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Direct Car Insurance Claim Settlement

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In this perticular example we will explain how FlexRule Designer can streamline the direct car insurance claim settlement decisions.

Scenario

In Belgium, car insurance companies adhered to the RDR (Rapid Dispute Resolution) convention to make settling car accident damages simpler. It’s like an agreement between these companies to make the claim process smoother. In this setup, the insurance companies of the people involved in an accident directly handle the damages without bothering the insured individuals. While joining the RDR convention is optional for insurance companies, most in Belgium have chosen to be part of it. So, if you have comprehensive car insurance with one of these companies, they’ll use the RDR convention to settle your claims if you’re in a qualifying car accident.

Mainly there are two sections associated with this process.

  1. Determine RDR Clearing Eligibility
  2. Determine Accident Liability

Determine RDR Clearing Eligibility

In order to eligible for the RDR settlement, certain criteria has to be met by both parties:

  • Where? Accident should occur in Belgium.
  • Who? Both drivers hold active comprehensive insurance with company .
  • What? Only two cars were involved, no bodily injuries.
  • Proof? Signed European Accident Statement with clear liability based on checkboxes.

To determine RDR Clearing Eligibility, two decisions will be involved:

  1. Counterparty Object RDR Eligibility
  2. Car Accident RDR Eligibility

Counterparty Object RDR Eligibility

This decision involves deciding whether the counterparty is eligible for the RDR settlement. In order to do that we need some additional information about the counterparty like RDR Affiliated Companies list. Then the input counterparty details will be checked against that list. And also Motor vehicle type will be considered.

Then, those two decisions will be considered against the Counterparty Vehicle Country of Registration, Counterparty Vehicle Insurance Obligation, and Counterparty Vehicle Insurance Status. As the final outcome of this stage “Counerparty Object RDR Eligibility” will be determined.

Counterparty Object RDR Eligibility

Car Accident RDR Eligibility

Car Accident RDR Eligibility will be determined based on information related o the car accident.

Car Accident RDR Eligibility

RDR Clearing Eligibility

Then those two decision outcomes(Car Accident RDR Eligibility and Counterparty Object RDR Eligibility ) will leads to RDR Clearing Eligibility decision as follows.

RDR Clearing Eligibility

The overall RDR CLearing Eligibility decision can be represent in a decision graph as follows.

RDR Clearing Eligibility Overall View

Determine Accident Liability

This Decision combines with 2 major decisions.

  1. Insured and counterparty accident circumstances
  2. Car Accident Liability

Insured and Counterparty Accident Circumstances

Insured and counterparty accident circumstances will be evaluated to determine car accident liability.

Since the possibility of multiple input circumstances, we will be considering one circumstance at a time to determine its gravity. The following Decision Table called “Circumstances Enrichment” is used to determine the gravity of each input circumstance.

Circumstance Enrichment

This Decision Table is embedded in a Business Formula document inside the Glossaries.

Embedded Model

This embedded model will be called in both insured and counterparty circumstances. And then results (Gravity and Circumstance) will be added to a list called Insured Customer/Counterparty Accident Circumstances.

Embedded model call

These two( Insured and counterparty accident circumstances ) decisions direct to the Car Accident Liability decision(describe later in this article) as follows.

Car Accident Liability DG

Car Accident Liability

This decision involves following 5 sub decisions:

  1. Insured Customer Number Of Circumstances : count of Insured Customer Accident Circumstances
  2. Counterparty Number Of Circumstances : count of Counterparty Accident Circumstances
  3. Insured Customer Accident Circumstance
  4. Counterparty Accident Circumstance
  5. Circumstance Gravity Liability

Insured Customer Accident Circumstance

Insured Customer Accident Circumstance

Counterparty Accident Circumstance

Circumstance Gravity Liability

This decision again consist with:

  • Insured Customer Highest Circumstance Gravity
  • Counterparty Highest Circumstance Gravity

This highest circumstance gravity will be derived from the each gravity of the circumstance in the decision of Circumstances Enrichment.

Once the Highest Circumstance gravity derevied for both insured customer and counterparty, the Circumstance Gravity Liability decision as follows.

Circumstance Gravity Liability

Finally, let’s see how all of these 5 decision outcomes determine the Car Accident Liability decision.

Car Accident Liability DT

In a Decision Graph, we can link all these decisions together to determine Car Accident Liability decision.

Car Accident Liability

Once the RDR Clearing Eligibility and Accident Liability is determined, RDR Car Accident Position can be determined as follows. This will be the final outcome of the RDR claim settlement.

RDR Car Accident Position

Overall Decision Graph will be as follows:

RDR settlement

How to Run the Project

Open the RDR Car Accident Position.xml and navigate to the given run templates and then you can choose run or debug option from there.

Run Template for RDR

WorkFlow Implementation

The Workflow is designed to give an overall understanding of the RDR settlement process which means that after the final decision outcome it leads to 2 different paths:

  1. RDR Settlement
  2. Cannot apply RDR convention: this leads to a human task(Underwriter) who take the decision of either approve or decline.

At the end, regardless of the path, model creates a notification based on the decision path.

For this workflow, you can find 2 Run Templates for both scenarios.

WorkFlow for RDR

Test Cases

You can also run the defined test cases by navigating Test Case folder and open the TestCase.xml. Select the test case section and click on Run Tests.

Test Case for RDR

Download

Use the attachment at the end of the page to download the sample project.

Updated on May 3, 2024

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