📘

Schadenfälle & Versicherungen

claims core_platform 🛡️ RLS Protected

Schadenfälle & Versicherungen — aus Code abgeleitete Prozess- und API-Dokumentation.

Fachliche Bestimmung: Schadenfälle & Versicherungen — aus Code abgeleitete Prozess- und API-Dokumentation. Erfasst alle registrierten Prozesse, Capabilities, Zustandsmaschinen, APIs und Tabellen für Simulationen und Reviews.

⚡ Arbeidsstrømme og livssykluser (1) 🗄️ Datamodeller & felt (2) 🔌 Startpunkter (UI og API) (24) 🛡️ Reglering og etterlevelse

⚡ Arbeidsstrømme og livssykluser

Benutzerbefehl: claims agent `plan:command_claims_agent`

Kontrollert varig plan (durable_plan), Start: manual_command.

1. claims_agent

claims_agent

{"key": "execute_command", "label": "Befehl prüfen, ausführen oder zur Freigabe vorlegen", "adapter": "agent.execute", "agent": "claims_agent", "condition_fact": null}

Aktionen: claims_agent

🗄️ Datamodeller & felt

ClaimEvents claim_events RLS Aktiv

10 Feltet / kolonne

Tabelle claim_events

Feldname	Data-type	Tiltak	Schlüssel	Spesialdekst
`claim_id`	`UUID`	Ja *	FK ➔ claims.id	Feld claim_id
`event_type`	`VARCHAR(32)`	Ja *	-	Feld event_type
`from_status`	`VARCHAR(16)`	Nein	-	Feld from_status
`to_status`	`VARCHAR(16)`	Nein	-	Feld to_status
`note`	`TEXT`	Nein	-	Feld note
`actor`	`VARCHAR(128)`	Nein	-	Feld actor
`created_at`	`DATETIME`	Ja *	-	Feld created_at
`id`	`UUID`	Nein	PK	Feld id
`tenant_id`	`UUID`	Ja *	FK ➔ organizations.id	Feld tenant_id
`metadata`	`JSONB`	Ja *	-	Feld metadata

Claims claims RLS Aktiv

28 Feltet / kolonne

Tabelle claims

Feldname	Data-type	Tiltak	Schlüssel	Spesialdekst
`claim_number`	`VARCHAR(64)`	Ja *	-	Feld claim_number
`claim_type`	`VARCHAR(24)`	Ja *	-	Feld claim_type
`status`	`VARCHAR(16)`	Ja *	-	Feld status
`title`	`VARCHAR(255)`	Ja *	-	Feld title
`description`	`TEXT`	Nein	-	Feld description
`occurred_at`	`DATE`	Nein	-	Feld occurred_at
`entity_type`	`VARCHAR(64)`	Nein	-	Feld entity_type
`entity_id`	`UUID`	Nein	-	Feld entity_id
`estimated_amount`	`NUMERIC(14, 2)`	Nein	-	Feld estimated_amount
`settled_amount`	`NUMERIC(14, 2)`	Nein	-	Feld settled_amount
`deductible`	`NUMERIC(14, 2)`	Nein	-	Feld deductible
`insurer_name`	`VARCHAR(255)`	Nein	-	Feld insurer_name
`insurer_ref`	`VARCHAR(128)`	Nein	-	Feld insurer_ref
`policy_id`	`UUID`	Nein	FK ➔ insurance_policies.id	Feld policy_id
`document_ids`	`JSONB`	Ja *	-	Feld document_ids
`reported_by`	`UUID`	Nein	FK ➔ organization_users.id	Feld reported_by
`submitted_at`	`DATETIME`	Nein	-	Feld submitted_at
`settled_at`	`DATETIME`	Nein	-	Feld settled_at
`notes`	`TEXT`	Nein	-	Feld notes
`id`	`UUID`	Nein	PK	Feld id
`tenant_id`	`UUID`	Ja *	FK ➔ organizations.id	Feld tenant_id
`created_at`	`DATETIME`	Ja *	-	Feld created_at
`updated_at`	`DATETIME`	Ja *	-	Feld updated_at
`created_by`	`UUID`	Nein	-	Feld created_by
`updated_by`	`UUID`	Nein	-	Feld updated_by
`source_type`	`VARCHAR(32)`	Nein	-	Feld source_type
`source_id`	`UUID`	Nein	-	Feld source_id
`metadata`	`JSONB`	Ja *	-	Feld metadata

🔌 Startpunkter (UI og API)

Art	Metode	Endpunkt / vei	Titel & Zweck	Tillatelse
⚡ REST API	GET	`/api/v1/claims`	list_claims Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/policies`	list_policies Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/policies/expiring`	expiring_policies Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/policies/{policy_id}`	get_policy Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/summary`	claims_summary Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/{claim_id}`	get_claim Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/api/v1/claims/{claim_id}/events`	list_claim_events Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/schaeden`	claims_page Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/schaeden/{claim_id}`	claim_detail_page Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	GET	`/versicherungen`	policies_page Semantic binding: inventory_only; mutation=False	`claims`
⚡ REST API	PATCH	`/api/v1/claims/policies/{policy_id}`	update_policy Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	PATCH	`/api/v1/claims/{claim_id}`	update_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims`	create_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/policies`	create_policy Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/events`	add_claim_event Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/reject`	reject_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/reopen`	reopen_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/review`	review_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/settle`	settle_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/api/v1/claims/{claim_id}/submit`	submit_claim Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/schaeden/neu`	create_claim_form Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/schaeden/{claim_id}/aktion`	claim_action_form Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/schaeden/{claim_id}/notiz`	claim_note_form Semantic binding: operator_surface; mutation=True	`claims`
⚡ REST API	POST	`/versicherungen/neu`	create_policy_form Semantic binding: operator_surface; mutation=True	`claims`

🛡️ Reglering og etterlevelse

Dieses Modul unterliegt folgenden gesetzlichen, regulatorischen und Revisionsstandards: