SCR-7966 / SCR-7949

Combined Insured Event Status Logic

Service for checking the actual status / substatus of an Insured Event and defining the visibility of ADUM documents in the customer portal.

Interactive test

Status combination tester

Select Insured Event location, status, detailed status and claim statuses to calculate the resulting combined status.

Where is the Insured Event located?

Insured Event status

Detailed status on Insured Event

Claims on this Insured Event

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

combined insured event status

Portal visibility: -

Outgoing channel

IPS

KPOR tab

Von Makler Betreut

Visibility trigger

SETTLED / REJECTED

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.

This combined status should be used as the main decision criterion for the visibility of ADUM documents in the customer portal. The complete business logic is therefore centralized in the COMBINED STATUS.

The advantage of this approach is that the customer portal does not have to interpret several separate technical fields independently. Instead, the portal only evaluates one final status.

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.

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 when they are received as an Einreichung from IPS.

Parameter	Value / Rule
Outgoing channel	IPS
KPOR display tab	Von Makler Betreut (NEW TAB)
Main visibility criterion	COMBINED STATUS
Visible for customer	Only if COMBINED STATUS = SETTLED or REJECTED

The document should only be displayed in the customer portal once the Insured Event has been finally completed, for example when the combined status is SETTLED or REJECTED, and when there is no further open processing or request for additional documentation.

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”

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) and Insured Event status = 1 In Process or 5 Re-opened.

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