Homeowners Claims — Playbook
Audience: Homeowners, insurers, adjusters, contractors, inspectors. Playbook Type: Scenario pack + Solve + Optimize loop Status: Soft (practice) — not yet LIVE Source: Claims Plane — Processing Claims, Guarded Transitions, and Declarative Packs §4 (home claims pack), D-09 — Optimization Capability (developer) §1.3 (procurement.consolidated_order@1)
1. Use & Purpose
Homeowners claims processing for property damage, theft, liability, and catastrophe — multi-party asset governance with expert sign-off. The playbook takes a home claim from loss notice to settlement, using solver-assisted contractor selection and escrow-backed payment, with expert sign-off required before any money moves.
Optimizers propose, claim gates authorize, never settle or pay.
2. Who Uses It
| Player | Role |
|---|---|
| Homeowner | Reports loss, provides evidence, receives settlement |
| Adjuster | Loss assessment, approval |
| Contractor | Repair execution, evidence upload |
| Inspector | Quality verification, sign-off |
| Insurer | Risk bearer, settlement payer |
| Reinsurer | Notice for catastrophe/high-value claims |
3. Flow
| Step | Actor | Action | Gate |
|---|---|---|---|
| 1 | Homeowner | Loss notice via broker/direct intake | Photos, police report (theft), authority report (fire) |
| 2 | System | Claim created: cns://claim/type/insurance/home_claim, PoCE session started | Required fields validated; 400 if missing |
| 3 | Adjuster | Assigned via panel eligibility (two-person quorum for amounts > $500) | SOD: adjuster ≠ contractor |
| 4 | Solver | procurement.consolidated_order@1 recommends contractor + route composite | Fail closed: solver down → 503 |
| 5 | Human adjuster | Approves contractor + estimate | Named human confirms; expert sign-off mandatory |
| 6 | Contractor | Performs repair, uploads completion evidence | Evidence: photos, arrival point, sign-off |
| 7 | Inspector | Verifies repair quality, signs off | SOD: inspector ≠ contractor |
| 8 | Finance | Escrow releases to contractor against verified proof | fn::escrow::disburse against inspector sign-off |
| 9 | System | Claim finalized with PoCE receipt | All transitions recorded; receipt sealed |
4. Guard Rails
- Expert sign-off is mandatory. No path around it — no auto-certify, no auto-fine.
- Two-person quorum for claim amounts above $500.
- Solver verdicts are gates, not approvals. Never settles or pays.
- Home lines demand photos and authority report as evidence.
- No match means no assignment.
fill_infeasibleverdict if no qualified contractor available. - External verdicts honoured. Negative verdict blocks settlement.
- Escrow releases only against verified proof. No cash handling.
5. Evidence & Rollout
| Element | Detail |
|---|---|
| Version | 1.0.0 (Soft) |
| Source pack | Home claims (Kenya) — cns://claim/type/insurance/home_claim |
| CNS types | cns://claim/type/insurance/home_claim, cns://resource/property |
| Lookup values | Guard policies, quorum bands, SLA windows, panel roles, intake maps (NATS KV) |
| PoCE integration | fn::lifecycle::start_poce_session → record_poce_step → finalize_poce_session |
| Solver capability | procurement.consolidated_order@1, engine cope_composite (basket split + VROOM route) |
| Escrow | fn::escrow::hold / fn::escrow::disburse / fn::escrow::rollback |
| Rollout path | Soft → pilot in single region → LIVE gate |
| Low-resource behavior | FNOL via WhatsApp/USSD/walk-in; contractor works from issued list; verification via supervisor tap or SMS code |
Soft ≠ LIVE honesty: Nothing sets live_gate_met without REAL probe results. Env flags alone never count.
6. What We Do Not Build
- No synthetic settlement. The solver never settles or pays; a named human approver confirms via PoCE.
- No fake contractor matches. Unqualified providers are never shortlisted.
- No synthetic "OPTIMAL" verdict. Solver down → 503 fail closed.
- No fake metrics (e.g., "97% claims settled in 7 days"). Live data or honest empty states.
- No catastrophe modeling replacement. Reinsurer notice and catastrophe screening are configured, not invented.