Published

Insurance

vr.wm-eco-003 · wm-eco-003-insurance

Describe one policy-centered insurance arrangement and its coverage, premium, risk-transfer, reporting and claim interfaces.

World Models Society, people and institutions SOC.ECO.INS

Bundle → Layer → Finding → Questions Classifiers What it is Why it exists Distinguishing features What robots and AI may and may not do Moral aspects Owners Links to other meta-models Identity and identifiers Direct properties Recognition Capabilities and actions Hazards and failure modes Standards and interfaces Context of use Sources

Bundle → Layer → Finding → Questions Filled

7 bundles · 14 layers · 14 findings · 42 questions

Identity and responsibility Proposed insurance context for identity and responsibility.

Policy identity context

A proposed aggregate keyed to one policy arrangement, including its coverage and premium schedules. The insurance business, pool and product definition are separate roots.

Policy identity

A proposed aggregate keyed to one policy arrangement, including its coverage and premium schedules. The insurance business, pool and product definition are separate roots.

Which issuing namespace and master identifier identify this policy arrangement across amendments? identity
Which insurance line, benefit basis and risk-transfer classification apply under the selected profile? classification
Which schedules belong to this policy and which records remain external references? composition

Party roles and authority context

Proposed role bindings distinguish insurer, policyholder, insured, beneficiary and intermediary. Contract participation does not itself establish joint data ownership or full access.

Party roles and authority

Proposed role bindings distinguish insurer, policyholder, insured, beneficiary and intermediary. Contract participation does not itself establish joint data ownership or full access.

Which parties occupy each role, and for what effective period? relationship
What evidence permits the recorded representative or intermediary to act for this arrangement? authority
Who stewards each local record and determines its permitted processing purposes? ownership

Coverage and time Proposed insurance context for coverage and time.

Coverage schedule context

Proposed coverage components bind interests to versioned terms, limits, deductibles and benefit triggers. They allow benefit-based products as well as indemnity without asserting legal coverage.

Coverage schedule

Proposed coverage components bind interests to versioned terms, limits, deductibles and benefit triggers. They allow benefit-based products as well as indemnity without asserting legal coverage.

What interest, event or benefit trigger does each coverage component describe? definition
Which limits, deductibles, exclusions and conditions apply to that component? constraint
Which territories and governing-law profiles qualify the coverage? spatial

Coverage continuity and amendments context

Proposed effective-time history separates issuance, inception, amendment, renewal, cancellation and runoff. A local record update cannot create legal effect.

Coverage continuity and amendments

Proposed effective-time history separates issuance, inception, amendment, renewal, cancellation and runoff. A local record update cannot create legal effect.

Which effective interval and trigger dates govern this version of cover? temporal
What authorized evidence supports a renewal, cancellation, lapse or reinstatement? lifecycle
How are late notification, backdated correction and unresolved gaps represented? exception

Placement and underwriting Proposed insurance context for placement and underwriting.

Underwriting evidence context

A proposed record of the underwriting position and its inputs. It preserves uncertainty, restricted factors and authority without operating a rating or acceptance engine.

Underwriting evidence

A proposed record of the underwriting position and its inputs. It preserves uncertainty, restricted factors and authority without operating a rating or acceptance engine.

Which disclosures and observations informed the recorded underwriting position? evidence
Which authorized assessment records the accepted, declined or referred position? decision
Which proposed rating inputs require restriction or specialist review under the adopting profile? privacy

Needs and disclosure evidence context

Proposed placement evidence links customer needs, product disclosure and distribution responsibility. A signature is not a substitute for the assessment or a universal requirement.

Needs and disclosure evidence

Proposed placement evidence links customer needs, product disclosure and distribution responsibility. A signature is not a substitute for the assessment or a universal requirement.

Which customer needs and product-profile requirements were recorded before placement? requirement
What disclosure version and communication channel were used for the recipient? process
Which unresolved mismatch, conflict of interest or missing disclosure requires review? quality

Premium and risk transfer Proposed insurance context for premium and risk transfer.

Premium obligations and receipts context

Proposed premium schedule and payment references retain distinct due, billed, collected, reversed and refunded values. Receipt alone does not prove coverage or accounting revenue.

Premium obligations and receipts

Proposed premium schedule and payment references retain distinct due, billed, collected, reversed and refunded values. Receipt alone does not prove coverage or accounting revenue.

What premium amounts, currencies, taxes and fees are recorded for each installment? measurement
Which external receipts, reversals or refunds reconcile with each obligation? state
What policy-qualified consequence is asserted for nonpayment or disputed collection? exception

Pool participation and reinsurance links context

Proposed policy-level allocation references distinguish participation in a pool from reinsurance held. Economic risk transfer does not automatically replace the original obligor.

Pool participation and reinsurance links

Proposed policy-level allocation references distinguish participation in a pool from reinsurance held. Economic risk transfer does not automatically replace the original obligor.

Which pool participation or treaty references attach to this exposure? relationship
Which share, attachment, limit and exclusion terms qualify the allocation? constraint
Which counterparty, basis or recovery uncertainty is recorded without assuming payment? quality

Reporting and financial assurance Proposed insurance context for reporting and financial assurance.

Valuation and accounting references context

Proposed reporting links keep policy amounts distinct from accounting groups and prudential measures. Calculations and ledger posting remain external.

Valuation and accounting references

Proposed reporting links keep policy amounts distinct from accounting groups and prudential measures. Calculations and ledger posting remain external.

Which measurement purpose, accounting group and adopted standard version apply to the referenced report? classification
Which amounts are gross, ceded or net, and what period and currency qualify them? measurement
What reconciliation explains differences between policy, claim and reporting figures? validation

Prudential assurance references context

Proposed links to external insurer or pool assurance reports. A policy-level link neither calculates capital adequacy nor guarantees future claim payment.

Prudential assurance references

Proposed links to external insurer or pool assurance reports. A policy-level link neither calculates capital adequacy nor guarantees future claim payment.

Which insurer or pool report supports the stated financial-assurance context? evidence
Which applicable and future-effective regulatory versions qualify this report? temporal
Which limitations prevent using the report as a policy-level guarantee? quality

Claim and redress interfaces Proposed insurance context for claim and redress interfaces.

Claim association context

Proposed contextual association with independently mastered claims. The registry containment candidate does not imply exclusive parentage, mandatory claims or deletion cascade.

Claim association

Proposed contextual association with independently mastered claims. The registry containment candidate does not imply exclusive parentage, mandatory claims or deletion cascade.

Which independently identified claims invoke this policy and coverage revision? composition
Which claim-side assertions and insurer positions are available without collapsing their states? state
How are multiple policies, multiple claimants and duplicate notifications linked without merging masters? constraint

Outcome and complaint references context

Proposed summary links separate decision, agreement, settlement, payment, recovery and complaint. Handling workflows and legal redress are delegated.

Outcome and complaint references

Proposed summary links separate decision, agreement, settlement, payment, recovery and complaint. Handling workflows and legal redress are delegated.

Which decision, settlement, payment or recovery records support the outcome summary? relationship
What subsequent correction, reopening or partial outcome changes the available summary? event
Which reason and complaint-route information may each recipient receive? access

Records and exchange Proposed insurance context for records and exchange.

Access and retention context context

Proposed record-specific access and disposition bindings. Views are purpose-limited; history must coexist with lawful payload deletion and unresolved preservation duties.

Access and retention context

Proposed record-specific access and disposition bindings. Views are purpose-limited; history must coexist with lawful payload deletion and unresolved preservation duties.

Which purpose and role authorize access to each underwriting, policy or linked-claim view? security
Which retention trigger, review date and scoped hold apply to the local record? retention
What evidence resolves a conflict between correction, erasure and preservation duties? exception

Provenance and exchange profile context

Proposed exchange manifest preserves identity, derivation and time while stating mapping loss. Transport success, a hash or a vocabulary term is not substantive verification.

Provenance and exchange profile

Proposed exchange manifest preserves identity, derivation and time while stating mapping loss. Transport success, a hash or a vocabulary term is not substantive verification.

Which master revision, source actor and transformation produced this projection? provenance
Which exact exchange profile and licensed schema version are bound, and what information is lost? interoperability
Which checks reject an export with unresolved references, ambiguous time or excessive disclosure? validation

Classifiers Filled

Family: World Models
Category: Society, people and institutions
Entry kind: aggregate
Navigation path: NAV.SOC.ECO.INS
Domain: SOC.ECO.INS
Industry: Cross-industry
Tags: insurancesoc.eco.ins
Also called: C8

What it is Filled

A proposed aggregate rooted in one policy arrangement, with local coverage and premium schedules and typed references to parties, pools, claims and reports. It supports an arrangement before any claim exists. It does not represent the entire insurer, the insurance market or a pool-only scheme. Legal validity and financial execution remain external.

In scope

Stable policy arrangement identity and versioned coverage and premium components
Party role bindings, underwriting and distribution evidence, effective-time continuity
Policy-level pool and reinsurance allocations, financial-assurance references and claim/redress links
Restricted projections, provenance, access and local retention context

Out of scope

Claim master identity, claim lines and amendments; claim handling workflows; loss, decision, dispute and payment masters
Insurer corporate governance, standalone pool administration, treaty formation, actuarial reserving and solvency computation
Issuing binding cover, certifying coverage, rating risk, denying claims, paying funds or making legal decisions
Complete life, health, annuity, parametric, mutual, public-scheme and cross-border profiles

Why it exists Filled

Describe one policy-centered insurance arrangement and its coverage, premium, risk-transfer, reporting and claim interfaces.

Distinguishing features Derived, awaiting review

Unlike WM-ECO-036: Preserve the registry CONTAINS candidate as optional contextual composition. Claim identity, request assertions, lines and amendments belong to the claim master; zero-to-many links, possible cross-policy association and no cascade. Cardinality remains a proposed profile rule.
Unlike WM-ACT-045: Insurance Claim Handling owns task execution and handling progress; only source-qualified summaries are referenced here.
Unlike WM-ECO-006: Commercial Contract supplies generic agreement references. Legacy EXTEND is qualified to an optional semantic reference until inheritance is validated.
Unlike WM-ECO-002: Price / Valuation supplies independent insured-interest valuation and appraisal evidence.
Unlike WM-ECO-009: Payment owns payment authorization, execution, reversal and settlement; local allocations never move funds.
Unlike WM-ORG-001: Organization owns legal-entity masters; insurer, pool operator and intermediary roles are local bindings.
Unlike WM-PER-001: Person owns natural-person identity; insured, policyholder and beneficiary roles do not duplicate that master.
Unlike WM-XCT-035: Retention / Disposition supplies rule and decision references; adopting storage service owns actual disposal execution.
Unlike Pool and reinsurance treaty master: Pool governance, treaty lifecycle and portfolio membership stay externally mastered; only policy-level allocations and assurance links are local.

Note: Derived from boundary notes against neighbouring models.

What robots and AI may and may not do Derived, awaiting review

Must not

Append authorized revisions using concurrency checks and source evidence; never infer legal change from successful storage.
Deny by default.

Only with a human decision

Consent is not a universal processing basis.
Emergency or statutory disclosure requires documented applicable authority, scope and review; neither user role nor consent alone is universal authorization.

May

Register local arrangement: Proposed local operation to link an authorized policy master and define the aggregate boundary. Not implemented by this research package.
Record coverage revision: Proposed local operation to record source-qualified wording and effective intervals. Not implemented by this research package.
Attach placement evidence: Proposed local operation to associate underwriting and needs/disclosure evidence. Not implemented by this research package.
Reconcile premium references: Proposed local operation to compare supplied schedule and payment allocations. Not implemented by this research package.
Link risk transfer and assurance: Proposed local operation to bind policy-level allocation and external report references. Not implemented by this research package.
Link claim and outcome records: Proposed local operation to maintain claim context with separately sourced outcome states. Not implemented by this research package.
Prepare restricted projection: Proposed local operation to compose a purpose-limited view for local review. Not implemented by this research package.

Note: Derived from functions, policies, CRUD and access rules; prohibitions were not authored for agents as such.

Moral aspects Derived, awaiting review

Consent is not a universal processing basis.
Privacy and records steward
Emergency or statutory disclosure requires documented applicable authority, scope and review; neither user role nor consent alone is universal authorization.
UK privacy guidance has amendment and review limits and must not be generalized to all jurisdictions.

Note: Sentences mentioning harm, privacy, consent or similar, collected from the specification.

Owners Filled

Steward

Adopting steward role and policy master namespace with authority evidence

Roles

Arrangement steward: Maintains local identity, revision and master links under documented authority.
Insurance subject reviewer: Reviews cover, underwriting, distribution and source interpretation within a qualified profile.
Financial reviewer: Validates referenced valuation, reconciliation and prudential context without delegating computations to this package.
Privacy and records steward: Determines permitted views, retention and rights-request routing under applicable policy.
Independent reviewer: Challenges evidence and boundaries before canonical promotion; currently absent.
Reader or agent: Reads authorized scope, preserves uncertainty and refuses unsupported legal or financial actions.

Links to other meta-models Filled

composes

WM-ECO-036 - Preserve the registry CONTAINS candidate as optional contextual composition. Claim identity, request assertions, lines and amendments belong to the claim master; zero-to-many links, possible cross-policy association and no cascade. Cardinality remains a proposed profile rule.

references

WM-ACT-045 - Insurance Claim Handling owns task execution and handling progress; only source-qualified summaries are referenced here.
WM-ECO-006 - Commercial Contract supplies generic agreement references. Legacy EXTEND is qualified to an optional semantic reference until inheritance is validated.
WM-ECO-002 - Price / Valuation supplies independent insured-interest valuation and appraisal evidence.
WM-ECO-009 - Payment owns payment authorization, execution, reversal and settlement; local allocations never move funds.
WM-ORG-001 - Organization owns legal-entity masters; insurer, pool operator and intermediary roles are local bindings.
WM-PER-001 - Person owns natural-person identity; insured, policyholder and beneficiary roles do not duplicate that master.
WM-XCT-035 - Retention / Disposition supplies rule and decision references; adopting storage service owns actual disposal execution.
Pool and reinsurance treaty master - Pool governance, treaty lifecycle and portfolio membership stay externally mastered; only policy-level allocations and assurance links are local.

aligned

PROV-O - Conceptual provenance mapping only; no implemented RDF profile or conformance claim.
RFC 3339 - Timestamp syntax alignment only; contractual dates and deadline rules require separate semantics.

neighbor

WM-ECO-036 - Preserve the registry CONTAINS candidate as optional contextual composition. Claim identity, request assertions, lines and amendments belong to the claim master; zero-to-many links, possible cross-policy association and no cascade. Cardinality remains a proposed profile rule.
WM-ACT-045 - Insurance Claim Handling owns task execution and handling progress; only source-qualified summaries are referenced here.
WM-ECO-006 - Commercial Contract supplies generic agreement references. Legacy EXTEND is qualified to an optional semantic reference until inheritance is validated.
WM-ECO-002 - Price / Valuation supplies independent insured-interest valuation and appraisal evidence.
WM-ECO-009 - Payment owns payment authorization, execution, reversal and settlement; local allocations never move funds.
WM-ORG-001 - Organization owns legal-entity masters; insurer, pool operator and intermediary roles are local bindings.
WM-PER-001 - Person owns natural-person identity; insured, policyholder and beneficiary roles do not duplicate that master.
WM-XCT-035 - Retention / Disposition supplies rule and decision references; adopting storage service owns actual disposal execution.
Pool and reinsurance treaty master - Pool governance, treaty lifecycle and portfolio membership stay externally mastered; only policy-level allocations and assurance links are local.

contains

WM-ECO-036

What else AI and robots need to interact with it Incomplete

Sources Filled

Insurance Core Principles and ComFrame - International Association of Insurance Supervisors
IFRS 17 Insurance Contracts - official overview - IFRS Foundation
Q&A 2525 - Signature requirements relating to demands and needs statement - European Insurance and Occupational Pensions Authority
Solvency II - regulatory framework overview - European Insurance and Occupational Pensions Authority
Principle (e): Storage limitation - Information Commissioner's Office
A guide to lawful basis - Information Commissioner's Office
PROV-O: The PROV Ontology - World Wide Web Consortium
RFC 3339: Date and Time on the Internet: Timestamps - Internet Engineering Task Force

Open questions

Verify current source versions, consolidated legal applicability, licensed standard access and claim-level support outside the sandbox.
Develop specialist insurance-line and pool-only profiles with explicit root boundaries, legal authority and qualified actuarial review.
Build nested schemas and adversarial fixtures for overlapping covers, retrospective amendments, disputed collection, partial claims, reinsurance default, privacy restrictions and lawful disposal.
Restore independent external review before any canonical or publishable-draft promotion.
Pool-only schemes and insurer-wide portfolios require separately scoped roots; this draft records only policy-level participation and report links.
Detailed life, annuity, health, parametric, compulsory, mutual and public insurance profiles remain incomplete.
Nested instance schemas, precision rules, event fixtures, legal calendars and executable conformance are not supplied.
ACORD licensed schemas were not accessed; no ACORD mapping or conformance is admitted.
Current consolidated legislation, source HTTP statuses, independent review and legal/actuarial applicability remain unverified.

Machine files

Card as JSON Specification AGENTS.md Source Card backlog vercy.card/1

Provenance

world-models research · reviewable-draft

Built from: models/wm-eco-003-insurance/spec.yaml