insurance-track-claim-status

insurance-track-claim-status

Trigger:

• User input: "log a new claim", "update claim status", "claim follow-up"
• Called by: op-claims-review, op-document-claims-process, op-life-event-coverage-trigger (death event)

What It Does

Claims often take weeks or months and have multiple deadlines (proof-of-loss, appraisal, settlement response, appeal). Without structured tracking, deadlines get missed and adjusters go quiet. This task is the per-claim ledger.

Per-claim record contents:

• claim_number, carrier, policy_type, policy_number
• incident_date, incident_description
• filing_date, claim_status (open / under-investigation / approved / denied / settled / closed / disputed)
• adjuster_name, adjuster_phone, adjuster_email
• documents_submitted (list with dates)
• documents_requested (list with deadline dates)
• expected_resolution_date (from carrier guidance)
• last_status_update_date
• follow_up_actions (list with action and date)
• settlement_offers (list with amount, date, response)
• notes_log (running journal)

Stall detection: If last_status_update_date is more than 30 days ago, the claim is flagged STALLED. State insurance regulations typically require timely communication; a stall is a prompt to escalate (call adjuster, request supervisor, file complaint with state DOI).

Steps

1. Receive input: new claim creation, status update, or follow-up note.
2. If new: create vault/insurance/00_current/claims/{claim-number}.md with full record.
3. If update: append to the existing record, update status fields, append note to journal.
4. Compute days since last status update.
5. If stalled (>30 days): flag via task-update-open-loops with severity HIGH.
6. If a document deadline is within 7 days: flag as URGENT.
7. If a settlement offer is open: flag with response deadline.
8. Return the updated record.

Configuration

vault/insurance/config.md:

• claim_stall_threshold_days (default 30)
• state — used to surface state-DOI escalation guidance for stalled claims

Error Handling

• Claim record exists at same number: Treat as update, not new.
• Status update without claim number: Prompt user to either provide the number or create a new claim record.

Vault Paths

• Reads: ~/Documents/aireadylife/vault/insurance/00_current/claims/
• Writes: ~/Documents/aireadylife/vault/insurance/00_current/claims/{claim-number}.md, ~/Documents/aireadylife/vault/insurance/open-loops.md