Insurance & Risk Pooling
Policies, pools, claims as value routing
Bundle → Layer → Finding → Questions Incomplete
3 bundles · 6 layers · 0 findings · 0 questions
cover What is promised and at what price
policyTerms
cover, exclusions and insured interests
underwriting
risk assessment and premium setting
pooling How exposure is spread
participation
pool membership, cessions and reinsurance
reserves
funding, reserves and solvency snapshots
claims How losses are made good
assessment
notification, documentation and loss evaluation
settlement
payout, denial and subrogation
Note: Legacy card: layers named, findings and questions never written.
Classifiers Filled
- Family
- World Models
- Category
- Society, people and institutions
- Entry kind
- standalone-mm
- Navigation path
- NAV.SOC.ECO.INS
- Domain
- SOC.ECO.INS
- Industry
- Cross-industry
- Tags
- insurancesoc.eco.ins
- Also called
- C8
What it is Derived, awaiting review
This meta-model describes how risks are shared: policies that promise to make losses good, premiums that fund the promise, pools and reinsurance that spread the exposure, and claims that call the promise in.
Note: First sentence of the legacy card introduction.
Why it exists Filled
Policies, pools, claims as value routing
Distinguishing features Derived, awaiting review
- It is its own model because the policy is a bilateral record with a lifecycle of its own, while pooling and claims settlement follow rules that no general agreement model captures.
What robots and AI may and may not do Missing, in the backlog
Not described yet. This gap is in the card backlog.
Moral aspects Missing, in the backlog
Not described yet. This gap is in the card backlog.
Owners Filled
Steward
Policy and claim records are bilateral, owned jointly by insurer and insured; pool records are stewarded by the pool operator for its participants.
Links to other meta-models Filled
extends
- world.commercialContract - a policy is a specialized agreement with insurance-specific obligations and lifecycle.
references
- world.priceValuation - insured values and loss quantification rely on appraisals and indices.
- world.organization - insurers, holders and beneficiaries.
- world.person - insurers, holders and beneficiaries.
- world.landParcel - insured property interests resolve to parcels and buildings.
- world.disputeResolution - contested claims escalate there.
- world.stewardship - ownership and access grants over policy, pool and claim records.
- world.accessGrant - ownership and access grants over policy, pool and claim records.
composes
- world.auditTrail - audit facets on issuance, cession and settlement events.
imports
- acord - ALIGN: insurance data interchange vocabulary across cover, pooling and claims.
- iso-4217 - REFERENCE: currency codes on premiums, reserves and settlements.
contains
- WM-ECO-036
requires
- vr.wm-pol-010
- vr.wm-pol-014
What else AI and robots need to interact with it Incomplete
Identity and identifiers required Missing, in the backlog
Not described yet. This gap is in the card backlog.
Direct properties not applicable Not applicable
Not applicable
Institutional or informational subject: no invented physical properties.
Recognition optional Missing, in the backlog
Not described yet. This gap is in the card backlog.
Capabilities and actions required Derived, awaiting review
- policyIssued: cover took effect between insurer and insured.
- coverAmended: interests, sums or exclusions changed mid-term.
- premiumCollected: a scheduled payment was received.
- riskCeded: exposure was passed into a pool or reinsurance treaty.
- claimNotified: the insured reported a loss.
- lossAssessed: the loss was evaluated.
- claimSettled: the claim was paid, partly paid or denied.
- policyLapsed: cover ended by expiry, cancellation or non-payment.
Legacy events listed as state transitions.
Hazards and failure modes optional Missing, in the backlog
Not described yet. This gap is in the card backlog.
Standards and interfaces required Derived, awaiting review
- policyMirror: insurer and insured hold the identical policy and claim record as a bilateral mirror.
- claimsHistoryDisclosure: consented disclosure of a holder's claims experience to another insurer or broker.
- poolAccounts: participants receive periodic pool composition, exposure and reserve reports.
- coverCertificate: proof of cover for third parties; omits premium and underwriting detail.
- claimsExperience: per-holder loss history summary; omits assessment working papers.
- poolExposureView: aggregate exposure and reserve adequacy for a pool; omits individual policies.
Context of use required Filled
- Access is granted by the owners under the S1/S2 models of this catalogue.
Sources Missing, in the backlog
Not described yet. This gap is in the card backlog.
Open questions
- Superseded by a researched world model? Map this legacy card to its successor or retire it.
Machine files
Provenance
legacy MMAS card (world-models v0.2) · legacy
Built from: models/world-c8-insurance-and-risk-pooling/spec.yaml, models/docs/economy/C8-insurance-and-risk-pooling.md