SCR-7966 / SCR-7949

Combined Insured Event Status Logic

Service for checking the actual status / substatus of an Insured Event and defining the resulting Combined Insured Event Status. ADUM documents are visible as soon as the document is created; the KPOR Postfach tab is determined by the Claim incoming channel.

Interactive test

Status combination tester

Select Claim incoming channel, Insured Event location, status, detailed status and claim statuses to calculate the resulting combined status and the KPOR Postfach tab. Detailed status 3 - Requirement always has priority.

No claims entered - only the Insured Event status is used.

combined insured event status
-
Portal visibility: -
Claim incoming channel
6 - IPS
KPOR tab
Von Makler Betreut
Visibility trigger
DOCUMENT CREATED

Logical summary / solution description

The proposed solution is to introduce one central Combined Insured Event Status, which is calculated based on the Insured Event status, the detailed status on the Insured Event and the related claim statuses.

The detailed status 3 - Requirement has absolute priority. If the detailed status on the Insured Event is 3 - Requirement, the Combined Insured Event Status is always REQUIREMENT, regardless of the Insured Event status and regardless of the related claim statuses.

ADUM documents are visible as soon as the document is created. The target KPOR Postfach tab is determined by the Claim incoming channel: Post, E-Mail, Website, Merkur App and Customer Portal are shown in Posteingang; IPS is shown in Von Makler Betreut.

The individual technical values, such as Insured Event status, Insured Event substatus / detailed status and claim status, may still be exposed for transparency, testing, debugging or other internal purposes. The Combined Status remains the central status value for display and service logic.

ADUM document visibility logic

Within SCR-7966 MI: CP Inbox extension (adding a new tab), the following logic is defined for the documents ADUM GV and ADUM ANFORDERUNGEN. The visibility is triggered when the document is created. The KPOR Postfach tab is determined by the Claim incoming channel.

Parameter Value / Rule
Claim incoming channel 6 - IPS
KPOR display tab Von Makler Betreut
Visibility trigger Document created
Visible for customer As soon as the ADUM document is created. The KPOR tab is selected according to the Claim incoming channel.
The ADUM document is visible as soon as the document is created. The former visibility trigger SETTLED / REJECTED is no longer used for this document visibility decision. The KPOR Postfach tab is determined by the Claim incoming channel: channels 1 Post, 2 E-Mail, 3 Website, 4 Merkur App and 5 Customer Portal are shown in Posteingang; channel 6 IPS is shown in Von Makler Betreut.

Combined Insured Event Status based on claims

The statuses SETTLED and REJECTED are linked to JIRA ticket SCR-7949, where the detailed logic for determining the Insured Event status based on claim statuses is defined using the attribute:
“COMBINED INSURED EVENT STATUS BASED ON CLAIMS”

The Claim incoming channel does not change the Combined Insured Event Status. It only determines the KPOR Postfach tab where the created ADUM document is displayed.

SAVED
The Insured Event was created in an external system, for example IPS, and has not yet been transferred to Symass.
IN PROCESS
The Insured Event is still open, or at least one related claim is in process or postponed.
REQUIREMENT
Detailed status on Insured Event = 3 (Requirement). This status has absolute priority and is independent of the Insured Event status and claim statuses.
SETTLED
The Insured Event or the related claims are finally completed. A mix of settled and rejected claims is also treated as settled if at least one claim is settled.
REJECTED
The Insured Event is disposed of, or all related claims are rejected / mistakenly entered.

Claim object mapping

Combined group Claim status
PROCESS 1 In Process, 5 Postponed
SETTLED 3 Settled, 7 Reverted, 4 Migrated Claim
REJECTED 2 Rejected, 6 Mistakenly entered

Insured Event object mapping

Combined group Insured Event status
PROCESS 1 In Process, 5 Re-opened, 6 Postponed
SETTLED 2 Finished, 4 Preliminary finished, 7 Time-barred
REJECTED 3 Disposed of

Claim incoming channel mapping to KPOR Postfach tab

The following mapping defines in which KPOR Postfach tab the created ADUM document is displayed, depending on the Claim incoming channel.

Claim incoming channel code Claim incoming channel KPOR Postfach tab
1 Post Posteingang
2 E-Mail Posteingang
3 Website Posteingang
4 Merkur App Posteingang
5 Customer Portal Posteingang
6 IPS Von Makler Betreut
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