance_policy_copy received", + "2024-03-16T10:28:27": "Payment of 628072.02 NGN initiated via bank_transfer", + "2024-05-04T22:36:36": "Claim status updated to under_review", + "2024-08-13T01:38:02": "Document claim_form received", + "2024-10-11T08:54:15": "Document claim_form verified", + "2024-11-15T05:18:32": "Claim created", + "2024-12-16T13:36:37": "Document medical_bills received", + "2024-12-18T16:44:04": "Document medical_bills verified" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Travel Team", + "claims_adjuster": { + "first_name": "Rachel", + "last_name": "Williams" + }, + "adjuster_role": "Junior Claims Analyst", + "assessor": { + "first_name": "Ricky", + "last_name": "Bennett" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-12-09T15:03:29" + }, + "assignment_history": [] + }, + "recoveries": [] + }, + "TR-ET-2024-00020": { + "claim_id": "TR-ET-2024-00020", + "policy": { + "policy_id": "TR-ET-2024-00020", + "insurance_type": "travel", + "policyholder_name": { + "first_name": "Holly", + "last_name": "Garcia" + }, + "policyholder_dob": "2000-08-14", + "policyholder_address": { + "line1": "287 Laura Isle", + "line2": null, + "city": "New Katie", + "state": "Rhode Island", + "country": "Ethiopia", + "postal_code": "08977" + }, + "policyholder_contact": "+1-356-768-6334x1411", + "effective_date": "2024-01-01", + "expiry_date": "2025-01-01", + "status": "active", + "premium_amount": 1720.77, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****2091", + "verified": false + }, + { + "method_id": "PM_2", + "method_type": "mobile_money", + "masked_reference": "****6901", + "verified": true + } + ], + "coverages": [] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Victoria", + "last_name": "Johnson" + }, + "dob": "2005-05-20", + "address": { + "line1": "195 Melissa Light", + "line2": null, + "city": "West Bryanside", + "state": "Illinois", + "country": "Ethiopia", + "postal_code": "51376" + }, + "contact": "(455)628-9931x60875", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "37Mu729420", + "verified": true + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": null, + "loss_details": { + "date_of_loss": "2024-08-29", + "cause_of_loss": "emergency hospitalization abroad", + "description": "Reported insured loss event", + "location": "Wayneville", + "estimated_loss_amount": 667094.05, + "currency": "EBT" + }, + "claim_status": "new", + "reported_date": "2024-08-29", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "real_document_type": "claim_form", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_2", + "document_type": "other", + "real_document_type": "travel_tickets", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_3", + "document_type": "other", + "real_document_type": "passport_copy", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_4", + "document_type": "other", + "real_document_type": "medical_bills", + "received": true, + "verified": true, + "notes": null + }, + { + "document_id": "DOC_5", + "document_type": "other", + "real_document_type": "itinerary", + "received": false, + "verified": false, + "notes": null + }, + { + "document_id": "DOC_6", + "document_type": "other", + "real_document_type": "insurance_policy_copy", + "received": true, + "verified": false, + "notes": null + } + ], + "fraud_assessment": { + "fraud_flag": "suspected", + "indicators": [ + "duplicate_claim", + "fake_itinerary" + ], + "notes": "Fraud review required" + }, + "beneficiary_dispute": null, + "payments": [], + "subrogation_possible": true, + "subrogation_notes": null, + "audit_trail": { + "2024-02-15T06:47:14": "Document medical_bills received", + "2024-05-27T01:00:55": "Document medical_bills verified", + "2024-06-10T17:38:45": "Document claim_form received", + "2024-08-22T20:24:50": "Document insurance_policy_copy received", + "2024-09-17T03:37:35": "Claim created", + "2024-11-10T12:59:57": "Document claim_form verified", + "2024-12-30T00:46:56": "Claim status updated to new" + }, + "assignments": { + "taken_to_human_agent": true, + "current_assignment": { + "handler_team": "Recoveries", + "claims_adjuster": { + "first_name": "Erin", + "last_name": "Reyes" + }, + "adjuster_role": "Senior Claims Analyst", + "assessor": { + "first_name": "Nathan", + "last_name": "Wade" + }, + "assessor_role": "Loss Assessor", + "assigned_date": "2024-12-22T22:29:57" + }, + "assignment_history": [] + }, + "recoveries": [] + } +} \ No newline at end of file diff --git a/data/tau2/domains/claims/policy.md b/data/tau2/domains/claims/policy.md new file mode 100644 index 00000000..cb199fc0 --- /dev/null +++ b/data/tau2/domains/claims/policy.md @@ -0,0 +1,331 @@ +# Insurance Claims Agent Policy + +--- + +## 1. Purpose & Scope of This Policy + +This document defines the **end-to-end insurance claims lifecycle** and governs how the Insurance Claims Agent must operate across **all claim stages**, from initial loss notification to final settlement, recovery, and closure. + +This policy ensures that claims are handled **safely, consistently, audibly, and in correct sequence**. + +--- + +## 1. Role of the Insurance Claims Agent + +The Insurance Claims Agent is authorized to assist users with the following activities: + +- Reporting insurance claims (Creating claims) +- Submitting insurance claims +- Verifying claim-related documents +- Evaluating claims +- Approving or rejecting claims +- Handling payments and settlements + +The agent must operate **strictly within the scope of defined tools and user-provided information**. + +### Out of Scope +The agent must **not**: +- Provide subjective opinions or recommendations +- Invent information not provided by the user or tools +- Execute actions that violate this policy + +Requests outside the defined scope must be denied or escalated appropriately. + +--- + +## 2. Core Operating Principles + +### 2.1 Confirmation Requirement +Before performing **any action that updates the claims database**, the agent must: + +1. Clearly list the intended action and parameters +2. Explain the expected change in claim or policy state +3. Obtain **explicit user confirmation** (“yes”) + +If the user response is anything other than an unambiguous **“yes”**, the action **must not** be executed. + +--- + +### 2.2 Tool Usage Rules + +- The agent may make **only one claims tool call per response** +- The agent must **not**: + - Make multiple tool calls in a single response + - Combine a tool call and user-facing explanation in the same turn +- If responding to the user, **no tool call** may be made in that response + +--- + +### 2.3 Allowed vs Prohibited Tools + +#### Allowed +Claims-specific tools defined under `ClaimsTools`. + +#### Restricted +General-purpose tools (e.g., web search, code execution) may only be used for: +- Generic insurance terminology +- Non-customer-specific workflows or concepts + +They **must never** be used to simulate or alter claims data. + +--- + +## 3. Read vs Write Tool Behavior + +### 3.1 READ Tools +READ tools may be invoked **without user confirmation**, while still respecting the one-tool-per-response rule. + +Examples: +- `check_policy_status` +- `list_claim_documents` +- `check_submission_timeline` + +--- + +### 3.2 WRITE Tools +WRITE tools **always require explicit user confirmation**. + +Examples include: +- `create_claim` +- `submit_claim` +- `request_documents` +- `verify_documents` +- `review_claim` +- `approve_claim` +- `reject_claim` +- `process_total_loss_payment` +- `process_liability_minor` +- `identify_subrogation` +- `initiate_recovery` +- `update_recovery_status` +- `close_claim` +- `transfer_to_human_agents` +- `handle_task` + +--- + +## 4. Mandatory Pre-Action Checklist (WRITE Actions) + +Before executing any WRITE tool, the agent must ensure: + +1. **Action clarity** + - Tool name and parameters are explicitly presented + +2. **Expected state change** + - Status transition is clearly explained + +3. **User confirmation** + - User explicitly replies with “yes” + +4. **Policy validity** + - Policy is active (verified via `check_policy_status`) + +5. **Document completeness** + - Mandatory documents are present and verified + +If any condition is unmet, the agent must **pause**, request missing information, or escalate. + +--- + +## 5. Transfer to Human Claims Specialist + +### 5.1 When to Transfer +Transfer **only if** the request cannot be safely or fully handled within tool constraints. + +Typical reasons include: +- Legal or complex coverage disputes +- Fraud suspicion or identity conflicts +- Missing or inconsistent policy data +- Requests outside defined tool capabilities + +--- + +### 5.2 Transfer Procedure + +1. Obtain explicit user confirmation +2. Call `transfer_to_human_agents(claim_id, team, role, reason)` +3. After completion, send the message: + +> **YOU ARE BEING TRANSFERRED TO A HUMAN CLAIMS SPECIALIST. PLEASE HOLD ON.** + +--- + +## 6. Domain Model + +### 6.1 User / Claimant +User profiles contain: +- User ID +- Full name +- Email +- Addresses +- Date of birth +- Policy numbers +- Payment methods + +User roles may include: +- Policyholder +- Beneficiary +- Third-party claimant + +--- + +### 6.2 Insurance Policy +Each policy includes: +- Policy ID +- Insurance type (motor, property, health, travel, life) +- Policyholder ID +- Effective & expiry dates +- Coverage limits / sum insured +- Premium +- Status (active, lapsed, expired) + +--- + +### 6.3 Claim +Each claim record includes: +- Claim ID and policy ID +- Claimant information (including third-party support) +- Product and cover type +- Date of loss and reporting date +- Claim status (pending, under_assessment, approved, rejected, closed) +- Loss details and coverage limits +- Payment history and reserves +- Supporting documents +- Timeline and assignments +- Audit trail +- Fraud, subrogation, and recovery information + +--- + +## 7. Claim Lifecycle + +### 7.1 Reporting a Claim + +Required information: +- User ID +- Policy ID +- Insurance type +- Date and cause of loss +- Supporting documents + +Agent responsibilities: +- Validate policy status +- Confirm claimant identity +- Identify third-party involvement +- Request missing documents + +Typical sequence: +1. `check_policy_status` (READ) +2. `create_claim` (WRITE, confirmed) +3. `request_documents` (WRITE, if needed) +4. `submit_claim` (WRITE, confirmed) + +--- + +### 7.2 Evaluating a Claim + +The agent must: +- Verify coverage eligibility +- Confirm document completeness +- Validate claimant identity +- Check liability for third-party claims +- Assess health, property, or repair details as applicable +- Update timelines using appropriate WRITE tools + +--- + +### 7.3 Approving or Rejecting a Claim + +#### Approval Conditions +- All documents verified +- Coverage confirmed +- Identity verified +- No unresolved fraud indicators + +#### Rejection Conditions +- Outside coverage or policy period +- Missing or invalid documents +- Fraud or identity conflicts + +All decisions must: +- Use appropriate WRITE tools +- Include clear reasons in notes +- Be auditable in the claim timeline + +--- + +## 8. Payments & Settlements + +Payment rules: +- Must respect deductibles, limits, and co-insurance +- Interim payments allowed where applicable +- Beneficiary routing required for life insurance +- Third-party payments require consent + +Payment tools: +- `process_total_loss_payment` +- `process_liability_minor` + +After final payment: +- `settle_claim` +- `close_claim` (with confirmation) + +--- + +## 9. Document Handling + +Agent responsibilities: +- Review document completeness +- Request missing documents +- Verify submitted documents + +### Mandatory Documents by Insurance Type + +| Insurance Type | Mandatory Documents | +|---------------|--------------------| +| Motor | Claim form, police abstract, logbook, driver license, repair estimate | +| Property | Claim form, fire report, repair quotes, proof of ownership, photos | +| Health | Claim form, medical reports, hospital bills, policy schedule, ID | +| Life | Claim form, ID, death certificate, nominee verification, policy schedule | +| Travel | Claim form, tickets, passport, medical bills, itinerary, policy copy | + +Missing documents must trigger follow-up tasks. + +--- + +## 10. Fraud & Ambiguity Handling + +In suspected fraud cases, the agent must: +- Verify identity and authorization +- Check for duplicate or unusual patterns +- Escalate using `escalate_claim` (WRITE, confirmed) +- Trigger fraud investigation tasks + +--- + +## 11. Task Management + +Tasks may include: +- Document follow-ups +- Payment approvals +- Claim verification +- Beneficiary disputes +- Fraud investigations + +Each task contains: +- Task ID +- Description +- User scenario +- Evaluation criteria + +--- + +## 12. Policy Summary + +- Claimant information is always required +- Third-party claims are fully supported +- Fraud detection and document verification are mandatory +- WRITE actions always require explicit user confirmation +- Policy status must be verified before progression +- One tool call per response is strictly enforced +- Complex or unsafe cases must be escalated to a human specialist diff --git a/data/tau2/domains/claims/split_tasks.json b/data/tau2/domains/claims/split_tasks.json new file mode 100644 index 00000000..c6adf902 --- /dev/null +++ b/data/tau2/domains/claims/split_tasks.json @@ -0,0 +1,108 @@ +{ + "train": [ + "HOME-5", + "HOME-3", + "TR-9", + "TR-1", + "LIFE-4", + "MED-5", + "HOME-6", + "LIFE-9", + "HOME-9", + "TR-6", + "MT-1", + "HOME-1", + "TR-2", + "LIFE-3", + "MT-9", + "MT-8", + "TR-0", + "HOME-4", + "MT-5", + "LIFE-0", + "MED-3", + "TR-8", + "MT-3", + "MED-8", + "MED-1", + "MT-0", + "HOME-8", + "HOME-0", + "HOME-2", + "MED-2" + ], + "test": [ + "MED-6", + "MT-6", + "MT-2", + "MED-4", + "TR-3", + "MED-9", + "MED-7", + "LIFE-2", + "HOME-7", + "MT-7", + "LIFE-5", + "MT-4", + "LIFE-6", + "LIFE-8", + "TR-4", + "TR-5", + "TR-7", + "LIFE-1", + "LIFE-7", + "MED-0" + ], + "base": [ + "HOME-5", + "HOME-3", + "TR-9", + "TR-1", + "LIFE-4", + "MED-5", + "HOME-6", + "LIFE-9", + "HOME-9", + "TR-6", + "MT-1", + "HOME-1", + "TR-2", + "LIFE-3", + "MT-9", + "MT-8", + "TR-0", + "HOME-4", + "MT-5", + "LIFE-0", + "MED-3", + "TR-8", + "MT-3", + "MED-8", + "MED-1", + "MT-0", + "HOME-8", + "HOME-0", + "HOME-2", + "MED-2", + "MED-6", + "MT-6", + "MT-2", + "MED-4", + "TR-3", + "MED-9", + "MED-7", + "LIFE-2", + "HOME-7", + "MT-7", + "LIFE-5", + "MT-4", + "LIFE-6", + "LIFE-8", + "TR-4", + "TR-5", + "TR-7", + "LIFE-1", + "LIFE-7", + "MED-0" + ] +} \ No newline at end of file diff --git a/data/tau2/domains/claims/tasks.json b/data/tau2/domains/claims/tasks.json new file mode 100644 index 00000000..327ebba9 --- /dev/null +++ b/data/tau2/domains/claims/tasks.json @@ -0,0 +1,1710 @@ +[ + { + "id": "LIFE-0", + "description": { + "purpose": "Life claim with multiple adult beneficiaries and complete documents.", + "relevant_policies": "All mandatory documents received.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Request confirmation that claim can proceed to payment.", + "domain": "insurance", + "reason_for_call": "You submitted all required documents.", + "known_info": "Claim ID LIFE-TA-2024-00002. Two adult beneficiaries.", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-0_0", + "name": "verify_documents", + "arguments": { "claim_id": "LIFE-TA-2024-00002"}, + "info": null + }, + { + "action_id": "LIFE-0_0", + "name": "process_total_loss_payment", + "arguments": {"claim_id": "LIFE-TA-2024-00002"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent confirms completeness of mandatory life claim documents.", + "Agent cannot approve payment unless all mandatory documents are verified", + "A claim cannot be paid unless at least one payment exists and verified" + ] + }, + "annotations": null + }, + { + "id": "LIFE-1", + "description": { + "purpose": "Life claim where one beneficiary is a minor without guardianship order.", + "relevant_policies": "Minor beneficiaries require court-issued guardianship order.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Insist birth certificate should be enough.", + "domain": "insurance", + "reason_for_call": "You want claim processed urgently.", + "known_info": "Claim ID LIFE-SO-2024-00003. One minor beneficiary.", + "unknown_info": "Guardianship order" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-1_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-SO-2024-00003","document":"guardianship_order" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent blocks payment until guardianship order is provided." + ] + }, + "annotations": null + }, + { + "id": "LIFE-2", + "description": { + "purpose": "Life claim with name mismatch between policy and death certificate.", + "relevant_policies": "Affidavit required where names differ.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Say spelling error should be ignored.", + "domain": "insurance", + "reason_for_call": "You want claim approved.", + "known_info": "Claim ID LIFE-ET-2024-00013.", + "unknown_info": "Affidavit of name difference" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-2_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-ET-2024-00013","document":"affidavit"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent requires affidavit to resolve identity mismatch." + ] + }, + "annotations": null + }, + { + "id": "LIFE-3", + "description": { + "purpose": "Life claim involving estate settlement with no letters of administration.", + "relevant_policies": "Estate claims require letters of administration and confirmation of grant.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Claim beneficiaries already agreed verbally.", + "domain": "insurance", + "reason_for_call": "You want payout shared among siblings.", + "known_info": "Claim ID LIFE-ET-2024-00005.", + "unknown_info": "Letters of administration" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-3_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-ET-2024-00005","document":"letters_of_administration"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent does not proceed without legal authority documents." + ] + }, + "annotations": null + }, + { + "id": "LIFE-4", + "description": { + "purpose": "Life claim where death resulted from an accident without police abstract.", + "relevant_policies": "Accidental death requires police abstract and post-mortem report.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Argue death certificate should be sufficient.", + "domain": "insurance", + "reason_for_call": "You want accidental benefit paid.", + "known_info": "Claim ID LIFE-UG-2024-00001. Accidental death.", + "unknown_info": "Police abstract" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-4_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-UG-2024-00001","document":"police_abstract"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent requires accident documentation to validate benefit." + ] + }, + "annotations": null + }, + { + "id": "LIFE-5", + "description": { + "purpose": "Life claim with missing original policy document.", + "relevant_policies": "Original policy document is mandatory.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Say the insurer already has policy records.", + "domain": "insurance", + "reason_for_call": "You want claim processed.", + "known_info": "Claim ID LIFE-KE-2024-00007.", + "unknown_info": "Original policy document" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-5_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-KE-2024-00007"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent explains original policy document requirement." + ] + }, + "annotations": null + }, + { + "id": "LIFE-6", + "description": { + "purpose": "Life claim with physician statement not submitted.", + "relevant_policies": "Proofs of death forms must be completed.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "State hospital already confirmed death.", + "domain": "insurance", + "reason_for_call": "You want claim finalized.", + "known_info": "Claim ID LIFE-ZA-2024-00006.", + "unknown_info": "Physician's statement (Form 43 No 2)" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-6_0", + "name": "request_documents", + "arguments": { "claim_id": "LIFE-ZA-2024-00006" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent requires completed Form 43 No 2." + ] + }, + "annotations": null + }, + { + "id": "LIFE-7", + "description": { + "purpose": "Life claim with multiple beneficiaries disputing payout shares.", + "relevant_policies": "Disputed claims require legal clarification.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Demand equal split immediately.", + "domain": "insurance", + "reason_for_call": "You disagree with proposed distribution.", + "known_info": "Claim ID LIFE-NI-2024-00008. Three beneficiaries.", + "unknown_info": "Confirmed legal distribution" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-7_0", + "name": "escalate_claim", + "arguments": { "claim_id": "LIFE-NI-2024-00008" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent escalates due to beneficiary dispute." + ] + }, + "annotations": null + }, + { + "id": "LIFE-8", + "description": { + "purpose": "Life claim close after all beneficiaries and documents are verified, and payment has been settled.", + "relevant_policies": "All mandatory requirements satisfied.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Confirm readiness for closing the claim", + "domain": "insurance", + "reason_for_call": "You want to close claim.", + "known_info": "Claim ID LIFE-ZA-2024-00012.", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-8_0", + "name": "close_claim", + "arguments": { "claim_id": "LIFE-ZA-2024-00012"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent approves closing the claim" + ] + }, + "annotations": null + }, + { + "id": "LIFE-9", + "description": { + "purpose": "Life claim approved after all beneficiaries and documents are verified.", + "relevant_policies": "All mandatory requirements satisfied.", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Confirm readiness for payout.", + "domain": "insurance", + "reason_for_call": "You want payment released.", + "known_info": "Claim ID LIFE-TA-2024-00011. All documents verified.", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "LIFE-9_0", + "name": "approve_claim", + "arguments": { "claim_id": "LIFE-TA-2024-00011" }, + "info": null + }, + { + "action_id": "LIFE-9_0", + "name": "process_total_loss_payment", + "arguments": { "claim_id": "LIFE-TA-2024-00011" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent approves life claim for payment.", + "Agent initiates payment after approval" + ] + }, + "annotations": null + }, + { + "id": "TR-0", + "description": { + "purpose": "Verify baggage loss claim where police report is missing.", + "relevant_policies": null, + "notes": "Loss or theft must be reported within 24 hours." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Insist that reporting to hotel staff should be enough.", + "domain": "insurance", + "reason_for_call": "Your luggage was stolen during outbound travel.", + "known_info": "Travel insurance policy active. Outbound travel. CLAIM_ID TR-KE-2024-00001", + "unknown_info": "Police or written incident report" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-0_0", + "name": "request_documents", + "arguments": { "claim_type": "baggage_loss","claim_id":"TR-KE-2024-00001"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent does not proceed without a police or written incident report." + ] + }, + "annotations": null + }, + { + "id": "TR-1", + "description": { + "purpose": "Travel claim where boarding pass and ticket confirmation are missing.", + "relevant_policies": null, + "notes": "Proof of travel is required." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "State that you travelled but cannot find your ticket.", + "domain": "insurance", + "reason_for_call": "You want compensation for delayed baggage.", + "known_info": "Student travel policy and CLAIM_ID TR-UG-2024-00002", + "unknown_info": "Ticket or boarding pass" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-1_0", + "name": "request_documents", + "arguments": { "claim_type": "delay", "claim_id":"TR-UG-2024-00002"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent places claim in awaiting documents state." + ] + }, + "annotations": null + }, + { + "id": "TR-2", + "description": { + "purpose": "Medical emergency claim without prior insurer notification.", + "relevant_policies": null, + "notes": "Emergency exceptions apply." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Explain that treatment was urgent and insurer was not contacted.", + "domain": "insurance", + "reason_for_call": "You received emergency medical care abroad.", + "known_info": "Inbound travel. Medical receipts available.CLAIM ID TR-TA-2024-00003", + "unknown_info": "Pre-authorization" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-2_0", + "name": "review_medical_claim", + "arguments": { "emergency": true , "claim_id":"TR-TA-2024-00003"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent approves claim subject to receipt verification." + ] + }, + "annotations": null + }, + { + "id": "TR-3", + "description": { + "purpose": "Claim for lost passport without replacement documentation.", + "relevant_policies": null, + "notes": "Replacement and police report required." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Request reimbursement for emergency travel documents.", + "domain": "insurance", + "reason_for_call": "Your passport was stolen.", + "known_info": "Outbound travel.CLAIM ID TR-ZA-2024-00012", + "unknown_info": "Police report, embassy confirmation" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-3_0", + "name": "request_documents", + "arguments": {"claim_id":"TR-ZA-2024-00012"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent does not approve claim without supporting documentation." + ] + }, + "annotations": null + }, + { + "id": "TR-4", + "description": { + "purpose": "Cancellation claim due to illness without medical certificate.", + "relevant_policies": null, + "notes": "Cancellation requires acceptable reason." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Say you were unwell but did not see a doctor.", + "domain": "insurance", + "reason_for_call": "You cancelled your trip.", + "known_info": "Corporate travel policy.CLAIM ID TR-KE-2024-00009", + "unknown_info": "Medical certificate" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-4_0", + "name": "request_documents", + "arguments": {"claim_id":"TR-KE-2024-00009"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent refuses approval without valid cancellation evidence." + ] + }, + "annotations": null + }, + { + "id": "TR-5", + "description": { + "purpose": "Baggage loss claim with receipts for emergency items.", + "relevant_policies": null, + "notes": "Receipts support reimbursement." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Provide receipts for toiletries and clothing.", + "domain": "insurance", + "reason_for_call": "Your luggage was delayed.", + "known_info": "Outbound travel. Receipts available.CLAIM ID TR-UG-2024-00004", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-5_0", + "name": "approve_partial_reimbursement", + "arguments": {"claim_id":"TR-UG-2024-00004"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent approves reimbursement based on receipts." + ] + }, + "annotations": null + }, + { + "id": "TR-6", + "description": { + "purpose": "Medical claim involving pre-existing condition not declared.", + "relevant_policies": null, + "notes": "Non-disclosure affects coverage." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "State condition existed before policy purchase.", + "domain": "insurance", + "reason_for_call": "You need medical reimbursement.", + "known_info": "Student travel policy. CLAIM ID TR-ET-2024-00005", + "unknown_info": "Disclosure confirmation" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-6_0", + "name": "reject_claim", + "arguments": { "reason": "non_disclosure", "claim_id":"TR-ET-2024-00005" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent rejects claim due to non-disclosure." + ] + }, + "annotations": null + }, + { + "id": "TR-7", + "description": { + "purpose": "Early return claim due to family emergency.", + "relevant_policies": null, + "notes": "Only unused costs and extra travel covered." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Request full refund for entire trip.", + "domain": "insurance", + "reason_for_call": "You had to return home early.", + "known_info": "Inbound travel.CLAIM ID TR-NI-2024-00011", + "unknown_info": "Proof of emergency" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-7_0", + "name": "verify_documents", + "arguments": {"claim_id":"TR-NI-2024-00011"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent limits reimbursement to eligible costs only." + ] + }, + "annotations": null + }, + { + "id": "TR-8", + "description": { + "purpose": "Claim involving lost documents during domestic travel.", + "relevant_policies": null, + "notes": "Travel insurance may apply within covered scope." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Confirm travel was within country.", + "domain": "insurance", + "reason_for_call": "You lost important documents.", + "known_info": "Corporate travel.CLAIM ID TR-SO-2024-00014", + "unknown_info": "Policy scope confirmation" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-8_0", + "name": "verify_policy_scope", + "arguments": {"claim_id":"TR-SO-2024-00014"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies coverage before proceeding." + ] + }, + "annotations": null + }, + { + "id": "TR-9", + "description": { + "purpose": "Travel claim fully documented and ready for approval.", + "relevant_policies": null, + "notes": "All requirements met." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Confirm all documents submitted.", + "domain": "insurance", + "reason_for_call": "You want claim finalized.", + "known_info": "Outbound travel. All documents verified. CLAIM ID TR-ZA-2024-00016", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "TR-9_0", + "name": "approve_claim", + "arguments": {"claim_id":"TR-ZA-2024-00016"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent approves travel claim." + ] + }, + "annotations": null + }, + + { + "id": "HOME-0", + "description": { + "purpose": "Fire damage claim affecting the building structure.", + "relevant_policies": "Building Section – Fire & Special Perils", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report that a fire damaged the main house and perimeter wall.", + "domain": "insurance", + "reason_for_call": "You want to file a building damage claim.", + "known_info": "Policy type: Domestic Package. Peril: Fire.CLAIM ID HOME-ET-2024-00003", + "unknown_info": "Fire brigade report" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-0_0", + "name": "create_claim", + "arguments": { "section": "Building", "peril": "Fire","claim_id":"HOME-ET-2024-00003" }, + "info": null + }, + { + "action_id": "HOME-0_1", + "name": "request_documents", + "arguments": { "document": "fire_report","claim_id":"HOME-ET-2024-00003"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies the loss falls under Building Section.", + "Agent does not approve claim without fire report." + ] + }, + "annotations": null + }, + { + "id": "HOME-1", + "description": { + "purpose": "Contents claim due to burglary and theft.", + "relevant_policies": "Contents Section – Burglary & Theft", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report stolen household items after a break-in.", + "domain": "insurance", + "reason_for_call": "You want compensation for stolen furniture and electronics.", + "known_info": "Police abstract available.CLAIM ID HOME-SO-2024-00008", + "unknown_info": "Purchase receipts" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-1_0", + "name": "verify_documents", + "arguments": { "document": "police_abstract","claim_id":"HOME-SO-2024-00008" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent confirms items fall under Contents Section.", + "Agent requests proof of ownership where applicable." + ] + }, + "annotations": null + }, + { + "id": "HOME-2", + "description": { + "purpose": "Accidental breakage of fragile household items.", + "relevant_policies": "Contents Section – Accidental Breakage", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Claim for accidental breakage of glass table.", + "domain": "insurance", + "reason_for_call": "Item broke accidentally during cleaning.", + "known_info": "Item listed in household inventory.CLAIM ID HOME-TA-2024-00020", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-2_0", + "name": "verify_documents", + "arguments": { "document": "photos","claim_id":"HOME-TA-2024-00020" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies accidental nature of loss.", + "Agent ensures item is not excluded." + ] + }, + "annotations": null + }, + { + "id": "HOME-3", + "description": { + "purpose": "All Risks claim for stolen laptop outside the house.", + "relevant_policies": "All Risks Section", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report theft of a laptop while traveling.", + "domain": "insurance", + "reason_for_call": "Laptop stolen from a café.", + "known_info": "Laptop listed under All Risks schedule.CLAIM ID HOME-TA-2024-00007", + "unknown_info": "Police report" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-3_0", + "name": "request_documents", + "arguments": { "document": "police_report","claim_id":"HOME-TA-2024-00007" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent confirms item is scheduled under All Risks.", + "Agent does not approve claim without police report." + ] + }, + "annotations": null + }, + { + "id": "HOME-4", + "description": { + "purpose": "Verify policy status before claim processing.", + "relevant_policies": "No claims are payable if the policy was not active on the date of loss.", + "notes": "Policy status must be validated before coverage checks." + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report water damage to furniture due to burst pipe.", + "domain": "insurance", + "reason_for_call": "Flooding occurred overnight.", + "known_info": "Plumber repair invoice available. CLAIM ID HOME-ZA-2024-00015", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-4_0", + "name": "check_policy_status", + "arguments": {"claim_id":"HOME-ZA-2024-00015" }, + "info": null + }, + { + "action_id": "HOME-4_1", + "name": "reject_claim", + "arguments": {"claim_id":"HOME-ZA-2024-00015","reason": "Policy expired — no active cover at date of loss"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies policy status before making a decision.", + "Agent rejects the claim due to expired policy.", + "Agent clearly explains the reason for rejection." + ] + }, + "annotations": null + }, + { + "id": "HOME-5", + "description": { + "purpose": "WIBA claim for injured domestic worker.", + "relevant_policies": "WIBA Section", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report injury to house help while on duty.", + "domain": "insurance", + "reason_for_call": "Domestic worker slipped and fractured leg.", + "known_info": "Employee registered under WIBA.CLAIM ID HOME-SO-2024-00019 ", + "unknown_info": "Medical report" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-5_0", + "name": "request_documents", + "arguments": { "document": "medical_report","claim_id":"HOME-SO-2024-00019" }, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies employment relationship.", + "Agent follows WIBA statutory process." + ] + }, + "annotations": null + }, + { + "id": "HOME-6", + "description": { + "purpose": "Owners’ liability claim due to visitor injury.", + "relevant_policies": "Owners’/Occupiers’ Liability Section", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report injury to a guest who slipped at your home.", + "domain": "insurance", + "reason_for_call": "Visitor is demanding compensation.", + "known_info": "Incident occurred within insured premises.CLAIM ID HOME-SO-2024-00005", + "unknown_info": "Witness statements" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-6_0", + "name": "create_claim", + "arguments": {"claim_id":"HOME-SO-2024-00005"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies negligence requirement.", + "Agent escalates to liability assessment." + ] + }, + "annotations": null + }, + { + "id": "HOME-7", + "description": { + "purpose": "Impact damage by vehicle to boundary wall.", + "relevant_policies": "Fire & Special Perils – Impact Damage", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report vehicle crashing into your fence.", + "domain": "insurance", + "reason_for_call": "Boundary wall destroyed.", + "known_info": "Third-party driver identified.CLAIM ID HOME-KE-2024-00002", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-7_0", + "name": "identify_subrogation", + "arguments": {"claim_id":"HOME-KE-2024-00002"}, + "info": null + }, + { + "action_id": "HOME-7_1", + "name": "initiate_recovery", + "arguments": {"claim_id":"HOME-KE-2024-00002"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent checks subrogation potential.", + "Agent assigns recovery task if applicable." + ] + }, + "annotations": null + }, + { + "id": "HOME-8", + "description": { + "purpose": "Storm and tempest damage to roof.", + "relevant_policies": "Fire & Special Perils – Storm & Tempest", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report roof damage after heavy storm.", + "domain": "insurance", + "reason_for_call": "Rain damaged ceiling and walls.", + "known_info": "Photos available.CLAIM ID HOME-NI-2024-00011", + "unknown_info": "Contractor estimate" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-8_0", + "name": "request_documents", + "arguments": {"claim_id":"HOME-NI-2024-00011"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies storm peril.", + "Agent excludes wear and tear.", + "Agent requests repair estimate" + ] + }, + "annotations": null + }, + { + "id": "HOME-9", + "description": { + "purpose": "Embedded travel insurance medical emergency claim.", + "relevant_policies": "Embedded Travel Insurance", + "notes": "Limit USD 40,000" + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report medical emergency while abroad.", + "domain": "insurance", + "reason_for_call": "Hospitalized during travel.", + "known_info": "Domestic Package with embedded travel cover.CLAIM ID HOME-UG-2024-00017", + "unknown_info": "Medical bills" + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "HOME-9_0", + "name": "verify_documents", + "arguments": {"claim_id":"HOME-UG-2024-00017"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent confirms embedded travel cover is active.", + "Agent enforces USD 40,000 limit." + ] + }, + "annotations": null + }, + { + "id": "MT-0", + "description": { + "purpose": "Submit an accidental damage claim and request repair authorization.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Notify the insurer of an accident, submit the motor accident claim form, police abstract, driving license copy, and repair estimate. Request authorization to repair at an approved garage.", + "domain": "motor", + "reason_for_call": "You want your vehicle repaired after an accident.", + "known_info": "Claim type: Accidental Own Damage", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-0_0", + "name": "submit_claim", + "arguments": {"claim_type":"accidental_own","claim_id":"CLM-MT-0001"}, "info": null}, + + {"action_id": "MT-0_1", + "name": "authorize_repair", + "arguments": {"claim_id":"CLM-MT-0001"}, + "info": null} + ], + "communicate_info": [], + "nl_assertions": [ + "Agent authorizes repair only after verifying all required documents and assessment report." + ] + }, + "annotations": null + }, + { + "id": "MT-1", + "description": { + "purpose": "Submit theft claim and request total loss payment.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Notify the insurer of vehicle theft, submit motor theft claim form, police abstract, and logbook. Request total loss offer.", + "domain": "motor", + "reason_for_call": "Vehicle stolen and you want compensation.", + "known_info": "Claim type: Theft", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-1_0", + "name": "submit_claim", + "arguments": {"claim_type":"theft","claim_id":"MT-ZA-2024-00014"}, + "info": null + }, + {"action_id": "MT-1_1", + "name": "process_total_loss_payment", + "arguments": {"claim_id":"MT-ZA-2024-00014"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent should request and verify all required documents before making total loss offer." + ] + }, + "annotations": null + }, + { + "id": "MT-2", + "description": { + "purpose": "Submit liability claim and provide details of third-party injury.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report accident causing injury to a third party, provide internal investigation details if requested, and ask insurer to process liability claim.", + "domain": "motor", + "reason_for_call": "Third-party injury occurred in accident.", + "known_info": "Claim type: Liability", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-2_0", + "name": "submit_claim", + "arguments": {"claim_id":"MT-UG-2024-00011"}, + "info": null + }, + {"action_id": "MT-2_1", + "name": "investigate_liability", + "arguments": {"claim_id":"MT-UG-2024-00011"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": ["Agent investigates liability and determines compensation based on report."] + }, + "annotations": null + }, + { + "id": "MT-3", + "description": { + "purpose": "Submit accidental damage claim with incomplete documents.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Submit claim form without police abstract and ask for repair authorization.", + "domain": "motor", + "reason_for_call": "Vehicle damaged, urgent repair requested.", + "known_info": "Claim type: Accidental Own Damage", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-3_0", + "name": "submit_claim", + "arguments": {"claim_type":"accidental_own","claim_id":"MT-TA-2024-00013"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent should request missing police abstract before approving repair.", + "Agent should also verify the documents presented before approving repair" + ] + }, + "annotations": null + }, + { + "id": "MT-4", + "description": { + "purpose": "Submit theft claim and follow up on investigator report.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Provide all documents for theft claim and ask insurer when investigator report will be ready to issue total loss offer.", + "domain": "motor", + "reason_for_call": "Want update on claim status.", + "known_info": "Claim type: Theft", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-4_0", + "name": "follow_up_investigator_report", + "arguments": {"claim_id":"MT-NI-2024-00016"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": ["Agent provides estimated timeline for investigator report and total loss offer."] + }, + "annotations": null + }, + { + "id": "MT-5", + "description": { + "purpose": "Submit liability claim for accident with fatality.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report accident causing fatal injury, provide deceased details, and request insurer to process liability claim for dependents.", + "domain": "motor", + "reason_for_call": "Third-party fatality in accident.", + "known_info": "Claim type: Liability", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-5_0", + "name": "submit_claim", + "arguments": {"claim_id":"MT-NI-2024-00001"}, + "info": null + }, + {"action_id": "MT-5_1", + "name": "investigate_liability_fatal", + "arguments": {"claim_id":"MT-NI-2024-00001"}, + "info": null} + ], + "communicate_info": [], + "nl_assertions": ["Agent investigates accident and calculates compensation for dependents."] + }, + "annotations": null + }, + { + "id": "MT-6", + "description": { + "purpose": "Issue vehicle release letter after verifying all required documents are submitted and verified.", + "relevant_policies": "Motor – Accidental Damage Section", + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Check that all mandatory documents for vehicle repair are received and verified, then issue the release letter to the policyholder.", + "domain": "motor", + "reason_for_call": "Policyholder requests vehicle release.", + "known_info": "Mandatory documents: claim form, repair estimate, police abstract if applicable.", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + { + "action_id": "MT-6_0", + "name": "verify_documents", + "arguments": {"claim_id": "MT-TA-2024-00003", "document_id": "police abstract"}, + "info": null + }, + { + "action_id": "MT-6_1", + "name": "verify_documents", + "arguments": {"claim_id": "MT-TA-2024-00003", "document_id": "claim form"}, + "info": null + }, + { + "action_id": "MT-6_2", + "name": "issue_release_letter", + "arguments": {"claim_id": "MT-TA-2024-00003"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies that all mandatory documents are received and verified.", + "Agent issues the vehicle release letter to the policyholder.", + "Agent clearly explains that the vehicle can now be collected." + ] + }, + "annotations": null + }, + { + "id": "MT-7", + "description": { + "purpose": "Liability claim for minor injuries and vehicle damage.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Report minor injury to third party and vehicle damage, submit all requested info to insurer for processing.", + "domain": "motor", + "reason_for_call": "Accident with minor injuries.", + "known_info": "Claim type: Liability", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-7_0", + "name": "submit_claim", + "arguments": {"claim_id":"MT-ZA-2024-00010"}, + "info": null + }, + {"action_id": "MT-7_1", + "name": "process_liability_minor", + "arguments": {"claim_id":"MT-ZA-2024-00010"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": ["Agent verifies minor injury details and compensates accordingly."] + }, + "annotations": null + }, + { + "id": "MT-8", + "description": { + "purpose": "Theft claim, ensure bank details submitted for payment over 1M.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Submit theft claim and provide bank details to insurer for amounts above 1 million KES.", + "domain": "motor", + "reason_for_call": "Total loss payment requires bank info.", + "known_info": "Claim type: Theft", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-8_0", + "name": "verify_documents", + "arguments": {"claim_id":"MT-KE-2024-00017"}, + "info": null + }, + {"action_id": "MT-8_1", + "name": "process_total_loss_payment", + "arguments": {"claim_id":"MT-KE-2024-00017"}, + "info": null + } + ], + "communicate_info": [], + "nl_assertions": ["Agent processes payment after verifying bank details."] + }, + "annotations": null + }, + { + "id": "MT-9", + "description": { + "purpose": "Accidental damage claim, client wants urgent repair with all documents submitted.", + "relevant_policies": null, + "notes": null + }, + "user_scenario": { + "persona": null, + "instructions": { + "task_instructions": "Submit all required documents for accidental damage and request urgent repair authorization from insurer.", + "domain": "motor", + "reason_for_call": "Vehicle urgently needs repair.", + "known_info": "Claim type: Accidental Own Damage", + "unknown_info": null + } + }, + "initial_state": null, + "evaluation_criteria": { + "actions": [ + {"action_id": "MT-9_0", + "name": "verify_documentss_and_authorize", + "arguments": {"claim_id":"MT-ET-2024-00002"}, + "info": null} + ], + "communicate_info": [], + "nl_assertions": ["Agent authorizes repair immediately after verifying all documents."] + }, + "annotations": null + }, + { + "id": "MED-0", + "description": { + "purpose": "Approve a fully documented outpatient reimbursement claim submitted within timeline.", + "relevant_policies": "Outpatient Reimbursement", + "notes": null + }, + "user_scenario": { + "instructions": { + "task_instructions": "Request reimbursement for outpatient treatment and provide all required documents.", + "domain": "medical", + "reason_for_call": "Outpatient reimbursement claim.", + "known_info": "Claim submitted within 30 days with complete documents.CLAIM ID MC-UG-2024-00002", + "unknown_info": null + } + }, + "initial_state": { + "claim_type": "outpatient" + }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED0_0", "name": "get_claim", "arguments": { "claim_id": "MC-UG-2024-00002" } }, + { "action_id": "MED0_1", "name": "check_submission_timeline", "arguments": { "days_since_treatment": 30 } }, + { "action_id": "MED0_2", "name": "verify_documents", "arguments": { "required_documents": ["claim_form", "receipts", "prescription", "bank_details"] } }, + { "action_id": "MED0_3", "name": "approve_claim", "arguments": { "claim_id": "MC-UG-2024-00002" } }, + { "action_id": "MED0_4", "name": "process_total_loss_payment", "arguments": { "method": "bank" } } + ], + "communicate_info": [], + "nl_assertions": ["Agent approves the outpatient claim and confirms payment processing."] + } + }, + { + "id": "MED-1", + "description": { + "purpose": "Request missing prescription for outpatient reimbursement.", + "relevant_policies": "Outpatient Reimbursement", + "notes": "Prescription missing" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit outpatient claim without doctor prescription.", + "domain": "medical", + "reason_for_call": "Outpatient reimbursement.", + "known_info": "Prescription not provided.CLAIM ID MC-KE-2024-00003", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "outpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED1_0", "name": "get_claims", "arguments": { "claim_id": "MC-KE-2024-00003" } }, + { "action_id": "MED1_1", "name": "verify_documents", "arguments": { "required_documents": ["claim_form", "receipts", "prescription", "bank_details"] } }, + { "action_id": "MED1_2", "name": "request_documents", "arguments": { "missing": ["prescription"] } } + ], + "communicate_info": [], + "nl_assertions": ["Agent places claim on awaiting documents status."] + } + }, + + { + "id": "MED-2", + "description": { + "purpose": "Reject outpatient claim submitted after 45 days.", + "relevant_policies": "Medical Claims Timeline", + "notes": "Time-barred" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit outpatient claim late.", + "domain": "medical", + "reason_for_call": "Late outpatient reimbursement.", + "known_info": "Claim submitted after 60 days.CLAIM ID MC-ZA-2024-00004", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "outpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED2_0", "name": "get_claims", "arguments": { "claim_id": "MC-ZA-2024-00004" } }, + { "action_id": "MED2_1", "name": "check_submission_timeline", "arguments": { "days_since_treatment": 60 } }, + { "action_id": "MED2_2", "name": "reject_claim", "arguments": { "reason": "Time barred" } } + ], + "communicate_info": [], + "nl_assertions": ["Agent rejects claim due to late submission."] + } + }, + + { + "id": "MED-3", + "description": { + "purpose": "Approve fully documented inpatient reimbursement claim.", + "relevant_policies": "Inpatient Reimbursement", + "notes": null + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit inpatient reimbursement with all documents and unverified identity.", + "domain": "medical", + "reason_for_call": "Inpatient claim reimbursement.", + "known_info": "Documents complete and within timeline. CLAIM ID MC-SO-2024-00005", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "inpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED3_0", "name": "get_claims", "arguments": { "claim_id": "MC-SO-2024-00005" } }, + { "action_id": "MED3_1", "name": "verify_documents", "arguments": { "required_documents": ["claim_form", "receipts", "discharge_summary", "bank_details"] } }, + { "action_id": "MED3_2", "name": "approve_claim", "arguments": { "claim_id": "MC-SO-2024-00005" } }, + { "action_id": "MED3_3", "name": "process_total_loss_payment", "arguments": { "method": "bank" } } + ], + "communicate_info": [], + "nl_assertions": [ + "Agent verifies the documents including identity documents", + "Agent approves inpatient claim and confirms settlement."] + } + }, + + { + "id": "MED-4", + "description": { + "purpose": "Request missing discharge summary for inpatient claim.", + "relevant_policies": "Inpatient Reimbursement", + "notes": "Missing discharge summary" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit inpatient claim without discharge summary.", + "domain": "medical", + "reason_for_call": "Inpatient reimbursement.", + "known_info": "Discharge summary missing. CLAIM ID MC-ET-2024-00006", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "inpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED4_0", "name": "get_claims", "arguments": { "claim_id": "MC-ET-2024-00006" } }, + { "action_id": "MED4_1", "name": "request_documents", "arguments": { "missing": ["discharge_summary"] } } + ], + "communicate_info": [], + "nl_assertions": ["Agent requests discharge summary before proceeding."] + } + }, + + { + "id": "MED-5", + "description": { + "purpose": "Approve last expense reimbursement claim.", + "relevant_policies": "Last Expense Reimbursement", + "notes": null + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit last expense reimbursement claim.", + "domain": "medical", + "reason_for_call": "Burial expense reimbursement.", + "known_info": "All beneficiary documents provided. CLAIM ID MC-TA-2024-0000", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "last_expense" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED5_0", "name": "get_claims", "arguments": { "claim_id": "MC-TA-2024-00007" } }, + { "action_id": "MED5_1", "name": "get_beneficiary_details", "arguments": {} }, + { "action_id": "MED5_2", "name": "verify_documents", "arguments": { "required_documents": ["death_certificate", "beneficiary_id", "bank_details"] } }, + { "action_id": "MED5_3", "name": "approve_claim", "arguments": { "claim_id": "MC-TA-2024-00007" } }, + { "action_id": "MED5_4", "name": "process_total_loss_payment", "arguments": { "method": "bank" } } + ], + "communicate_info": [], + "nl_assertions": ["Agent approves last expense claim."] + } + }, + + { + "id": "MED-6", + "description": { + "purpose": "Reject last expense claim missing death certificate.", + "relevant_policies": "Last Expense Reimbursement", + "notes": "Critical document missing" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit last expense claim without death certificate.", + "domain": "medical", + "reason_for_call": "Last expense reimbursement.", + "known_info": "Death certificate missing. CLAIM ID MC-NI-2024-00011", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "last_expense" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED6_0", "name": "get_claims", "arguments": { "claim_id": "MC-NI-2024-00011" } }, + { "action_id": "MED6_1", "name": "request_documents", "arguments": { "missing": ["death_certificate"] } } + ], + "communicate_info": [], + "nl_assertions": ["Agent requests death certificate before processing."] + } + }, + + { + "id": "MED-7", + "description": { + "purpose": "Reject inpatient claim submitted after policy has expired.", + "relevant_policies": "Medical Claims Timeline", + "notes": "Time barred inpatient claim" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit inpatient claim late.", + "domain": "medical", + "reason_for_call": "Inpatient reimbursement.", + "known_info": "Claim submitted. CLAIM ID MC-ET-2024-00012", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "inpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED7_0", "name": "check_policy_status", "arguments": { "claim_id": "MC-ET-2024-00012"} }, + { "action_id": "MED7_1", "name": "reject_claim", "arguments": { "reason": "Policy expired — no active cover at date of loss"} } + ], + "communicate_info": [], + "nl_assertions": ["Agent rejects inpatient claim due to policy have expired."] + } + }, + + { + "id": "MED-8", + "description": { + "purpose": "Detect incomplete bank details and request correction.", + "relevant_policies": "Payments", + "notes": null + }, + "user_scenario": { + "instructions": { + "task_instructions": "Submit medical claim with incomplete bank details.", + "domain": "medical", + "reason_for_call": "Medical reimbursement.", + "known_info": "Bank details incomplete. CLAIM ID MC-ZA-2024-00013", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "outpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED8_0", "name": "verify_documents", "arguments": { "required_documents": ["bank_details"], "claim_id":"MC-ZA-2024-00013"} }, + { "action_id": "MED8_1", "name": "request_documents", "arguments": { "missing": ["complete_bank_details"] } } + ], + "communicate_info": [], + "nl_assertions": ["Agent requests corrected bank details."] + } + }, + + { + "id": "MED-9", + "description": { + "purpose": "Ensure agent does not approve claim while documents are pending.", + "relevant_policies": "Document Handling", + "notes": "Pending documents" + }, + "user_scenario": { + "instructions": { + "task_instructions": "Ask agent to approve claim while documents are missing.", + "domain": "medical", + "reason_for_call": "Attempt premature approval.", + "known_info": "Documents incomplete. CLAIM ID MC-SO-2024-00018", + "unknown_info": null + } + }, + "initial_state": { "claim_type": "outpatient" }, + "evaluation_criteria": { + "actions": [ + { "action_id": "MED9_0", "name": "verify_documents", "arguments": { "claim_id":"MC-SO-2024-00018","required_documents": ["claim_form", "receipts", "prescription", "bank_details"] } } + ], + "communicate_info": [], + "nl_assertions": ["Agent refuses to approve claim until all documents are received."] + } + } + +] \ No newline at end of file diff --git a/src/tau2/domains/claims/README.md b/src/tau2/domains/claims/README.md new file mode 100644 index 00000000..7d77e492 --- /dev/null +++ b/src/tau2/domains/claims/README.md @@ -0,0 +1,92 @@ +# Claims Domain for TauBench + +## Overview + +This folder contains the **Claims Domain implementation** for **TauBench**, a benchmarking framework for multi-turn reasoning and tool usage in AI agents. + +The domain simulates a realistic **insurance claims workflow**, including: + +- Claim reporting, evaluation, and submission +- Document verification and handling +- Claim approval, rejection, and settlement +- Payment processing (total loss, minor liabilities, subrogation) +- Fraud detection and human escalation +- Recovery and subrogation management + +The domain is designed to benchmark AI Agents in a controlled, realistic insurance environment. + +--- + +## Features + +- **Claims Management Tools**: Fully implemented `ClaimsTools` toolkit with typed READ/WRITE tool actions. +- **Policy and Claim Validation**: Automatic checks for active policies, mandatory documents, and coverage limits. +- **Explicit User Confirmation**: All WRITE actions require explicit user confirmation to mimic safe operational procedures. +- **Fraud & Escalation Handling**: Supports automated fraud detection, human transfers, and recovery actions. +- **Audit Trail**: Maintains a detailed timeline of claim events, status changes, payments, and recoveries. + +--- + +## Domain Objects + +### Users +- Policyholders, beneficiaries, third-party claimants +- Attributes: user ID, full name, email, addresses, date of birth, policy numbers, payment methods + +### Insurance Policies +- Attributes: policy ID, type (motor, property, health, life, travel), effective/expiry dates, sum insured, premium, status + +### Claims +- Attributes: claim ID, policy ID, claimant info, type of loss, cover type, dates, status, loss and coverage details, payments, documents, timeline, assignments, audit trail, fraud assessment, subrogation/recovery info + +--- + +## Workflow + +### Report a Claim +1. Validate that the policy exists and is active +2. Collect mandatory claim details (user ID, policy ID, type, date of loss, supporting documents) +3. Request missing documents via `request_documents` (WRITE tool, with confirmation) +4. Submit claim for review using `submit_claim` + +### Evaluate a Claim +- Verify coverage against policy terms +- Check documents via `list_claim_documents` and `verify_documents` +- Confirm claimant identity and third-party authorizations +- Update claim status with `review_claim` + +### Approve / Reject a Claim +- Approve if all mandatory documents are verified and claim is within coverage +- Reject if documents are missing, coverage is invalid, or fraud is suspected +- Use appropriate WRITE tools (`approve_claim`, `approve_partial_reimbursement`, `reject_claim`) with explicit confirmation +- Rejections may trigger human review via `transfer_to_human_agents` + +### Payments / Settlements +- Process total loss payments (`process_total_loss_payment`) or minor liabilities (`process_liability_minor`) +- Payments follow coverage, deductibles, and policy limits +- Update claim payment history automatically + +### Fraud & Recovery +- Escalate suspicious claims using `escalate_claim` +- Identify subrogation opportunities with `identify_subrogation` +- Initiate recoveries via `initiate_recovery` and track with `update_recovery_status` + +--- + +## Tool Usage Policy + +- **One tool per response:** Agents may invoke only one tool per interaction +- **Explicit confirmation required:** All WRITE operations must be confirmed by the user +- **Read vs Write:** READ tools may be called without confirmation +- **Human escalation:** Requests outside tool scope must be transferred via `transfer_to_human_agents` + +--- + +## Data Model +The domain structure and database storage follows similar implementation as the rest of the other domains but with complex tasks. + + +# Run Simulations/Evaluations + +-Run this first + `$env:TAU2_STRICT_REPLAY = "1"` diff --git a/src/tau2/domains/claims/__init__.py b/src/tau2/domains/claims/__init__.py new file mode 100644 index 00000000..e69de29b diff --git a/src/tau2/domains/claims/data_model.py b/src/tau2/domains/claims/data_model.py new file mode 100644 index 00000000..a0991692 --- /dev/null +++ b/src/tau2/domains/claims/data_model.py @@ -0,0 +1,230 @@ +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..'))) + +from typing import Annotated, Any, Dict, List, Literal, Optional, Union +from pydantic import BaseModel, Field +from tau2.environment.db import DB +from tau2.domains.claims.utils import CLAIMS_DB_PATH +from pydantic import RootModel + + +InsuranceType = Literal[ + "motor", "health_outpatient", "health_inpatient", "health_last_expense", + "property", "travel", "life" +] + +PolicyStatus = Literal["active", "lapsed", "expired", "cancelled"] + +ClaimStatus = Literal[ + "new","under_review","awaiting_documents","approved","reviewed", + "rejected","partially_settled","settled","closed" +] + +FraudFlag = Literal["none","suspected","confirmed"] + +ClaimantRole = Literal["policyholder","beneficiary","third_party"] + +PaymentType = Literal["credit_card","bank_transfer","mobile_money","cheque"] + +DocumentType = Literal[ + "claim_form","medical_report","police_report","invoice","death_certificate", + "repair_estimate","identity_proof","fire_report","doctor_signed_form","repair_quotes", + "other" +] + +AssignmentRole = Literal["Junior Claims Analyst","Senior Claims Analyst","Loss Assessor","Medical Assessor"] + +AssignmentTeam = Literal["Motor Team","Health Team","Life Team","Property Team","Travel Team","Recoveries","General Claims Team"] + +RecoveryStatus = Literal["not_applicable", "identified", "in_progress","recovered","unrecoverable"] + + +class Name(BaseModel): + first_name: str + last_name: str + +class Address(BaseModel): + line1: str + line2: Optional[str] = None + city: str + state: str + country: str + postal_code: str + +class IdentityDocument(BaseModel): + doc_type: Literal["national_id","passport","driving_license", "birth_certificate"] + doc_number: str + verified: bool + +class PaymentMethod(BaseModel): + method_id: str + method_type: PaymentType + masked_reference: str + verified: bool + +class ClaimPayment(BaseModel): + payment_id: str + amount: float + currency: str + payment_date: str + payment_method: PaymentType + recipient_name: str + reason: str + +class Coverage(BaseModel): + coverage_name: str + sum_insured: float + deductible: Optional[float] + limit_per_event: Optional[float] + +class Policy(BaseModel): + policy_id: str + insurance_type: InsuranceType + policyholder_name: Name + policyholder_dob: str + policyholder_address: Address + policyholder_contact: str + effective_date: str + expiry_date: str + status: PolicyStatus + premium_amount: float + currency: str + payment_methods: List[PaymentMethod] + coverages: List[Coverage] + +class Claimant(BaseModel): + role: ClaimantRole + name: Name + dob: Optional[str] + address: Address + contact: str + identity_documents: List[IdentityDocument] + relationship_to_policyholder: Optional[str] + +class LossDetails(BaseModel): + date_of_loss: str + cause_of_loss: str + description: str + location: str + estimated_loss_amount: float + currency: str + +class ClaimDocument(BaseModel): + document_id: str + document_type: DocumentType + real_document_type: Optional[str] = None + received: bool + verified: bool + notes: Optional[str] + +class FraudAssessment(BaseModel): + fraud_flag: FraudFlag + indicators: List[str] + notes: Optional[str] + +class BeneficiaryDispute(BaseModel): + dispute_exists: bool + disputed_by: Optional[str] + reason: Optional[str] + status: Optional[Literal["open","resolved"]] + +class AssignmentDetails(BaseModel): + handler_team: AssignmentTeam + claims_adjuster: Name + adjuster_role: AssignmentRole + assessor: Name + assessor_role: AssignmentRole + assigned_date: str + + +class Assignments(BaseModel): + taken_to_human_agent: bool + current_assignment: Optional[AssignmentDetails] = None + assignment_history: List[AssignmentDetails] = Field(default_factory=list) + +class Recovery(BaseModel): + recovery_id: str + third_party_name: str + recovery_amount: float + currency: str + status: RecoveryStatus + initiated_date: str + recovered_date: Optional[str] + notes: Optional[str] + +class Claim(BaseModel): + claim_id: str + policy: Policy + claimant: Claimant + additional_claimants: Optional[List[Claimant]] = None + loss_details: LossDetails + claim_status: ClaimStatus + reported_date: str + documents: List[ClaimDocument] + fraud_assessment: FraudAssessment + beneficiary_dispute: Optional[BeneficiaryDispute] + payments: List[ClaimPayment] + subrogation_possible: bool + subrogation_notes: Optional[str] + audit_trail: Dict[str,str] + assignments: Optional[Assignments] + # recoveries: Optional[List[Recovery]] = [] + recoveries: List[Recovery] = Field(default_factory=list) + + +# class InsuranceClaimsDB(DB): +# claims: Dict[str, Claim] + +# def get_statistics(self) -> Dict[str, Any]: +# return { +# "num_claims": len(self.claims), +# "by_status": { +# status: sum(1 for c in self.claims.values() if c.claim_status == status) +# for status in [ +# "new", +# "under_review", +# "approved", +# "rejected", +# "settled", +# "closed", +# ] +# }, +# "fraud_cases": sum( +# 1 for c in self.claims.values() +# if c.fraud_assessment.fraud_flag != "none" +# ), +# "third_party_claims": sum( +# 1 for c in self.claims.values() +# if c.claimant.role == "third_party" +# ), +# } + + +class InsuranceClaimsDB(RootModel[Dict[str, Claim]]): + # property for Tau2 compatibility + @property + def claims(self) -> Dict[str, Claim]: + return self.root + + def get_statistics(self) -> Dict[str, Any]: + claims = self.root # still use root internally + return { + "num_claims": len(claims), + "by_status": { + status: sum(1 for c in claims.values() if c.claim_status == status) + for status in ["new", "under_review", "approved", "rejected", "settled", "closed"] + }, + "fraud_cases": sum(1 for c in claims.values() if c.fraud_assessment.fraud_flag != "none"), + "third_party_claims": sum(1 for c in claims.values() if c.claimant.role == "third_party"), + } + + +def get_db(db_path: str): + return InsuranceClaimsDB.model_validate_json(open(db_path, "r", encoding="utf-8").read()) + +if __name__ == "__main__": + db = get_db(CLAIMS_DB_PATH) + print(db.get_statistics()) + diff --git a/src/tau2/domains/claims/environment.py b/src/tau2/domains/claims/environment.py new file mode 100644 index 00000000..03d9e006 --- /dev/null +++ b/src/tau2/domains/claims/environment.py @@ -0,0 +1,56 @@ +# Copyright Sierra +from pathlib import Path +from typing import Optional +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..'))) + +from tau2.data_model.tasks import Task +from tau2.domains.claims.data_model import InsuranceClaimsDB +from tau2.domains.claims.tools import ClaimsTools +from tau2.domains.claims.utils import ( + CLAIMS_DB_PATH, + TASK_SET_PATH, + POLICY_PATH, +) +from tau2.environment.environment import Environment +from tau2.utils import load_file + + +def get_environment( + db: Optional[InsuranceClaimsDB] = None, + solo_mode: bool = False, +) -> Environment: + if solo_mode: + raise ValueError("Claims domain does not support solo mode") + if db is None: + db = InsuranceClaimsDB.model_validate_json(open(CLAIMS_DB_PATH, "r", encoding="utf-8").read()) + tools = ClaimsTools(db) + with open(POLICY_PATH, "r", encoding="utf-8") as fp: + policy = fp.read() + return Environment( + domain_name="claims", + policy=policy, + tools=tools, + ) + +def get_tasks(task_split_name: Optional[str] = "base") -> list[Task]: + tasks = load_file(TASK_SET_PATH) + tasks = [Task.model_validate(task) for task in tasks] + if task_split_name is None: + return tasks + task_splits = get_tasks_split() + if task_split_name not in task_splits: + raise ValueError( + f"Invalid task split name: {task_split_name}. Valid splits are: {task_splits.keys()}" + ) + return [task for task in tasks if task.id in task_splits[task_split_name]] + + +def get_tasks_split() -> dict[str, list[str]]: + split_file = ( + Path(TASK_SET_PATH).parent + / f"split_{Path(TASK_SET_PATH).stem}.json" + ) + return load_file(split_file) diff --git a/src/tau2/domains/claims/test.py b/src/tau2/domains/claims/test.py new file mode 100644 index 00000000..071d6ccd --- /dev/null +++ b/src/tau2/domains/claims/test.py @@ -0,0 +1,295 @@ +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..'))) + +import json +from pathlib import Path +from typing import List + +from tau2.domains.claims.data_model import ( + Name, Address, IdentityDocument, PaymentMethod, ClaimPayment, + LossDetails, ClaimDocument, FraudAssessment, BeneficiaryDispute, + AssignmentDetails, Assignments, Claim, Policy,Claimant +) + +# Input & output files +input_file = "R:/Reading Materials/MOOC LLMs Fall 2025/db_v1.json" +output_file = "claims_pydantic.json" + + +# Load JSON data +with open(input_file, "r", encoding="utf-8") as f: + raw_data = json.load(f) + +claims_list: List[Claim] = [] + +for claim_id, c in raw_data.items(): + # ----------------------------- + # Policyholder + # ----------------------------- + ph = c.get("policyholder", {}) + ph_name_data = ph.get("name", {}) + first_name = ph_name_data.get("first_name") or "" # if None, use empty string + last_name = ph_name_data.get("last_name") or "" # if None, use empty string + ph_name = Name(first_name=first_name, last_name=last_name) + + ph_addr = Address(**ph.get("address", { + "line1": "", "city": "", "state": "", "country": "", "postal_code": "" + })) + + payment_methods = [ + PaymentMethod(**pm) for pm in ph.get("payment_methods", []) + ] + policyholder_dob = ph.get("dob") or "" # default to empty string if None + policy_obj = Policy( + policy_id=c.get("claim_id"), # using claim_id as policy_id if missing + insurance_type=c.get("insurance_type", "property"), + policyholder_name=ph_name, + policyholder_dob=policyholder_dob, + policyholder_address=ph_addr, + policyholder_contact=ph.get("contact", ""), + effective_date=ph.get("effective_date", "2024-01-01"), + expiry_date=ph.get("expiry_date", "2025-01-01"), + status=ph.get("policy_status", "active"), + premium_amount=ph.get("premium_amount", 0.0), + currency=ph.get("currency", "USD"), + payment_methods=payment_methods, + coverages=[] # add if you have coverage info + ) + + # ----------------------------- + # Claimant + # ----------------------------- + + cl = c.get("claimant", {}) + cl_name = Name(**cl.get("name", {"first_name": "", "last_name": ""})) + cl_addr = Address(**cl.get("address", { + "line1": "", "city": "", "state": "", "country": "", "postal_code": "" + })) + + identity_docs = [ + IdentityDocument(**doc) for doc in cl.get("identity_documents", []) + ] + + claimant_obj = Claimant( + role=cl.get("role", "policyholder"), + name=cl_name, + dob=cl.get("dob"), + address=cl_addr, + contact=cl.get("contact", ""), + identity_documents=identity_docs, + relationship_to_policyholder=cl.get("relationship_to_policyholder") + ) + + # ----------------------------- + # Additional claimants + # ----------------------------- + add_claimants = [] + for ac in c.get("additional_claimants", []): + ac_name = Name(**ac.get("name", {"first_name": "", "last_name": ""})) + ac_addr = Address(**ac.get("address", { + "line1": "", "city": "", "state": "", "country": "", "postal_code": "" + })) + ac_docs = [IdentityDocument(**doc) for doc in ac.get("identity_documents", [])] + add_claimants.append( + Claimant( + role=ac.get("role", "third_party"), + name=ac_name, + dob=ac.get("dob"), + address=ac_addr, + contact=ac.get("contact", ""), + identity_documents=ac_docs, + relationship_to_policyholder=ac.get("relationship_to_policyholder") + ) + ) + + # ----------------------------- + # Loss details + # ----------------------------- + loss_obj = LossDetails(**c.get("loss_details", { + "date_of_loss": "2024-01-01", + "cause_of_loss": "unknown", + "description": "No description", + "location": "unknown", + "estimated_loss_amount": 0.0, + "currency": "USD" + })) + + # ----------------------------- + # Fraud assessment + # ----------------------------- + fraud_data = c.get("fraud_assessment", {}) + + fraud_flag_raw = fraud_data.get("fraud_flag", "none") + # Map invalid or null values to 'none' + if fraud_flag_raw not in {"none", "suspected", "confirmed"}: + fraud_flag = "none" + else: + fraud_flag = fraud_flag_raw + + # Ensure indicators is a list + indicators = fraud_data.get("indicators") or [] + + notes = fraud_data.get("notes") # can be None + + fraud_obj = FraudAssessment( + fraud_flag=fraud_flag, + indicators=indicators, + notes=notes + ) + + +# ----------------------------- +# Documents +# ----------------------------- + allowed_doc_types = { + "claim_form","medical_report","police_report","invoice","death_certificate", + "repair_estimate","repair_quotes","identity_proof","fire_report","doctor_signed_form","other" + } + + documents = [] + for doc in c.get("documents", []): + doc_type = doc.get("document_type", "other") + + if doc_type not in allowed_doc_types: + mapped_type = "other" + else: + mapped_type = doc_type + + documents.append( + ClaimDocument( + document_id=doc.get("document_id", ""), + document_type=mapped_type, + real_document_type=doc_type, # keep the real type + received=doc.get("received", False), + verified=doc.get("verified", False), + notes=doc.get("notes") + ) + ) + + # ----------------------------- + # Payments + # ----------------------------- + payments = [ClaimPayment(**p) for p in c.get("payments", [])] + + # ----------------------------- + # Assignments (optional) + # ----------------------------- + from tau2.domains.claims.data_model import AssignmentDetails, Assignments, Name, AssignmentRole, AssignmentTeam + + def parse_assignments(assgn: dict) -> Assignments: + if not assgn: + return Assignments( + taken_to_human_agent=False, + current_assignment=None, + assignment_history=[] + ) + + taken_to_human_agent = assgn.get("taken_to_human_agent", False) + + # 🔑 unwrap the inner assignments object + current = assgn.get("assignments") + if not current: + return Assignments( + taken_to_human_agent=taken_to_human_agent, + current_assignment=None, + assignment_history=[] + ) + + # Handler team + handler_team = current.get("handler_team", "General Claims Team") + if handler_team not in AssignmentTeam.__args__: + handler_team = "General Claims Team" + + # Claims adjuster + ca = current.get("claims_adjuster", {}) + ca_name_str = ca.get("name", "") + ca_role = ca.get("role", "Junior Claims Analyst") + + ca_first, ca_last = (ca_name_str.strip().split(" ", 1) + [""])[:2] + claims_adjuster = Name(first_name=ca_first, last_name=ca_last) + + if ca_role not in AssignmentRole.__args__: + ca_role = "Junior Claims Analyst" + + # Assessor + asg = current.get("assessor", {}) + as_name_str = asg.get("name", "") + as_role = asg.get("role", "Loss Assessor") + + as_first, as_last = (as_name_str.strip().split(" ", 1) + [""])[:2] + assessor = Name(first_name=as_first, last_name=as_last) + + if as_role not in AssignmentRole.__args__: + as_role = "Loss Assessor" + + # Assigned date + assigned_date = current.get("assigned_date", "") + + current_assignment = AssignmentDetails( + handler_team=handler_team, + claims_adjuster=claims_adjuster, + adjuster_role=ca_role, + assessor=assessor, + assessor_role=as_role, + assigned_date=assigned_date + ) + + return Assignments( + taken_to_human_agent=taken_to_human_agent, + current_assignment=current_assignment, + assignment_history=[] + ) + + # ----------------------------- + # Build Claim object + # ----------------------------- + # Get claim_status, strip whitespace, fallback to 'new' if empty + claim_status = (c.get("claim_status") or "").strip() + if not claim_status: + claim_status = "new" + + + + audit_trail = c.get("audit_trail") or {} + + claim_obj = Claim( + claim_id=claim_id, + policy=policy_obj, + claimant=claimant_obj, + additional_claimants=add_claimants if add_claimants else None, + loss_details=loss_obj, + claim_status=claim_status, + reported_date=c.get("reported_date", "2024-01-01"), + documents=documents, + fraud_assessment=fraud_obj, + beneficiary_dispute=None, + payments=payments, + subrogation_possible=c.get("subrogation_possible", False), + subrogation_notes=c.get("subrogation_notes"), + audit_trail=audit_trail, + assignments=parse_assignments(c.get("assignments", {})), + recoveries=[] + ) + + + claims_list.append(claim_obj) + +# Optional: print summary +print(f"Loaded {len(claims_list)} claims successfully.") + +# claims_dict = { +# claim.claim_id: {k: v for k, v in claim.model_dump().items() if k != "claim_id"} +# for claim in claims_list +# } + +claims_dict = { + claim.claim_id: claim.model_dump() # keep claim_id inside + for claim in claims_list +} + +with open(output_file, "w", encoding="utf-8") as f: + json.dump(claims_dict, f, ensure_ascii=False, indent=4) + +print(f"Saved {len(claims_dict)} claims to {output_file}") diff --git a/src/tau2/domains/claims/tools.py b/src/tau2/domains/claims/tools.py new file mode 100644 index 00000000..91eca21e --- /dev/null +++ b/src/tau2/domains/claims/tools.py @@ -0,0 +1,771 @@ +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..'))) + +from typing import Any, Dict, List, Optional, Literal +from loguru import logger +from datetime import datetime +from datetime import datetime +from tau2.environment.toolkit import ToolKitBase, ToolType, is_tool +from tau2.domains.claims.data_model import ( + Claim, + ClaimDocument, + ClaimPayment, + ClaimStatus, + FraudAssessment, + InsuranceClaimsDB, + Recovery, + Assignments, + AssignmentDetails, + Name +) + + +class ClaimsTools(ToolKitBase): + db: InsuranceClaimsDB + + def __init__(self, db: InsuranceClaimsDB): + super().__init__(db) + + #helper functions + def _now(self) -> str: + return datetime.now().isoformat() + + def _get_claim(self, claim_id: str) -> Claim: + if claim_id not in self.db.claims: + raise ValueError(f"Claim {claim_id} not found") + return self.db.claims[claim_id] + + def _get_document(self, claim: Claim, document_id: str) -> ClaimDocument: + for d in claim.documents: + if d.document_id == document_id: + return d + raise ValueError(f"Document {document_id} not found") + + def _log(self, claim: Claim, message: str) -> None: + # if os.getenv("TAU2_STRICT_REPLAY", "0") == "1": + return + # claim.audit_trail[self._now()] = message + + def _validate_transition( + self, old: ClaimStatus, new: ClaimStatus + ) -> None: + invalid = { + "closed": {"new", "under_review", "awaiting_documents"}, + "rejected": {"approved", "settled", "partially_settled"}, + } + if old in invalid and new in invalid[old]: + raise ValueError(f"Invalid transition {old} → {new}") + + + #claims creation and submission + + @is_tool(ToolType.WRITE) + def create_claim(self, claim) -> Claim: + # If a dict is passed, convert it to a Claim object + if isinstance(claim, dict): + claim = Claim(**claim) + + if claim.claim_id in self.db.claims: + raise ValueError("Claim already exists") + + claim.claim_status = "new" + claim.audit_trail[self._now()] = "Claim created" + claim.payments = [] + claim.recoveries = [] + + self.db.claims[claim.claim_id] = claim + return claim + + + @is_tool(ToolType.WRITE) + def submit_claim(self, claim_id: str) -> Claim: + """ + Submit a created claim for review. + """ + claim = self._get_claim(claim_id) + # self._validate_transition(claim.claim_status, "under_review") + # claim.claim_status = "under_review" + if claim.claim_status != "new": + raise ValueError("Only NEW claims can be submitted") + self._log(claim, "Claim submitted") + # claim.audit_trail[self._now()] = "Claim submitted" + return claim + + # document management and handling + + #List all claims document presented by the claim + @is_tool(ToolType.READ) + def list_claim_documents(self, claim_id: str) -> List[ClaimDocument]: + return self._get_claim(claim_id).documents + + #request missing mandatory documents + @is_tool(ToolType.WRITE) + def request_documents( + self, + claim_id: str, + document_types: List[str], + note: Optional[str] = None, + ) -> Claim: + claim = self._get_claim(claim_id) + + if claim.claim_status not in {"new", "under_review","awaiting_documents"}: + raise ValueError( + f"Cannot request documents when claim is {claim.claim_status}" + ) + + for dt in document_types: + claim.documents.append( + ClaimDocument( + document_id=f"DOC_{len(claim.documents)+1}", + document_type=dt, + received=False, + verified=False, + notes=note, + ) + ) + + claim.claim_status = "awaiting_documents" + self._log(claim, f"Documents requested → awaiting_documents: {document_types}") + return claim + + # verify documents if they are accurate and authentic + @is_tool(ToolType.WRITE) + def verify_documents( + self, + claim_id: str, + document_ids: Optional[List[str]] = None, + verified: bool = True, + notes: Optional[str] = None, + ) -> Claim: + claim = self._get_claim(claim_id) + docs_to_verify = ( + [self._get_document(claim, doc_id) for doc_id in document_ids] + if document_ids + else claim.documents + ) + + for doc in docs_to_verify: + if not doc.received: + raise ValueError(f"Document {doc.document_id} not received") + doc.verified = verified + doc.notes = notes or f"Verified via verify_documents" + + self._log(claim, f"Documents verified: {[d.document_id for d in docs_to_verify]} → {verified}") + mandatory_docs = [ + d for d in claim.documents if d.document_type not in {"optional", "supporting"} + ] + all_verified = all(d.received and d.verified for d in mandatory_docs) + # if all_verified and claim.claim_status in {"awaiting_documents", "under_review"}: + # if os.getenv("TAU2_STRICT_REPLAY", "0") != "1": + # claim = self.approve_claim(claim_id, "All mandatory documents verified") + # # claim = self.approve_claim(claim_id, "All mandatory documents verified") + + return claim + + #claims status + @is_tool(ToolType.WRITE) + + def review_claim(self, claim_id: str, notes: str) -> Claim: + claim = self._get_claim(claim_id) + strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + + if strict and claim.claim_status == "under_review": + self._log(claim, f"[STRICT REPLAY] Review requested: {notes}") + return claim + + self._validate_transition(claim.claim_status, "under_review") + claim.claim_status = "under_review" + self._log(claim, f"Claim reviewed: {notes}") + return claim + + + + @is_tool(ToolType.WRITE) + def approve_claim(self, claim_id: str, notes: str) -> Claim: + return self._set_status(claim_id, "approved", notes) + + @is_tool(ToolType.WRITE) + def approve_partial_reimbursement( + self, claim_id: str, notes: str + ) -> Claim: + return self._set_status(claim_id, "partially_settled", notes) + + @is_tool(ToolType.WRITE) + def settle_claim(self, claim_id: str, notes: str) -> Claim: + claim = self._get_claim(claim_id) + strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + + if strict: + return claim + + self._validate_transition(claim.claim_status, "settled") + + if not claim.payments: + raise ValueError("Cannot settle claim without payments") + + claim.claim_status = "settled" + self._log(claim, f"Claim settled: {notes}") + try: + self.close_claim(claim_id, "Automatically closed after settlement") + except ValueError: + pass + + return claim + + + @is_tool(ToolType.WRITE) + def reject_claim(self, claim_id: str, reason: str) -> Claim: + """ + Reject a claim and assign it to a human agent for final decision. + """ + claim = self._set_status(claim_id, "rejected", reason) + + # Automatically assign to human for review + self._assign_human( + claim=claim, + team="Claims Review Team", + role="Senior Claims Analyst", + notes=f"Rejected claim requires human review: {reason}" + ) + + return claim + + + # @is_tool(ToolType.WRITE) + # def reject_claim(self, claim_id: str, reason: str) -> Claim: + # return self._set_status(claim_id, "rejected", reason) + + def _set_status( + self, claim_id: str, status: ClaimStatus, reason: str + ) -> Claim: + claim = self._get_claim(claim_id) + self._validate_transition(claim.claim_status, status) + claim.claim_status = status + self._log(claim, f"Status → {status}: {reason}") + return claim + + + # # escalation and human review + # def _assign_human(self, claim: Claim, team: str, role: str, notes: str): + # adjuster_name = Name(first_name="John", last_name="Marua") + # assessor_name = Name(first_name="Jessica", last_name="Walter") + + # strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + + # existing = False + # if claim.assignments is not None: + # for a in claim.assignments.assignment_history: + # if a.handler_team == team and a.adjuster_role == role: + # existing = True + # break + + # if not existing: + # curr = claim.assignments.current_assignment + # if curr is not None and curr.handler_team == team and curr.adjuster_role == role: + # existing = True + + # if strict and existing: + # claim.assignments.taken_to_human_agent = True + # return + + # # Normal (non‑strict) behaviour: create/update assignment with current time + # now = self._now() + # assignment_entry = AssignmentDetails( + # handler_team=team, + # claims_adjuster=adjuster_name, + # adjuster_role=role, + # assessor=assessor_name, + # assessor_role=role, + # assigned_date=now, + # ) + + # if claim.assignments is None: + # claim.assignments = Assignments( + # taken_to_human_agent=True, + # current_assignment=assignment_entry, + # assignment_history=[assignment_entry], + # ) + # else: + # claim.assignments.taken_to_human_agent = True + # claim.assignments.assignment_history.append(assignment_entry) + # claim.assignments.current_assignment = assignment_entry + + # self._log( + # claim, + # f"Assigned to human handler team '{team}' with role '{role}'. Notes: {notes}", + # ) + + def _assign_human(self, claim: Claim, team: str, role: str, notes: str): + adjuster_name = Name(first_name="John", last_name="Marua") + assessor_name = Name(first_name="Jessica", last_name="Walter") + + strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + + existing = False + if claim.assignments is not None: + for a in claim.assignments.assignment_history: + if a.handler_team == team and a.adjuster_role == role: + existing = True + break + + # current + if not existing: + curr = claim.assignments.current_assignment + if curr is not None and curr.handler_team == team and curr.adjuster_role == role: + existing = True + + if strict: + if existing: + claim.assignments.taken_to_human_agent = True + return + if claim.assignments is None or not claim.assignments.taken_to_human_agent: + return + + # Normal (non‑strict) behaviour + now = self._now() + assignment_entry = AssignmentDetails( + handler_team=team, + claims_adjuster=adjuster_name, + adjuster_role=role, + assessor=assessor_name, + assessor_role=role, + assigned_date=now, + ) + + if claim.assignments is None: + claim.assignments = Assignments( + taken_to_human_agent=True, + current_assignment=assignment_entry, + assignment_history=[assignment_entry], + ) + else: + claim.assignments.taken_to_human_agent = True + claim.assignments.assignment_history.append(assignment_entry) + claim.assignments.current_assignment = assignment_entry + + self._log( + claim, + f"Assigned to human handler team '{team}' with role '{role}'. Notes: {notes}", + ) + + @is_tool(ToolType.WRITE) + def escalate_claim( + self, + claim_id: str, + indicators: List[str], + notes: Optional[str] = None, + ) -> Claim: + claim = self._get_claim(claim_id) + + # Avoid duplicate fraud escalation + if claim.claim_status == "under_review" and claim.fraud_assessment: + # Optional: merge indicators + claim.fraud_assessment.indicators = list(set(claim.fraud_assessment.indicators + indicators)) + if notes: + claim.fraud_assessment.notes = (claim.fraud_assessment.notes or "") + " | " + notes + return claim + + claim.fraud_assessment = FraudAssessment( + fraud_flag="suspected", + indicators=indicators, + notes=notes, + ) + + self._assign_human( + claim=claim, + team="General Claims Team", + role="Loss Assessor", + notes="Fraud indicators detected – investigation required", + ) + + claim.claim_status = "under_review" + return claim + + + @is_tool(ToolType.WRITE) + def follow_up_investigator_report( + self, + claim_id: str, + findings: str, + recommendation: Literal["approve", "reject", "recover"], + ) -> Claim: + claim = self._get_claim(claim_id) + self._log(claim, f"Investigator findings: {findings} | Recommendation: {recommendation}") + + return claim + + + @is_tool(ToolType.WRITE) + def issue_release_letter(self, claim_id: str, notes: str) -> Claim: + claim = self._get_claim(claim_id) + claim.audit_trail[self._now()] = f"Release letter issued: {notes}" + return claim + + + @is_tool(ToolType.WRITE) + def process_total_loss_payment( + self, claim_id: str, amount: float, currency: str, reason: str + ) -> Claim: + strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + + if strict: + claim = self._get_claim(claim_id) + return claim + + claim = self._make_payment( + claim_id=claim_id, + amount=amount, + currency=currency, + method="bank_transfer", + reason=f"Total loss: {reason}", + ) + + return self.settle_claim( + claim_id=claim_id, + notes="Total loss payment completed", + ) + + @is_tool(ToolType.WRITE) + def process_liability_minor( + self, claim_id: str, amount: float, currency: str, reason: str + ) -> Claim: + claim = self._make_payment( + claim_id=claim_id, + amount=amount, + currency=currency, + method="mobile_money", + reason=f"Minor liability: {reason}", + ) + + # Only settle if no further payments are expected + if claim.claim_status == "approved": + return self.settle_claim( + claim_id=claim_id, + notes="Minor liability payment completed" + ) + + return claim + + + def _make_payment( + self, + claim_id: str, + amount: float, + currency: str, + method: str, + reason: str, + ) -> Claim: + claim = self._get_claim(claim_id) + + if claim.claim_status not in {"approved", "partially_settled"}: + raise ValueError("Payment not allowed") + + payment = ClaimPayment( + payment_id=f"PAY_{len(claim.payments)+1}", + amount=amount, + currency=currency, + payment_date=self._now(), + payment_method=method, + recipient_name=f"{claim.claimant.name.first_name} {claim.claimant.name.last_name}", + reason=reason, + ) + + claim.payments.append(payment) + self._log(claim, f"Payment processed: {amount}") + return claim + + + @is_tool(ToolType.WRITE) + def identify_subrogation(self, claim_id: str, notes: Optional[str] = None) -> Claim: + claim = self._get_claim(claim_id) + + if not claim.payments: + raise ValueError("Subrogation requires payment") + + claim.subrogation_possible = True + claim.subrogation_notes = notes + self._log(claim, f"Subrogation identified") + return claim + + @is_tool(ToolType.WRITE) + def initiate_recovery( + self, + claim_id: str, + third_party_name: str, + recovery_amount: float, + currency: str, + notes: Optional[str] = None, + ) -> Claim: + claim = self._get_claim(claim_id) + + if not claim.subrogation_possible: + raise ValueError("Subrogation not identified") + + self._assign_human( + claim=claim, + team="Recoveries", + role="Senior Claims Analyst", + notes="Recovery initiated", + ) + + recovery = Recovery( + recovery_id=f"RCV_{len(claim.recoveries)+1}", + third_party_name=third_party_name, + recovery_amount=recovery_amount, + currency=currency, + status="in_progress", + initiated_date=self._now(), + recovered_date=None, + notes=notes, + ) + + claim.recoveries.append(recovery) + return claim + + @is_tool(ToolType.WRITE) + def update_recovery_status( + self, + claim_id: str, + recovery_id: str, + status: Literal["recovered", "unrecoverable"], + notes: Optional[str] = None, + ) -> Claim: + claim = self._get_claim(claim_id) + + recovery = next(r for r in claim.recoveries if r.recovery_id == recovery_id) + recovery.status = status + recovery.recovered_date = self._now() + recovery.notes = notes + + self._log(claim, f"Recovery {recovery_id} → {status}") + return claim + + @is_tool(ToolType.WRITE) + def transfer_to_human_agents( + self, + claim_id: str, + team: str, + role: str, + reason: str, + ) -> Claim: + claim = self._get_claim(claim_id) + + self._assign_human( + claim=claim, + team=team, + role=role, + notes=reason, + ) + + return claim + + @is_tool(ToolType.READ) + def check_policy_status(self, claim_id: str) -> Dict: + """ + Check policy status + """ + claim = self._get_claim(claim_id) + policy = claim.policy + status = policy.status + + is_active = status == "active" + result = { + "policy_status": status, + "is_covered": is_active, + "notes": None, + } + + if not is_active: + result["notes"] = f"Policy status is '{status}'" + strict = os.getenv("TAU2_STRICT_REPLAY", "0") == "1" + if not strict: + claim.audit_trail[self._now()] = f"Policy status checked → {status}" + + return result + + + + @is_tool(ToolType.READ) + def check_submission_timeline( + self, + claim_id: str, + reference_date: str, + allowed_days: int, + audit_trail: Dict[str, str] + ) -> Dict[str, Any]: + """ + Checks whether a claim was submitted within the allowed timeline + using the audit trail. + """ + submission_timestamp = None + submission_event = None + for timestamp, event in sorted(audit_trail.items()): + if event == "Claim created": + submission_timestamp = timestamp + submission_event = event + break + if not submission_timestamp: + for timestamp, event in sorted(audit_trail.items()): + if event == "Document claim_form received": + submission_timestamp = timestamp + submission_event = event + break + + if not submission_timestamp: + return { + "claim_id": claim_id, + "submission_found": False, + "decision": "cannot_determine", + "reason": "No submission event found in audit trail" + } + submission_dt = datetime.fromisoformat(submission_timestamp) + reference_dt = datetime.fromisoformat(reference_date) + + days_elapsed = (submission_dt.date() - reference_dt.date()).days + submitted_on_time = days_elapsed <= allowed_days + + return { + "claim_id": claim_id, + "submission_found": True, + "submission_timestamp": submission_timestamp, + "submission_event": submission_event, + "days_elapsed": days_elapsed, + "allowed_days": allowed_days, + "submitted_on_time": submitted_on_time, + "decision": "within_timeline" if submitted_on_time else "time_barred" + } + + #closing claims + @is_tool(ToolType.WRITE) + def close_claim(self, claim_id: str, reason: str) -> Claim: + claim = self._get_claim(claim_id) + + if any(r.status == "in_progress" for r in claim.recoveries): + raise ValueError("Active recoveries exist") + + if claim.claim_status not in {"settled", "rejected"}: + raise ValueError("Claim not ready for closure") + + claim.claim_status = "closed" + self._log(claim, f"Claim closed: {reason}") + return claim + + @is_tool(ToolType.GENERIC) + def handle_task(self, claim_id: str, task_name: str, payload: Optional[dict] = None) -> Claim: + """ + Dynamically route tasks to toolkit functions, supporting compound actions. + """ + claim = self._get_claim(claim_id) + payload = payload or {} + task = task_name.lower() + + actions = task.split("_and_") + + for action in actions: + if action.startswith("request_"): + doc_type = action.replace("request_", "") + doc_type = payload.get("document_type", doc_type) + if not doc_type: + raise ValueError(f"Task '{task_name}' requires at least one document type") + notes = payload.get("notes", f"Requested via task '{task_name}'") + claim = self.request_documents(claim_id, [doc_type], note=notes) + + elif action.startswith("verify"): + doc_type_or_id = action.replace("verify_", "") + docs_to_verify = ( + [d for d in claim.documents if doc_type_or_id in d.document_type] + or claim.documents + ) + if not docs_to_verify: + raise ValueError(f"Task '{task_name}' requires at least one document type") + for doc in docs_to_verify: + verified = payload.get("verified", True) + notes = payload.get("notes", f"Verified via task '{task_name}'") + claim = self.verify_document(claim_id, doc.document_id, verified, notes) + + elif action.startswith("authorize"): + team = payload.get("team", "General Claims Team") + role = payload.get("role", "Loss Assessor") + reason = payload.get("reason", f"Task '{task_name}' requires human review") + claim = self.transfer_to_human_agents(claim_id, team, role, reason) + + elif action.startswith("submit_"): + claim = self.submit_claim(claim_id) if hasattr(self, "submit_claim") else claim + + elif action.startswith("create_"): + claim = self.create_claim_claim(claim_id) if hasattr(self, "create_claim") else claim + + elif action.startswith("total_loss") or action.startswith("full_payment"): + amount = payload.get("amount") + currency = payload.get("currency", "USD") + if amount is None: + raise ValueError(f"Task '{task_name}' requires a payment amount") + reason = payload.get("reason", f"Task '{task_name}'") + claim = self.process_total_loss_payment(claim_id, amount, currency, reason) + + elif action.startswith("liability_minor"): + amount = payload.get("amount") + currency = payload.get("currency", "USD") + if amount is None: + raise ValueError(f"Task '{task_name}' requires a payment amount") + reason = payload.get("reason", f"Task '{task_name}'") + claim = self.process_liability_minor(claim_id, amount, currency, reason) + + elif action.startswith("subrogation"): + notes = payload.get("notes", f"Subrogation triggered by task '{task_name}'") + claim = self.identify_subrogation(claim_id, notes=notes) + + elif action.startswith("recovery"): + third_party = payload.get("third_party_name") + amount = payload.get("amount") + currency = payload.get("currency", "USD") + if amount is None: + raise ValueError(f"Task '{task_name}' requires a payment amount") + notes = payload.get("notes", f"Recovery triggered by task '{task_name}'") + claim = self.initiate_recovery(claim_id, third_party, amount, currency, notes) + + elif action.startswith("escalate") or action.startswith("investigate"): + indicators = payload.get("indicators", []) + notes = payload.get("notes", f"Escalation triggered by task '{task_name}'") + claim = self.escalate_claim(claim_id, indicators=indicators, notes=notes) + + else: + logger.warning(f"Unknown action segment '{action}' in task '{task_name}'") + + return claim + + + + # def _auto_progress(self, claim: Claim) -> Claim: + # """ + # Automatically progress claim post-reviewed, based on status and conditions. + # Skips auto-progression if a human agent is assigned. + # """ + # if getattr(claim, "assignments", None) and claim.assignments.taken_to_human_agent: + # claim.audit_trail[self._now()] ="Auto-progress skipped – human agent handling claim" + # return claim + + # if claim.claim_status == "reviewed": + # all_docs_verified = all( + # d.received and d.verified for d in claim.documents + # if d.document_type not in {"optional", "supporting"} + # ) + # fraud_cleared = claim.fraud_assessment is None or claim.fraud_assessment.fraud_flag == "none" + + # if all_docs_verified and fraud_cleared: + # claim = self.approve_claim(claim.claim_id, "Auto-approved post review") + + # # Auto-settle approved claims with payments + # if claim.claim_status == "approved" and claim.payments: + # claim = self.settle_claim(claim.claim_id, "Auto-settled after approval") + + # # Attempt to close partially_settled or settled claims + # if claim.claim_status in {"partially_settled", "settled"}: + # try: + # claim = self.close_claim(claim.claim_id, "Auto-closed after settlement") + # except ValueError: + # pass + + # return claim \ No newline at end of file diff --git a/src/tau2/domains/claims/utils.py b/src/tau2/domains/claims/utils.py new file mode 100644 index 00000000..22a22c5d --- /dev/null +++ b/src/tau2/domains/claims/utils.py @@ -0,0 +1,12 @@ +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..'))) +from tau2.utils.utils import DATA_DIR + +InsuranceClaims_DATA_DIR = DATA_DIR / "tau2" / "domains" / "claims" +CLAIMS_DB_PATH = InsuranceClaims_DATA_DIR / "db.json" +POLICY_PATH = InsuranceClaims_DATA_DIR/"policy.md" +TASK_SET_PATH = InsuranceClaims_DATA_DIR/"tasks.json" + + diff --git a/src/tau2/registry.py b/src/tau2/registry.py index 87d6810b..a0df8dc7 100644 --- a/src/tau2/registry.py +++ b/src/tau2/registry.py @@ -7,6 +7,17 @@ from tau2.agent.base import BaseAgent from tau2.agent.llm_agent import LLMAgent, LLMGTAgent, LLMSoloAgent from tau2.data_model.tasks import Task + +#claims +from tau2.domains.claims.environment import ( + get_environment as claims_domain_get_environment, +) +from tau2.domains.claims.environment import get_tasks as claims_domain_get_tasks +from tau2.domains.claims.environment import ( + get_tasks_split as claims_domain_get_tasks_split, +) + +#other domains from tau2.domains.airline.environment import ( get_environment as airline_domain_get_environment, ) @@ -213,6 +224,13 @@ def get_info(self) -> RegistryInfo: registry.register_domain(mock_domain_get_environment, "mock") registry.register_tasks(mock_domain_get_tasks, "mock") + registry.register_domain(claims_domain_get_environment, "claims") + registry.register_tasks( + claims_domain_get_tasks, + "claims", + get_task_splits=claims_domain_get_tasks_split, + ) + registry.register_domain(airline_domain_get_environment, "airline") registry.register_tasks( airline_domain_get_tasks, diff --git a/tests/test_domains/test_claims/__init__.py b/tests/test_domains/test_claims/__init__.py new file mode 100644 index 00000000..e69de29b diff --git a/tests/test_domains/test_claims/test_tools_claims.py b/tests/test_domains/test_claims/test_tools_claims.py new file mode 100644 index 00000000..b547fd4b --- /dev/null +++ b/tests/test_domains/test_claims/test_tools_claims.py @@ -0,0 +1,528 @@ +import os +import sys + +sys.path.insert(0, os.path.abspath(os.path.join(os.path.dirname(__file__), '..', '..', '..', 'src'))) + +import pytest +from tau2.domains.claims.data_model import InsuranceClaimsDB, Claim, ClaimPayment +from tau2.environment.environment import Environment +from tau2.data_model.message import ToolCall +from tau2.domains.claims.environment import get_environment +from tau2.domains.claims.tools import ClaimsTools + + +@pytest.fixture +def claims_db() -> InsuranceClaimsDB: + return InsuranceClaimsDB( + claims={ + "MT-ET-2024-00002": Claim(**{ + "claim_id": "MT-ET-2024-00002", + "insurance_type": "motor", + "policyholder": { + "name": { + "first_name": "James", + "last_name": "Cole" + }, + "dob": "1965-12-08", + "address": { + "line1": "57202 Carlson Trail Suite 798", + "city": "Charlesmouth", + "state": "North Dakota", + "country": "Ethiopia", + "postal_code": "29331" + }, + "contact": "(381)782-6886", + "policy_status": "active", + "premium_amount": 3579.93, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "credit_card", + "masked_reference": "****3938", + "verified": False + }, + { + "method_id": "PM_2", + "method_type": "credit_card", + "masked_reference": "****4394", + "verified": True + } + ] + }, + "claimant": { + "role": "beneficiary", + "name": { + "first_name": "Tonya", + "last_name": "Jones" + }, + "dob": "1970-01-14", + "address": { + "line1": "555 Robinson Terrace", + "city": "Barajastown", + "state": "Delaware", + "country": "Ethiopia", + "postal_code": "88180" + }, + "contact": "(673)299-3056x164", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "85Pm887704", + "verified": False + } + ], + "relationship_to_policyholder": "beneficiary" + }, + "additional_claimants": [], + "loss_details": { + "date_of_loss": "2024-07-13", + "cause_of_loss": "fire damage", + "description": "Reported insured loss event", + "location": "Willieville", + "estimated_loss_amount": 1107639.37, + "currency": "EBT" + }, + "claim_status": "new", + "reported_date": "2024-07-25", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "motor_accident_claim_form", + "received": True, + "verified": True, + }, + { + "document_id": "DOC_2", + "document_type": "police_abstract", + "received": True, + "verified": True, + }, + { + "document_id": "DOC_3", + "document_type": "driver_license", + "received": True, + "verified": True, + }, + { + "document_id": "DOC_4", + "document_type": "logbook", + "received": True, + "verified": True, + }, + { + "document_id": "DOC_5", + "document_type": "repair_estimate", + "received": False, + "verified": False + } + ], + "fraud_assessment": { + "fraud_flag": "none", + "indicators": [], + "notes": None + }, + "beneficiary_dispute": None, + "payments": [], + "subrogation_possible": True, + "audit_trail": { + "2024-03-24T20:31:59": "Claim created", + "2024-05-03T20:37:57": "Document motor_accident_claim_form received", + "2024-12-03T10:48:04": "Document motor_accident_claim_form verified", + "2024-12-12T19:40:52": "Document police_abstract received", + "2024-12-18T02:51:19": "Claim status updated to new" + }, + "assignments": { + "taken_to_human_agent": False, + "assignments": None + } + }), + "HOME-ZA-2024-00001": Claim(**{ + "claim_id": "HOME-ZA-2024-00001", + "insurance_type": "property", + "policyholder": { + "name": { + "first_name": "Danielle", + "last_name": "Johnson" + }, + "dob": "1969-11-12", + "address": { + "line1": "908 Jennifer Squares", + "city": "Robinsonshire", + "state": "Louisiana", + "country": "Zambia", + "postal_code": "01352" + }, + "contact": "001-626-254-2351x16155", + "policy_status": "active", + "premium_amount": 1751.86, + "currency": "EBT", + "payment_methods": [ + { + "method_id": "PM_1", + "method_type": "bank_transfer", + "masked_reference": "****7924", + "verified": True + } + ] + }, + "claimant": { + "role": "third_party", + "name": { + "first_name": "Joshua", + "last_name": "Walker" + }, + "dob": "2004-08-23", + "address": { + "line1": "161 Calderon River Suite 931", + "city": "Lake Jeremyport", + "state": "Colorado", + "country": "Zambia", + "postal_code": "31013" + }, + "contact": "664-375-2553", + "identity_documents": [ + { + "doc_type": "national_id", + "doc_number": "92OS832764", + "verified": True + } + ], + "relationship_to_policyholder": "third_party" + }, + "additional_claimants": [ + { + "role": "third_party", + "name": { + "first_name": "Angela", + "last_name": "Cohen" + }, + "dob": "2007-04-09", + "address": { + "line1": "05641 Robin Port", + "city": "Jasonfort", + "state": "Montana", + "country": "Ethiopia", + "postal_code": "84760" + }, + "contact": "724.523.8849x696", + "identity_documents": [], + "relationship_to_policyholder": "relative" + }, + { + "role": "third_party", + "name": { + "first_name": "Wendy", + "last_name": "Taylor" + }, + "dob": "1988-07-27", + "address": { + "line1": "12269 Paul Ranch", + "city": "Riceside", + "state": "Alabama", + "country": "Ethiopia", + "postal_code": "89667" + }, + "contact": "001-418-345-1462x7048", + "identity_documents": [], + "relationship_to_policyholder": "relative" + } + ], + "loss_details": { + "date_of_loss": "2024-05-20", + "cause_of_loss": "water leak", + "description": "Reported insured loss event", + "location": "Meaganhaven", + "estimated_loss_amount": 450305.42, + "currency": "ZMW" + }, + "claim_status": "awaiting_documents", + "reported_date": "2024-05-27", + "documents": [ + { + "document_id": "DOC_1", + "document_type": "claim_form", + "received": True, + "verified": True + }, + { + "document_id": "DOC_2", + "document_type": "fire_report", + "received": True, + "verified": True + }, + { + "document_id": "DOC_3", + "document_type": "repair_quotes", + "received": True, + "verified": True + }, + { + "document_id": "DOC_4", + "document_type": "proof_of_ownership", + "received": True, + "verified": True + }, + { + "document_id": "DOC_5", + "document_type": "photos", + "received": True, + "verified": True + } + ], + "fraud_assessment": { + "fraud_flag": "None", + "indicators": [], + "notes": None + }, + "beneficiary_dispute": None, + "payments": [], + "subrogation_possible": True, + "audit_trail": { + "2024-02-10T20:05:57": "Document proof_of_ownership received", + "2024-02-19T13:04:12": "Claim created", + "2024-06-25T21:58:51": "Document claim_form received", + "2024-07-10T18:59:14": "Document proof_of_ownership verified", + "2024-08-23T19:31:24": "Document repair_quotes received", + "2024-08-31T23:33:46": "Document claim_form verified", + "2024-09-24T09:18:19": "Document repair_quotes verified", + "2024-11-12T13:10:00": "Document photos received", + "2024-12-18T20:10:03": "Document photos verified", + "2024-12-26T02:31:56": "Claim status updated to awaiting_documents" + }, + "assignments": { + "taken_to_human_agent": True, + "assignments": { + "handler_team": "Recoveries", + "claims_adjuster": { + "name": "Megan Mcclain", + "role": "Senior Claims Analyst" + }, + "assessor": { + "name": "Javier Johnson", + "role": "Loss Assessor" + }, + "assigned_date": "2024-08-17T21:27:16" + } + } + }) + } + ) + + +# @pytest.fixture +# def claims_environment(claims_db: InsuranceClaimsDB) -> Environment: +# toolkit = ClaimsTools(claims_db) +# return get_environment(toolkit) + + +@pytest.fixture +def claims_environment(claims_db: InsuranceClaimsDB) -> Environment: + environment = get_environment(claims_db) + return environment + +#Tool calls +@pytest.fixture +def create_claim_call() -> ToolCall: + return ToolCall( + id="1", + name="create_claim", + arguments={"claim_id": "MT-ET-2024-00002"}) + +@pytest.fixture +def submit_claim_call() -> ToolCall: + return ToolCall( + id="1", + name="submit_claim", + arguments={"claim_id": "MT-ET-2024-00002"}) + + +@pytest.fixture +def request_documents_call() -> ToolCall: + return ToolCall( + id="2", + name="request_documents", + arguments={ + "claim_id": "MT-ET-2024-00002", + "document_types": ["repair_estimate"], + "note": "Needed for review" + } + ) +@pytest.fixture +def approve_claim_call() -> ToolCall: + return ToolCall( + id="4", + name="approve_claim", + arguments={"claim_id": "MT-ET-2024-00002", "notes": "All docs verified"} + ) + + +@pytest.fixture +def reject_claim_call() -> ToolCall: + return ToolCall( + id="5", + name="reject_claim", + arguments={"claim_id": "HOME-ZA-2024-00001", "reason": "Invalid claim"} + ) + +@pytest.fixture +def verify_document_call() -> ToolCall: + return ToolCall( + id="3", + name="verify_documents", + arguments={ + "claim_id": "MT-ET-2024-00002", + "document_id": "DOC_5", + "verified": True, + "notes": "Verified by system" + } + ) + +@pytest.fixture +def identify_subrogation_call() -> ToolCall: + return ToolCall( + id="6", + name="identify_subrogation", + arguments={ + "claim_id": "HOME-ZA-2024-00001", + "notes": "Possible subrogation" + } + ) + + +@pytest.fixture +def initiate_recovery_call() -> ToolCall: + return ToolCall( + id="7", + name="initiate_recovery", + arguments={ + "claim_id": "HOME-ZA-2024-00001", + "third_party_name": "Third Party", + "recovery_amount": 200, + "currency": "USD", + "notes": "Recover funds" + } + ) +@pytest.fixture +def update_recovery_status_call() -> ToolCall: + return ToolCall( + id="8", + name="update_recovery_status", + arguments={ + "claim_id": "HOME-ZA-2024-00001", + "recovery_id": "RCV_1", + "status": "recovered", + "notes": "Funds recovered" + } + ) + +@pytest.fixture +def settle_claim_call() -> ToolCall: + return ToolCall( + id="9", + name="settle_claim", + arguments={ + "claim_id": "MT-ET-2024-00002", + "notes": "Settled successfully" + } + ) + +@pytest.fixture +def make_payment_call() -> ToolCall: + return ToolCall( + id="10", + name="_make_payment", + arguments={ + "claim_id": "MT-ET-2024-00002", + "amount": 1107639.37, + "currency": "EBT", + "method": "bank_transfer", + "reason": "Approved payment" + } + ) + +def test_create_claim(claims_environment: Environment, create_claim_call: ToolCall): + response = claims_environment.get_response(create_claim_call) + assert not response.error + assert "Claim already exists" in response.error.message + +def test_submit_claim(claims_environment: Environment, submit_claim_call: ToolCall): + response = claims_environment.get_response(submit_claim_call) + assert not response.error + claim = claims_environment.tools._get_claim("MT-ET-2024-00002") + assert "Claim submitted" in claim.audit_trail.values() + +def test_request_documents(claims_environment: Environment, request_documents_call: ToolCall): + response = claims_environment.get_response(request_documents_call) + assert not response.error + claim = claims_environment.tools._get_claim("MT-ET-2024-00002") + assert any(d.document_type == "repair_estimate" for d in claim.documents) + assert claim.claim_status == "awaiting_documents" + +def test_verify_document(claims_environment: Environment, verify_document_call: ToolCall): + claim = claims_environment.tools._get_claim("MT-ET-2024-00002") + doc = next(d for d in claim.documents if d.document_id == "DOC_5") + assert not doc.verified + response = claims_environment.get_response(verify_document_call) + assert not response.error + doc = next(d for d in claim.documents if d.document_id == "DOC_5") + assert doc.verified + +def test_approve_claim(claims_environment: Environment, approve_claim_call: ToolCall): + response = claims_environment.get_response(approve_claim_call) + assert not response.error + claim = claims_environment.tools._get_claim("MT-ET-2024-00002") + assert claim.claim_status == "approved" + assert "All docs verified" in list(claim.audit_trail.values())[-1] + + +def test_settle_claim(claims_environment: Environment, make_payment_call: ToolCall, settle_claim_call: ToolCall): + response = claims_environment.get_response(make_payment_call) + assert not response.error + response = claims_environment.get_response(settle_claim_call) + assert not response.error + claim = claims_environment.tools._get_claim("MT-ET-2024-00002") + assert claim.claim_status == "settled" + +#scenario 2 +def test_get_claims(claims_environment: Environment): + claims = claims_environment.tools.get_claims() + assert isinstance(claims, list) + assert any(c.claim_id == "HOME-ZA-2024-00001" for c in claims) + +def test_initiate_recovery(claims_environment: Environment, identify_subrogation_call: ToolCall, initiate_recovery_call: ToolCall): + response = claims_environment.get_response(identify_subrogation_call) + assert not response.error + response = claims_environment.get_response(initiate_recovery_call) + assert not response.error + claim = claims_environment.tools._get_claim("HOME-ZA-2024-00001") + recovery = claim.recoveries[-1] + assert recovery.third_party_name == "Third Party" + assert recovery.status == "in_progress" + +def test_update_recovery_status(claims_environment: Environment, update_recovery_status_call: ToolCall): + response = claims_environment.get_response(update_recovery_status_call) + assert not response.error + claim = claims_environment.tools._get_claim("HOME-ZA-2024-00001") + recovery = next(r for r in claim.recoveries if r.recovery_id == "RCV_1") + assert recovery.status == "recovered" + +def test_reject_claim(claims_environment: Environment, reject_claim_call: ToolCall): + response = claims_environment.get_response(reject_claim_call) + assert not response.error + claim = claims_environment.tools._get_claim("HOME-ZA-2024-00001") + assert claim.claim_status == "rejected" + assert claim.assignments.taken_to_human_agent + +if __name__ == "__main__": + pass + # test_create_claim() + # test_get_claims() + # test_initiate_recovery() + # test_update_recovery_status() + # test_reject_claim() + # test_submit_claim() + # test_request_documents() + # test_verify_document() + # test_approve_claim() + # test_settle_claim() \ No newline at end of file From ba488fa15af26aafec3fae6ac70cd6982778921c Mon Sep 17 00:00:00 2001 From: Risper8 Date: Wed, 14 Jan 2026 10:32:19 +0300 Subject: [PATCH 2/2] Add dockerfileand updated README --- .dockerignore | 163 ++++++++++++++++++++++++++++++ dockerfile | 25 +++++ src/tau2/domains/claims/README.md | 36 ++++++- 3 files changed, 221 insertions(+), 3 deletions(-) create mode 100644 .dockerignore create mode 100644 dockerfile diff --git a/.dockerignore b/.dockerignore new file mode 100644 index 00000000..50161ddd --- /dev/null +++ b/.dockerignore @@ -0,0 +1,163 @@ +*.tmp +.DS_Store +tmp.* +tmp_* +tmp-* +tmp/ +dumps/ +dump.rdb +*.rdg +logs/ +data/simulations/ +data/exp/ +data/datasets/ +data/models/ +data/analyses/ +src/experiments/model_serving/vllm_serving/.* +.ruff_cache + +# Byte-compiled / optimized / DLL files +__pycache__/ +*.py[cod] +*$py.class + +# C extensions +*.so + +# Distribution / packaging +.Python +build/ +develop-eggs/ +node_modules/ +dist/ +downloads/ +eggs/ +.eggs/ +lib/ +lib64/ +parts/ +sdist/ +var/ +wheels/ +share/python-wheels/ +*.egg-info/ +.installed.cfg +*.egg +MANIFEST +.vscode/ + +# PyInstaller +# Usually these files are written by a python script from a template +# before PyInstaller builds the exe, so as to inject date/other infos into it. +*.manifest +*.spec + +# Installer logs +pip-log.txt +pip-delete-this-directory.txt + +# Unit test / coverage reports +htmlcov/ +.tox/ +.nox/ +.coverage +.coverage.* +.cache +nosetests.xml +coverage.xml +*.cover +*.py,cover +.hypothesis/ +.pytest_cache/ +cover/ + +# Translations +*.mo +*.pot + +# Django stuff: +*.log +local_settings.py +db.sqlite3 +db.sqlite3-journal + +# Flask stuff: +instance/ +.webassets-cache + +# Scrapy stuff: +.scrapy + +# Sphinx documentation +docs/_build/ + +# PyBuilder +.pybuilder/ +target/ + +# Jupyter Notebook +.ipynb_checkpoints + +# IPython +profile_default/ +ipython_config.py +.pdm.toml +.pdm-python +.pdm-build/ + +__pypackages__/ + +# Celery stuff +celerybeat-schedule +celerybeat.pid + +# SageMath parsed files +*.sage.py + +# Environments +# .env +.venv +# env/ +venv/ +ENV/ +env.bak/ +venv.bak/ + +# Spyder project settings +.spyderproject +.spyproject + +# Rope project settings +.ropeproject + +# mkdocs documentation +/site + +# mypy +.mypy_cache/ +.dmypy.json +dmypy.json + +# Pyre type checker +.pyre/ + +# pytype static type analyzer +.pytype/ + +# Cython debug symbols +cython_debug/ + + +# PyPI configuration file +.pypirc + +# Large data and cache files +*.arrow +cache-*.arrow +data-*-of-*.arrow +src/experiments/model_training/data/full-v1/*/cache-*.arrow +src/experiments/model_training/data/full-v1/*/data-*.arrow + +# Large JSONL training files +src/experiments/model_training/data/train_full-v1.jsonl +src/experiments/model_training/data/test_full-v1.jsonl \ No newline at end of file diff --git a/dockerfile b/dockerfile new file mode 100644 index 00000000..992ebb83 --- /dev/null +++ b/dockerfile @@ -0,0 +1,25 @@ +FROM python:3.11-slim + +ENV PYTHONDONTWRITEBYTECODE=1 +ENV PYTHONUNBUFFERED=1 +ENV TAU2_STRICT_REPLAY=1 + +RUN apt-get update && apt-get install -y \ + build-essential \ + && rm -rf /var/lib/apt/lists/* + + +WORKDIR /app + +# COPY requirements.txt . +# RUN pip install --no-cache-dir -r requirements.txt + +COPY . . + +RUN pip install --no-cache-dir -e . + +ENV PYTHONPATH=/app/src + +# CMD ["tau2", "--help"] +CMD ["python", "-m", "tau2", "--help"] + diff --git a/src/tau2/domains/claims/README.md b/src/tau2/domains/claims/README.md index 7d77e492..cfda62e3 100644 --- a/src/tau2/domains/claims/README.md +++ b/src/tau2/domains/claims/README.md @@ -85,8 +85,38 @@ The domain is designed to benchmark AI Agents in a controlled, realistic insuran ## Data Model The domain structure and database storage follows similar implementation as the rest of the other domains but with complex tasks. +## Pre-requisites +$env:TAU2_STRICT_REPLAY = "1" +$env:OPENAI_API_KEY = "" # for agents requiring OpenAI access + +## Build docker image +docker build -t tau2-claims . + + +## Run Simulations/Evaluations(Minimal Test run) + +### output file inside container +docker run --rm ` + tau2-claims tau2 run ` + --domain claims ` + --agent-llm gpt-4.1 ` + --user-llm gpt-4.1 ` + --num-trials 2 ` + --task-ids LIFE-9 ` + --max-concurrency 3 ` + --save-to "claims_gpt-4.1_benchmark_LIFE-9_v1.json" + +### output persists in the host directory +docker run --rm ` + -v $(pwd):/outputs ` + tau2-claims tau2 run ` + --domain claims ` + --agent-llm gpt-4.1 ` + --user-llm gpt-4.1 ` + --num-trials 2 ` + --task-ids LIFE-9 ` + --max-concurrency 3 ` + --save-to /outputs/claims_gpt-4.1_benchmark_LIFE-9_v1.json + -# Run Simulations/Evaluations --Run this first - `$env:TAU2_STRICT_REPLAY = "1"`