Claims Processing Mechanism

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Claims Processing Mechanism

As a participant in the decentralized and tokenized marketplace, I want to have a reliable and transparent mechanism to process flood insurance claims, ensuring accuracy and prompt claim resolution for the coverage areas of the Southern United States and Puerto Rico.

Acceptance Criteria

• Claims can be submitted through a decentralized application (dApp).
• Claims are timestamped and recorded immutably on the blockchain.
• The claims processing mechanism uses smart contracts to validate claim conditions against policy rules.
• Claimants receive automatic notifications about claim status changes.
• Adjusters can update the status of the claim after investigation.
• Claim resolutions trigger automatic payouts if the conditions are met.
• There is an arbitration system for disputed claims.
• Claim history is accessible to users for audit and transparency purposes.

sequenceDiagram
  participant Claimant as Insured User
  participant SmartContract as Insurance Smart Contract
  participant Oracle as Data Verification Oracle
  participant Adjuster as Claim Adjuster
  Claimant->>SmartContract: Submit claim with evidence
  SmartContract->>Oracle: Request data verification
  Oracle-->>SmartContract: Provide verified data
  SmartContract->>Adjuster: Notify to investigate
  Adjuster->>SmartContract: Update claim status
  SmartContract->>Claimant: Notify claimant of status
  SmartContract->>Claimant: Initiate payout upon successful claim verification

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