# Claim Adjudication Enterprise Ontology — MERGED convenience file
# Version 0.1.0 · 2026-08-06 · Draft pending SME validation
# Contents: fnd/process (CR draft) + adjmeta + 18 claims modules + 39 SKOS schemes.
# The MODULAR files under ontology/ and vocabulary/ are canonical; this merge is
# generated for single-file loading (Protégé / triplestore) and drops comments.
# SHACL shapes (shapes/) and fixtures (samples/) are separate artifacts by design.
@prefix adj: .
@prefix adjmeta: .
@prefix adjstage: .
@prefix agr: .
@prefix aipred: .
@prefix asg: .
@prefix audarea: .
@prefix audout: .
@prefix biz: .
@prefix cfregime: .
@prefix chan: .
@prefix claim: .
@prefix cmp: .
@prefix core: .
@prefix coverage: .
@prefix covtype: .
@prefix cplx: .
@prefix crole: .
@prefix ctrig: .
@prefix cvp: .
@prefix cvpos: .
@prefix dct: .
@prefix dmdtype: .
@prefix doctype: .
@prefix dpv: .
@prefix dtr: .
@prefix evd: .
@prefix evduse: .
@prefix excl: .
@prefix fin: .
@prefix fincat: .
@prefix fncat: .
@prefix fra: .
@prefix fraind: .
@prefix gate: .
@prefix hstat: .
@prefix injnature: .
@prefix inv: .
@prefix itk: .
@prefix itm: .
@prefix jrule: .
@prefix legalact: .
@prefix lia: .
@prefix liadesc: .
@prefix ltg: .
@prefix ltgdisp: .
@prefix ltgstat: .
@prefix med: .
@prefix outcome: .
@prefix ovrsn: .
@prefix owl: .
@prefix p-plan: .
@prefix paymeth: .
@prefix policy: .
@prefix premcond: .
@prefix proc: .
@prefix prov: .
@prefix rcv: .
@prefix rcvreason: .
@prefix rdf: .
@prefix rdfs: .
@prefix rsvreason: .
@prefix schema: .
@prefix siuout: .
@prefix siusrc: .
@prefix skos: .
@prefix stl: .
@prefix stlmeth: .
@prefix stp: .
@prefix stpdisp: .
@prefix taskstat: .
@prefix tasktype: .
@prefix time: .
@prefix trtstat: .
@prefix val: .
@prefix vann: .
@prefix xsd: .
adj:Process-GLAutoAdjudication-1 a owl:NamedIndividual,
adj:AdjudicationProcess ;
rdfs:label "GL/Auto claim adjudication process, v1"@en ;
dct:source "Adjudication Process Flow tab"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The published definition of the General Liability and Auto claim adjudication process for North America: ten ordered stages, eleven decision gates."@en ;
adj:hasStage adj:Stage-Adjudication,
adj:Stage-ClosurePostSettlement,
adj:Stage-CoverageVerification,
adj:Stage-EvaluationValuation,
adj:Stage-ExclusionLimitCalculation,
adj:Stage-FNOLIntake,
adj:Stage-HistoricalAssessment,
adj:Stage-Investigation,
adj:Stage-SettlementPayment,
adj:Stage-TriageAssignment ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adj:acordProcessRef a owl:DatatypeProperty ;
rdfs:label "ACORD process reference"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:string ;
skos:definition "ACORD Capability / Process Model reference for a stage."@en ;
schema:domainIncludes adj:AdjudicationStage .
adj:bpmnActivityRef a owl:DatatypeProperty ;
rdfs:label "BPMN activity reference"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:anyURI ;
skos:definition "Pointer to the BPMN/CMMN activity a stage corresponds to, so the modelled and executable processes stay reconcilable. BPMN structure is never encoded in OWL axioms."@en ;
schema:domainIncludes adj:AdjudicationStage .
adj:complexityScore a owl:DatatypeProperty ;
rdfs:label "complexity score"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:decimal ;
skos:definition "The automated complexity score on the claim. Available now in the refined layer."@en ;
schema:domainIncludes adj:ComplexityAssessment .
adj:complexityTier a owl:ObjectProperty ;
rdfs:label "complexity tier"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The complexity tier of an assessment, as a concept from the complexity-tier scheme (cplx:)."@en ;
schema:domainIncludes adj:ComplexityAssessment .
adj:decisionDate a owl:DatatypeProperty ;
rdfs:label "decision date"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:dateTime ;
skos:definition "The single canonical decision timestamp. Do not mint determinationDate, positionDate or adjudicatedOn — one property per meaning."@en ;
schema:domainIncludes adj:AdjudicationDecision .
adj:dmnDecisionRef a owl:DatatypeProperty ;
rdfs:label "DMN decision reference"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:anyURI ;
skos:definition "Pointer to the OMG DMN decision that implements the logic. The ontology records which decision fired and what it concluded; DMN owns the decision logic."@en ;
schema:domainIncludes adj:AdjudicationRule,
adj:DecisionGate .
adj:gateOrdinal a owl:DatatypeProperty ;
rdfs:label "gate ordinal"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:integer ;
skos:definition "The position of a gate in the plan, 1–11. Range enforced in SHACL."@en ;
schema:domainIncludes adj:DecisionGate .
adj:outcomeValue a owl:ObjectProperty ;
rdfs:label "outcome value"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The outcome value of a decision outcome, as a concept from the decision-outcome scheme (outcome:)."@en ;
schema:domainIncludes adj:DecisionOutcome .
adj:ruleIdentifier a owl:DatatypeProperty ;
rdfs:label "rule identifier"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:string ;
skos:definition "The configured identifier of an adjudication rule."@en ;
schema:domainIncludes adj:AdjudicationRule .
adj:ruleStatement a owl:DatatypeProperty ;
rdfs:label "rule statement"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:string ;
skos:definition "SBVR-style natural-language statement of the rule."@en ;
schema:domainIncludes adj:AdjudicationRule .
adj:ruleVersion a owl:DatatypeProperty ;
rdfs:label "rule version"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:string ;
skos:definition "The version of an adjudication rule; needed so historical rule applications can be compared."@en ;
schema:domainIncludes adj:AdjudicationRule .
adj:stageOrdinal a owl:DatatypeProperty ;
rdfs:label "stage ordinal"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:integer ;
skos:definition "The position of a stage in the plan, 1–10. Range enforced in SHACL."@en ;
schema:domainIncludes adj:AdjudicationStage .
adj:stepDescription a owl:DatatypeProperty ;
rdfs:label "step description"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:string ;
skos:definition "The description of one adjudication step."@en ;
schema:domainIncludes adj:AdjudicationStep .
adj:stepOrdinal a owl:DatatypeProperty ;
rdfs:label "step ordinal"@en ;
dct:source "ONTOSPEC §5.2.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:range xsd:integer ;
skos:definition "The position of a step within a decision's reasoning record."@en ;
schema:domainIncludes adj:AdjudicationStep .
asg:Adjudicator a owl:Class ;
rdfs:label "Adjudicator"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:AdjudicatorRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the adjudicator role."@en .
asg:Adjuster a owl:Class ;
rdfs:label "Adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:AdjusterRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the adjuster role."@en .
asg:AssignmentHistory a owl:Class ;
rdfs:label "Assignment history"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The routing and reassignment log. Exists operationally; not in the analytical layer."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
asg:Auditor a owl:Class ;
rdfs:label "Auditor"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:AuditorRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the auditor role."@en .
asg:AuthorityRequest a owl:Class ;
rdfs:label "Authority request"@en ;
dct:source "Source table RSRV_REQ (reserves); ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf proc:Referral ;
skos:definition "An escalation request above an adjuster's threshold, with its approval chain and dates."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
asg:CATAdjuster a owl:Class ;
rdfs:label "CAT adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:CATAdjusterRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the CAT-adjuster role."@en .
asg:FNOLHandler a owl:Class ;
rdfs:label "FNOL handler"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:FNOLHandlerRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the FNOL-handler role."@en .
asg:Insured a owl:Class ;
rdfs:label "Insured"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:InsuredRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A party currently holding the insured role."@en .
asg:LineOwner a owl:Class ;
rdfs:label "Line owner"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:LineOwnerRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the line-owner role."@en .
asg:Payee a owl:Class ;
rdfs:label "Payee"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:PayeeRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A party currently holding the payee role."@en .
asg:PublicAdjuster a owl:Class ;
rdfs:label "Public adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:PublicAdjusterRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the public-adjuster role."@en .
asg:SIUInvestigator a owl:Class ;
rdfs:label "SIU investigator"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:SIUInvestigatorRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the SIU-investigator role."@en .
asg:SpecialtyTask a owl:Class ;
rdfs:label "Specialty task"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf asg:Task ;
skos:definition "A task of a specialty type requiring a designated skill."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
asg:Supervisor a owl:Class ;
rdfs:label "Supervisor"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:SupervisorRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the supervisor role."@en .
asg:SystemPerformer a owl:Class ;
rdfs:label "System performer"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf prov:SoftwareAgent,
asg:Performer ;
skos:definition "An automated process acting as a performer. Distinguishing a system authorisation from a named adjuster is the proxy signal for STP confirmation."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
asg:TaskNotification a owl:Class ;
rdfs:label "Task notification"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A notification raised for a task."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
asg:TriageAssessment a owl:Class ;
rdfs:label "Triage assessment"@en ;
dct:source "ONTOSPEC §5.6.1; Gate 4"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-4 determination: classify complexity, assign to the right adjuster or queue. SME note: triage happens earlier than the model suggests — a policy document may be consulted here for a coverage pre-check before Stage 2."@en ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
asg:VendorAssignment a owl:Class ;
rdfs:label "Vendor assignment"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf asg:AssignmentRecord ;
skos:definition "Assignment of a third-party service provider — IME physician, independent adjuster, expert, medical bill review, repair shop."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
asg:VendorParty a owl:Class ;
rdfs:label "Vendor party"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:VendorRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the vendor role."@en .
asg:Witness a owl:Class ;
rdfs:label "Witness"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue asg:WitnessRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the witness role."@en .
asg:authorityLimit a owl:ObjectProperty ;
rdfs:label "authority limit"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf proc:authorityLimit ;
skos:definition "The monetary limit of an authority, as a core:MoneyAmount."@en ;
schema:domainIncludes asg:Authority ;
schema:rangeIncludes core:MoneyAmount .
asg:complaintClassification a owl:ObjectProperty ;
rdfs:label "complaint classification"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The complaint classification on a coverage line, as a SKOS concept."@en ;
schema:domainIncludes cvp:CoverageLine .
asg:diaryDate a owl:DatatypeProperty ;
rdfs:label "diary date"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:date ;
skos:definition "The diary date of a task. Partially mapped."@en ;
schema:domainIncludes asg:Task .
asg:escalationIndicator a owl:DatatypeProperty ;
rdfs:label "escalation indicator"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the claim has been escalated. Mostly mapped."@en ;
schema:domainIncludes claim:Claim .
asg:participantRole a owl:ObjectProperty ;
rdfs:label "participant role"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The capacity of participation, from the participant-role scheme (crole:)."@en ;
schema:domainIncludes asg:ParticipantRecord .
asg:queueAssignedAt a owl:DatatypeProperty ;
rdfs:label "queue assigned at"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:dateTime ;
skos:definition "When the claim entered the queue. Enables dwell-time analytics."@en ;
schema:domainIncludes asg:QueueAssignment .
asg:queueReleasedAt a owl:DatatypeProperty ;
rdfs:label "queue released at"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:dateTime ;
skos:definition "When the claim left the queue."@en ;
schema:domainIncludes asg:QueueAssignment .
asg:referralDescription a owl:DatatypeProperty ;
rdfs:label "referral description"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:string ;
skos:definition "Free-text description of a referral. Partially mapped."@en ;
schema:domainIncludes proc:Referral .
asg:routingDestination a owl:ObjectProperty ;
rdfs:label "routing destination"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The routing destination code, from the routing-destination scheme (route:)."@en ;
schema:domainIncludes asg:AssignmentRecord,
cvp:CoverageLine .
asg:taskCompletionDate a owl:DatatypeProperty ;
rdfs:label "task completion date"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:date ;
skos:definition "When the task was completed."@en ;
schema:domainIncludes asg:Task .
asg:taskDueDate a owl:DatatypeProperty ;
rdfs:label "task due date"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:date ;
skos:definition "When the task is due."@en ;
schema:domainIncludes asg:Task .
asg:taskMemo a owl:DatatypeProperty ;
rdfs:label "task memo"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range xsd:string ;
skos:definition "Short-form memo text; lower extraction value than file notes but carries workflow rationale."@en ;
schema:domainIncludes asg:Task .
asg:taskOutcome a owl:ObjectProperty ;
rdfs:label "task outcome"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The outcome of a task, as a SKOS concept."@en ;
schema:domainIncludes asg:Task .
asg:taskStatus a owl:ObjectProperty ;
rdfs:label "task status"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The status of a task, from the task-status scheme (taskstat:)."@en ;
schema:domainIncludes asg:Task .
asg:taskType a owl:ObjectProperty ;
rdfs:label "task type"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The type of a task, from the task-type scheme (tasktype:)."@en ;
schema:domainIncludes asg:Task .
asg:vendorType a owl:ObjectProperty ;
rdfs:label "vendor type"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The type of vendor, as a SKOS concept — never a subclass."@en ;
schema:domainIncludes asg:Vendor .
cmp:JurisdictionRule a owl:Class ;
rdfs:label "Jurisdiction rule"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf cmp:ComplianceRequirement ;
skos:definition "The jurisdiction-specific parameterisation of a requirement. The values are DATA, never hard-coded axioms — ~44 states enacted statutes substantially based on the model act, with per-state variation."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cmp:RegulatoryFiling a owl:Class ;
rdfs:label "Regulatory filing"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A filing made to a regulator in respect of a claim."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cmp:comparativeFaultRegime a owl:ObjectProperty ;
rdfs:label "comparative fault regime"@en ;
dct:source "ONTOSPEC §5.18; Question 17"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Whether a jurisdiction applies comparative fault or contributory negligence, from the comparative-fault-regime scheme (cfregime:). A jurisdiction ATTRIBUTE, never a claim subclass (PIT-2)."@en ;
schema:domainIncludes cmp:Jurisdiction .
cmp:deadlineInterval a owl:ObjectProperty ;
rdfs:label "deadline interval"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The interval of the deadline (e.g. 10 working days) as a time:DurationDescription — preferred over a bare integer so \"working days\" is explicit."@en ;
schema:domainIncludes cmp:StatutoryDeadline ;
schema:rangeIncludes time:DurationDescription .
cmp:dueAt a owl:DatatypeProperty ;
rdfs:label "due at"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:range xsd:dateTime ;
skos:definition "The computed due timestamp of the deadline for one claim."@en ;
schema:domainIncludes cmp:StatutoryDeadline .
cmp:penaltyDescription a owl:DatatypeProperty ;
rdfs:label "penalty description"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:range xsd:string ;
skos:definition "Description of the penalty."@en ;
schema:domainIncludes cmp:Penalty .
cmp:ruleType a owl:ObjectProperty ;
rdfs:label "rule type"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Acknowledgement / Claim-Forms Supply / Accept-or-Deny / Investigation-Status Notice / Payment / Fraud Reporting, from the jurisdiction-rule-type scheme (jrule:)."@en ;
schema:domainIncludes cmp:ComplianceRequirement .
cvp:ConditionAssessment a owl:Class ;
rdfs:label "Condition assessment"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The assessment of a policy condition — notice, cooperation, proof of loss — and whether it was met."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:CoverageConfirmation a owl:Class ;
rdfs:label "Coverage confirmation"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf cvp:CoveragePositionStatement ;
skos:definition "A coverage position in which the insurer confirms coverage."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:CoverageCounsel a owl:Class ;
rdfs:label "Coverage counsel"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue cvp:CoverageCounselRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the coverage-counsel role."@en .
cvp:CoverageRuleApplication a owl:Class ;
rdfs:label "Coverage rule application"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf adj:RuleApplication ;
skos:definition "The per-claim record of which coverage rule logic was applied. Rule configuration exists; per-claim application does not."@en ;
adjmeta:acordAlignment "OMG DMN" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:ReservationOfRights a owl:Class ;
rdfs:label "Reservation of rights"@en ;
dct:source "ONTOSPEC §5.5.1; Document Type Reference — ROR Letter"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf cvp:CoveragePositionStatement ;
skos:definition "Formal written notice that the claim is under investigation and coverage is not yet confirmed. Names the provisions or exclusions under review and preserves the right to later deny. Without it, paying defence costs can be read as accepting coverage."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:agreedLimitAmount a owl:ObjectProperty ;
rdfs:label "agreed limit amount"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The agreed coverage limit, in local currency and USD. Mapped."@en ;
schema:domainIncludes cvp:LimitApplication ;
schema:rangeIncludes core:MoneyAmount .
cvp:appliedLimitAmount a owl:ObjectProperty ;
rdfs:label "applied limit amount"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The limit amount actually applied. Not in the analytical layer."@en ;
schema:domainIncludes cvp:LimitApplication ;
schema:rangeIncludes core:MoneyAmount .
cvp:coverageType a owl:ObjectProperty ;
rdfs:label "coverage type"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The coverage type of a line, from the coverage-type scheme (covtype:)."@en ;
schema:domainIncludes cvp:CoverageLine .
cvp:coverageVerificationDate a owl:DatatypeProperty ;
rdfs:label "coverage verification date"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range xsd:date ;
skos:definition "The date coverage was verified. The decision date is not in the analytical layer."@en ;
schema:domainIncludes cvp:CoverageDetermination .
cvp:deductibleAmount a owl:ObjectProperty ;
rdfs:label "deductible amount"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The deductible applied."@en ;
schema:domainIncludes cvp:DeductibleApplication ;
schema:rangeIncludes core:MoneyAmount .
cvp:excessAmount a owl:ObjectProperty ;
rdfs:label "excess amount"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount above the applied limit. Not in the analytical layer."@en ;
schema:domainIncludes cvp:LimitApplication ;
schema:rangeIncludes core:MoneyAmount .
cvp:exclusionType a owl:ObjectProperty ;
rdfs:label "exclusion type"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The type of exclusion invoked, from the exclusion-type scheme (excl:)."@en ;
schema:domainIncludes cvp:ExclusionApplication .
cvp:financialCloseDate a owl:DatatypeProperty ;
rdfs:label "financial close date"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range xsd:date ;
skos:definition "The financial close date of a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine .
cvp:handlingStatus a owl:ObjectProperty ;
rdfs:label "handling status"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf proc:hasStatus ;
skos:definition "The current handling status of a coverage line, from the handling-status scheme (hstat:). Derived from the latest assignment."@en ;
schema:domainIncludes cvp:CoverageLine .
cvp:legalBasis a owl:DatatypeProperty ;
rdfs:label "legal basis"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range xsd:string ;
skos:definition "The legal basis for a denial, extracted from the denial correspondence."@en ;
schema:domainIncludes cvp:CoverageDenial .
cvp:netPayableAmount a owl:ObjectProperty ;
rdfs:label "net payable amount"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The net payable after deductible, exclusions and coordination. Extraction needed."@en ;
schema:domainIncludes cvp:PayableAmount ;
schema:rangeIncludes core:MoneyAmount .
cvp:policySectionReference a owl:DatatypeProperty ;
rdfs:label "policy section reference"@en ;
dct:source "ONTOSPEC §5.5.3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range xsd:string ;
skos:definition "The cited policy section of an exclusion application."@en ;
schema:domainIncludes cvp:ExclusionApplication .
cvp:positionValue a owl:ObjectProperty ;
rdfs:label "position value"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The coverage position value: Confirmed / Reserved / Denied / Partial / UnderReview, from the coverage-position scheme (cvpos:)."@en ;
schema:domainIncludes cvp:CoveragePositionStatement .
dtr:auditArea a owl:ObjectProperty ;
rdfs:label "audit area"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The audited area, as a concept from the audit-area scheme (audarea:)."@en ;
schema:domainIncludes dtr:AuditRecord .
dtr:auditDate a owl:DatatypeProperty ;
rdfs:label "audit date"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:date ;
skos:definition "The date of the audit."@en ;
schema:domainIncludes dtr:AuditRecord .
dtr:auditOutcome a owl:ObjectProperty ;
rdfs:label "audit outcome"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The audit outcome, as a concept from the audit-outcome scheme (audout:)."@en ;
schema:domainIncludes dtr:AuditRecord .
dtr:auditQuestion a owl:DatatypeProperty ;
rdfs:label "audit question"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "The audit question a finding answers."@en ;
schema:domainIncludes dtr:AuditFinding .
dtr:citationPresent a owl:DatatypeProperty ;
rdfs:label "citation present"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:boolean ;
skos:definition "Whether a citation appears in the model output. OPEN QUESTION (Dhaji, 2026-07-31; Joe to confirm) — emitted rather than resolved either way."@en ;
skos:editorialNote "Open question (2026-07-31): unsure whether a citation appears in the model output."@en ;
adjmeta:openQuestion true ;
schema:domainIncludes dtr:AIOutput .
dtr:humanOverrideFlag a owl:DatatypeProperty ;
rdfs:label "human override flag"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the output was overridden by a human. May already be structured in ADT — open question, Joe to confirm; if it is, the extraction scope narrows to the free-text reason only."@en ;
skos:editorialNote "Open question (2026-07-31): the override flag may already be structured in ADT. Joe to confirm."@en ;
adjmeta:openQuestion true ;
schema:domainIncludes dtr:AIOutput .
dtr:informationRecorded a owl:DatatypeProperty ;
rdfs:label "information recorded"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "\"What do you record in the claim note or system?\" — SME-completed."@en ;
schema:domainIncludes dtr:EvidenceUse .
dtr:informationReferenced a owl:DatatypeProperty ;
rdfs:label "information referenced"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "\"What info do you reference from this document?\" — SME-completed. Free text initially; a target for later structuring."@en ;
schema:domainIncludes dtr:EvidenceUse .
dtr:modelVersion a owl:DatatypeProperty ;
rdfs:label "model version"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "Scoring-model vintage. Without it, historical scores cannot be compared."@en ;
schema:domainIncludes dtr:AIModel .
dtr:overrideReason a owl:ObjectProperty ;
rdfs:label "override reason"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The coded reason for an override, as a concept from the override-reason scheme (ovrsn:). The real distribution of reasons is the answer to CQ-QB-27 and must be derived from extracted note text, not invented."@en ;
schema:domainIncludes dtr:HumanOverride .
dtr:overrideTimestamp a owl:DatatypeProperty ;
rdfs:label "override timestamp"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:dateTime ;
skos:definition "When the override happened. Prefer prov:startedAtTime on the dtr:HumanOverride activity; retained for source fidelity."@en ;
schema:domainIncludes dtr:HumanOverride .
dtr:predictionType a owl:ObjectProperty ;
rdfs:label "prediction type"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "What kind of prediction the output is, as a concept from the ai-prediction-type scheme (aipred:)."@en ;
schema:domainIncludes dtr:AIOutput .
dtr:smeCorrection a owl:DatatypeProperty ;
rdfs:label "SME correction"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "The SME's correction column. Preserves the validation trail; SME notes are data, never prose to be discarded."@en ;
schema:domainIncludes dtr:EvidenceUse .
dtr:statementText a owl:DatatypeProperty ;
rdfs:label "statement text"@en ;
dct:source "ONTOSPEC §5.3.3"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range xsd:string ;
skos:definition "The rationale text as written. PII-bearing free text."@en ;
schema:domainIncludes dtr:RationaleStatement ;
dpv:hasPersonalDataCategory dpv:Identifying .
dtr:usageDisposition a owl:ObjectProperty ;
rdfs:label "usage disposition"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Whether the document was consulted: Used / NotUsed / Sometimes / PendingSMEConfirmation, from the evidence-use scheme (evduse:). The Y/N/Sometimes column of the template."@en ;
schema:domainIncludes dtr:EvidenceUse .
dtr:usedDocumentType a owl:ObjectProperty ;
rdfs:label "used document type"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The document category consulted, as a concept from the claim-document-type scheme (doctype:). Template rows are category-level; instance rows may add dtr:usedDocument."@en ;
schema:domainIncludes dtr:EvidenceUse .
evd:characterOffset a owl:DatatypeProperty ;
rdfs:label "character offset"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:integer ;
skos:definition "The character offset within the anchored text, where available."@en ;
schema:domainIncludes evd:DocumentAnchor .
evd:contentReference a owl:DatatypeProperty ;
rdfs:label "content reference"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:anyURI ;
skos:definition "A resolvable pointer to the stored object; never the content itself."@en ;
schema:domainIncludes evd:Attachment,
evd:ClaimDocument .
evd:direction a owl:DatatypeProperty ;
rdfs:label "direction"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The direction of a correspondence: Inbound or Outbound. Constrained in SHACL, not enumerated in OWL."@en ;
schema:domainIncludes evd:Correspondence .
evd:documentDate a owl:DatatypeProperty ;
rdfs:label "document date"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:date ;
skos:definition "The date of a claim document. Prefer a time: interval where a range matters."@en ;
schema:domainIncludes evd:ClaimDocument .
evd:documentTitle a owl:DatatypeProperty ;
rdfs:label "document title"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The title of a claim document."@en ;
schema:domainIncludes evd:ClaimDocument .
evd:documentType a owl:ObjectProperty ;
rdfs:label "document type"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The document category of a claim document, as a concept from the claim-document-type scheme (doctype:). Never a class per category."@en ;
schema:domainIncludes evd:ClaimDocument .
evd:extractionConfidence a owl:DatatypeProperty ;
rdfs:label "extraction confidence"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:decimal ;
skos:definition "The extraction model's confidence in an extracted fact, 0.0–1.0. Range enforced in SHACL (sh:minInclusive 0 / sh:maxInclusive 1)."@en ;
schema:domainIncludes evd:ExtractedFact .
evd:extractionMethod a owl:DatatypeProperty ;
rdfs:label "extraction method"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The model plus version that ran the extraction; also carried as prov:hadPlan on the evd:Extraction activity."@en ;
schema:domainIncludes evd:Extraction .
evd:fileFormat a owl:DatatypeProperty ;
rdfs:label "file format"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The file format of an attachment; supports attachment-format distribution analytics."@en ;
schema:domainIncludes evd:Attachment .
evd:isSystemGenerated a owl:DatatypeProperty ;
rdfs:label "is system generated"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:boolean ;
skos:definition "Distinguishes automated from adjuster-authored notes and tasks. Feeds CQ-STP-03."@en ;
schema:domainIncludes evd:FileNote .
evd:noteCategory a owl:ObjectProperty ;
rdfs:label "note category"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The category of a file note, as a concept from the file-note-category scheme (fncat:). GAP-06: the official code table is unknown; scheme concepts are seeded and flagged as open questions."@en ;
adjmeta:gapId "GAP-06" ;
schema:domainIncludes evd:FileNote .
evd:noteSequence a owl:DatatypeProperty ;
rdfs:label "note sequence"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:integer ;
skos:definition "Ordering of a text block within a note."@en ;
schema:domainIncludes evd:FileNoteText .
evd:noteText a owl:DatatypeProperty ;
rdfs:label "note text"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The text content of a note text block. Carries free-text PII: assume it contains everything."@en ;
schema:domainIncludes evd:FileNoteText ;
dpv:hasPersonalDataCategory dpv:Identifying .
evd:pageReference a owl:DatatypeProperty ;
rdfs:label "page reference"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The page within the anchored document, where available."@en ;
schema:domainIncludes evd:DocumentAnchor .
fin:AttorneyFeeRecord a owl:Class ;
rdfs:label "Attorney fee record"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf fin:Payment ;
skos:definition "Defence-cost allocation. Not in any source as a distinct entity."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fin:PaymentTransaction a owl:Class ;
rdfs:label "Payment transaction"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf fin:FinancialTransaction ;
skos:definition "One payment movement, including state changes."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fin:ReserveRequest a owl:Class ;
rdfs:label "Reserve request"@en ;
dct:source "Source table RSRV_REQ; ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf proc:Referral ;
skos:definition "An escalation above the adjuster's reserve threshold, with its approval chain and dates. Intended alignment: asg:AuthorityRequest (assignment module) — parented here at proc:Referral to keep the import DAG acyclic; asg:AuthorityRequest shares the same parent."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
fin:SignalReserve a owl:Class ;
rdfs:label "Signal reserve"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf fin:Reserve ;
skos:definition "A sub-category of reserve indicated by a signal-reserve flag and type. Semantics unconfirmed — open SME question."@en ;
skos:editorialNote "GAP-07: the semantics of the signal-reserve flag are unconfirmed. Do not silently resolve."@en ;
adjmeta:gapId "GAP-07" ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
fin:actuarialFlag a owl:DatatypeProperty ;
rdfs:label "actuarial flag"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the reserve is actuarially set."@en ;
schema:domainIncludes fin:Reserve .
fin:currentReserveAmount a owl:ObjectProperty ;
rdfs:label "current reserve amount"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The reserve as currently held."@en ;
schema:domainIncludes fin:Reserve ;
schema:rangeIncludes core:MoneyAmount .
fin:financialCategory a owl:ObjectProperty ;
rdfs:label "financial category"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Indemnity / Expense / Medical, from the financial-category scheme (fincat:)."@en ;
schema:domainIncludes fin:Payment,
fin:Reserve .
fin:initialReserveAmount a owl:ObjectProperty ;
rdfs:label "initial reserve amount"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The reserve as first set."@en ;
schema:domainIncludes fin:Reserve ;
schema:rangeIncludes core:MoneyAmount .
fin:isSystemSet a owl:DatatypeProperty ;
rdfs:label "is system set"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the reserve was set by the algorithm. UNCONFIRMED whether the source writes this (GAP-11) — essential to compare STP vs adjuster reserve adequacy."@en ;
adjmeta:gapId "GAP-11" ;
adjmeta:openQuestion true ;
schema:domainIncludes fin:Reserve .
fin:paymentAmount a owl:ObjectProperty ;
rdfs:label "payment amount"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount of a payment."@en ;
schema:domainIncludes fin:Payment ;
schema:rangeIncludes core:MoneyAmount .
fin:paymentDate a owl:DatatypeProperty ;
rdfs:label "payment date"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:date ;
skos:definition "When the payment was made."@en ;
schema:domainIncludes fin:Payment .
fin:paymentMethod a owl:ObjectProperty ;
rdfs:label "payment method"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Check / EFT / Card / StructuredAnnuity, from the payment-method scheme (paymeth:)."@en ;
schema:domainIncludes fin:Payment .
fin:periodToDateAmount a owl:ObjectProperty ;
rdfs:label "period to date amount"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The period-to-date amount by financial category."@en ;
schema:domainIncludes fin:Reserve ;
schema:rangeIncludes core:MoneyAmount .
fin:reserveAmount a owl:ObjectProperty ;
rdfs:label "reserve amount"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The current reserve amount. Money is never a bare decimal."@en ;
schema:domainIncludes fin:Reserve ;
schema:rangeIncludes core:MoneyAmount .
fin:reserveChangeDate a owl:DatatypeProperty ;
rdfs:label "reserve change date"@en ;
dct:source "Source table RESERVE_AH; ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:dateTime ;
skos:definition "When the reserve moved."@en ;
schema:domainIncludes fin:ReserveTransaction .
fin:reserveChangeReasonCode a owl:ObjectProperty ;
rdfs:label "reserve change reason code"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The coded reason a reserve moved, from the reserve-change-reason scheme (rsvreason:), where structured. The rationale NARRATIVE is the core gap of Theme 6 — see fin:reserveChangeRationale."@en ;
schema:domainIncludes fin:ReserveTransaction .
fin:reserveCommitteeFlag a owl:DatatypeProperty ;
rdfs:label "reserve committee flag"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the reserve went to the reserve committee (large claims)."@en ;
schema:domainIncludes fin:Reserve .
fin:reserveDerivationBasis a owl:DatatypeProperty ;
rdfs:label "reserve derivation basis"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:range xsd:string ;
skos:definition "Algorithm inputs for auto-set reserves. Extraction/new capture."@en ;
schema:domainIncludes fin:Reserve .
fin:totalIncurred a owl:ObjectProperty ;
rdfs:label "total incurred"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "DERIVED = paid + outstanding reserve. Defined once, in the glossary and a SQL view; never double-stored."@en ;
schema:domainIncludes fin:ClaimFinancialSummary ;
schema:rangeIncludes core:MoneyAmount .
fra:DOIComplaint a owl:Class ;
rdfs:label "DOI complaint"@en ;
dct:source "Workbook clm:DOIComplaint; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A Department of Insurance complaint filing."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:DocumentFraudFlag a owl:Class ;
rdfs:label "Document fraud flag"@en ;
dct:source "Workbook clm:DocumentFraudFlag; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf fra:FraudIndicator ;
skos:definition "An altered- or fabricated-document indicator (altered photos, inconsistent forms)."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:LawEnforcementReferral a owl:Class ;
rdfs:label "Law enforcement referral"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf proc:Referral ;
skos:definition "Referral to law enforcement. Tracked outside the operational system."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:SIUInvestigation a owl:Class ;
rdfs:label "SIU investigation"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf inv:ClaimInvestigation ;
skos:definition "The SIU's investigation, with narrative and evidence chain."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:StateFraudReferral a owl:Class ;
rdfs:label "State fraud referral"@en ;
dct:source "Source tables SIU_STATE_RFRL_TY, SIU_ST_RFRLRCPTNT; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf proc:Referral ;
skos:definition "A referral to a state insurance fraud bureau, with status, type and recipient."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fra:StatutoryClaimReport a owl:Class ;
rdfs:label "Statutory claim report"@en ;
dct:source "Workbook clm:StatutoryClaimReport; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The filed state fraud-bureau form and its acknowledgment. Status is structured; the filed document content is not."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:VelocityAlert a owl:Class ;
rdfs:label "Velocity alert"@en ;
dct:source "Workbook clm:VelocityAlert; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf fra:FraudIndicator ;
skos:definition "A frequency-of-claim alert scored across carriers. ISO ClaimSearch gives prior-claim signal but not velocity scoring."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:confidenceScore a owl:DatatypeProperty ;
rdfs:label "confidence score"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:decimal ;
skos:definition "The confidence of a fraud indicator."@en ;
schema:domainIncludes fra:FraudIndicator .
fra:confirmedFraudAmount a owl:ObjectProperty ;
rdfs:label "confirmed fraud amount"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The confirmed fraud amount at resolution."@en ;
schema:domainIncludes fra:FraudAssessment ;
schema:rangeIncludes core:MoneyAmount .
fra:detectionDate a owl:DatatypeProperty ;
rdfs:label "detection date"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:dateTime ;
skos:definition "When the indicator was detected."@en ;
schema:domainIncludes fra:FraudIndicator .
fra:factorWeight a owl:DatatypeProperty ;
rdfs:label "factor weight"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:decimal ;
skos:definition "The weight of a fraud factor."@en ;
schema:domainIncludes fra:FraudFactor .
fra:fraudGroupDesignation a owl:ObjectProperty ;
rdfs:label "fraud group designation"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The fraud group designation of a claim, as a SKOS concept. Operational-only."@en ;
schema:domainIncludes claim:Claim .
fra:fraudScore a owl:DatatypeProperty ;
rdfs:label "fraud score"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:decimal ;
skos:definition "The numeric fraud-risk score. Convention: 0–1 (state the convention in the SHACL shape)."@en ;
schema:domainIncludes fra:FraudAssessment .
fra:indicatorType a owl:ObjectProperty ;
rdfs:label "indicator type"@en ;
dct:source "ONTOSPEC §5.16; Question 14"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The type of fraud indicator, from the fraud-indicator scheme (fraind:)."@en ;
schema:domainIncludes fra:FraudIndicator .
fra:publicAdjusterInvolved a owl:DatatypeProperty ;
rdfs:label "public adjuster involved"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:boolean ;
skos:definition "Whether a public adjuster is involved. An early fraud signal."@en ;
schema:domainIncludes claim:Claim .
fra:referralDate a owl:DatatypeProperty ;
rdfs:label "referral date"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:date ;
skos:definition "The date of the SIU referral. Enables time-from-FNOL-to-SIU-referral analytics."@en ;
schema:domainIncludes fra:SIUReferral .
fra:referralSource a owl:ObjectProperty ;
rdfs:label "referral source"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The source of the referral, from the siu-referral-source scheme (siusrc:)."@en ;
schema:domainIncludes fra:SIUReferral .
fra:relatedClaimsText a owl:DatatypeProperty ;
rdfs:label "related claims text"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:string ;
skos:definition "The free-text related-claims field. An extraction target."@en ;
schema:domainIncludes claim:Claim .
fra:sharedAttribute a owl:ObjectProperty ;
rdfs:label "shared attribute"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The attribute shared across the link — bank account / phone / address / provider — as a SKOS concept."@en ;
schema:domainIncludes fra:NetworkLink ;
dpv:hasPersonalDataCategory dpv:Financial,
dpv:Identifying .
fra:siuCloseTimestamp a owl:DatatypeProperty ;
rdfs:label "SIU close timestamp"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:dateTime ;
skos:definition "When the SIU matter closed."@en ;
schema:domainIncludes fra:SIUOutcome .
fra:siuIndicator a owl:DatatypeProperty ;
rdfs:label "SIU indicator"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range xsd:boolean ;
skos:definition "The SIU indicator flag on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine .
fra:siuOutcomeValue a owl:ObjectProperty ;
rdfs:label "SIU outcome value"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Confirmed / Cleared / NoBasisFound / Pending, from the siu-outcome scheme (siuout:)."@en ;
schema:domainIncludes fra:SIUOutcome .
itk:ClaimRegistration a owl:Class ;
rdfs:label "Claim registration"@en ;
dct:source "ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-1 determination to open a claim, assign a claim number and capture the basic loss facts."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:catSeverity a owl:ObjectProperty ;
rdfs:label "CAT severity"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The severity rating of a CAT designation, from the cat-severity scheme (catsev:)."@en ;
schema:domainIncludes itk:CatastropheDesignation .
itk:causeOfLossAtFNOL a owl:ObjectProperty ;
rdfs:label "cause of loss at FNOL"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The cause of loss as first reported, from the enterprise cause-of-loss scheme (col: — read-only; never extended here)."@en ;
schema:domainIncludes itk:FNOLReport .
itk:coverageTrigger a owl:ObjectProperty ;
rdfs:label "coverage trigger"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The coverage trigger applying to the claim (Occurrence / ClaimsMade / ClaimsMadeAndReported / Manifestation), from the coverage-trigger scheme (ctrig:)."@en ;
schema:domainIncludes claim:Claim .
itk:incidentNarrative a owl:DatatypeProperty ;
rdfs:label "incident narrative"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:string ;
skos:definition "The narrative of what happened. PII-bearing free text with quasi-identifier location risk."@en ;
schema:domainIncludes itk:IncidentProfile ;
dpv:hasPersonalDataCategory dpv:Identifying,
dpv:Location .
itk:intakeChannel a owl:ObjectProperty ;
rdfs:label "intake channel"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "How the loss was reported: Web / Phone / Agent / Broker / Email / Mobile, from the intake-channel scheme (chan:)."@en ;
schema:domainIncludes itk:FNOLReport .
itk:isCatastrophe a owl:DatatypeProperty ;
rdfs:label "is catastrophe"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:boolean ;
skos:definition "The CAT flag on the claim header. Present for source fidelity; the designation object carries the detail."@en ;
schema:domainIncludes claim:Claim .
itk:lossDate a owl:DatatypeProperty ;
rdfs:label "loss date"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:dateTime ;
skos:definition "When the loss occurred. Prefer time:hasBeginning on a time:Instant for a loss with duration; retained as the simple case."@en ;
schema:domainIncludes claim:Loss .
itk:reportedDate a owl:DatatypeProperty ;
rdfs:label "reported date"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:dateTime ;
skos:definition "When the loss was reported."@en ;
schema:domainIncludes itk:FNOLReport .
itk:reportingLagDays a owl:DatatypeProperty ;
rdfs:label "reporting lag days"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:integer ;
skos:definition "DERIVED — reportedDate minus lossDate. Compute in a SQL view or SPARQL; never double-store."@en ;
schema:domainIncludes itk:FNOLReport .
inv:AssetLossHistory a owl:Class ;
rdfs:label "Asset loss history"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf inv:PriorLossProfile ;
skos:definition "Prior losses on the same property or vehicle."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:BenchmarkRecord a owl:Class ;
rdfs:label "Benchmark record"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "An industry or book benchmark used for comparison. No benchmark table exists in either source."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:ChronologyOfEvents a owl:Class ;
rdfs:label "Chronology of events"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The assembled timeline of the incident and the claim. A document category AND an extraction target."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:ClaimantHistory a owl:Class ;
rdfs:label "Claimant history"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf inv:PriorLossProfile ;
skos:definition "Prior claims by the same claimant across events."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:EvidenceItem a owl:Class ;
rdfs:label "Evidence item"@en ;
dct:source "Question-bank entity Evidence; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A discrete item of evidence with a type and a source."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:ExaminationUnderOath a owl:Class ;
rdfs:label "Examination under oath"@en ;
dct:source "Workbook clm:EUORecord; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf inv:Statement ;
skos:definition "A formal sworn statement. The person is legally obligated to answer and the transcript is admissible."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:ExpertReport a owl:Class ;
rdfs:label "Expert report"@en ;
dct:source "Workbook clm:ExpertReport; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "An independent assessor's or expert's findings and opinion, with its methodology."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:HistoricalAssessment a owl:Class ;
rdfs:label "Historical assessment"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Stage-5 assessment drawing on prior loss history to inform reserving."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
inv:RecordedStatement a owl:Class ;
rdfs:label "Recorded statement"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf inv:Statement ;
skos:definition "An informal, voluntary recorded interview of a claimant, insured or witness, taken early in investigation to lock in the account."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:SceneInspection a owl:Class ;
rdfs:label "Scene inspection"@en ;
dct:source "Workbook clm:SceneInspection; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf prov:Activity,
core:InformationEntity ;
skos:definition "An on-site investigation with findings and photographs."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:contradicts a owl:ObjectProperty,
owl:SymmetricProperty ;
rdfs:label "contradicts"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "An account this opinion contradicts. Symmetric. Feeds CQ-5 and CQ-15. (med:IMEOpinion also carries this signature — annotation-only, no import.)"@en ;
schema:domainIncludes inv:ExpertOpinion,
med:IMEOpinion ;
schema:rangeIncludes inv:Statement,
med:MedicalOpinion .
inv:expertMethodology a owl:DatatypeProperty ;
rdfs:label "expert methodology"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range xsd:string ;
skos:definition "The methodology stated in an expert opinion."@en ;
schema:domainIncludes inv:ExpertOpinion .
inv:expertOpinionValue a owl:ObjectProperty ;
rdfs:label "expert opinion value"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The conclusion of an expert opinion, as a SKOS concept."@en ;
schema:domainIncludes inv:ExpertOpinion .
inv:investigationSummary a owl:DatatypeProperty ;
rdfs:label "investigation summary"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range xsd:string ;
skos:definition "The extracted summary of an investigation. PII-bearing free text."@en ;
schema:domainIncludes inv:ClaimInvestigation ;
dpv:hasPersonalDataCategory dpv:Identifying .
inv:investigationType a owl:ObjectProperty ;
rdfs:label "investigation type"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Coverage / Liability / Fraud / Expert / Scene, as a SKOS concept."@en ;
schema:domainIncludes inv:ClaimInvestigation .
inv:liabilityAdmission a owl:ObjectProperty ;
rdfs:label "liability admission"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Admitted / Denied / Partial — a key extractable fact from the Document Type Reference."@en ;
schema:domainIncludes inv:Statement .
inv:premisesCondition a owl:ObjectProperty ;
rdfs:label "premises condition"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The premises condition found, from the premises-condition scheme (premcond:) — a scheme shared with the liability module, defined once."@en ;
schema:domainIncludes inv:InvestigationFinding .
inv:priorClaimCount a owl:DatatypeProperty ;
rdfs:label "prior claim count"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range xsd:integer ;
skos:definition "The number of prior claims in a profile."@en ;
schema:domainIncludes inv:PriorLossProfile .
inv:statementDate a owl:DatatypeProperty ;
rdfs:label "statement date"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range xsd:date ;
skos:definition "The date a statement was given."@en ;
schema:domainIncludes inv:Statement .
inv:statementType a owl:ObjectProperty ;
rdfs:label "statement type"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Recorded Statement / EUO, as a SKOS concept."@en ;
schema:domainIncludes inv:Statement .
itm:ItemArticle a owl:Class ;
rdfs:label "Item article"@en ;
dct:source "Source table ITEM_ARTICLE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf itm:ClaimItem ;
skos:definition "An individual article within a property loss."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
itm:approvedValue a owl:ObjectProperty ;
rdfs:label "approved value"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The approved value of a damage item."@en ;
schema:domainIncludes itm:DamageItem ;
schema:rangeIncludes core:MoneyAmount .
itm:claimedValue a owl:ObjectProperty ;
rdfs:label "claimed value"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The claimed value of a damage item. The approved-vs-claimed ratio is a headline analytic."@en ;
schema:domainIncludes itm:DamageItem ;
schema:rangeIncludes core:MoneyAmount .
itm:damageSeverity a owl:ObjectProperty ;
rdfs:label "damage severity"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The severity of vehicle damage, as a SKOS concept."@en ;
schema:domainIncludes itm:VehicleDamage .
itm:damageType a owl:ObjectProperty ;
rdfs:label "damage type"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The damage type, from the damage-type scheme (dmgtype:)."@en ;
schema:domainIncludes itm:DamageItem .
itm:estimateAmount a owl:ObjectProperty ;
rdfs:label "estimate amount"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount of a repair estimate."@en ;
schema:domainIncludes itm:RepairEstimate ;
schema:rangeIncludes core:MoneyAmount .
itm:occupancyType a owl:ObjectProperty ;
rdfs:label "occupancy type"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The occupancy type, as a SKOS concept — a value, not a subclass (PIT-5)."@en ;
schema:domainIncludes itm:PropertyLoss .
itm:propertyAddress a owl:ObjectProperty ;
rdfs:label "property address"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The address of the property. Quasi-identifier — re-identification risk; generalise before publishing."@en ;
schema:domainIncludes itm:PropertyLoss ;
schema:rangeIncludes core:Location ;
dpv:hasPersonalDataCategory dpv:Location .
itm:propertyType a owl:ObjectProperty ;
rdfs:label "property type"@en ;
dct:source "ONTOSPEC §5.10; Question 20"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The property type, as a SKOS concept — a value, not a subclass (PIT-5)."@en ;
schema:domainIncludes itm:PropertyLoss .
itm:repairStatus a owl:ObjectProperty ;
rdfs:label "repair status"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The repair status of a damage item, as a SKOS concept."@en ;
schema:domainIncludes itm:DamageItem .
itm:siteLocation a owl:ObjectProperty ;
rdfs:label "site location"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The location of a site. Optionally a geo:Geometry where a competency question needs spatial query."@en ;
schema:domainIncludes itm:ItemSite ;
schema:rangeIncludes core:Location .
itm:vehicleMake a owl:DatatypeProperty ;
rdfs:label "vehicle make"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range xsd:string ;
skos:definition "The make of a vehicle."@en ;
schema:domainIncludes itm:Vehicle .
itm:vehicleModel a owl:DatatypeProperty ;
rdfs:label "vehicle model"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range xsd:string ;
skos:definition "The model of a vehicle."@en ;
schema:domainIncludes itm:Vehicle .
itm:vehicleYear a owl:DatatypeProperty ;
rdfs:label "vehicle year"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range xsd:gYear ;
skos:definition "The model year of a vehicle."@en ;
schema:domainIncludes itm:Vehicle .
itm:verifiedValue a owl:ObjectProperty ;
rdfs:label "verified value"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The verified value of a damage item."@en ;
schema:domainIncludes itm:DamageItem ;
schema:rangeIncludes core:MoneyAmount .
lia:atFaultIndicator a owl:DatatypeProperty ;
rdfs:label "at-fault indicator"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range xsd:boolean ;
skos:definition "Source fidelity for the up-to-four at-fault flags on the line; the apportionment objects carry the real model."@en ;
schema:domainIncludes cvp:CoverageLine .
lia:causationValue a owl:ObjectProperty ;
rdfs:label "causation value"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Confirmed / Disputed / Partial, as a SKOS concept (Document Type Reference, IME)."@en ;
schema:domainIncludes lia:CausationOpinion .
lia:comparativeNegligencePercentage a owl:DatatypeProperty ;
rdfs:label "comparative negligence percentage"@en ;
dct:source "ONTOSPEC §5.8; Question 12"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range xsd:decimal ;
skos:definition "The claimant's share of fault."@en ;
schema:domainIncludes lia:LiabilityApportionment .
lia:isEstablished a owl:DatatypeProperty ;
rdfs:label "is established"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range xsd:boolean ;
skos:definition "Established vs. tentative liability flag."@en ;
schema:domainIncludes lia:LiabilityAssessment .
lia:liabilityDescriptor a owl:ObjectProperty ;
rdfs:label "liability descriptor"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Clear / Probable / Questionable / Disputed, from the liability-descriptor scheme (liadesc:)."@en ;
schema:domainIncludes lia:LiabilityAssessment .
lia:liabilityPercentage a owl:DatatypeProperty ;
rdfs:label "liability percentage"@en ;
dct:source "LIAB.N_PCT; ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range xsd:decimal ;
skos:definition "The percentage of fault attributed to the party. 0–100, enforced in SHACL; the cross-apportionment sum rule (≤ 100) is a sh:sparql constraint."@en ;
schema:domainIncludes lia:LiabilityApportionment .
lia:premisesConditionCited a owl:ObjectProperty ;
rdfs:label "premises condition cited"@en ;
dct:source "ONTOSPEC §5.8; Question 11"@en ;
rdfs:isDefinedBy lia: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The premises condition cited — wet floor, uneven surface, … — from the shared premises-condition scheme (premcond:)."@en ;
schema:domainIncludes lia:NegligenceBasis .
ltg:CoDefendant a owl:Class ;
rdfs:label "Co-defendant"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue ltg:CoDefendantRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A party currently holding the co-defendant role."@en .
ltg:DefenseCounsel a owl:Class ;
rdfs:label "Defense counsel"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue ltg:DefenseCounselRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the defense-counsel role."@en .
ltg:LawsuitFiling a owl:Class ;
rdfs:label "Lawsuit filing"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:Event ;
skos:definition "The filing of suit, with its date and case number."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
ltg:PlaintiffAttorney a owl:Class ;
rdfs:label "Plaintiff attorney"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue ltg:PlaintiffAttorneyRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the plaintiff-attorney role."@en .
ltg:activityOutcome a owl:ObjectProperty ;
rdfs:label "activity outcome"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The outcome of a legal activity, as a SKOS concept."@en ;
schema:domainIncludes ltg:LegalActivity .
ltg:activityType a owl:ObjectProperty ;
rdfs:label "activity type"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Deposition / Mediation / Trial / Motion / Discovery, from the legal-activity-type scheme (legalact:)."@en ;
schema:domainIncludes ltg:LegalActivity .
ltg:attorneyJurisdiction a owl:ObjectProperty ;
rdfs:label "attorney jurisdiction"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The jurisdiction of an attorney assignment, as a SKOS concept."@en ;
schema:domainIncludes ltg:AttorneyAssignment .
ltg:county a owl:ObjectProperty ;
rdfs:label "county"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The county of the venue, aligned to OMG LCC."@en ;
schema:domainIncludes ltg:Venue .
ltg:courtState a owl:ObjectProperty ;
rdfs:label "court state"@en ;
dct:source "ONTOSPEC §5.15; Theme 4"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The state of the venue, aligned to OMG LCC subdivisions — never a private geography."@en ;
schema:domainIncludes ltg:Venue .
ltg:discoveryDate a owl:DatatypeProperty ;
rdfs:label "discovery date"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range xsd:date ;
skos:definition "The discovery date of the matter."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:litigationDisposition a owl:ObjectProperty ;
rdfs:label "litigation disposition"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Settled / Dismissed / Trial / Verdict / Arbitrated, from the litigation-disposition scheme (ltgdisp:)."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:litigationStatus a owl:ObjectProperty ;
rdfs:label "litigation status"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The status of a matter, from the litigation-status scheme (ltgstat:)."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:representationSide a owl:ObjectProperty ;
rdfs:label "representation side"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Plaintiff / Defense, as a SKOS concept."@en ;
schema:domainIncludes ltg:AttorneyAssignment .
ltg:suitFiledDate a owl:DatatypeProperty ;
rdfs:label "suit filed date"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range xsd:date ;
skos:definition "When the suit was filed."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:trialDate a owl:DatatypeProperty ;
rdfs:label "trial date"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range xsd:date ;
skos:definition "The set trial date."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:verdictAmount a owl:ObjectProperty ;
rdfs:label "verdict amount"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount of a verdict. Extraction-only."@en ;
schema:domainIncludes ltg:Verdict ;
schema:rangeIncludes core:MoneyAmount .
med:IndependentMedicalExaminer a owl:Class ;
rdfs:label "Independent medical examiner"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue med:IndependentMedicalExaminerRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the independent-medical-examiner role."@en .
med:MedicalProvider a owl:Class ;
rdfs:label "Medical provider"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:SocialAgent ;
skos:definition "A treating provider (person or organisation). Provider TYPE is a SKOS value (PIT-5); named providers are instances (PIT-3)."@en ;
adjmeta:acordAlignment "schema:MedicalOrganization at the serving edge" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:PreExistingCondition a owl:Class ;
rdfs:label "Pre-existing condition"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf med:Diagnosis ;
skos:definition "A condition predating the loss, material to causation and reserve. Boolean in the raw layer; the impact on reserve rationale is in file notes."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:TreatingPhysician a owl:Class ;
rdfs:label "Treating physician"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue med:TreatingPhysicianRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the treating-physician role."@en .
med:adjudicationCategory a owl:ObjectProperty ;
rdfs:label "adjudication category"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The category of a medical line adjudication; skos:exactMatch to http://terminology.hl7.org/CodeSystem/adjudication."@en ;
schema:domainIncludes med:MedicalLineAdjudication .
med:adjudicationReason a owl:ObjectProperty ;
rdfs:label "adjudication reason"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The reason code of a medical line adjudication; skos:exactMatch to FHIR adjudication-reason."@en ;
schema:domainIncludes med:MedicalLineAdjudication .
med:allowedAmount a owl:ObjectProperty ;
rdfs:label "allowed amount"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The allowed amount of an invoice or treatment."@en ;
schema:domainIncludes med:MedicalInvoice,
med:MedicalTreatment ;
schema:rangeIncludes core:MoneyAmount .
med:billedAmount a owl:ObjectProperty ;
rdfs:label "billed amount"@en ;
dct:source "ONTOSPEC §5.9; Questions 3, 6"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The billed amount of an invoice or treatment."@en ;
schema:domainIncludes med:MedicalInvoice,
med:MedicalTreatment ;
schema:rangeIncludes core:MoneyAmount .
med:bodyPart a owl:ObjectProperty ;
rdfs:label "body part"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The affected body part, from the body-part scheme (bodypart:). Special-category personal data (health)."@en ;
schema:domainIncludes med:Injury ;
dpv:hasPersonalDataCategory dpv:Health .
med:causationOpinionValue a owl:ObjectProperty ;
rdfs:label "causation opinion value"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Confirmed / Disputed / Partial, as a SKOS concept."@en ;
schema:domainIncludes med:IMEOpinion .
med:diagnosisCode a owl:ObjectProperty ;
rdfs:label "diagnosis code"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The ICD-10-CM concept of a diagnosis: skos:notation carries the code, skos:exactMatch links to the published concept. Special-category personal data; access requires a stated purpose (see the ODRL policy set)."@en ;
schema:domainIncludes med:Diagnosis ;
dpv:hasPersonalDataCategory dpv:Health .
med:disabilityPercentage a owl:DatatypeProperty ;
rdfs:label "disability percentage"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range xsd:decimal ;
skos:definition "The assessed disability percentage."@en ;
schema:domainIncludes med:DisabilityRating ;
dpv:hasPersonalDataCategory dpv:Health .
med:examinationDate a owl:DatatypeProperty ;
rdfs:label "examination date"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range xsd:date ;
skos:definition "The date of an IME."@en ;
schema:domainIncludes med:IndependentMedicalExamination .
med:futureMedicalEstimate a owl:ObjectProperty ;
rdfs:label "future medical estimate"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The estimated future medical cost."@en ;
schema:domainIncludes med:MedicalValuation ;
schema:rangeIncludes core:MoneyAmount .
med:hasPreExistingCondition a owl:DatatypeProperty ;
rdfs:label "has pre-existing condition"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range xsd:boolean ;
skos:definition "Whether a pre-existing condition exists (raw-layer boolean). The reserve impact narrative is extraction-only."@en ;
schema:domainIncludes med:Injury ;
dpv:hasPersonalDataCategory dpv:Health .
med:lostWorkDays a owl:DatatypeProperty ;
rdfs:label "lost work days"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range xsd:integer ;
skos:definition "Days of work lost to the injury. Partially mapped."@en ;
schema:domainIncludes med:Injury ;
dpv:hasPersonalDataCategory dpv:Health .
med:medicalObligationStatus a owl:ObjectProperty ;
rdfs:label "medical obligation status"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The medical obligation status on a coverage line, as a SKOS concept. Mostly mapped."@en ;
schema:domainIncludes cvp:CoverageLine .
med:mmiDate a owl:DatatypeProperty ;
rdfs:label "MMI date"@en ;
dct:source "ONTOSPEC §5.9; Question 2"@en ;
rdfs:isDefinedBy med: ;
rdfs:range xsd:date ;
skos:definition "The date of maximum medical improvement."@en ;
schema:domainIncludes med:MaximumMedicalImprovement ;
dpv:hasPersonalDataCategory dpv:Health .
med:natureOfInjury a owl:ObjectProperty ;
rdfs:label "nature of injury"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The nature of the injury, from the injury-nature scheme (injnature:). Special-category personal data (health)."@en ;
schema:domainIncludes med:Injury ;
dpv:hasPersonalDataCategory dpv:Health .
med:painAndSufferingEstimate a owl:ObjectProperty ;
rdfs:label "pain and suffering estimate"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The pain-and-suffering component of a medical valuation."@en ;
schema:domainIncludes med:MedicalValuation ;
schema:rangeIncludes core:MoneyAmount .
med:procedureCode a owl:ObjectProperty ;
rdfs:label "procedure code"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The CPT/HCPCS concept of a treatment: notation + exactMatch; the AMA set is never redistributed. Special-category personal data (health)."@en ;
schema:domainIncludes med:MedicalTreatment ;
dpv:hasPersonalDataCategory dpv:Health .
med:recoveryStatus a owl:ObjectProperty ;
rdfs:label "recovery status"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The recovery status of an injury, as a SKOS concept."@en ;
schema:domainIncludes med:Injury .
med:treatmentAssessment a owl:ObjectProperty ;
rdfs:label "treatment assessment"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Appropriate / Excessive / Unrelated, as a SKOS concept."@en ;
schema:domainIncludes med:IMEOpinion .
med:treatmentStatus a owl:ObjectProperty ;
rdfs:label "treatment status"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Ongoing / Completed / Discontinued / AtMMI, from the treatment-status scheme (trtstat:)."@en ;
schema:domainIncludes med:MedicalTreatment .
med:treatmentType a owl:ObjectProperty ;
rdfs:label "treatment type"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The treatment type as a SKOS concept. Includes IME as a VALUE — not a subclass."@en ;
schema:domainIncludes med:MedicalTreatment .
adjmeta:CDSValidated a owl:NamedIndividual ;
rdfs:label "CDS-validated"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Process knowledge validated against the CDS refined layer and SME session."@en .
adjmeta:ChangeRecord a owl:Class ;
rdfs:label "Change record"@en ;
dct:source "ONTOSPEC §16.4"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:subClassOf prov:Entity ;
skos:definition "A reified record of one change to a published module or scheme: the term affected, the change level (major/minor/patch), the release it shipped in, and the reason. Part of the Tier-3 queryable changelog; annotation-level only, never participating in domain reasoning."@en .
adjmeta:SMEValidated a owl:NamedIndividual ;
rdfs:label "SME-validated"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Reviewed and confirmed by the adjudication subject-matter experts."@en .
adjmeta:acordAlignment a owl:AnnotationProperty ;
rdfs:label "ACORD alignment"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Reference (IRI or string) to the ACORD AIM concept or Capability Model element the term aligns with."@en .
adjmeta:anchoringReadiness a owl:AnnotationProperty ;
rdfs:label "anchoring readiness"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range rdfs:Resource ;
skos:definition "The readiness of a term for anchoring to structured sources: AnchoringReady, Partial, or ExtractionNeeded."@en .
adjmeta:appearsAtStage a owl:AnnotationProperty ;
rdfs:label "appears at stage"@en ;
dct:source "ONTOSPEC §7.1"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "The adjudication stage(s) at which a document category or concept typically appears, by reference to the adjstage: scheme."@en .
adjmeta:buildPriority a owl:AnnotationProperty ;
rdfs:label "build priority"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "The workbook build priority: High, Medium or Low."@en .
adjmeta:buildWave a owl:AnnotationProperty ;
rdfs:label "build wave"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:integer ;
skos:definition "The build wave (1–3) in which the term's module ships."@en .
adjmeta:gapId a owl:AnnotationProperty ;
rdfs:label "gap id"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:string ;
skos:definition "Key into the gap register (Appendix B of the build specification)."@en .
adjmeta:lineOfBusinessScope a owl:AnnotationProperty ;
rdfs:label "line of business scope"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "The lines of business a term or concept applies to (General Liability, Auto, or both), by reference to the lob: scheme."@en .
adjmeta:mappingStatus a owl:AnnotationProperty ;
rdfs:label "mapping status"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:string ;
skos:definition "Source-mapping status: \"mapped\", \"pending-fractal\", \"extraction-only\" or \"unmapped\"."@en .
adjmeta:openQuestion a owl:AnnotationProperty ;
rdfs:label "open question"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:boolean ;
skos:definition "True where the term or value embodies an unresolved SME question. Open questions are never silently resolved; each carries a skos:editorialNote and appears in the conformance report."@en .
adjmeta:primaryExtractionTarget a owl:AnnotationProperty ;
rdfs:label "primary extraction target"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:boolean ;
skos:definition "True where the term is one of the two primary extraction targets: the coverage-position rationale and the guided-adjudication accept/reject rationale."@en .
adjmeta:processGrounding a owl:AnnotationProperty ;
rdfs:label "process grounding"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Whether the process knowledge behind a term is CDS-validated or rests on external reference only."@en .
adjmeta:sourceAvailability a owl:AnnotationProperty ;
rdfs:label "source availability"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Whether the data behind a term is AvailableNow (CDS refined layer), PendingMapping (in CCS 5, not yet refined), or NotInAnySource (extraction or new capture)."@en .
adjmeta:validationStatus a owl:AnnotationProperty ;
rdfs:label "validation status"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "SME validation status of the module or term: DraftPendingSMEValidation or SMEValidated."@en .
adjmeta:workbookRef a owl:AnnotationProperty ;
rdfs:label "workbook reference"@en ;
dct:source "ONTOSPEC §4.7"@en ;
rdfs:isDefinedBy adjmeta: ;
rdfs:range xsd:string ;
skos:definition "Traceability pointer of the form \"#!R\" to the source workbook cell the term derives from."@en .
rcv:ArbitrationRecord a owl:Class ;
rdfs:label "Arbitration record"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "An arbitration proceeding record. Not in any source."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
rcv:ClaimClosureNotice a owl:Class ;
rdfs:label "Claim closure notice"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The closure letter. Generated from a template; not a structured entity."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
rcv:ClosureDecision a owl:Class ;
rdfs:label "Closure decision"@en ;
dct:source "ONTOSPEC §5.14; Gate 11"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-11 decision to close and whether to pursue recovery."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
rcv:LienWaiver a owl:Class ;
rdfs:label "Lien waiver"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A waived lien recorded against a recovery."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
rcv:RecoveryNegotiation a owl:Class ;
rdfs:label "Recovery negotiation"@en ;
dct:source "Source table RCOVRY_NEGOTIATION; ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf stl:Negotiation ;
skos:definition "Negotiation of a recovery."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
rcv:SalvageRecovery a owl:Class ;
rdfs:label "Salvage recovery"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf rcv:RecoveryAction ;
skos:definition "Recovery of value from damaged property."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
rcv:SubrogationTarget a owl:Class ;
rdfs:label "Subrogation target"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue rcv:SubrogationTargetRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A party currently holding the subrogation-target role."@en .
rcv:closureDate a owl:DatatypeProperty ;
rdfs:label "closure date"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range xsd:date ;
skos:definition "The claim closure date. Fully mapped."@en ;
schema:domainIncludes claim:Claim .
rcv:closureReason a owl:ObjectProperty ;
rdfs:label "closure reason"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The claim closure reason, as a SKOS concept. GAP-05: observed blank on the real claim reviewed."@en ;
adjmeta:gapId "GAP-05" ;
adjmeta:openQuestion true ;
schema:domainIncludes claim:Claim .
rcv:demandDate a owl:DatatypeProperty ;
rdfs:label "demand date"@en ;
dct:source "ONTOSPEC §7.2.7"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range xsd:date ;
skos:definition "The date of the subrogation demand."@en ;
schema:domainIncludes rcv:SubrogationDemand .
rcv:demandedRecoveryAmount a owl:ObjectProperty ;
rdfs:label "demanded recovery amount"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount demanded in a subrogation demand."@en ;
schema:domainIncludes rcv:SubrogationDemand ;
schema:rangeIncludes core:MoneyAmount .
rcv:recoveredAmount a owl:ObjectProperty ;
rdfs:label "recovered amount"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount recouped in a recovery credit."@en ;
schema:domainIncludes rcv:RecoveryCredit ;
schema:rangeIncludes core:MoneyAmount .
rcv:recoveryBasis a owl:DatatypeProperty ;
rdfs:label "recovery basis"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range xsd:string ;
skos:definition "The liability theory behind the recovery demand. Extracted."@en ;
schema:domainIncludes rcv:SubrogationDemand .
rcv:recoveryCloseReason a owl:ObjectProperty ;
rdfs:label "recovery close reason"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Why the recovery closed, from the recovery-close-reason scheme (rcvreason:)."@en ;
schema:domainIncludes rcv:RecoveryAction .
rcv:reopenReason a owl:ObjectProperty ;
rdfs:label "reopen reason"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The reason a claim reopened, as a SKOS concept."@en ;
schema:domainIncludes rcv:ClaimReopen .
rcv:salvageStatus a owl:ObjectProperty ;
rdfs:label "salvage status"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The salvage status code on the coverage line, as a SKOS concept."@en ;
schema:domainIncludes cvp:CoverageLine .
rcv:subrogationStatus a owl:ObjectProperty ;
rdfs:label "subrogation status"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The subrogation status code on the coverage line, as a SKOS concept."@en ;
schema:domainIncludes cvp:CoverageLine .
stl:DemandPackage a owl:Class ;
rdfs:label "Demand package"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The document that carries the demand: total, category breakdown, exhibits, expiry, liability theory. A document — the demand itself is the information entity stl:Demand."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:SettlementAuthorization a owl:Class ;
rdfs:label "Settlement authorization"@en ;
dct:source "ONTOSPEC §5.13; Gate 10"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-10 authorisation of the final settlement amount, within authority or escalated."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:StructuredSettlement a owl:Class ;
rdfs:label "Structured settlement"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf stl:Settlement ;
skos:definition "A periodic-payment arrangement."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stl:demandAmount a owl:ObjectProperty ;
rdfs:label "demand amount"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount demanded."@en ;
schema:domainIncludes stl:Demand ;
schema:rangeIncludes core:MoneyAmount .
stl:demandDate a owl:DatatypeProperty ;
rdfs:label "demand date"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:date ;
skos:definition "The date of the demand."@en ;
schema:domainIncludes stl:Demand .
stl:demandExpiryDate a owl:DatatypeProperty ;
rdfs:label "demand expiry date"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:date ;
skos:definition "When the demand expires."@en ;
schema:domainIncludes stl:Demand .
stl:demandType a owl:ObjectProperty ;
rdfs:label "demand type"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "P&S / Medical Specials / Lost Wages / Future Medical …, from the demand-type scheme (dmdtype:). May not be coded — the source may be adjuster notes or letter text (Question 6)."@en ;
schema:domainIncludes stl:Demand .
stl:executionDate a owl:DatatypeProperty ;
rdfs:label "execution date"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:date ;
skos:definition "The execution date of a release or settlement agreement."@en ;
schema:domainIncludes stl:Release,
stl:SettlementAgreement .
stl:offerAmount a owl:ObjectProperty ;
rdfs:label "offer amount"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The amount offered."@en ;
schema:domainIncludes stl:Offer ;
schema:rangeIncludes core:MoneyAmount .
stl:rangeHigh a owl:ObjectProperty ;
rdfs:label "range high"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The high end of the settlement range."@en ;
schema:domainIncludes stl:SettlementRange ;
schema:rangeIncludes core:MoneyAmount .
stl:rangeLow a owl:ObjectProperty ;
rdfs:label "range low"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The low end of the settlement range."@en ;
schema:domainIncludes stl:SettlementRange ;
schema:rangeIncludes core:MoneyAmount .
stl:responseDeadline a owl:DatatypeProperty ;
rdfs:label "response deadline"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:date ;
skos:definition "The response deadline of a time-limit demand. Joins to the compliance module's statutory deadlines."@en ;
schema:domainIncludes stl:TimeLimitDemand .
stl:roundOrdinal a owl:DatatypeProperty ;
rdfs:label "round ordinal"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:integer ;
skos:definition "The position of a round within the negotiation."@en ;
schema:domainIncludes stl:NegotiationRound .
stl:settlementAmount a owl:ObjectProperty ;
rdfs:label "settlement amount"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The agreed settlement amount."@en ;
schema:domainIncludes stl:Settlement ;
schema:rangeIncludes core:MoneyAmount .
stl:settlementDate a owl:DatatypeProperty ;
rdfs:label "settlement date"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range xsd:date ;
skos:definition "The date of the settlement."@en ;
schema:domainIncludes stl:Settlement .
stl:settlementMethod a owl:ObjectProperty ;
rdfs:label "settlement method"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "LumpSum / Structured / Periodic, from the settlement-method scheme (stlmeth:). Partial on the coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
stl:Settlement .
stl:settlementType a owl:ObjectProperty ;
rdfs:label "settlement type"@en ;
dct:source "ONTOSPEC §5.13; Question 30"@en ;
rdfs:isDefinedBy stl: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The type of settlement, as a SKOS concept."@en ;
schema:domainIncludes stl:Settlement .
stp:AutoReserveSetting a owl:Class ;
rdfs:label "Auto reserve setting"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf fin:InitialReserveSetting ;
skos:definition "A reserve set by the algorithm without adjuster touch, with its derivation basis and adequacy validation."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:AutomatedApproval a owl:Class ;
rdfs:label "Automated approval"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The automated approval record when all gates pass."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:PartialApprovalRecord a owl:Class ;
rdfs:label "Partial approval record"@en ;
dct:source "Workbook clm:PartialApprovalRecord; ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf adj:PartialApproval ;
skos:definition "A split STP outcome — part auto-approved, part referred."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:criterionPassed a owl:DatatypeProperty ;
rdfs:label "criterion passed"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the criterion passed for this claim."@en ;
schema:domainIncludes stp:GateCriterionResult .
stp:dispositionValue a owl:ObjectProperty ;
rdfs:label "disposition value"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Eligible / Ineligible / AutoProcessed / FellOut / PartiallyProcessed, from the stp-disposition scheme (stpdisp:). GAP-04: enumerate from the source once confirmed."@en ;
schema:domainIncludes stp:STPDisposition .
stp:exceptionReason a owl:ObjectProperty ;
rdfs:label "exception reason"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range skos:Concept ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "Why the claim fell out of STP, as a SKOS concept."@en ;
schema:domainIncludes stp:STPException .
stp:factorContribution a owl:DatatypeProperty ;
rdfs:label "factor contribution"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:decimal ;
skos:definition "The contribution of a scoring factor to the score."@en ;
schema:domainIncludes stp:ScoringFactor .
stp:factorWeight a owl:DatatypeProperty ;
rdfs:label "factor weight"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:decimal ;
skos:definition "The weight of a scoring factor."@en ;
schema:domainIncludes stp:ScoringFactor .
stp:gateEvaluatedAt a owl:DatatypeProperty ;
rdfs:label "gate evaluated at"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:dateTime ;
skos:definition "When the STP gate was evaluated."@en ;
schema:domainIncludes stp:STPGate .
stp:metCriteriaAtClosure a owl:DatatypeProperty ;
rdfs:label "met criteria at closure"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the claim met STP criteria at automated closure."@en ;
schema:domainIncludes stp:STPAuditLog .
stp:noManualIntervention a owl:DatatypeProperty ;
rdfs:label "no manual intervention"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:boolean ;
skos:definition "Whether the routing ran with no human touch."@en ;
schema:domainIncludes stp:AutomatedRouting .
stp:scorePercentile a owl:DatatypeProperty ;
rdfs:label "score percentile"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:decimal ;
skos:definition "The percentile rank of the score."@en ;
schema:domainIncludes stp:STPScore .
stp:scoreValue a owl:DatatypeProperty ;
rdfs:label "score value"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:decimal ;
skos:definition "The STP eligibility score."@en ;
schema:domainIncludes stp:STPScore .
stp:systemAuthorizedPayment a owl:DatatypeProperty ;
rdfs:label "system authorized payment"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:range xsd:boolean ;
skos:definition "DERIVED from fin:authorizedBy being an asg:SystemPerformer. A proxy for STP confirmation, NOT a guaranteed signal."@en ;
skos:editorialNote "Proxy signal only; annotate any use accordingly."@en ;
schema:domainIncludes fin:Payment .
val:BusinessInterruptionValuation a owl:Class ;
rdfs:label "Business interruption valuation"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf val:Valuation ;
skos:definition "Lost-revenue calculation for a business-interruption exposure."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:depreciationRate a owl:DatatypeProperty ;
rdfs:label "depreciation rate"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:range xsd:decimal ;
skos:definition "The rate applied by a depreciation schedule."@en ;
schema:domainIncludes val:DepreciationSchedule .
val:evaluationCycleTimeDays a owl:DatatypeProperty ;
rdfs:label "evaluation cycle time days"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:range xsd:integer ;
skos:definition "DERIVED — compute, do not store twice."@en ;
schema:domainIncludes val:DamageEvaluation .
val:incomeVerificationDate a owl:DatatypeProperty ;
rdfs:label "income verification date"@en ;
dct:source "ONTOSPEC §5.11; Question 10"@en ;
rdfs:isDefinedBy val: ;
rdfs:range xsd:date ;
skos:definition "When income was verified for a wage-loss valuation."@en ;
schema:domainIncludes val:WageLossValuation ;
dpv:hasPersonalDataCategory dpv:Financial .
val:valuationAmount a owl:ObjectProperty ;
rdfs:label "valuation amount"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The assessed amount, as a core:MoneyAmount."@en ;
schema:domainIncludes val:Valuation ;
schema:rangeIncludes core:MoneyAmount .
val:valuationBasis a owl:DatatypeProperty ;
rdfs:label "valuation basis"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:range xsd:string ;
skos:definition "The stated basis of the valuation. Extracted."@en ;
schema:domainIncludes val:Valuation .
val:valuationDate a owl:DatatypeProperty ;
rdfs:label "valuation date"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:range xsd:date ;
skos:definition "The date of the valuation."@en ;
schema:domainIncludes val:Valuation .
proc:Status a owl:Class ;
rdfs:label "Status"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Abstract reserved class for process status. Concrete status values are SKOS concepts in a governed scheme, never subclasses (a state is not a kind of case)."@en .
proc:assignedStatus a owl:ObjectProperty ;
rdfs:label "assigned status"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The status value carried by a status assignment."@en ;
schema:domainIncludes proc:StatusAssignment ;
schema:rangeIncludes skos:Concept .
proc:conformsToPlan a owl:ObjectProperty ;
rdfs:label "conforms to plan"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf prov:hadPlan ;
skos:definition "Links an execution to the process definition (plan version) it ran under. This link is what makes process audit possible: one definition, many runs."@en ;
schema:domainIncludes proc:GateEvaluation,
proc:ProcessExecution,
proc:StageExecution ;
schema:rangeIncludes proc:ProcessDefinition .
proc:statusEffectiveFrom a owl:DatatypeProperty ;
rdfs:label "status effective from"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:range xsd:dateTime ;
skos:definition "The instant from which a status assignment holds."@en ;
schema:domainIncludes proc:StatusAssignment .
proc:statusEffectiveTo a owl:DatatypeProperty ;
rdfs:label "status effective to"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:range xsd:dateTime ;
skos:definition "The instant at which a status assignment ceased to hold; absent while current."@en ;
schema:domainIncludes proc:StatusAssignment .
adjstage:StageOrder a skos:OrderedCollection ;
skos:memberList ( adjstage:FNOLIntake adjstage:CoverageVerification adjstage:TriageAssignment adjstage:Investigation adjstage:HistoricalAssessment adjstage:ExclusionLimitCalculation adjstage:Adjudication adjstage:EvaluationValuation adjstage:SettlementPayment adjstage:ClosurePostSettlement ) ;
skos:prefLabel "Adjudication stages in plan order"@en .
doctype:AttorneyCorrespondence a skos:Concept ;
skos:broader doctype:CorrespondenceDocument ;
skos:inScheme doctype: ;
skos:notation "ATTCOR" ;
skos:prefLabel "Attorney Correspondence"@en .
doctype:BreachOfContract a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "BREOFCON" ;
skos:prefLabel "Breach of Contract"@en .
doctype:ChronologyOfEvents a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "CHROFEVE" ;
skos:prefLabel "Chronology of Events"@en .
doctype:ClaimAffidavit a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "CLAAFF" ;
skos:prefLabel "Claim Affidavit"@en .
doctype:CoDefendantDocuments a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "CODEFDOC" ;
skos:prefLabel "Co-Defendant Documents"@en .
doctype:CoverageAnalysisAndROR a skos:Concept ;
skos:altLabel "Coverage Analysis"@en,
"ROR Letter"@en ;
skos:broader doctype:CoverageDocument ;
skos:editorialNote "High-value type. skos:altLabel: Coverage Analysis; ROR Letter."@en ;
skos:inScheme doctype: ;
skos:notation "COVANAANDROR" ;
skos:prefLabel "Coverage Analysis & Reservation of Rights"@en .
doctype:CoverageLetterFinalPosition a skos:Concept ;
skos:broader doctype:CoverageDocument ;
skos:editorialNote "High-value type; extraction contract in ONTOSPEC §7.2.2."@en ;
skos:inScheme doctype: ;
skos:notation "COVLETFINPOS" ;
skos:prefLabel "Coverage Letter (Final Position)"@en .
doctype:DamageReport a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "DAMREP" ;
skos:prefLabel "Damage Report"@en .
doctype:DefenseCounselReports a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "DEFCOUREP" ;
skos:prefLabel "Defense Counsel Reports"@en .
doctype:DemandPackage a skos:Concept ;
skos:broader doctype:FinancialDocument ;
skos:editorialNote "High-value type; extraction contract in ONTOSPEC §7.2.3."@en ;
skos:inScheme doctype: ;
skos:notation "DEMPAC" ;
skos:prefLabel "Demand Package"@en .
doctype:DenialCorrespondence a skos:Concept ;
skos:broader doctype:CorrespondenceDocument ;
skos:inScheme doctype: ;
skos:notation "DENCOR" ;
skos:prefLabel "Denial Correspondence"@en .
doctype:Endorsement a skos:Concept ;
skos:broader doctype:CoverageDocument ;
skos:inScheme doctype: ;
skos:notation "END" ;
skos:prefLabel "Endorsement"@en .
doctype:FirstNoticeOfLoss a skos:Concept ;
skos:altLabel "First Notice of Loss (FNOL)"@en ;
skos:broader doctype:EvidenceDocument ;
skos:editorialNote "GAP-01: rows 12 and 13 of the Document Inventory are the SAME concept, differing only in punctuation and the Auto flag. One concept emitted, applicable to both GL and Auto."@en ;
skos:inScheme doctype: ;
skos:notation "FIRNOTOFLOS" ;
skos:prefLabel "First Notice of Loss"@en .
doctype:GeneralCorrespondence a skos:Concept ;
skos:broader doctype:CorrespondenceDocument ;
skos:inScheme doctype: ;
skos:notation "GENCOR" ;
skos:prefLabel "General Correspondence"@en .
doctype:HREmploymentRecords a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:editorialNote "dpv:Employment-sensitive content."@en ;
skos:inScheme doctype: ;
skos:notation "HREMPREC" ;
skos:prefLabel "HR & Employment Records"@en .
doctype:IMEReport a skos:Concept ;
skos:broader doctype:MedicalDocument0 ;
skos:editorialNote "High-value type; added from the Decision Tracing tab (Gate 9)."@en ;
skos:inScheme doctype: ;
skos:notation "IMEREP" ;
skos:prefLabel "IME Report"@en .
doctype:IncidentReport a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "INCREP" ;
skos:prefLabel "Incident Report"@en .
doctype:IndemnificationAndInsurance a skos:Concept ;
skos:broader doctype:CoverageDocument ;
skos:inScheme doctype: ;
skos:notation "INDANDINS" ;
skos:prefLabel "Indemnification and Insurance"@en .
doctype:IndemnificationAndInsuranceAgreement a skos:Concept ;
skos:broader doctype:CoverageDocument ;
skos:editorialNote "Added from the Decision Tracing tab (row 35) — the longer form of Indemnification and Insurance."@en ;
skos:inScheme doctype: ;
skos:notation "INDANDINSAGR" ;
skos:prefLabel "Indemnification and Insurance Agreement"@en .
doctype:Invoice a skos:Concept ;
skos:broader doctype:FinancialDocument ;
skos:inScheme doctype: ;
skos:notation "INV" ;
skos:prefLabel "Invoice"@en .
doctype:ItemizationOfServicesAndExpenses a skos:Concept ;
skos:broader doctype:FinancialDocument ;
skos:inScheme doctype: ;
skos:notation "ITEOFSERANDE" ;
skos:prefLabel "Itemization of Services & Expenses"@en .
doctype:LegalInvoice a skos:Concept ;
skos:broader doctype:FinancialDocument ;
skos:inScheme doctype: ;
skos:notation "LEGINV" ;
skos:prefLabel "Legal Invoice"@en .
doctype:LiabilityDocument a skos:Concept ;
skos:altLabel "Liability"@en ;
skos:broader doctype:EvidenceDocument ;
skos:editorialNote "GAP-02: rows 21 and 22 of the Document Inventory are the SAME concept. One concept emitted; the bare form 'Liability' is an altLabel."@en ;
skos:inScheme doctype: ;
skos:notation "LIADOC" ;
skos:prefLabel "Liability Document"@en .
doctype:LitigationDocument a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "LITDOC" ;
skos:prefLabel "Litigation Document"@en .
doctype:MedicalDocument a skos:Concept ;
skos:broader doctype:MedicalDocument0 ;
skos:inScheme doctype: ;
skos:notation "MEDDOC" ;
skos:prefLabel "Medical Document"@en .
doctype:Misrepresentation a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "MIS" ;
skos:prefLabel "Misrepresentation"@en .
doctype:Other a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:editorialNote "GAP-03: not a semantic category — the absence of classification. Emitted for source fidelity; excluded from any exhaustive sh:in list. High-value target for reclassification."@en ;
skos:inScheme doctype: ;
skos:notation "OTH" ;
skos:prefLabel "Other"@en .
doctype:PoliceReport a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "POLREP" ;
skos:prefLabel "Police Report"@en .
doctype:PolicyDocument a skos:Concept ;
skos:broader doctype:CoverageDocument ;
skos:editorialNote "Also consulted at Gate 4 for a coverage pre-check at triage — the gate context lives on the dtr:EvidenceUse, not on the document type."@en ;
skos:inScheme doctype: ;
skos:notation "POLDOC" ;
skos:prefLabel "Policy Document"@en .
doctype:PromissoryEstoppel a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "PROEST" ;
skos:prefLabel "Promissory Estoppel"@en .
doctype:QuantumMeruit a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "QUAMER" ;
skos:prefLabel "Quantum Meruit"@en .
doctype:RecordedStatementEUO a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:editorialNote "High-value type; ONTOSPEC §7.2.5."@en ;
skos:inScheme doctype: ;
skos:notation "RECSTAEUO" ;
skos:prefLabel "Recorded Statement / EUO"@en .
doctype:SettlementAgreementRelease a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:editorialNote "High-value type; ONTOSPEC §7.2.6."@en ;
skos:inScheme doctype: ;
skos:notation "SETAGRREL" ;
skos:prefLabel "Settlement Agreement / Release"@en .
doctype:SettlementDocument a skos:Concept ;
skos:broader doctype:LegalDocument ;
skos:inScheme doctype: ;
skos:notation "SETDOC" ;
skos:prefLabel "Settlement Document"@en .
doctype:SiteInspectionReport a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "SITINSREP" ;
skos:prefLabel "Site Inspection Report"@en .
doctype:SpecialHandlingInstructions a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "SPEHANINS" ;
skos:prefLabel "Special Handling Instructions"@en .
doctype:SubrogationDemandLetter a skos:Concept ;
skos:broader doctype:FinancialDocument ;
skos:editorialNote "High-value type; ONTOSPEC §7.2.7."@en ;
skos:inScheme doctype: ;
skos:notation "SUBDEMLET" ;
skos:prefLabel "Subrogation Demand Letter"@en .
doctype:WitnessReport a skos:Concept ;
skos:broader doctype:EvidenceDocument ;
skos:inScheme doctype: ;
skos:notation "WITREP" ;
skos:prefLabel "Witness Report"@en .
cplx:TierOrder a skos:OrderedCollection ;
skos:memberList ( cplx:Simple cplx:Standard cplx:Complex cplx:HighComplexity ) ;
skos:prefLabel "Complexity, lowest to highest"@en .
liadesc:CertaintyOrder a skos:OrderedCollection ;
skos:memberList ( liadesc:Clear liadesc:Probable liadesc:Questionable liadesc:Disputed ) ;
skos:prefLabel "Liability certainty, most to least"@en .
ltgstat:ProceduralOrder a skos:OrderedCollection ;
skos:memberList ( ltgstat:SuitFiled ltgstat:Answered ltgstat:Discovery ltgstat:Mediation ltgstat:TrialSet ltgstat:Verdict ltgstat:Appealed ltgstat:Resolved ) ;
skos:prefLabel "Litigation statuses in procedural order"@en .
adj:Gate-ClaimRegistration a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Claim Registration"@en ;
dct:source "Decision Tracing tab, gate 1"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Decide whether to open a claim and register the loss event: assign a claim number and capture the basic loss facts. Decision subclass: itk:ClaimRegistration (intake module)."@en ;
adj:gateOf adj:Stage-FNOLIntake ;
adj:gateOrdinal 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:ClaimRegistration .
adj:Gate-ClosureRecovery a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Closure and Post-Settlement Recovery"@en ;
dct:source "Decision Tracing tab, gate 11"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Close the claim once payment is made and the release is signed; determine whether to pursue subrogation or salvage; confirm regulatory requirements are met. Decision subclass: rcv:ClosureDecision."@en ;
adj:gateOf adj:Stage-ClosurePostSettlement ;
adj:gateOrdinal 11 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:ClosureRecovery .
adj:Gate-CoverageDetermination a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Coverage Determination"@en ;
dct:source "Decision Tracing tab, gate 2"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Confirm whether a policy is in force covering this type of loss; identify the applicable coverage type and trigger. Decision subclass: cvp:CoverageDetermination."@en ;
adj:gateOf adj:Stage-CoverageVerification ;
adj:gateOrdinal 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:CoverageDetermination .
adj:Gate-CoveragePosition a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Coverage Position / ROR / Denial"@en ;
dct:source "Decision Tracing tab, gate 3"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Take a formal coverage position: confirm, issue a Reservation of Rights, or deny. Decision subclass: cvp:CoveragePositionStatement."@en ;
skos:editorialNote "PRIMARY EXTRACTION TARGET. SME (Manish, 2026-07-31): the reason for the position is in the note, not in any structured field."@en ;
adj:gateOf adj:Stage-CoverageVerification ;
adj:gateOrdinal 3 ;
adjmeta:primaryExtractionTarget true ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:CoveragePosition .
adj:Gate-DemandEvaluation a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Demand Evaluation and Negotiation"@en ;
dct:source "Decision Tracing tab, gate 9"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Assess the claimant's demand; determine a fair settlement value; set or adjust the reserve to reflect current valuation. Decision subclass: val:DemandEvaluation."@en ;
adj:gateOf adj:Stage-EvaluationValuation ;
adj:gateOrdinal 9 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:DemandEvaluation .
adj:Gate-GuidedAdjudication a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Guided Adjudication Decision"@en ;
dct:source "Decision Tracing tab, gate 8"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The guided-adjudication system produces an adjudication recommendation; the adjudicator (or Line Owner) accepts or rejects it. Decision: adj:AdjudicationDecision responding to an adj:GuidedAdjudicationRecommendation."@en ;
skos:editorialNote "PRIMARY EXTRACTION TARGET (highest priority). The recommendation may be structured, but the rationale for accept/reject lives ONLY in file notes. Open question (Dhaji, 2026-07-31; Joe to confirm): unsure whether a citation appears in the model output."@en ;
adj:gateOf adj:Stage-Adjudication ;
adj:gateOrdinal 8 ;
adjmeta:openQuestion true ;
adjmeta:primaryExtractionTarget true ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:GuidedAdjudication .
adj:Gate-InitialReserveSetting a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Initial Reserve Setting"@en ;
dct:source "Decision Tracing tab, gate 6"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Set the initial reserve — the insurer's estimated liability. Decision subclass: fin:InitialReserveSetting."@en ;
skos:editorialNote "SME (Jos): reserve setting does not happen in isolation; it follows coverage determination and may happen simultaneously with coverage verification. SME (Manish): the reason a reserve is $1,000 vs $1,500 lives only in the file note."@en ;
adj:gateOf adj:Stage-HistoricalAssessment ;
adj:gateOrdinal 6 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:InitialReserveSetting .
adj:Gate-LiabilityAssessment a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Liability Assessment"@en ;
dct:source "Decision Tracing tab, gate 7"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Formally determine the insured's degree of fault; assign a liability percentage. Decision subclass: lia:LiabilityDetermination."@en ;
skos:editorialNote "The SMEs believed liability assessment was already in the analytical layer — it is operational-only (Amber). Needs Fractal mapping."@en ;
adj:gateOf adj:Stage-Adjudication ;
adj:gateOrdinal 7 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:LiabilityAssessment .
adj:Gate-SIUReferral a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "SIU Referral Decision"@en ;
dct:source "Decision Tracing tab, gate 5"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Decide whether to refer the claim to the Special Investigations Unit based on fraud indicators, statement inconsistencies, or prior claim history. Decision record: fra:SIUReferral."@en ;
adj:gateOf adj:Stage-Investigation ;
adj:gateOrdinal 5 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:SIUReferral .
adj:Gate-SettlementAuthorization a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Settlement Authorization"@en ;
dct:source "Decision Tracing tab, gate 10"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Authorise the final settlement amount; confirm it falls within authority or escalate; initiate payment. Decision subclass: stl:SettlementAuthorization."@en ;
adj:gateOf adj:Stage-SettlementPayment ;
adj:gateOrdinal 10 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:SettlementAuthorization .
adj:Gate-TriageAssignment a owl:NamedIndividual,
adj:DecisionGate ;
rdfs:label "Triage and Assignment"@en ;
dct:source "Decision Tracing tab, gate 4"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "Classify claim complexity; assign to the right adjuster or queue. Decision subclass: asg:TriageAssessment."@en ;
skos:editorialNote "SME (Jos): triage happens earlier than the process model suggests — a policy document may be consulted at this gate for a coverage pre-check before Stage 2."@en ;
adj:gateOf adj:Stage-TriageAssignment ;
adj:gateOrdinal 4 ;
adjmeta:openQuestion true ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier gate:TriageAssignment .
adj:GuidedAdjudicationRecommendation a owl:Class ;
rdfs:label "Guided adjudication recommendation"@en ;
dct:source "ONTOSPEC §5.2.1; Gate 8"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf adj:AdjudicationDecisionProposal ;
skos:definition "The recommendation produced by the existing guided-adjudication system, which an adjudicator or Line Owner accepts or rejects. The recommendation may be structured; the rationale for accepting or rejecting it lives only in the file note."@en ;
adjmeta:acordAlignment "NAIC AI Model Bulletin (2023-12-04)" ;
adjmeta:primaryExtractionTarget true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:PartialApproval a owl:Class ;
rdfs:label "Partial approval"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf adj:DecisionOutcome ;
skos:definition "An outcome in which part of the claim is approved automatically and the remainder is referred for manual handling. A named split outcome, not two decisions."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:adjudicationOf a owl:ObjectProperty ;
rdfs:label "adjudication of"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf adj:hasAdjudicationCase ;
skos:definition "Links an adjudication case to the claim it is the process view of."@en ;
schema:domainIncludes adj:AdjudicationCase ;
schema:rangeIncludes claim:Claim .
adj:appliedRule a owl:ObjectProperty ;
rdfs:label "applied rule"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:hadPlan ;
owl:inverseOf adj:ruleAppliedIn ;
skos:definition "The rule (as configured, versioned plan) that a rule application applied."@en ;
schema:domainIncludes adj:RuleApplication ;
schema:rangeIncludes adj:AdjudicationRule .
adj:atGate a owl:ObjectProperty ;
rdfs:label "at gate"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf adj:decisionAtGate ;
skos:definition "The decision gate at which a decision was reached."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes adj:DecisionGate .
adj:complexityOf a owl:ObjectProperty ;
rdfs:label "complexity of"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasComplexityAssessment .
adj:decided a owl:ObjectProperty ;
rdfs:label "decided"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:decidedBy .
adj:decidedBy a owl:ObjectProperty ;
rdfs:label "decided by"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf adj:decided ;
skos:definition "The social agent accountable for a decision. For richer accountability use prov:qualifiedAssociation with prov:hadRole on the gate evaluation."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes core:SocialAgent .
adj:decisionAtGate a owl:ObjectProperty ;
rdfs:label "decision at gate"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:atGate .
adj:decisionFrom a owl:ObjectProperty ;
rdfs:label "decision from"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:wasGeneratedBy ;
owl:inverseOf adj:producedDecision .
adj:derivedFromEvidence a owl:ObjectProperty ;
rdfs:label "derived from evidence"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf adj:evidenceFor ;
skos:definition "The evidence (documents, file notes, extracted facts — classes in the evidence module; annotation-only signature, no import) a decision was derived from."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes evd:ClaimDocument,
evd:ExtractedFact,
evd:FileNote .
adj:evaluatesGate a owl:ObjectProperty ;
rdfs:label "evaluates gate"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:hadPlan ;
owl:inverseOf adj:gateEvaluatedBy ;
skos:definition "Links a gate evaluation (a prov:Activity on one claim) to the gate in the plan it evaluates."@en ;
schema:domainIncludes adj:GateEvaluation ;
schema:rangeIncludes adj:DecisionGate .
adj:evidenceFor a owl:ObjectProperty ;
rdfs:label "evidence for"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:derivedFromEvidence .
adj:executesStage a owl:ObjectProperty ;
rdfs:label "executes stage"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:hadPlan ;
owl:inverseOf adj:stageExecutedBy ;
skos:definition "Links a stage execution (a prov:Activity on one claim) to the stage in the plan it executes."@en ;
schema:domainIncludes adj:StageExecution ;
schema:rangeIncludes adj:AdjudicationStage .
adj:gateEvaluatedBy a owl:ObjectProperty ;
rdfs:label "gate evaluated by"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:evaluatesGate .
adj:gateOf a owl:ObjectProperty ;
rdfs:label "gate of"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasGate .
adj:hasAdjudicationCase a owl:ObjectProperty ;
rdfs:label "has adjudication case"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:adjudicationOf .
adj:hasComplexityAssessment a owl:ObjectProperty ;
rdfs:label "has complexity assessment"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:complexityOf ;
skos:definition "The complexity assessment on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes adj:ComplexityAssessment .
adj:hasExecution a owl:ObjectProperty ;
rdfs:label "has execution"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:onCase .
adj:hasGate a owl:ObjectProperty ;
rdfs:label "has gate"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:gateOf ;
skos:definition "Links a stage to a decision gate within it."@en ;
schema:domainIncludes adj:AdjudicationStage ;
schema:rangeIncludes adj:DecisionGate .
adj:hasOutcome a owl:ObjectProperty ;
rdfs:label "has outcome"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:outcomeOf ;
skos:definition "The reified outcome of a decision."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes adj:DecisionOutcome .
adj:hasRationale a owl:ObjectProperty ;
rdfs:label "has rationale"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:rationaleFor ;
skos:definition "The stated reason for a decision."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes adj:DecisionRationale .
adj:hasRuleApplication a owl:ObjectProperty ;
rdfs:label "has rule application"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:ruleApplicationFor .
adj:hasStage a owl:ObjectProperty ;
rdfs:label "has stage"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:stageOf ;
skos:definition "Links the process definition to one of its stages."@en ;
schema:domainIncludes adj:AdjudicationProcess ;
schema:rangeIncludes adj:AdjudicationStage .
adj:hasStep a owl:ObjectProperty ;
rdfs:label "has step"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf adj:stepOf ;
skos:definition "Links a decision to one ordered step of its reasoning record."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes adj:AdjudicationStep .
adj:onCase a owl:ObjectProperty ;
rdfs:label "on case"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf adj:hasExecution ;
skos:definition "The adjudication case a stage execution or gate evaluation ran on."@en ;
schema:domainIncludes adj:GateEvaluation,
adj:StageExecution ;
schema:rangeIncludes adj:AdjudicationCase .
adj:outcomeOf a owl:ObjectProperty ;
rdfs:label "outcome of"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasOutcome .
adj:precededByStage a owl:ObjectProperty ;
rdfs:label "preceded by stage"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf proc:precededBy ;
owl:inverseOf adj:precedesStage ;
skos:definition "The stage immediately before this one in the plan ordering."@en ;
schema:domainIncludes adj:AdjudicationStage ;
schema:rangeIncludes adj:AdjudicationStage .
adj:precedesStage a owl:ObjectProperty ;
rdfs:label "precedes stage"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:precededByStage .
adj:producedDecision a owl:ObjectProperty ;
rdfs:label "produced decision"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:generated ;
owl:inverseOf adj:decisionFrom ;
skos:definition "The decision generated by a gate evaluation."@en ;
schema:domainIncludes adj:GateEvaluation ;
schema:rangeIncludes adj:AdjudicationDecision .
adj:rationaleFor a owl:ObjectProperty ;
rdfs:label "rationale for"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasRationale .
adj:recommendationActedOn a owl:ObjectProperty ;
rdfs:label "recommendation acted on"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:respondsToRecommendation .
adj:recommendedBy a owl:ObjectProperty ;
rdfs:label "recommended by"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:recommends .
adj:recommends a owl:ObjectProperty ;
rdfs:label "recommends"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf adj:recommendedBy ;
skos:definition "The outcome a decision proposal recommends."@en ;
schema:domainIncludes adj:AdjudicationDecisionProposal ;
schema:rangeIncludes adj:DecisionOutcome .
adj:respondsToRecommendation a owl:ObjectProperty ;
rdfs:label "responds to recommendation"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf adj:recommendationActedOn ;
skos:definition "Links the human decision to the guided-adjudication recommendation it accepted or rejected. The accept/reject rationale is the highest-priority extraction target."@en ;
schema:domainIncludes adj:AdjudicationDecision ;
schema:rangeIncludes adj:GuidedAdjudicationRecommendation .
adj:ruleApplicationFor a owl:ObjectProperty ;
rdfs:label "rule application for"@en ;
dct:source "ONTOSPEC §5.2.2"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf adj:hasRuleApplication ;
skos:definition "The decision a rule application contributed to."@en ;
schema:domainIncludes adj:RuleApplication ;
schema:rangeIncludes adj:AdjudicationDecision .
adj:ruleAppliedIn a owl:ObjectProperty ;
rdfs:label "rule applied in"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:appliedRule .
adj:stageExecutedBy a owl:ObjectProperty ;
rdfs:label "stage executed by"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:executesStage .
adj:stageOf a owl:ObjectProperty ;
rdfs:label "stage of"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasStage .
adj:stepOf a owl:ObjectProperty ;
rdfs:label "step of"@en ;
rdfs:isDefinedBy adj: ;
owl:inverseOf adj:hasStep .
asg:AdjudicatorRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Adjudicator role"@en ;
dct:source "SME session — guided adjudication; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when acting on guided-adjudication recommendations."@en ;
core:roleProperty asg:adjudicator .
asg:AdjusterRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Adjuster role"@en ;
dct:source "PARTICIPANT, PERFORMER; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when assigned to handle a claim or coverage line. Not a kind of person — a party may hold it, relinquish it, and hold other roles simultaneously."@en ;
core:roleProperty asg:adjuster .
asg:AuditorRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Auditor role"@en ;
dct:source "Question 29; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when auditing a claim file."@en ;
core:roleProperty asg:auditor .
asg:CATAdjusterRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "CAT adjuster role"@en ;
dct:source "CAT_WORKFORCE; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when assigned to a catastrophe response workforce."@en ;
core:roleProperty asg:catAdjuster .
asg:ClaimQueue a owl:Class ;
rdfs:label "Claim queue"@en ;
dct:source "Source table CLAIM_QUEUE; ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A work queue a claim is routed to. The routing basis — which rule triggered which queue — is the gap."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
asg:FNOLHandlerRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "FNOL handler role"@en ;
dct:source "FNOL_HANDLER; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when taking first notice of loss."@en ;
core:roleProperty asg:fnolHandlerParty .
asg:InsuredRole a owl:NamedIndividual,
agr:PartyRole ;
rdfs:label "Insured role"@en ;
dct:source "PARTICIPANT; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a party plays as the insured under the policy a claim draws on. A contract-party role (agr:PartyRole)."@en ;
core:roleProperty asg:insured .
asg:LineOwnerRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Line owner role"@en ;
dct:source "SME session 2026-07-31; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when owning a coverage line's handling, including accepting or rejecting guided-adjudication recommendations."@en ;
core:roleProperty asg:lineOwner .
asg:PayeeRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Payee role"@en ;
dct:source "PAYMENT; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a party plays when receiving a claim payment."@en ;
core:roleProperty asg:payeeParty .
asg:PublicAdjusterRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Public adjuster role"@en ;
dct:source "Public adjuster flag — fraud signal; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when representing the claimant as a public adjuster. Public-adjuster involvement is an early fraud signal."@en ;
core:roleProperty asg:publicAdjuster .
asg:SIUInvestigatorRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "SIU investigator role"@en ;
dct:source "SIU_REFERRAL; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when investigating a claim for the Special Investigations Unit."@en ;
core:roleProperty asg:siuInvestigator .
asg:SupervisorRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Supervisor role"@en ;
dct:source "PERFORMER, authority chain; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when supervising claim handling and approving escalations above authority."@en ;
core:roleProperty asg:supervisor .
asg:Vendor a owl:Class ;
rdfs:label "Vendor"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:Organization ;
skos:definition "A third-party service provider organisation. Vendor TYPE is a SKOS value, never a subclass (PIT-5); named vendors are instances (PIT-3)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
asg:VendorRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Vendor role"@en ;
dct:source "Question bank — Vendor; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role an organisation or person plays when engaged as a third-party service provider on a claim."@en ;
core:roleProperty asg:vendorParty .
asg:WitnessRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Witness role"@en ;
dct:source "PARTICIPANT; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
skos:definition "The role a social agent plays when giving a witness account on a claim. The same person may be a claimant on one claim and a witness on another."@en ;
core:roleProperty asg:witness .
asg:assignedPerformer a owl:ObjectProperty ;
rdfs:label "assigned performer"@en ;
dct:source "ONTOSPEC §5.6"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:performerAssignedBy ;
skos:definition "The performer assigned by an assignment record."@en ;
schema:domainIncludes asg:AssignmentRecord ;
schema:rangeIncludes asg:Performer .
asg:assignedQueue a owl:ObjectProperty ;
rdfs:label "assigned queue"@en ;
dct:source "ONTOSPEC §5.6"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:queueAssignedIn ;
skos:definition "The queue a queue assignment routes to."@en ;
schema:domainIncludes asg:QueueAssignment ;
schema:rangeIncludes asg:ClaimQueue .
asg:assignmentFor a owl:ObjectProperty ;
rdfs:label "assignment for"@en ;
dct:source "ONTOSPEC §5.6"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:hasAssignmentRecord ;
skos:definition "The claim or coverage line an assignment record assigns work on."@en ;
schema:domainIncludes asg:AssignmentRecord ;
schema:rangeIncludes cvp:CoverageLine,
claim:Claim .
asg:authorityOf a owl:ObjectProperty ;
rdfs:label "authority of"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:hasAuthority .
asg:hasAssignmentRecord a owl:ObjectProperty ;
rdfs:label "has assignment record"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:assignmentFor .
asg:hasAuthority a owl:ObjectProperty ;
rdfs:label "has authority"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf asg:authorityOf ;
skos:definition "The authority threshold held by a performer or applying to a coverage line."@en ;
schema:domainIncludes asg:Performer,
cvp:CoverageLine ;
schema:rangeIncludes asg:Authority .
asg:hasParticipant a owl:ObjectProperty ;
rdfs:label "has participant"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf asg:participantOf ;
skos:definition "A reified participant record on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes asg:ParticipantRecord .
asg:hasQueueAssignment a owl:ObjectProperty ;
rdfs:label "has queue assignment"@en ;
dct:source "ONTOSPEC §5.6"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf asg:queueAssignmentOf ;
skos:definition "A time-indexed queue assignment of a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes asg:QueueAssignment .
asg:hasRoutingRationale a owl:ObjectProperty ;
rdfs:label "has routing rationale"@en ;
dct:source "ONTOSPEC §5.6"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf asg:routingRationaleOf ;
skos:definition "The extracted rationale for a routing or assignment choice."@en ;
schema:domainIncludes asg:AssignmentRecord ;
schema:rangeIncludes asg:RoutingRationale .
asg:hasTask a owl:ObjectProperty ;
rdfs:label "has task"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf asg:taskOf ;
skos:definition "A task or diary item on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes asg:Task .
asg:isAdjudicatorFor a owl:ObjectProperty ;
rdfs:label "is adjudicator for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:adjudicator .
asg:isAdjusterFor a owl:ObjectProperty ;
rdfs:label "is adjuster for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:adjuster .
asg:isAuditorFor a owl:ObjectProperty ;
rdfs:label "is auditor for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:auditor .
asg:isCATAdjusterFor a owl:ObjectProperty ;
rdfs:label "is CAT adjuster for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:catAdjuster .
asg:isFNOLHandlerFor a owl:ObjectProperty ;
rdfs:label "is FNOL handler for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:fnolHandlerParty .
asg:isInsuredOn a owl:ObjectProperty ;
rdfs:label "is insured on"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:insured .
asg:isLineOwnerFor a owl:ObjectProperty ;
rdfs:label "is line owner for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:lineOwner .
asg:isParticipantIn a owl:ObjectProperty ;
rdfs:label "is participant in"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:participantParty .
asg:isPayeeOn a owl:ObjectProperty ;
rdfs:label "is payee on"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:payeeParty .
asg:isPublicAdjusterFor a owl:ObjectProperty ;
rdfs:label "is public adjuster for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:publicAdjuster .
asg:isSIUInvestigatorFor a owl:ObjectProperty ;
rdfs:label "is SIU investigator for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:siuInvestigator .
asg:isSupervisorFor a owl:ObjectProperty ;
rdfs:label "is supervisor for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:supervisor .
asg:isVendorPartyFor a owl:ObjectProperty ;
rdfs:label "is vendor party for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:vendorParty .
asg:isWitnessFor a owl:ObjectProperty ;
rdfs:label "is witness for"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:witness .
asg:participantOf a owl:ObjectProperty ;
rdfs:label "participant of"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:hasParticipant .
asg:participantParty a owl:ObjectProperty ;
rdfs:label "participant party"@en ;
dct:source "ONTOSPEC §5.6.3"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isParticipantIn ;
skos:definition "The party a participant record concerns. Personal data: identifying."@en ;
schema:domainIncludes asg:ParticipantRecord ;
schema:rangeIncludes core:SocialAgent .
asg:performerAssignedBy a owl:ObjectProperty ;
rdfs:label "performer assigned by"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:assignedPerformer .
asg:queueAssignedIn a owl:ObjectProperty ;
rdfs:label "queue assigned in"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:assignedQueue .
asg:queueAssignmentOf a owl:ObjectProperty ;
rdfs:label "queue assignment of"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:hasQueueAssignment .
asg:routingRationaleOf a owl:ObjectProperty ;
rdfs:label "routing rationale of"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:hasRoutingRationale .
asg:taskOf a owl:ObjectProperty ;
rdfs:label "task of"@en ;
rdfs:isDefinedBy asg: ;
owl:inverseOf asg:hasTask .
cmp:breachOf a owl:ObjectProperty ;
rdfs:label "breach of"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:hasBreach .
cmp:derivedFromRequirement a owl:ObjectProperty ;
rdfs:label "derived from requirement"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf cmp:requirementInstantiatedBy ;
skos:definition "The requirement a deadline instantiates."@en ;
schema:domainIncludes cmp:StatutoryDeadline ;
schema:rangeIncludes cmp:ComplianceRequirement .
cmp:hasBreach a owl:ObjectProperty ;
rdfs:label "has breach"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cmp:breachOf ;
skos:definition "A breach of the deadline."@en ;
schema:domainIncludes cmp:StatutoryDeadline ;
schema:rangeIncludes cmp:ComplianceBreach .
cmp:hasPenalty a owl:ObjectProperty ;
rdfs:label "has penalty"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cmp:penaltyOf ;
skos:definition "The penalty attaching to a breach."@en ;
schema:domainIncludes cmp:ComplianceBreach ;
schema:rangeIncludes cmp:Penalty .
cmp:hasRequirement a owl:ObjectProperty ;
rdfs:label "has requirement"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cmp:requirementOf ;
skos:definition "A compliance requirement applying in a jurisdiction."@en ;
schema:domainIncludes cmp:Jurisdiction ;
schema:rangeIncludes cmp:ComplianceRequirement .
cmp:inJurisdiction a owl:ObjectProperty ;
rdfs:label "in jurisdiction"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cmp:jurisdictionOf ;
skos:definition "The jurisdiction governing a claim, venue or site. (Venue and site classes live in the litigation and item modules — annotation-only cross-references.)"@en ;
schema:domainIncludes itm:ItemSite,
ltg:Venue,
claim:Claim ;
schema:rangeIncludes cmp:Jurisdiction .
cmp:jurisdictionOf a owl:ObjectProperty ;
rdfs:label "jurisdiction of"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:inJurisdiction .
cmp:penaltyOf a owl:ObjectProperty ;
rdfs:label "penalty of"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:hasPenalty .
cmp:requirementInstantiatedBy a owl:ObjectProperty ;
rdfs:label "requirement instantiated by"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:derivedFromRequirement .
cmp:requirementOf a owl:ObjectProperty ;
rdfs:label "requirement of"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:hasRequirement .
cmp:satisfiedBy a owl:ObjectProperty ;
rdfs:label "satisfied by"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cmp:satisfies ;
skos:definition "The acknowledgment or decision event/correspondence that met the deadline."@en ;
schema:domainIncludes cmp:StatutoryDeadline ;
schema:rangeIncludes evd:Correspondence,
core:Event .
cmp:satisfies a owl:ObjectProperty ;
rdfs:label "satisfies"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:satisfiedBy .
cmp:triggeringEvent a owl:ObjectProperty ;
rdfs:label "triggering event"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cmp:triggersDeadline ;
skos:definition "The event that starts the clock: FNOL receipt, proof-of-loss receipt, demand receipt."@en ;
schema:domainIncludes cmp:StatutoryDeadline ;
schema:rangeIncludes core:Event .
cmp:triggersDeadline a owl:ObjectProperty ;
rdfs:label "triggers deadline"@en ;
rdfs:isDefinedBy cmp: ;
owl:inverseOf cmp:triggeringEvent .
cvp:CoordinationOfBenefits a owl:Class ;
rdfs:label "Coordination of benefits"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The primary-versus-excess carrier arrangement and the resulting adjustment."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:CoverageCounselRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Coverage counsel role"@en ;
dct:source "Document Type Reference; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy cvp: ;
skos:definition "The role a social agent plays when engaged as coverage counsel on a claim. Not a kind of person."@en ;
core:roleProperty cvp:coverageCounsel .
cvp:CoverageDenial a owl:Class ;
rdfs:label "Coverage denial"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf cvp:CoveragePositionStatement ;
skos:definition "A structured denial record with reason and legal basis. The letter template exists; the structured entity does not."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:CoverageDetermination a owl:Class ;
rdfs:label "Coverage determination"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-2 determination that a policy is in force covering this loss type, and which coverage type and trigger apply."@en ;
adjmeta:acordAlignment "ACORD Capability — Claims Handling" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
cvp:CoverageLineValuation a owl:Class ;
rdfs:label "Coverage line valuation"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The gross-to-net computation chain for a coverage line — the step-by-step trail from claimed amount to payable amount. Not stored anywhere today in either source; modelled so the gap is visible."@en ;
skos:editorialNote "Gap — no source. The applied limit, excess amount and net payable all sit outside the analytical layer."@en ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:HandlingStatusAssignment a owl:Class ;
rdfs:label "Handling status assignment"@en ;
dct:source "Source table LINE_AH; ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf proc:StatusAssignment ;
skos:definition "A time-indexed assignment of a handling status to a coverage line, including the pre-push and push-pending states — states are history, never an overwritten flag."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
cvp:appliesExclusion a owl:ObjectProperty ;
rdfs:label "applies exclusion"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:exclusionAppliedIn ;
skos:definition "An exclusion application invoked by a coverage position."@en ;
schema:domainIncludes cvp:CoveragePositionStatement ;
schema:rangeIncludes cvp:ExclusionApplication .
cvp:citesPolicyProvision a owl:ObjectProperty ;
rdfs:label "cites policy provision"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cvp:provisionCitedBy ;
skos:definition "The policy provision a position or exclusion application cites."@en ;
schema:domainIncludes cvp:CoveragePositionStatement,
cvp:ExclusionApplication ;
schema:rangeIncludes policy:PolicyProvision .
cvp:coordinationOf a owl:ObjectProperty ;
rdfs:label "coordination of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasCoordinationOfBenefits .
cvp:coverageLineOf a owl:ObjectProperty ;
rdfs:label "coverage line of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasCoverageLine .
cvp:coveragePositionOf a owl:ObjectProperty ;
rdfs:label "coverage position of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasCoveragePosition .
cvp:deductibleApplicationOf a owl:ObjectProperty ;
rdfs:label "deductible application of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasDeductibleApplication .
cvp:evidencedByDocument a owl:ObjectProperty ;
rdfs:label "evidenced by document"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf cvp:evidencesPosition ;
skos:definition "The claim document (e.g. the ROR or coverage letter, reached through its file-note attachment) that evidences a coverage position."@en ;
schema:domainIncludes cvp:CoveragePositionStatement ;
schema:rangeIncludes evd:ClaimDocument .
cvp:evidencesPosition a owl:ObjectProperty ;
rdfs:label "evidences position"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:evidencedByDocument .
cvp:exclusionAppliedIn a owl:ObjectProperty ;
rdfs:label "exclusion applied in"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:appliesExclusion .
cvp:forCoverage a owl:ObjectProperty ;
rdfs:label "for coverage"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cvp:hasCoverageLineForCoverage ;
skos:definition "The policy coverage a coverage line draws on."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes coverage:Coverage .
cvp:handlingStatusOf a owl:ObjectProperty ;
rdfs:label "handling status of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasHandlingStatusAssignment .
cvp:hasCoordinationOfBenefits a owl:ObjectProperty ;
rdfs:label "has coordination of benefits"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:coordinationOf ;
skos:definition "The coordination-of-benefits arrangement on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:CoordinationOfBenefits .
cvp:hasCoverageLine a owl:ObjectProperty ;
rdfs:label "has coverage line"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:coverageLineOf ;
skos:definition "Links a claim to one of its coverage lines."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes cvp:CoverageLine .
cvp:hasCoverageLineForCoverage a owl:ObjectProperty ;
rdfs:label "has coverage line for coverage"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:forCoverage .
cvp:hasCoveragePosition a owl:ObjectProperty ;
rdfs:label "has coverage position"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:coveragePositionOf ;
skos:definition "The formal coverage position taken on a line or claim."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes cvp:CoveragePositionStatement .
cvp:hasDeductibleApplication a owl:ObjectProperty ;
rdfs:label "has deductible application"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:deductibleApplicationOf ;
skos:definition "The deductible application on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:DeductibleApplication .
cvp:hasHandlingStatusAssignment a owl:ObjectProperty ;
rdfs:label "has handling status assignment"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:handlingStatusOf ;
skos:definition "A time-indexed handling-status assignment on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:HandlingStatusAssignment .
cvp:hasLimitApplication a owl:ObjectProperty ;
rdfs:label "has limit application"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:limitApplicationOf ;
skos:definition "The limit application on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:LimitApplication .
cvp:hasPayableAmount a owl:ObjectProperty ;
rdfs:label "has payable amount"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:payableAmountOf ;
skos:definition "The net payable record on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:PayableAmount .
cvp:hasValuationChain a owl:ObjectProperty ;
rdfs:label "has valuation chain"@en ;
dct:source "ONTOSPEC §5.5.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf cvp:valuationChainOf ;
skos:definition "The gross-to-net valuation chain of a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes cvp:CoverageLineValuation .
cvp:isCoverageCounselFor a owl:ObjectProperty ;
rdfs:label "is coverage counsel for"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:coverageCounsel .
cvp:limitApplicationOf a owl:ObjectProperty ;
rdfs:label "limit application of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasLimitApplication .
cvp:payableAmountOf a owl:ObjectProperty ;
rdfs:label "payable amount of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasPayableAmount .
cvp:provisionCitedBy a owl:ObjectProperty ;
rdfs:label "provision cited by"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:citesPolicyProvision .
cvp:valuationChainOf a owl:ObjectProperty ;
rdfs:label "valuation chain of"@en ;
rdfs:isDefinedBy cvp: ;
owl:inverseOf cvp:hasValuationChain .
dtr:GroundTruthLabel a owl:Class ;
rdfs:label "Ground truth label"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The eventual observed outcome against which a prediction is scored, for model monitoring, drift detection and retraining."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:Remediation a owl:Class ;
rdfs:label "Remediation"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Activity,
core:InformationEntity ;
skos:definition "The corrective action taken in response to an audit finding, and its completion."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:auditOf a owl:ObjectProperty ;
rdfs:label "audit of"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf dtr:hasAuditRecord ;
skos:definition "The claim or decision an audit record audits."@en ;
schema:domainIncludes dtr:AuditRecord ;
schema:rangeIncludes adj:AdjudicationDecision,
claim:Claim .
dtr:documentUsedIn a owl:ObjectProperty ;
rdfs:label "document used in"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:usedDocument .
dtr:evidenceUseIn a owl:ObjectProperty ;
rdfs:label "evidence use in"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:hasEvidenceUse .
dtr:findingOf a owl:ObjectProperty ;
rdfs:label "finding of"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:hasFinding .
dtr:gateOfTrace a owl:ObjectProperty ;
rdfs:label "gate of trace"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:traceAtGate .
dtr:groundTruthFor a owl:ObjectProperty ;
rdfs:label "ground truth for"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:hasGroundTruth .
dtr:hasAuditRecord a owl:ObjectProperty ;
rdfs:label "has audit record"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:auditOf .
dtr:hasDecisionTrace a owl:ObjectProperty ;
rdfs:label "has decision trace"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:traceOf .
dtr:hasEvidenceUse a owl:ObjectProperty ;
rdfs:label "has evidence use"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf dtr:evidenceUseIn ;
skos:definition "One evidence-use row of the trace."@en ;
schema:domainIncludes dtr:DecisionTrace ;
schema:rangeIncludes dtr:EvidenceUse .
dtr:hasFinding a owl:ObjectProperty ;
rdfs:label "has finding"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf dtr:findingOf ;
skos:definition "A finding within an audit record."@en ;
schema:domainIncludes dtr:AuditRecord ;
schema:rangeIncludes dtr:AuditFinding .
dtr:hasGroundTruth a owl:ObjectProperty ;
rdfs:label "has ground truth"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf dtr:groundTruthFor ;
skos:definition "The observed outcome an AI output is eventually scored against."@en ;
schema:domainIncludes dtr:AIOutput ;
schema:rangeIncludes dtr:GroundTruthLabel .
dtr:hasRationaleStatement a owl:ObjectProperty ;
rdfs:label "has rationale statement"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf dtr:rationaleStatementFor ;
skos:definition "The extracted rationale statement attached to a trace or decision."@en ;
schema:domainIncludes adj:AdjudicationDecision,
dtr:DecisionTrace ;
schema:rangeIncludes dtr:RationaleStatement .
dtr:hasRemediation a owl:ObjectProperty ;
rdfs:label "has remediation"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:remediates .
dtr:modelProduced a owl:ObjectProperty ;
rdfs:label "model produced"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:producedByModel .
dtr:overrideRationale a owl:ObjectProperty ;
rdfs:label "override rationale"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf dtr:rationaleForOverride ;
skos:definition "The extracted rationale for the override — like the decision rationale, it lives only in the file note."@en ;
schema:domainIncludes dtr:HumanOverride ;
schema:rangeIncludes dtr:RationaleStatement .
dtr:overrides a owl:ObjectProperty ;
rdfs:label "overrides"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf prov:used ;
owl:inverseOf dtr:wasOverriddenBy ;
skos:definition "The AI output a human override rejected or amended."@en ;
schema:domainIncludes dtr:HumanOverride ;
schema:rangeIncludes dtr:AIOutput .
dtr:producedByModel a owl:ObjectProperty ;
rdfs:label "produced by model"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf dtr:modelProduced ;
skos:definition "The versioned model that produced an AI output."@en ;
schema:domainIncludes dtr:AIOutput ;
schema:rangeIncludes dtr:AIModel .
dtr:rationaleForOverride a owl:ObjectProperty ;
rdfs:label "rationale for override"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:overrideRationale .
dtr:rationaleStatementFor a owl:ObjectProperty ;
rdfs:label "rationale statement for"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:hasRationaleStatement .
dtr:recordedIn a owl:ObjectProperty ;
rdfs:label "recorded in"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf dtr:recordsRationale ;
skos:definition "The file-note text block the rationale was written in."@en ;
schema:domainIncludes dtr:RationaleStatement ;
schema:rangeIncludes evd:FileNoteText .
dtr:recordsRationale a owl:ObjectProperty ;
rdfs:label "records rationale"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:recordedIn .
dtr:referencedByFinding a owl:ObjectProperty ;
rdfs:label "referenced by finding"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:sourceReference .
dtr:remediates a owl:ObjectProperty ;
rdfs:label "remediates"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf dtr:hasRemediation ;
skos:definition "The audit finding a remediation corrects."@en ;
schema:domainIncludes dtr:Remediation ;
schema:rangeIncludes dtr:AuditFinding .
dtr:sourceReference a owl:ObjectProperty ;
rdfs:label "source reference"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf dtr:referencedByFinding ;
skos:definition "The document or file note a finding rests on."@en ;
schema:domainIncludes dtr:AuditFinding ;
schema:rangeIncludes evd:ClaimDocument,
evd:FileNote .
dtr:traceAtGate a owl:ObjectProperty ;
rdfs:label "trace at gate"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf dtr:gateOfTrace ;
skos:definition "The decision gate the traced decision was made at."@en ;
schema:domainIncludes dtr:DecisionTrace ;
schema:rangeIncludes adj:DecisionGate .
dtr:traceOf a owl:ObjectProperty ;
rdfs:label "trace of"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf dtr:hasDecisionTrace ;
skos:definition "The decision this trace records the making of."@en ;
schema:domainIncludes dtr:DecisionTrace ;
schema:rangeIncludes adj:AdjudicationDecision .
dtr:usedDocument a owl:ObjectProperty ;
rdfs:label "used document"@en ;
dct:source "ONTOSPEC §5.3.2"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subPropertyOf prov:used ;
owl:inverseOf dtr:documentUsedIn ;
skos:definition "The specific document consulted in an evidence use, where the instance is known."@en ;
schema:domainIncludes dtr:EvidenceUse ;
schema:rangeIncludes evd:ClaimDocument .
dtr:wasOverriddenBy a owl:ObjectProperty ;
rdfs:label "was overridden by"@en ;
rdfs:isDefinedBy dtr: ;
owl:inverseOf dtr:overrides .
evd:anchorDocument a owl:ObjectProperty ;
rdfs:label "anchor document"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf prov:wasDerivedFrom ;
owl:inverseOf evd:isAnchorSourceOf ;
skos:definition "The document or note-text block an anchor points into."@en ;
schema:domainIncludes evd:DocumentAnchor ;
schema:rangeIncludes evd:ClaimDocument,
evd:FileNoteText .
evd:anchoredTo a owl:ObjectProperty ;
rdfs:label "anchored to"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf evd:anchors ;
skos:definition "Links an extracted fact to the document anchor that grounds it."@en ;
schema:domainIncludes evd:ExtractedFact ;
schema:rangeIncludes evd:DocumentAnchor .
evd:anchors a owl:ObjectProperty ;
rdfs:label "anchors"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:anchoredTo .
evd:associatedArtifact a owl:ObjectProperty ;
rdfs:label "associated artifact"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf evd:hasNoteAssociation ;
skos:definition "The claim artefact (line, task, payment, reserve, participant) a file-note association points at."@en ;
schema:domainIncludes evd:FileNoteAssociation ;
schema:rangeIncludes owl:Thing .
evd:associationOfNote a owl:ObjectProperty ;
rdfs:label "association of note"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:hasAssociation .
evd:attachedDocument a owl:ObjectProperty ;
rdfs:label "attached document"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf evd:carriedByAttachment ;
skos:definition "The claim document carried by an attachment."@en ;
schema:domainIncludes evd:Attachment ;
schema:rangeIncludes evd:ClaimDocument .
evd:attachedTo a owl:ObjectProperty ;
rdfs:label "attached to"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:hasAttachment .
evd:authored a owl:ObjectProperty ;
rdfs:label "authored"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:authoredBy .
evd:authoredBy a owl:ObjectProperty ;
rdfs:label "authored by"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf evd:authored ;
skos:definition "The social agent that authored a file note or claim document."@en ;
schema:domainIncludes evd:ClaimDocument,
evd:FileNote ;
schema:rangeIncludes core:SocialAgent .
evd:carriedByAttachment a owl:ObjectProperty ;
rdfs:label "carried by attachment"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:attachedDocument .
evd:citationTarget a owl:ObjectProperty ;
rdfs:label "citation target"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf evd:isCitationTargetOf ;
skos:definition "The document or note-text block a citation points at."@en ;
schema:domainIncludes evd:Citation ;
schema:rangeIncludes evd:ClaimDocument,
evd:FileNoteText .
evd:citedBy a owl:ObjectProperty ;
rdfs:label "cited by"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:cites .
evd:cites a owl:ObjectProperty ;
rdfs:label "cites"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf evd:citedBy ;
skos:definition "Links a rationale statement or adjudication decision to a citation of the document passage relied on. (Domain classes live in downstream modules; the signature here is annotation-only and creates no import.)"@en ;
schema:domainIncludes adj:AdjudicationDecision,
dtr:RationaleStatement ;
schema:rangeIncludes evd:Citation .
evd:hasAssociation a owl:ObjectProperty ;
rdfs:label "has association"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf evd:associationOfNote ;
skos:definition "Links a file note to a reified association with a claim artefact."@en ;
schema:domainIncludes evd:FileNote ;
schema:rangeIncludes evd:FileNoteAssociation .
evd:hasAttachment a owl:ObjectProperty ;
rdfs:label "has attachment"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf evd:attachedTo ;
skos:definition "Links a file note to a file attached to it."@en ;
schema:domainIncludes evd:FileNote ;
schema:rangeIncludes evd:Attachment .
evd:hasFileNote a owl:ObjectProperty ;
rdfs:label "has file note"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf evd:noteOn ;
skos:definition "Links a claim or coverage line to a file note recorded on it."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes evd:FileNote .
evd:hasNoteAssociation a owl:ObjectProperty ;
rdfs:label "has note association"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:associatedArtifact .
evd:hasNoteText a owl:ObjectProperty ;
rdfs:label "has note text"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf evd:textOfNote ;
skos:definition "Links a file note to one of its text blocks."@en ;
schema:domainIncludes evd:FileNote ;
schema:rangeIncludes evd:FileNoteText .
evd:isAnchorSourceOf a owl:ObjectProperty ;
rdfs:label "is anchor source of"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:anchorDocument .
evd:isCitationTargetOf a owl:ObjectProperty ;
rdfs:label "is citation target of"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:citationTarget .
evd:noteId a owl:DatatypeProperty ;
rdfs:label "note id"@en ;
dct:source "ONTOSPEC §5.1.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:range xsd:string ;
skos:definition "The natural key of a file note. Uniqueness is asserted via owl:hasKey on evd:FileNote — never a datatype inverse-functional property (P-6)."@en ;
schema:domainIncludes evd:FileNote .
evd:noteOn a owl:ObjectProperty ;
rdfs:label "note on"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:hasFileNote .
evd:produced a owl:ObjectProperty ;
rdfs:label "produced"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:producedBy .
evd:producedBy a owl:ObjectProperty ;
rdfs:label "produced by"@en ;
dct:source "ONTOSPEC §5.1.2"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subPropertyOf prov:wasGeneratedBy ;
owl:inverseOf evd:produced ;
skos:definition "The extraction activity that produced an extracted fact."@en ;
schema:domainIncludes evd:ExtractedFact ;
schema:rangeIncludes evd:Extraction .
evd:textOfNote a owl:ObjectProperty ;
rdfs:label "text of note"@en ;
rdfs:isDefinedBy evd: ;
owl:inverseOf evd:hasNoteText .
fin:InitialReserveSetting a owl:Class ;
rdfs:label "Initial reserve setting"@en ;
dct:source "ONTOSPEC §5.12; Gate 6"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-6 decision that fixes the initial reserve. SME (Jos): reserve setting does not happen in isolation; it follows coverage determination and may happen simultaneously with coverage verification. SME (Manish): the reason a reserve is $1,000 vs $1,500 lives only in the file note."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
fin:authorized a owl:ObjectProperty ;
rdfs:label "authorized"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:authorizedBy .
fin:authorizedBy a owl:ObjectProperty ;
rdfs:label "authorized by"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf fin:authorized ;
skos:definition "The social agent that authorised a payment. For STP this should be a system performer — the proxy signal for no-human-touch processing."@en ;
schema:domainIncludes fin:Payment ;
schema:rangeIncludes core:SocialAgent .
fin:financialSummaryOf a owl:ObjectProperty ;
rdfs:label "financial summary of"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:hasFinancialSummary .
fin:hasFinancialSummary a owl:ObjectProperty ;
rdfs:label "has financial summary"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fin:financialSummaryOf ;
skos:definition "The point-in-time financial summary of a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes fin:ClaimFinancialSummary .
fin:hasPayment a owl:ObjectProperty ;
rdfs:label "has payment"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fin:paymentOf ;
skos:definition "A payment made on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes fin:Payment .
fin:hasReserve a owl:ObjectProperty ;
rdfs:label "has reserve"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fin:reserveOf ;
skos:definition "The reserve carried on a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes fin:Reserve .
fin:hasReserveTransaction a owl:ObjectProperty ;
rdfs:label "has reserve transaction"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fin:reserveTransactionOf ;
skos:definition "One movement in the reserve's history."@en ;
schema:domainIncludes fin:Reserve ;
schema:rangeIncludes fin:ReserveTransaction .
fin:payee a owl:ObjectProperty ;
rdfs:label "payee"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf fin:payeeOf ;
skos:definition "The party paid. GAP-09: payee address keys exist but are not resolved to a full party record."@en ;
adjmeta:gapId "GAP-09" ;
schema:domainIncludes fin:Payment ;
schema:rangeIncludes core:SocialAgent .
fin:payeeOf a owl:ObjectProperty ;
rdfs:label "payee of"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:payee .
fin:paymentOf a owl:ObjectProperty ;
rdfs:label "payment of"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:hasPayment .
fin:rationaleForReserveChange a owl:ObjectProperty ;
rdfs:label "rationale for reserve change"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:reserveChangeRationale .
fin:reserveChangeRationale a owl:ObjectProperty ;
rdfs:label "reserve change rationale"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fin:rationaleForReserveChange ;
skos:definition "The extracted narrative rationale for a reserve movement. THE PRIMARY PHASE-2 EXTRACTION TARGET. (Range class dtr:RationaleStatement lives in the decision-trace module; annotation-only signature, no import.)"@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource ;
schema:domainIncludes fin:ReserveTransaction ;
schema:rangeIncludes dtr:RationaleStatement .
fin:reserveOf a owl:ObjectProperty ;
rdfs:label "reserve of"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:hasReserve .
fin:reserveTransactionOf a owl:ObjectProperty ;
rdfs:label "reserve transaction of"@en ;
rdfs:isDefinedBy fin: ;
owl:inverseOf fin:hasReserveTransaction .
fra:ClaimSearchHit a owl:Class ;
rdfs:label "ClaimSearch hit"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A returned prior-claim match, with its correlation to subsequent referral."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fra:FraudReferralRecord a owl:Class ;
rdfs:label "Fraud referral record"@en ;
dct:source "Workbook clm:FraudReferralRecord; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf dtr:RationaleStatement ;
skos:definition "The structured BASIS for a referral — why it was made. The referral record captures that a referral happened and its source code, not why."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:FraudTrigger a owl:Class ;
rdfs:label "Fraud trigger"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The record that a fraud trigger fired on a claim. Structured today as an indicator flag; the flag records THAT a trigger fired, not the score or which factors contributed."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fra:NetworkFraudRecord a owl:Class ;
rdfs:label "Network fraud record"@en ;
dct:source "Workbook clm:NetworkFraudRecord; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A cross-claim party network: attorney, provider and claimant appearing together across multiple claims. The primary fraud signal for GL bodily-injury schemes. At resolution, the final map of confirmed participants."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31). Highest sensitivity in the model."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:claimLinkedIn a owl:ObjectProperty ;
rdfs:label "claim linked in"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:linkedClaim .
fra:claimSearchInquiryOf a owl:ObjectProperty ;
rdfs:label "ClaimSearch inquiry of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasClaimSearchInquiry .
fra:factorOf a owl:ObjectProperty ;
rdfs:label "factor of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasFactor .
fra:fraudAssessmentOf a owl:ObjectProperty ;
rdfs:label "fraud assessment of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasFraudAssessment .
fra:fraudTriggerOf a owl:ObjectProperty ;
rdfs:label "fraud trigger of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasFraudTrigger .
fra:hasClaimSearchInquiry a owl:ObjectProperty ;
rdfs:label "has ClaimSearch inquiry"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf fra:claimSearchInquiryOf ;
skos:definition "A ClaimSearch inquiry on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes fra:ClaimSearchInquiry .
fra:hasFactor a owl:ObjectProperty ;
rdfs:label "has factor"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:factorOf ;
skos:definition "A weighted factor of a fraud assessment."@en ;
schema:domainIncludes fra:FraudAssessment ;
schema:rangeIncludes fra:FraudFactor .
fra:hasFraudAssessment a owl:ObjectProperty ;
rdfs:label "has fraud assessment"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:fraudAssessmentOf ;
skos:definition "A fraud assessment on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes fra:FraudAssessment .
fra:hasFraudTrigger a owl:ObjectProperty ;
rdfs:label "has fraud trigger"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:fraudTriggerOf ;
skos:definition "A fraud trigger fired on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes fra:FraudTrigger .
fra:hasNetworkLink a owl:ObjectProperty ;
rdfs:label "has network link"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:networkLinkOf ;
skos:definition "A reified link within a fraud network."@en ;
schema:domainIncludes fra:NetworkFraudRecord ;
schema:rangeIncludes fra:NetworkLink .
fra:hasSIUReferral a owl:ObjectProperty ;
rdfs:label "has SIU referral"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:siuReferralOf ;
skos:definition "An SIU referral on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes fra:SIUReferral .
fra:hitFromInquiry a owl:ObjectProperty ;
rdfs:label "hit from inquiry"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:priorClaimHit .
fra:linkedClaim a owl:ObjectProperty ;
rdfs:label "linked claim"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf fra:claimLinkedIn ;
skos:definition "A claim in a network link."@en ;
schema:domainIncludes fra:NetworkLink ;
schema:rangeIncludes claim:Claim .
fra:linkedParty a owl:ObjectProperty ;
rdfs:label "linked party"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf fra:partyLinkedIn ;
skos:definition "A party in a network link. HIGHEST SENSITIVITY in the model: named-graph isolation and ODRL policy required."@en ;
schema:domainIncludes fra:NetworkLink ;
schema:rangeIncludes core:SocialAgent ;
dpv:hasPersonalDataCategory dpv:Identifying .
fra:networkLinkOf a owl:ObjectProperty ;
rdfs:label "network link of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasNetworkLink .
fra:partyLinkedIn a owl:ObjectProperty ;
rdfs:label "party linked in"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:linkedParty .
fra:priorClaimHit a owl:ObjectProperty ;
rdfs:label "prior claim hit"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf prov:generated ;
owl:inverseOf fra:hitFromInquiry ;
skos:definition "A prior-claim match returned by an inquiry."@en ;
schema:domainIncludes fra:ClaimSearchInquiry ;
schema:rangeIncludes fra:ClaimSearchHit .
fra:rationaleForReferral a owl:ObjectProperty ;
rdfs:label "rationale for referral"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:referralRationale .
fra:referralRationale a owl:ObjectProperty ;
rdfs:label "referral rationale"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf fra:rationaleForReferral ;
skos:definition "The structured basis for the referral — the known gap."@en ;
schema:domainIncludes fra:SIUReferral ;
schema:rangeIncludes fra:FraudReferralRecord .
fra:siuReferralOf a owl:ObjectProperty ;
rdfs:label "SIU referral of"@en ;
rdfs:isDefinedBy fra: ;
owl:inverseOf fra:hasSIUReferral .
itk:CATWorkforceAssignment a owl:Class ;
rdfs:label "CAT workforce assignment"@en ;
dct:source "Source table CAT_WORKFORCE; ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "An assignment of a performer to a catastrophe event's response workforce."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:assignedToCATEvent a owl:ObjectProperty ;
rdfs:label "assigned to CAT event"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:hasWorkforceAssignment ;
skos:definition "The catastrophe event a workforce assignment serves."@en ;
schema:domainIncludes itk:CATWorkforceAssignment ;
schema:rangeIncludes itk:CatastropheEvent .
itk:catEventId a owl:DatatypeProperty ;
rdfs:label "CAT event id"@en ;
dct:source "ONTOSPEC §5.4.3"@en ;
rdfs:isDefinedBy itk: ;
rdfs:range xsd:string ;
skos:definition "The natural key of a catastrophe event; uniqueness via owl:hasKey on itk:CatastropheEvent."@en ;
schema:domainIncludes itk:CatastropheEvent .
itk:catastropheDesignationOf a owl:ObjectProperty ;
rdfs:label "catastrophe designation of"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:hasCatastropheDesignation .
itk:designatesEvent a owl:ObjectProperty ;
rdfs:label "designates event"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:hasDesignatedClaim ;
skos:definition "The catastrophe event a designation refers to."@en ;
schema:domainIncludes itk:CatastropheDesignation ;
schema:rangeIncludes itk:CatastropheEvent .
itk:fnolHandler a owl:ObjectProperty ;
rdfs:label "FNOL handler"@en ;
dct:source "Source table FNOL_HANDLER; ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:handlesFNOL ;
skos:definition "The handler that took the FNOL, via the FNOL-handler role."@en ;
schema:domainIncludes itk:FNOLReport ;
schema:rangeIncludes core:SocialAgent .
itk:handlesFNOL a owl:ObjectProperty ;
rdfs:label "handles FNOL"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:fnolHandler .
itk:hasCatastropheDesignation a owl:ObjectProperty ;
rdfs:label "has catastrophe designation"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf itk:catastropheDesignationOf ;
skos:definition "The CAT designation on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes itk:CatastropheDesignation .
itk:hasDesignatedClaim a owl:ObjectProperty ;
rdfs:label "has designated claim"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:designatesEvent .
itk:hasIncidentProfile a owl:ObjectProperty ;
rdfs:label "has incident profile"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf itk:incidentProfileOf ;
skos:definition "The incident profile of a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes itk:IncidentProfile .
itk:hasWitnessAccount a owl:ObjectProperty ;
rdfs:label "has witness account"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:witnessAccountFor ;
skos:definition "A witness statement surfaced at intake. The class inv:WitnessStatement is defined in the investigation module; this signature is annotation-only and creates no import."@en ;
schema:domainIncludes itk:FNOLReport,
claim:Claim ;
schema:rangeIncludes inv:WitnessStatement .
itk:hasWorkforceAssignment a owl:ObjectProperty ;
rdfs:label "has workforce assignment"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:assignedToCATEvent .
itk:incidentProfileOf a owl:ObjectProperty ;
rdfs:label "incident profile of"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:hasIncidentProfile .
itk:initiatedByFNOL a owl:ObjectProperty ;
rdfs:label "initiated by FNOL"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:initiatesClaim .
itk:initiatesClaim a owl:ObjectProperty ;
rdfs:label "initiates claim"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:initiatedByFNOL ;
skos:definition "The claim opened as a result of the FNOL."@en ;
schema:domainIncludes itk:FNOLReport ;
schema:rangeIncludes claim:Claim .
itk:lossReportedBy a owl:ObjectProperty ;
rdfs:label "loss reported by"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:reportsLoss .
itk:reportedBy a owl:ObjectProperty ;
rdfs:label "reported by"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf itk:reportedFNOL ;
skos:definition "The social agent that reported the loss."@en ;
schema:domainIncludes itk:FNOLReport ;
schema:rangeIncludes core:SocialAgent .
itk:reportedFNOL a owl:ObjectProperty ;
rdfs:label "reported FNOL"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:reportedBy .
itk:reportsLoss a owl:ObjectProperty ;
rdfs:label "reports loss"@en ;
dct:source "ONTOSPEC §5.4.2"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itk:lossReportedBy ;
skos:definition "The loss an FNOL report reports."@en ;
schema:domainIncludes itk:FNOLReport ;
schema:rangeIncludes claim:Loss .
itk:witnessAccountFor a owl:ObjectProperty ;
rdfs:label "witness account for"@en ;
rdfs:isDefinedBy itk: ;
owl:inverseOf itk:hasWitnessAccount .
inv:ExpertWitness a owl:Class ;
rdfs:label "Expert witness"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:SocialAgent ;
owl:equivalentClass [ a owl:Restriction ;
owl:hasValue inv:ExpertWitnessRole ;
owl:onProperty core:hasRole ] ;
skos:definition "A social agent currently holding the expert-witness role."@en .
inv:ExpertWitnessRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Expert witness role"@en ;
dct:source "Expert Report; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy inv: ;
skos:definition "The role a social agent plays when designated as an expert witness."@en ;
core:roleProperty inv:expertWitness .
inv:StatementAnalysis a owl:Class ;
rdfs:label "Statement analysis"@en ;
dct:source "Workbook clm:StatementAnalysis; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Documentation of inconsistencies identified across statements."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:WitnessStatement a owl:Class ;
rdfs:label "Witness statement"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf inv:Statement ;
skos:definition "A witness's account. Explicitly flagged as captured in neither source — witness accounts appear only in file notes and attachments."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:findingOfInvestigation a owl:ObjectProperty ;
rdfs:label "finding of investigation"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:hasFinding .
inv:gaveStatement a owl:ObjectProperty ;
rdfs:label "gave statement"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:givenBy .
inv:givenBy a owl:ObjectProperty ;
rdfs:label "given by"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf inv:gaveStatement ;
skos:definition "The claimant, insured or witness that gave a statement — via their role."@en ;
schema:domainIncludes inv:Statement ;
schema:rangeIncludes core:SocialAgent .
inv:hasFinding a owl:ObjectProperty ;
rdfs:label "has finding"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf inv:findingOfInvestigation ;
skos:definition "A finding produced by an investigation."@en ;
schema:domainIncludes inv:ClaimInvestigation ;
schema:rangeIncludes inv:InvestigationFinding .
inv:hasInvestigation a owl:ObjectProperty ;
rdfs:label "has investigation"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:investigates .
inv:identifiesInconsistency a owl:ObjectProperty ;
rdfs:label "identifies inconsistency"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf inv:inconsistencyIdentifiedBy ;
skos:definition "A statement an analysis found inconsistent."@en ;
schema:domainIncludes inv:StatementAnalysis ;
schema:rangeIncludes inv:Statement .
inv:inconsistencyIdentifiedBy a owl:ObjectProperty ;
rdfs:label "inconsistency identified by"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:identifiesInconsistency .
inv:investigates a owl:ObjectProperty ;
rdfs:label "investigates"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf inv:hasInvestigation ;
skos:definition "The claim or coverage line an investigation concerns."@en ;
schema:domainIncludes inv:ClaimInvestigation ;
schema:rangeIncludes cvp:CoverageLine,
claim:Claim .
inv:isExpertWitnessFor a owl:ObjectProperty ;
rdfs:label "is expert witness for"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:expertWitness .
inv:profileSubject a owl:ObjectProperty ;
rdfs:label "profile subject"@en ;
dct:source "ONTOSPEC §5.7.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf inv:profiledIn ;
skos:definition "The insured, claimant, property or vehicle a prior-loss profile profiles."@en ;
schema:domainIncludes inv:PriorLossProfile ;
schema:rangeIncludes itm:ClaimItem,
core:SocialAgent .
inv:profiledIn a owl:ObjectProperty ;
rdfs:label "profiled in"@en ;
rdfs:isDefinedBy inv: ;
owl:inverseOf inv:profileSubject .
itm:ItemInvolvement a owl:Class ;
rdfs:label "Item involvement"@en ;
dct:source "Source table ITEM_INVOLVEMENT; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The reified involvement of an item in a claim, with its role in the loss."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
itm:RepairEstimate a owl:Class ;
rdfs:label "Repair estimate"@en ;
dct:source "Source table REPAIR_ESTIMATE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A repair cost estimate."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itm:VehicleDamage a owl:Class ;
rdfs:label "Vehicle damage"@en ;
dct:source "Source table VEHICLE_DAMAGE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf itm:DamageItem ;
skos:definition "Damage detail specific to a vehicle."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itm:assignedVehicle a owl:ObjectProperty ;
rdfs:label "assigned vehicle"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itm:vehicleAssignedIn ;
skos:definition "The vehicle in a driver assignment."@en ;
schema:domainIncludes itm:VehicleDriverAssignment ;
schema:rangeIncludes itm:Vehicle .
itm:atSite a owl:ObjectProperty ;
rdfs:label "at site"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itm:siteOf ;
skos:definition "The site of an item."@en ;
schema:domainIncludes itm:ClaimItem ;
schema:rangeIncludes itm:ItemSite .
itm:damageOf a owl:ObjectProperty ;
rdfs:label "damage of"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:hasDamage .
itm:driverOfVehicle a owl:ObjectProperty ;
rdfs:label "driver of vehicle"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itm:droveVehicleIn ;
skos:definition "The driver in a driver-of-vehicle-at-time-of-loss link. Personal data."@en ;
schema:domainIncludes itm:VehicleDriverAssignment ;
schema:rangeIncludes core:SocialAgent ;
dpv:hasPersonalDataCategory dpv:Identifying .
itm:droveVehicleIn a owl:ObjectProperty ;
rdfs:label "drove vehicle in"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:driverOfVehicle .
itm:hasDamage a owl:ObjectProperty ;
rdfs:label "has damage"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf itm:damageOf ;
skos:definition "A structured damage record on an item."@en ;
schema:domainIncludes itm:ClaimItem ;
schema:rangeIncludes itm:DamageItem .
itm:hasInvolvement a owl:ObjectProperty ;
rdfs:label "has involvement"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf itm:involvementOf ;
skos:definition "The reified involvement of an item."@en ;
schema:domainIncludes itm:ClaimItem ;
schema:rangeIncludes itm:ItemInvolvement .
itm:hasItem a owl:ObjectProperty ;
rdfs:label "has item"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf itm:itemOf ;
skos:definition "An item involved in a claim (or coverage line — annotation-only cross-reference)."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes itm:ClaimItem .
itm:involvementOf a owl:ObjectProperty ;
rdfs:label "involvement of"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:hasInvolvement .
itm:itemOf a owl:ObjectProperty ;
rdfs:label "item of"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:hasItem .
itm:siteOf a owl:ObjectProperty ;
rdfs:label "site of"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:atSite .
itm:vehicleAssignedIn a owl:ObjectProperty ;
rdfs:label "vehicle assigned in"@en ;
rdfs:isDefinedBy itm: ;
owl:inverseOf itm:assignedVehicle .
itm:vin a owl:DatatypeProperty ;
rdfs:label "VIN"@en ;
dct:source "ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:range xsd:string ;
skos:definition "The vehicle identification number. Uniqueness via owl:hasKey on itm:Vehicle (P-6); 17-character format enforced with sh:pattern."@en ;
schema:domainIncludes itm:Vehicle .
lia:apportionedFaultIn a owl:ObjectProperty ;
rdfs:label "apportioned fault in"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:liableParty .
lia:apportionmentOf a owl:ObjectProperty ;
rdfs:label "apportionment of"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:hasApportionment .
lia:causationOpinionOf a owl:ObjectProperty ;
rdfs:label "causation opinion of"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:hasCausationOpinion .
lia:decisionRationale a owl:ObjectProperty ;
rdfs:label "decision rationale"@en ;
dct:source "ONTOSPEC §5.8; Question 12"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf lia:rationaleForDetermination ;
skos:definition "The extracted rationale for the percentage assigned — typically in file notes. (Range class dtr:RationaleStatement lives in the decision-trace module; annotation-only signature, no import.)"@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource ;
schema:domainIncludes lia:LiabilityDetermination ;
schema:rangeIncludes dtr:RationaleStatement .
lia:hasApportionment a owl:ObjectProperty ;
rdfs:label "has apportionment"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf lia:apportionmentOf ;
skos:definition "One party's reified share of fault within an assessment."@en ;
schema:domainIncludes lia:LiabilityAssessment ;
schema:rangeIncludes lia:LiabilityApportionment .
lia:hasCausationOpinion a owl:ObjectProperty ;
rdfs:label "has causation opinion"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf lia:causationOpinionOf ;
skos:definition "A causation opinion on an assessment (or an injury — annotation-only cross-reference to the medical module)."@en ;
schema:domainIncludes lia:LiabilityAssessment,
med:Injury ;
schema:rangeIncludes lia:CausationOpinion .
lia:hasLiabilityAssessment a owl:ObjectProperty ;
rdfs:label "has liability assessment"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf lia:liabilityAssessmentOf ;
skos:definition "The liability assessment on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes lia:LiabilityAssessment .
lia:hasNegligenceBasis a owl:ObjectProperty ;
rdfs:label "has negligence basis"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf lia:negligenceBasisOf ;
skos:definition "The stated negligence basis behind a determination."@en ;
schema:domainIncludes lia:LiabilityDetermination ;
schema:rangeIncludes lia:NegligenceBasis .
lia:liabilityAssessmentOf a owl:ObjectProperty ;
rdfs:label "liability assessment of"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:hasLiabilityAssessment .
lia:liableParty a owl:ObjectProperty ;
rdfs:label "liable party"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf lia:apportionedFaultIn ;
skos:definition "The party an apportionment attributes fault to."@en ;
schema:domainIncludes lia:LiabilityApportionment ;
schema:rangeIncludes core:SocialAgent .
lia:negligenceBasisOf a owl:ObjectProperty ;
rdfs:label "negligence basis of"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:hasNegligenceBasis .
lia:rationaleForDetermination a owl:ObjectProperty ;
rdfs:label "rationale for determination"@en ;
rdfs:isDefinedBy lia: ;
owl:inverseOf lia:decisionRationale .
ltg:CoDefendantRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Co-defendant role"@en ;
dct:source "Co-Defendant documents; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
skos:definition "The role a party plays as a co-defendant in a matter."@en ;
core:roleProperty ltg:coDefendant .
ltg:Court a owl:Class ;
rdfs:label "Court"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:Organization ;
skos:definition "The court hearing a matter."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
ltg:DefenseCounselRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Defense counsel role"@en ;
dct:source "LITIGATION; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
skos:definition "The role a social agent plays when defending the insured or insurer."@en ;
core:roleProperty ltg:defenseCounsel .
ltg:DefenseStrategy a owl:Class ;
rdfs:label "Defense strategy"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf dtr:RationaleStatement ;
skos:definition "The defence rationale and any change after mediation. Notes only — an extraction target."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
ltg:LawFirm a owl:Class ;
rdfs:label "Law firm"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:Organization ;
skos:definition "A law firm. A named firm is an INSTANCE of this class, never a class of its own (PIT-3). The same firm may appear on both sides across different matters."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
ltg:LegalPleading a owl:Class ;
rdfs:label "Legal pleading"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A filed pleading. Source of expert-witness designations."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
ltg:PlaintiffAttorneyRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Plaintiff attorney role"@en ;
dct:source "ATTRNY_LTGTN; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
skos:definition "The role a social agent plays when representing the claimant/plaintiff. A law firm may appear on both sides across different matters."@en ;
core:roleProperty ltg:plaintiffAttorney .
ltg:Verdict a owl:Class ;
rdfs:label "Verdict"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A trial verdict and its amount. Judgment and verdict amounts are confirmed NOT available as structured fields — extraction-only."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
ltg:atVenue a owl:ObjectProperty ;
rdfs:label "at venue"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:venueOf ;
skos:definition "The venue of the matter."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes ltg:Venue .
ltg:attorneyAssignmentOf a owl:ObjectProperty ;
rdfs:label "attorney assignment of"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:hasAttorneyAssignment .
ltg:caseNumber a owl:DatatypeProperty ;
rdfs:label "case number"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:range xsd:string ;
skos:definition "The case number of a matter. Compound key with the court via owl:hasKey."@en ;
schema:domainIncludes ltg:LitigationMatter .
ltg:designatedIn a owl:ObjectProperty ;
rdfs:label "designated in"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:expertDesignation .
ltg:expertDesignation a owl:ObjectProperty ;
rdfs:label "expert designation"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:designatedIn ;
skos:definition "An expert witness designated in a pleading. (Filler class inv:ExpertWitness — annotation-only cross-reference.) Requires pleadings; Question 25."@en ;
schema:domainIncludes ltg:LegalPleading ;
schema:rangeIncludes inv:ExpertWitness .
ltg:firmEngagedIn a owl:ObjectProperty ;
rdfs:label "firm engaged in"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:lawFirm .
ltg:hasAttorneyAssignment a owl:ObjectProperty ;
rdfs:label "has attorney assignment"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf ltg:attorneyAssignmentOf ;
skos:definition "An attorney assignment on a matter."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes ltg:AttorneyAssignment .
ltg:hasLegalActivity a owl:ObjectProperty ;
rdfs:label "has legal activity"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf ltg:legalActivityOf ;
skos:definition "An activity within a matter."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes ltg:LegalActivity .
ltg:hasLitigationMatter a owl:ObjectProperty ;
rdfs:label "has litigation matter"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:litigationMatterOf ;
skos:definition "A litigation matter arising from a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes ltg:LitigationMatter .
ltg:hearsMatter a owl:ObjectProperty ;
rdfs:label "hears matter"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:inCourt .
ltg:isCoDefendantIn a owl:ObjectProperty ;
rdfs:label "is co-defendant in"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:coDefendant .
ltg:isDefenseCounselFor a owl:ObjectProperty ;
rdfs:label "is defense counsel for"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:defenseCounsel .
ltg:isPlaintiffAttorneyFor a owl:ObjectProperty ;
rdfs:label "is plaintiff attorney for"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:plaintiffAttorney .
ltg:lawFirm a owl:ObjectProperty ;
rdfs:label "law firm"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:firmEngagedIn ;
skos:definition "The law firm engaged in an attorney assignment."@en ;
schema:domainIncludes ltg:AttorneyAssignment ;
schema:rangeIncludes ltg:LawFirm .
ltg:legalActivityOf a owl:ObjectProperty ;
rdfs:label "legal activity of"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:hasLegalActivity .
ltg:litigationMatterOf a owl:ObjectProperty ;
rdfs:label "litigation matter of"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:hasLitigationMatter .
ltg:litigationStrategy a owl:ObjectProperty ;
rdfs:label "litigation strategy"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf ltg:strategyOf ;
skos:definition "The defence strategy of a matter. Notes only."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes ltg:DefenseStrategy .
ltg:strategyOf a owl:ObjectProperty ;
rdfs:label "strategy of"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:litigationStrategy .
ltg:venueOf a owl:ObjectProperty ;
rdfs:label "venue of"@en ;
rdfs:isDefinedBy ltg: ;
owl:inverseOf ltg:atVenue .
med:DisabilityRating a owl:Class ;
rdfs:label "Disability rating"@en ;
dct:source "Source table DISABILITY; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "An assessed disability percentage and its basis."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:IndependentMedicalExaminerRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Independent medical examiner role"@en ;
dct:source "IME Report; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
skos:definition "The role a physician plays when conducting an independent medical examination for the insurer."@en ;
core:roleProperty med:independentMedicalExaminer .
med:TreatingPhysicianRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Treating physician role"@en ;
dct:source "Question 5; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
skos:definition "The role a social agent plays when treating an injured party on a claim."@en ;
core:roleProperty med:treatingPhysician .
med:diagnosisOf a owl:ObjectProperty ;
rdfs:label "diagnosis of"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:hasDiagnosis .
med:examinedFor a owl:ObjectProperty ;
rdfs:label "examined for"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:examiningPhysician .
med:examiningPhysician a owl:ObjectProperty ;
rdfs:label "examining physician"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf prov:wasAssociatedWith ;
owl:inverseOf med:examinedFor ;
skos:definition "The physician conducting an IME, via the independent-medical-examiner role."@en ;
schema:domainIncludes med:IndependentMedicalExamination ;
schema:rangeIncludes core:SocialAgent .
med:hasDiagnosis a owl:ObjectProperty ;
rdfs:label "has diagnosis"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf med:diagnosisOf ;
skos:definition "A diagnosis of an injury. Special-category personal data (health)."@en ;
schema:domainIncludes med:Injury ;
schema:rangeIncludes med:Diagnosis ;
dpv:hasPersonalDataCategory dpv:Health .
med:hasInjury a owl:ObjectProperty ;
rdfs:label "has injury"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf med:injuryOf ;
skos:definition "An injury on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes med:Injury .
med:hasMMI a owl:ObjectProperty ;
rdfs:label "has MMI"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf med:mmiOf ;
skos:definition "The maximum-medical-improvement determination on an injury."@en ;
schema:domainIncludes med:Injury ;
schema:rangeIncludes med:MaximumMedicalImprovement .
med:hasTreatment a owl:ObjectProperty ;
rdfs:label "has treatment"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf med:treatmentOf ;
skos:definition "A treatment of an injury. Special-category personal data (health)."@en ;
schema:domainIncludes med:Injury ;
schema:rangeIncludes med:MedicalTreatment ;
dpv:hasPersonalDataCategory dpv:Health .
med:injuredIn a owl:ObjectProperty ;
rdfs:label "injured in"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:injuredParty .
med:injuredParty a owl:ObjectProperty ;
rdfs:label "injured party"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf med:injuredIn ;
skos:definition "The injured person. Special-category personal data (health)."@en ;
schema:domainIncludes med:Injury ;
schema:rangeIncludes core:SocialAgent ;
dpv:hasPersonalDataCategory dpv:Health .
med:injuryOf a owl:ObjectProperty ;
rdfs:label "injury of"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:hasInjury .
med:isIndependentMedicalExaminerFor a owl:ObjectProperty ;
rdfs:label "is independent medical examiner for"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:independentMedicalExaminer .
med:isTreatingPhysicianFor a owl:ObjectProperty ;
rdfs:label "is treating physician for"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:treatingPhysician .
med:mmiOf a owl:ObjectProperty ;
rdfs:label "MMI of"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:hasMMI .
med:provider a owl:ObjectProperty ;
rdfs:label "provider"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf med:providerOf ;
skos:definition "The provider of a treatment, via the treating-physician role."@en ;
schema:domainIncludes med:MedicalTreatment ;
schema:rangeIncludes core:SocialAgent .
med:providerOf a owl:ObjectProperty ;
rdfs:label "provider of"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:provider .
med:treatmentOf a owl:ObjectProperty ;
rdfs:label "treatment of"@en ;
rdfs:isDefinedBy med: ;
owl:inverseOf med:hasTreatment .
adjmeta:AnchoringReady a owl:NamedIndividual ;
rdfs:label "Anchoring-ready"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "The term's data is present and queryable in the refined analytical layer."@en .
adjmeta:Low a owl:NamedIndividual ;
rdfs:label "Low"@en ;
rdfs:isDefinedBy adjmeta: .
rcv:ClaimReopen a owl:Class ;
rdfs:label "Claim reopen"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf claim:ReopeningEvent ;
skos:definition "A claim reopening event with its reason. Reuses the existing ins/claim lifecycle event — never re-minted — and adds the reason."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
rcv:RecoveryCredit a owl:Class ;
rdfs:label "Recovery credit"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf fin:FinancialTransaction ;
skos:definition "A credit posted when the insurer recoups part of what it paid."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
rcv:SubrogationRecord a owl:Class ;
rdfs:label "Subrogation record"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf rcv:RecoveryAction ;
skos:definition "Formal subrogation tracking. Recovery amounts exist; no dedicated entity does."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
rcv:SubrogationTargetRole a owl:NamedIndividual,
core:AgentRole ;
rdfs:label "Subrogation target role"@en ;
dct:source "Subrogation Demand Letter; ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy rcv: ;
skos:definition "The role a party plays when pursued for reimbursement by the insurer."@en ;
core:roleProperty rcv:subrogationTargetParty .
rcv:hasRecoveryAction a owl:ObjectProperty ;
rdfs:label "has recovery action"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf rcv:recoveryActionOf ;
skos:definition "A recovery action on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes rcv:RecoveryAction .
rcv:recoveryActionOf a owl:ObjectProperty ;
rdfs:label "recovery action of"@en ;
rdfs:isDefinedBy rcv: ;
owl:inverseOf rcv:hasRecoveryAction .
rcv:subrogationTargetOf a owl:ObjectProperty ;
rdfs:label "subrogation target of"@en ;
rdfs:isDefinedBy rcv: ;
owl:inverseOf rcv:subrogationTargetParty .
stl:TimeLimitDemand a owl:Class ;
rdfs:label "Time-limit demand"@en ;
dct:source "Source table D_TLD; ONTOSPEC §5.13; Question 8"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf stl:Demand ;
skos:definition "A demand carrying a statutory or stated response deadline."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:demandOf a owl:ObjectProperty ;
rdfs:label "demand of"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:hasDemand .
stl:hasDemand a owl:ObjectProperty ;
rdfs:label "has demand"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stl:demandOf ;
skos:definition "A demand on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes stl:Demand .
stl:hasRelease a owl:ObjectProperty ;
rdfs:label "has release"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stl:releaseOf ;
skos:definition "The signed release attaching to a settlement."@en ;
schema:domainIncludes stl:Settlement ;
schema:rangeIncludes stl:Release .
stl:hasRound a owl:ObjectProperty ;
rdfs:label "has round"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stl:roundOf ;
skos:definition "One round of a negotiation."@en ;
schema:domainIncludes stl:Negotiation ;
schema:rangeIncludes stl:NegotiationRound .
stl:negotiationSummary a owl:ObjectProperty ;
rdfs:label "negotiation summary"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stl:summaryOfNegotiation ;
skos:definition "The extracted summary rationale of a negotiation. (Range class dtr:RationaleStatement lives in the decision-trace module; annotation-only signature, no import.)"@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource ;
schema:domainIncludes stl:Negotiation ;
schema:rangeIncludes dtr:RationaleStatement .
stl:releaseOf a owl:ObjectProperty ;
rdfs:label "release of"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:hasRelease .
stl:releasedIn a owl:ObjectProperty ;
rdfs:label "released in"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:releasedParty .
stl:releasedParty a owl:ObjectProperty ;
rdfs:label "released party"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf stl:releasedIn ;
skos:definition "A party released from future liability."@en ;
schema:domainIncludes stl:Release ;
schema:rangeIncludes core:SocialAgent .
stl:respondedToBy a owl:ObjectProperty ;
rdfs:label "responded to by"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:respondsTo .
stl:respondsTo a owl:ObjectProperty ;
rdfs:label "responds to"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf stl:respondedToBy ;
skos:definition "The demand an offer responds to."@en ;
schema:domainIncludes stl:Offer ;
schema:rangeIncludes stl:Demand .
stl:roundOf a owl:ObjectProperty ;
rdfs:label "round of"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:hasRound .
stl:signed a owl:ObjectProperty ;
rdfs:label "signed"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:signedBy .
stl:signedBy a owl:ObjectProperty ;
rdfs:label "signed by"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf stl:signed ;
skos:definition "The claimant that signed the release, via the claimant role (reused from ins/claim)."@en ;
schema:domainIncludes stl:Release,
stl:SettlementAgreement ;
schema:rangeIncludes core:SocialAgent .
stl:summaryOfNegotiation a owl:ObjectProperty ;
rdfs:label "summary of negotiation"@en ;
rdfs:isDefinedBy stl: ;
owl:inverseOf stl:negotiationSummary .
stp:DisqualifyingCondition a owl:Class ;
rdfs:label "Disqualifying condition"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A condition that removes a claim from STP eligibility: complexity tier, CAT designation, SIU trigger, prior-claim hit."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
stp:GateCriterion a owl:Class ;
rdfs:label "Gate criterion"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One criterion within the STP gate. The decision logic lives in DMN, referenced by adj:dmnDecisionRef."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:STPDisposition a owl:Class ;
rdfs:label "STP disposition"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf adj:DecisionOutcome ;
skos:definition "The disposition of the STP gate on a claim. GAP-04: observed blank on a real GL claim reviewed despite closure — if it does not populate, STP throughput cannot be measured from structured data."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31). GAP-04."@en ;
adjmeta:gapId "GAP-04" ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stp:STPException a owl:Class ;
rdfs:label "STP exception"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The reason a claim fell out of STP. Not captured in any structured field identified in the schema review."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:ScoringModel a owl:Class ;
rdfs:label "Scoring model"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf dtr:AIModel ;
skos:definition "The external scoring engine and its vintage, so historical scores can be compared."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:auditLogOf a owl:ObjectProperty ;
rdfs:label "audit log of"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf stp:hasSTPAuditLog ;
skos:definition "The claim an STP audit log covers."@en ;
schema:domainIncludes stp:STPAuditLog ;
schema:rangeIncludes claim:Claim .
stp:criterionEvaluatedBy a owl:ObjectProperty ;
rdfs:label "criterion evaluated by"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:evaluatesCriterion .
stp:criterionResultOf a owl:ObjectProperty ;
rdfs:label "criterion result of"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:hasCriterionResult .
stp:disqualifiedBy a owl:ObjectProperty ;
rdfs:label "disqualified by"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf stp:disqualifies ;
skos:definition "A condition that removed the claim from STP eligibility."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes stp:DisqualifyingCondition .
stp:disqualifies a owl:ObjectProperty ;
rdfs:label "disqualifies"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:disqualifiedBy .
stp:evaluatesCriterion a owl:ObjectProperty ;
rdfs:label "evaluates criterion"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf prov:hadPlan ;
owl:inverseOf stp:criterionEvaluatedBy ;
skos:definition "The criterion a result evaluates."@en ;
schema:domainIncludes stp:GateCriterionResult ;
schema:rangeIncludes stp:GateCriterion .
stp:firedInRouting a owl:ObjectProperty ;
rdfs:label "fired in routing"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:routingRuleFired .
stp:hasCriterionResult a owl:ObjectProperty ;
rdfs:label "has criterion result"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stp:criterionResultOf ;
skos:definition "A reified per-criterion result of the gate."@en ;
schema:domainIncludes stp:STPGate ;
schema:rangeIncludes stp:GateCriterionResult .
stp:hasSTPAuditLog a owl:ObjectProperty ;
rdfs:label "has STP audit log"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:auditLogOf .
stp:hasSTPGate a owl:ObjectProperty ;
rdfs:label "has STP gate"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf stp:stpGateOf ;
skos:definition "The STP gate evaluated on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes stp:STPGate .
stp:hasSTPScore a owl:ObjectProperty ;
rdfs:label "has STP score"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stp:stpScoreOf ;
skos:definition "The STP score on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes stp:STPScore .
stp:hasScoringFactor a owl:ObjectProperty ;
rdfs:label "has scoring factor"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stp:scoringFactorOf ;
skos:definition "A weighted input factor of the score — the audit gap."@en ;
schema:domainIncludes stp:STPScore ;
schema:rangeIncludes stp:ScoringFactor .
stp:modelProducedScore a owl:ObjectProperty ;
rdfs:label "model produced score"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:producedByModel .
stp:producedByModel a owl:ObjectProperty ;
rdfs:label "produced by model"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf prov:wasAttributedTo ;
owl:inverseOf stp:modelProducedScore ;
skos:definition "The scoring model (with vintage) that produced the score."@en ;
schema:domainIncludes stp:STPScore ;
schema:rangeIncludes stp:ScoringModel .
stp:rationaleForRouting a owl:ObjectProperty ;
rdfs:label "rationale for routing"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:routingRationale .
stp:routingRationale a owl:ObjectProperty ;
rdfs:label "routing rationale"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf stp:rationaleForRouting ;
skos:definition "The extracted rationale for the automated routing."@en ;
schema:domainIncludes stp:AutomatedRouting ;
schema:rangeIncludes asg:RoutingRationale .
stp:routingRuleFired a owl:ObjectProperty ;
rdfs:label "routing rule fired"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subPropertyOf prov:hadPlan ;
owl:inverseOf stp:firedInRouting ;
skos:definition "The adjudication rule that fired to produce the routing."@en ;
schema:domainIncludes stp:AutomatedRouting ;
schema:rangeIncludes adj:AdjudicationRule .
stp:scoringFactorOf a owl:ObjectProperty ;
rdfs:label "scoring factor of"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:hasScoringFactor .
stp:stpGateOf a owl:ObjectProperty ;
rdfs:label "STP gate of"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:hasSTPGate .
stp:stpScoreOf a owl:ObjectProperty ;
rdfs:label "STP score of"@en ;
rdfs:isDefinedBy stp: ;
owl:inverseOf stp:hasSTPScore .
val:ClaimItemValuation a owl:Class ;
rdfs:label "Claim item valuation"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf val:Valuation ;
skos:definition "Item-level valuation record."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:ClaimValuationWorksheet a owl:Class ;
rdfs:label "Claim valuation worksheet"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The gross-to-settlement calculation chain — how the number was built."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:DamageEvaluation a owl:Class ;
rdfs:label "Damage evaluation"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf val:Valuation ;
skos:definition "The formal evaluation of a damage item — claimed, approved, verified. The values are refined; the evaluation as an activity with a basis is extraction-only."@en ;
adjmeta:sourceAvailability adjmeta:Partial .
val:DemandEvaluation a owl:Class ;
rdfs:label "Demand evaluation"@en ;
dct:source "ONTOSPEC §5.11; Gate 9"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-9 assessment of the claimant's demand and determination of a fair settlement value."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:WageLossValuation a owl:Class ;
rdfs:label "Wage loss valuation"@en ;
dct:source "ONTOSPEC §5.11; Question 10"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf val:Valuation ;
skos:definition "Lost-wages component, with income verification and its lag. Financial and employment personal data."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource ;
dpv:hasPersonalDataCategory dpv:Financial .
val:depreciationOf a owl:ObjectProperty ;
rdfs:label "depreciation of"@en ;
rdfs:isDefinedBy val: ;
owl:inverseOf val:hasDepreciation .
val:hasDepreciation a owl:ObjectProperty ;
rdfs:label "has depreciation"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf val:depreciationOf ;
skos:definition "The depreciation schedule applied in an item valuation."@en ;
schema:domainIncludes val:ClaimItemValuation ;
schema:rangeIncludes val:DepreciationSchedule .
val:hasValuation a owl:ObjectProperty ;
rdfs:label "has valuation"@en ;
rdfs:isDefinedBy val: ;
owl:inverseOf val:valuationOf .
val:hasWorksheet a owl:ObjectProperty ;
rdfs:label "has worksheet"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf val:worksheetOf ;
skos:definition "The valuation worksheet behind a demand evaluation."@en ;
schema:domainIncludes val:DemandEvaluation ;
schema:rangeIncludes val:ClaimValuationWorksheet .
val:valuationOf a owl:ObjectProperty ;
rdfs:label "valuation of"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf val:hasValuation ;
skos:definition "The item, injury, coverage line or claim a valuation values. Cross-cutting subjects are expressed by domainIncludes/rangeIncludes and enforced with sh:or (R-2)."@en ;
schema:domainIncludes val:Valuation ;
schema:rangeIncludes owl:Thing .
val:worksheetOf a owl:ObjectProperty ;
rdfs:label "worksheet of"@en ;
rdfs:isDefinedBy val: ;
owl:inverseOf val:hasWorksheet .
proc:DecisionGate a owl:Class ;
rdfs:label "Decision gate"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf proc:ProcessStage ;
skos:definition "A point in a process definition at which a formal determination must be made before the case proceeds. A plan concept; per-case evaluations are proc:GateEvaluation activities."@en .
proc:approved a owl:ObjectProperty ;
rdfs:label "approved"@en ;
rdfs:isDefinedBy proc: ;
owl:inverseOf proc:approvedBy .
proc:approvedBy a owl:ObjectProperty ;
rdfs:label "approved by"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf proc:approved ;
skos:definition "The agent that approved a referral or authority request."@en ;
schema:domainIncludes proc:Referral ;
schema:rangeIncludes core:SocialAgent .
proc:authorityLimit a owl:ObjectProperty ;
rdfs:label "authority limit"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:isRelatedTo ;
skos:definition "The monetary limit of a delegated authority. Money is never a bare decimal: the value is a core:MoneyAmount."@en ;
schema:domainIncludes proc:Authority ;
schema:rangeIncludes core:MoneyAmount .
proc:hasStatus a owl:ObjectProperty ;
rdfs:label "has status"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:hasClassifier ;
skos:definition "The current status value of a case, as a SKOS concept. Derived from the latest status assignment; never a mutable flag with no history."@en ;
schema:domainIncludes core:InformationEntity ;
schema:rangeIncludes skos:Concept .
proc:hasStatusAssignment a owl:ObjectProperty ;
rdfs:label "has status assignment"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:hasProperPart ;
owl:inverseOf proc:statusAssignmentOf ;
skos:definition "Links a case to a time-indexed status assignment."@en ;
schema:rangeIncludes proc:StatusAssignment .
proc:performed a owl:ObjectProperty ;
rdfs:label "performed"@en ;
rdfs:isDefinedBy proc: ;
owl:inverseOf proc:performedBy .
proc:performedBy a owl:ObjectProperty ;
rdfs:label "performed by"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf prov:wasAssociatedWith ;
owl:inverseOf proc:performed ;
skos:definition "The agent-in-role that performed an execution."@en ;
schema:domainIncludes proc:GateEvaluation,
proc:ProcessExecution,
proc:StageExecution ;
schema:rangeIncludes core:SocialAgent .
proc:precedes a owl:ObjectProperty ;
rdfs:label "precedes"@en ;
rdfs:isDefinedBy proc: ;
owl:inverseOf proc:precededBy .
proc:requested a owl:ObjectProperty ;
rdfs:label "requested"@en ;
rdfs:isDefinedBy proc: ;
owl:inverseOf proc:requestedBy .
proc:requestedBy a owl:ObjectProperty ;
rdfs:label "requested by"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf proc:requested ;
skos:definition "The agent that raised a referral or authority request."@en ;
schema:domainIncludes proc:Referral ;
schema:rangeIncludes core:SocialAgent .
proc:statusAssignmentOf a owl:ObjectProperty ;
rdfs:label "status assignment of"@en ;
rdfs:isDefinedBy proc: ;
owl:inverseOf proc:hasStatusAssignment .
aipred:AdjudicationRecommendation a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "ADJREC" ;
skos:prefLabel "Adjudication Recommendation"@en ;
skos:topConceptOf aipred: .
aipred:CoveragePrediction a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "COVPRE" ;
skos:prefLabel "Coverage Prediction"@en ;
skos:topConceptOf aipred: .
aipred:FraudScore a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "FRASCO" ;
skos:prefLabel "Fraud Score"@en ;
skos:topConceptOf aipred: .
aipred:ReserveRecommendation a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "RESREC" ;
skos:prefLabel "Reserve Recommendation"@en ;
skos:topConceptOf aipred: .
aipred:STPEligibility a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "STPELI" ;
skos:prefLabel "S T P Eligibility"@en ;
skos:topConceptOf aipred: .
aipred:SeverityPrediction a skos:Concept ;
skos:inScheme aipred: ;
skos:notation "SEVPRE" ;
skos:prefLabel "Severity Prediction"@en ;
skos:topConceptOf aipred: .
audarea:Compliance a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "COM" ;
skos:prefLabel "Compliance"@en ;
skos:topConceptOf audarea: .
audarea:Coverage a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "COV" ;
skos:prefLabel "Coverage"@en ;
skos:topConceptOf audarea: .
audarea:Documentation a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "DOC" ;
skos:prefLabel "Documentation"@en ;
skos:topConceptOf audarea: .
audarea:Fraud a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "FRA" ;
skos:prefLabel "Fraud"@en ;
skos:topConceptOf audarea: .
audarea:Liability a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "LIA" ;
skos:prefLabel "Liability"@en ;
skos:topConceptOf audarea: .
audarea:Reserving a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "RES" ;
skos:prefLabel "Reserving"@en ;
skos:topConceptOf audarea: .
audarea:Settlement a skos:Concept ;
skos:inScheme audarea: ;
skos:notation "SET" ;
skos:prefLabel "Settlement"@en ;
skos:topConceptOf audarea: .
audout:Deficiency a skos:Concept ;
skos:inScheme audout: ;
skos:notation "DEF" ;
skos:prefLabel "Deficiency"@en ;
skos:topConceptOf audout: .
audout:MaterialDeficiency a skos:Concept ;
skos:inScheme audout: ;
skos:notation "MATDEF" ;
skos:prefLabel "Material Deficiency"@en ;
skos:topConceptOf audout: .
audout:Pass a skos:Concept ;
skos:inScheme audout: ;
skos:notation "PAS" ;
skos:prefLabel "Pass"@en ;
skos:topConceptOf audout: .
audout:PassWithObservation a skos:Concept ;
skos:inScheme audout: ;
skos:notation "PASWITOBS" ;
skos:prefLabel "Pass With Observation"@en ;
skos:topConceptOf audout: .
cfregime:ContributoryNegligence a skos:Concept ;
skos:inScheme cfregime: ;
skos:notation "CONNEG" ;
skos:prefLabel "Contributory Negligence"@en ;
skos:topConceptOf cfregime: .
cfregime:ModifiedComparative50 a skos:Concept ;
skos:inScheme cfregime: ;
skos:notation "MODCOM" ;
skos:prefLabel "Modified comparative (50%)"@en ;
skos:topConceptOf cfregime: .
cfregime:ModifiedComparative51 a skos:Concept ;
skos:inScheme cfregime: ;
skos:notation "MODCOM" ;
skos:prefLabel "Modified comparative (51%)"@en ;
skos:topConceptOf cfregime: .
cfregime:PureComparative a skos:Concept ;
skos:inScheme cfregime: ;
skos:notation "PURCOM" ;
skos:prefLabel "Pure Comparative"@en ;
skos:topConceptOf cfregime: .
cvpos:Confirmed a skos:Concept ;
skos:definition "The insurer confirms coverage."@en ;
skos:inScheme cvpos: ;
skos:notation "CON" ;
skos:prefLabel "Confirmed"@en ;
skos:topConceptOf cvpos: .
cvpos:Denied a skos:Concept ;
skos:definition "Coverage denied."@en ;
skos:inScheme cvpos: ;
skos:notation "DEN" ;
skos:prefLabel "Denied"@en ;
skos:topConceptOf cvpos: .
cvpos:Partial a skos:Concept ;
skos:definition "Coverage partially confirmed."@en ;
skos:inScheme cvpos: ;
skos:notation "PAR" ;
skos:prefLabel "Partial"@en ;
skos:topConceptOf cvpos: .
cvpos:Reserved a skos:Concept ;
skos:definition "Coverage under investigation; rights reserved (ROR issued)."@en ;
skos:inScheme cvpos: ;
skos:notation "RES" ;
skos:prefLabel "Reserved"@en ;
skos:topConceptOf cvpos: .
cvpos:UnderReview a skos:Concept ;
skos:definition "Position not yet taken."@en ;
skos:inScheme cvpos: ;
skos:notation "UNDREV" ;
skos:prefLabel "Under Review"@en ;
skos:topConceptOf cvpos: .
ctrig:ClaimsMade a skos:Concept ;
skos:inScheme ctrig: ;
skos:notation "CLAMAD" ;
skos:prefLabel "Claims Made"@en ;
skos:topConceptOf ctrig: .
ctrig:ClaimsMadeAndReported a skos:Concept ;
skos:inScheme ctrig: ;
skos:notation "CLAMADANDREP" ;
skos:prefLabel "Claims Made And Reported"@en ;
skos:topConceptOf ctrig: .
ctrig:Manifestation a skos:Concept ;
skos:inScheme ctrig: ;
skos:notation "MAN" ;
skos:prefLabel "Manifestation"@en ;
skos:topConceptOf ctrig: .
ctrig:Occurrence a skos:Concept ;
skos:inScheme ctrig: ;
skos:notation "OCC" ;
skos:prefLabel "Occurrence"@en ;
skos:topConceptOf ctrig: .
covtype:BodilyInjury a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "BODINJ" ;
skos:prefLabel "Bodily Injury"@en ;
skos:topConceptOf covtype: .
covtype:Liability a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "LIA" ;
skos:prefLabel "Liability"@en ;
skos:topConceptOf covtype: .
covtype:MedicalPayments a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "MEDPAY" ;
skos:prefLabel "Medical Payments"@en ;
skos:topConceptOf covtype: .
covtype:PhysicalDamage a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "PHYDAM" ;
skos:prefLabel "Physical Damage"@en ;
skos:topConceptOf covtype: .
covtype:Premises a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "PRE" ;
skos:prefLabel "Premises"@en ;
skos:topConceptOf covtype: .
covtype:Products a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "PRO" ;
skos:prefLabel "Products"@en ;
skos:topConceptOf covtype: .
covtype:PropertyDamage a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "PRODAM" ;
skos:prefLabel "Property Damage"@en ;
skos:topConceptOf covtype: .
covtype:UninsuredMotorist a skos:Concept ;
skos:inScheme covtype: ;
skos:notation "UNIMOT" ;
skos:prefLabel "Uninsured Motorist"@en ;
skos:topConceptOf covtype: .
outcome:Approved a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "APP" ;
skos:prefLabel "Approved"@en ;
skos:topConceptOf outcome: .
outcome:Deferred a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "DEF" ;
skos:prefLabel "Deferred"@en ;
skos:topConceptOf outcome: .
outcome:Denied a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "DEN" ;
skos:prefLabel "Denied"@en ;
skos:topConceptOf outcome: .
outcome:PartiallyApproved a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "PARAPP" ;
skos:prefLabel "Partially Approved"@en ;
skos:topConceptOf outcome: .
outcome:Referred a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "REF" ;
skos:prefLabel "Referred"@en ;
skos:topConceptOf outcome: .
outcome:Rejected a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "REJ" ;
skos:prefLabel "Rejected"@en ;
skos:topConceptOf outcome: .
outcome:Withdrawn a skos:Concept ;
skos:inScheme outcome: ;
skos:notation "WIT" ;
skos:prefLabel "Withdrawn"@en ;
skos:topConceptOf outcome: .
dmdtype:FutureMedical a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "FUTMED" ;
skos:prefLabel "Future Medical"@en ;
skos:topConceptOf dmdtype: .
dmdtype:GeneralDamages a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "GENDAM" ;
skos:prefLabel "General Damages"@en ;
skos:topConceptOf dmdtype: .
dmdtype:LostWages a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "LOSWAG" ;
skos:prefLabel "Lost Wages"@en ;
skos:topConceptOf dmdtype: .
dmdtype:MedicalSpecials a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "MEDSPE" ;
skos:prefLabel "Medical Specials"@en ;
skos:topConceptOf dmdtype: .
dmdtype:PainAndSuffering a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "PAIANDSUF" ;
skos:prefLabel "Pain And Suffering"@en ;
skos:topConceptOf dmdtype: .
dmdtype:PropertyDamage a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "PRODAM" ;
skos:prefLabel "Property Damage"@en ;
skos:topConceptOf dmdtype: .
dmdtype:TimeLimit a skos:Concept ;
skos:inScheme dmdtype: ;
skos:notation "TIMLIM" ;
skos:prefLabel "Time Limit"@en ;
skos:topConceptOf dmdtype: .
evduse:NotUsed a skos:Concept ;
skos:definition "The document is not consulted at this gate."@en ;
skos:inScheme evduse: ;
skos:notation "NOTUSE" ;
skos:prefLabel "Not Used"@en ;
skos:topConceptOf evduse: .
evduse:PendingSMEConfirmation a skos:Concept ;
skos:definition "Disposition awaiting SME confirmation. Surfaced as a SHACL warning."@en ;
skos:inScheme evduse: ;
skos:notation "PENSMECON" ;
skos:prefLabel "Pending S M E Confirmation"@en ;
skos:topConceptOf evduse: ;
adjmeta:openQuestion true .
evduse:Sometimes a skos:Concept ;
skos:definition "The document is sometimes consulted at this gate."@en ;
skos:inScheme evduse: ;
skos:notation "SOM" ;
skos:prefLabel "Sometimes"@en ;
skos:topConceptOf evduse: .
evduse:Used a skos:Concept ;
skos:definition "The document is consulted at this gate."@en ;
skos:inScheme evduse: ;
skos:notation "USE" ;
skos:prefLabel "Used"@en ;
skos:topConceptOf evduse: .
excl:Contractual a skos:Concept ;
skos:inScheme excl: ;
skos:notation "CON" ;
skos:prefLabel "Contractual"@en ;
skos:topConceptOf excl: .
excl:Employment a skos:Concept ;
skos:inScheme excl: ;
skos:notation "EMP" ;
skos:prefLabel "Employment"@en ;
skos:topConceptOf excl: .
excl:ExpectedOrIntended a skos:Concept ;
skos:inScheme excl: ;
skos:notation "EXPORINT" ;
skos:prefLabel "Expected Or Intended"@en ;
skos:topConceptOf excl: .
excl:Pollution a skos:Concept ;
skos:inScheme excl: ;
skos:notation "POL" ;
skos:prefLabel "Pollution"@en ;
skos:topConceptOf excl: .
excl:PriorKnowledge a skos:Concept ;
skos:inScheme excl: ;
skos:notation "PRIKNO" ;
skos:prefLabel "Prior Knowledge"@en ;
skos:topConceptOf excl: .
excl:ProfessionalServices a skos:Concept ;
skos:inScheme excl: ;
skos:notation "PROSER" ;
skos:prefLabel "Professional Services"@en ;
skos:topConceptOf excl: .
excl:WearAndTear a skos:Concept ;
skos:inScheme excl: ;
skos:notation "WEAANDTEA" ;
skos:prefLabel "Wear And Tear"@en ;
skos:topConceptOf excl: .
fncat:Coverage a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "COV" ;
skos:prefLabel "Coverage"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:General a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "GEN" ;
skos:prefLabel "General"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Investigation a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "INV" ;
skos:prefLabel "Investigation"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Legal a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "LEG" ;
skos:prefLabel "Legal"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Liability a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "LIA" ;
skos:prefLabel "Liability"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Medical a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "MED" ;
skos:prefLabel "Medical"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Payment a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "PAY" ;
skos:prefLabel "Payment"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Recovery a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "REC" ;
skos:prefLabel "Recovery"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Reserve a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "RES" ;
skos:prefLabel "Reserve"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fncat:Settlement a skos:Concept ;
skos:editorialNote "GAP-06: official code table unknown; seed value."@en ;
skos:inScheme fncat: ;
skos:notation "SET" ;
skos:prefLabel "Settlement"@en ;
skos:topConceptOf fncat: ;
adjmeta:openQuestion true .
fincat:Expense a skos:Concept ;
skos:inScheme fincat: ;
skos:notation "EXP" ;
skos:prefLabel "Expense"@en ;
skos:topConceptOf fincat: .
fincat:Indemnity a skos:Concept ;
skos:inScheme fincat: ;
skos:notation "IND" ;
skos:prefLabel "Indemnity"@en ;
skos:topConceptOf fincat: .
fincat:Medical a skos:Concept ;
skos:inScheme fincat: ;
skos:notation "MED" ;
skos:prefLabel "Medical"@en ;
skos:topConceptOf fincat: .
fraind:DocumentAnomaly a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "DOCANO" ;
skos:prefLabel "Document Anomaly"@en ;
skos:topConceptOf fraind: .
fraind:EarlyAttorneyInvolvement a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "EARATTINV" ;
skos:prefLabel "Early Attorney Involvement"@en ;
skos:topConceptOf fraind: .
fraind:InflatedDamages a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "INFDAM" ;
skos:prefLabel "Inflated Damages"@en ;
skos:topConceptOf fraind: .
fraind:NetworkAssociation a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "NETASS" ;
skos:prefLabel "Network Association"@en ;
skos:topConceptOf fraind: .
fraind:PriorClaimPattern a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "PRICLAPAT" ;
skos:prefLabel "Prior Claim Pattern"@en ;
skos:topConceptOf fraind: .
fraind:PublicAdjusterInvolvement a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "PUBADJINV" ;
skos:prefLabel "Public Adjuster Involvement"@en ;
skos:topConceptOf fraind: .
fraind:StagedLoss a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "STALOS" ;
skos:prefLabel "Staged Loss"@en ;
skos:topConceptOf fraind: .
fraind:StatementInconsistency a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "STAINC" ;
skos:prefLabel "Statement Inconsistency"@en ;
skos:topConceptOf fraind: .
fraind:Velocity a skos:Concept ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
skos:inScheme fraind: ;
skos:notation "VEL" ;
skos:prefLabel "Velocity"@en ;
skos:topConceptOf fraind: .
hstat:Closed a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "CLO" ;
skos:prefLabel "Closed"@en ;
skos:topConceptOf hstat: .
hstat:Investigating a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "INV" ;
skos:prefLabel "Investigating"@en ;
skos:topConceptOf hstat: .
hstat:Litigated a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "LIT" ;
skos:prefLabel "Litigated"@en ;
skos:topConceptOf hstat: .
hstat:Open a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "OPE" ;
skos:prefLabel "Open"@en ;
skos:topConceptOf hstat: .
hstat:PrePush a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "PREPUS" ;
skos:prefLabel "Pre-push"@en ;
skos:topConceptOf hstat: .
hstat:PushPending a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "PUSPEN" ;
skos:prefLabel "Push pending"@en ;
skos:topConceptOf hstat: .
hstat:Reopened a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "REO" ;
skos:prefLabel "Reopened"@en ;
skos:topConceptOf hstat: .
hstat:Settled a skos:Concept ;
skos:inScheme hstat: ;
skos:notation "SET" ;
skos:prefLabel "Settled"@en ;
skos:topConceptOf hstat: .
injnature:Burn a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "BUR" ;
skos:prefLabel "Burn"@en ;
skos:topConceptOf injnature: .
injnature:Fracture a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "FRA" ;
skos:prefLabel "Fracture"@en ;
skos:topConceptOf injnature: .
injnature:Laceration a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "LAC" ;
skos:prefLabel "Laceration"@en ;
skos:topConceptOf injnature: .
injnature:Psychological a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "PSY" ;
skos:prefLabel "Psychological"@en ;
skos:topConceptOf injnature: .
injnature:SoftTissue a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "SOFTIS" ;
skos:prefLabel "Soft Tissue"@en ;
skos:topConceptOf injnature: .
injnature:Sprain a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "SPR" ;
skos:prefLabel "Sprain"@en ;
skos:topConceptOf injnature: .
injnature:TraumaticBrainInjury a skos:Concept ;
skos:inScheme injnature: ;
skos:notation "TRABRAINJ" ;
skos:prefLabel "Traumatic Brain Injury"@en ;
skos:topConceptOf injnature: .
chan:Agent a skos:Concept ;
skos:inScheme chan: ;
skos:notation "AGE" ;
skos:prefLabel "Agent"@en ;
skos:topConceptOf chan: .
chan:Broker a skos:Concept ;
skos:inScheme chan: ;
skos:notation "BRO" ;
skos:prefLabel "Broker"@en ;
skos:topConceptOf chan: .
chan:Email a skos:Concept ;
skos:inScheme chan: ;
skos:notation "EMA" ;
skos:prefLabel "Email"@en ;
skos:topConceptOf chan: .
chan:Mobile a skos:Concept ;
skos:inScheme chan: ;
skos:notation "MOB" ;
skos:prefLabel "Mobile"@en ;
skos:topConceptOf chan: .
chan:Phone a skos:Concept ;
skos:inScheme chan: ;
skos:notation "PHO" ;
skos:prefLabel "Phone"@en ;
skos:topConceptOf chan: .
chan:Web a skos:Concept ;
skos:inScheme chan: ;
skos:notation "WEB" ;
skos:prefLabel "Web"@en ;
skos:topConceptOf chan: .
jrule:AcceptOrDeny a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "ACCORDEN" ;
skos:prefLabel "Accept Or Deny"@en ;
skos:topConceptOf jrule: .
jrule:Acknowledgement a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "ACK" ;
skos:prefLabel "Acknowledgement"@en ;
skos:topConceptOf jrule: .
jrule:ClaimFormsSupply a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "CLAFORSUP" ;
skos:prefLabel "Claim Forms Supply"@en ;
skos:topConceptOf jrule: .
jrule:FraudReporting a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "FRAREP" ;
skos:prefLabel "Fraud Reporting"@en ;
skos:topConceptOf jrule: .
jrule:InvestigationStatusNotice a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "INVSTANOT" ;
skos:prefLabel "Investigation Status Notice"@en ;
skos:topConceptOf jrule: .
jrule:Payment a skos:Concept ;
skos:inScheme jrule: ;
skos:notation "PAY" ;
skos:prefLabel "Payment"@en ;
skos:topConceptOf jrule: .
legalact:Appeal a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "APP" ;
skos:prefLabel "Appeal"@en ;
skos:topConceptOf legalact: .
legalact:Arbitration a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "ARB" ;
skos:prefLabel "Arbitration"@en ;
skos:topConceptOf legalact: .
legalact:Deposition a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "DEP" ;
skos:prefLabel "Deposition"@en ;
skos:topConceptOf legalact: .
legalact:Discovery a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "DIS" ;
skos:prefLabel "Discovery"@en ;
skos:topConceptOf legalact: .
legalact:Mediation a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "MED" ;
skos:prefLabel "Mediation"@en ;
skos:topConceptOf legalact: .
legalact:Motion a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "MOT" ;
skos:prefLabel "Motion"@en ;
skos:topConceptOf legalact: .
legalact:Trial a skos:Concept ;
skos:inScheme legalact: ;
skos:notation "TRI" ;
skos:prefLabel "Trial"@en ;
skos:topConceptOf legalact: .
ltgdisp:Arbitrated a skos:Concept ;
skos:inScheme ltgdisp: ;
skos:notation "ARB" ;
skos:prefLabel "Arbitrated"@en ;
skos:topConceptOf ltgdisp: .
ltgdisp:Dismissed a skos:Concept ;
skos:inScheme ltgdisp: ;
skos:notation "DIS" ;
skos:prefLabel "Dismissed"@en ;
skos:topConceptOf ltgdisp: .
ltgdisp:Settled a skos:Concept ;
skos:inScheme ltgdisp: ;
skos:notation "SET" ;
skos:prefLabel "Settled"@en ;
skos:topConceptOf ltgdisp: .
ltgdisp:Trial a skos:Concept ;
skos:inScheme ltgdisp: ;
skos:notation "TRI" ;
skos:prefLabel "Trial"@en ;
skos:topConceptOf ltgdisp: .
ltgdisp:Verdict a skos:Concept ;
skos:inScheme ltgdisp: ;
skos:notation "VER" ;
skos:prefLabel "Verdict"@en ;
skos:topConceptOf ltgdisp: .
ovrsn:CoverageConcern a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "COVCON" ;
skos:prefLabel "Coverage Concern"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
ovrsn:LiabilityDisagreement a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "LIADIS" ;
skos:prefLabel "Liability Disagreement"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
ovrsn:MissingEvidence a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "MISEVI" ;
skos:prefLabel "Missing Evidence"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
ovrsn:Other a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "OTH" ;
skos:prefLabel "Other"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
ovrsn:PolicyInterpretation a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "POLINT" ;
skos:prefLabel "Policy Interpretation"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
ovrsn:ValuationDisagreement a skos:Concept ;
skos:editorialNote "Seed only — the real distribution is derived from extracted note text (CQ-QB-27)."@en ;
skos:inScheme ovrsn: ;
skos:notation "VALDIS" ;
skos:prefLabel "Valuation Disagreement"@en ;
skos:topConceptOf ovrsn: ;
adjmeta:openQuestion true .
crole:Adjudicator a skos:Concept ;
skos:inScheme crole: ;
skos:notation "ADJ" ;
skos:prefLabel "Adjudicator"@en ;
skos:topConceptOf crole: .
crole:Adjuster a skos:Concept ;
skos:inScheme crole: ;
skos:notation "ADJ" ;
skos:prefLabel "Adjuster"@en ;
skos:topConceptOf crole: .
crole:Auditor a skos:Concept ;
skos:inScheme crole: ;
skos:notation "AUD" ;
skos:prefLabel "Auditor"@en ;
skos:topConceptOf crole: .
crole:CATAdjuster a skos:Concept ;
skos:inScheme crole: ;
skos:notation "CATADJ" ;
skos:prefLabel "C A T Adjuster"@en ;
skos:topConceptOf crole: .
crole:Claimant a skos:Concept ;
skos:inScheme crole: ;
skos:notation "CLA" ;
skos:prefLabel "Claimant"@en ;
skos:topConceptOf crole: .
crole:CoDefendant a skos:Concept ;
skos:inScheme crole: ;
skos:notation "CODEF" ;
skos:prefLabel "Co Defendant"@en ;
skos:topConceptOf crole: .
crole:CoverageCounsel a skos:Concept ;
skos:inScheme crole: ;
skos:notation "COVCOU" ;
skos:prefLabel "Coverage Counsel"@en ;
skos:topConceptOf crole: .
crole:DefenseCounsel a skos:Concept ;
skos:inScheme crole: ;
skos:notation "DEFCOU" ;
skos:prefLabel "Defense Counsel"@en ;
skos:topConceptOf crole: .
crole:ExpertWitness a skos:Concept ;
skos:inScheme crole: ;
skos:notation "EXPWIT" ;
skos:prefLabel "Expert Witness"@en ;
skos:topConceptOf crole: .
crole:FNOLHandler a skos:Concept ;
skos:inScheme crole: ;
skos:notation "FNOLHAN" ;
skos:prefLabel "F N O L Handler"@en ;
skos:topConceptOf crole: .
crole:IndependentMedicalExaminer a skos:Concept ;
skos:inScheme crole: ;
skos:notation "INDMEDEXA" ;
skos:prefLabel "Independent Medical Examiner"@en ;
skos:topConceptOf crole: .
crole:Insured a skos:Concept ;
skos:inScheme crole: ;
skos:notation "INS" ;
skos:prefLabel "Insured"@en ;
skos:topConceptOf crole: .
crole:LineOwner a skos:Concept ;
skos:inScheme crole: ;
skos:notation "LINOWN" ;
skos:prefLabel "Line Owner"@en ;
skos:topConceptOf crole: .
crole:Payee a skos:Concept ;
skos:inScheme crole: ;
skos:notation "PAY" ;
skos:prefLabel "Payee"@en ;
skos:topConceptOf crole: .
crole:PlaintiffAttorney a skos:Concept ;
skos:inScheme crole: ;
skos:notation "PLAATT" ;
skos:prefLabel "Plaintiff Attorney"@en ;
skos:topConceptOf crole: .
crole:PublicAdjuster a skos:Concept ;
skos:inScheme crole: ;
skos:notation "PUBADJ" ;
skos:prefLabel "Public Adjuster"@en ;
skos:topConceptOf crole: .
crole:SIUInvestigator a skos:Concept ;
skos:inScheme crole: ;
skos:notation "SIUINV" ;
skos:prefLabel "S I U Investigator"@en ;
skos:topConceptOf crole: .
crole:SubrogationTarget a skos:Concept ;
skos:inScheme crole: ;
skos:notation "SUBTAR" ;
skos:prefLabel "Subrogation Target"@en ;
skos:topConceptOf crole: .
crole:Supervisor a skos:Concept ;
skos:inScheme crole: ;
skos:notation "SUP" ;
skos:prefLabel "Supervisor"@en ;
skos:topConceptOf crole: .
crole:TreatingPhysician a skos:Concept ;
skos:inScheme crole: ;
skos:notation "TREPHY" ;
skos:prefLabel "Treating Physician"@en ;
skos:topConceptOf crole: .
crole:Vendor a skos:Concept ;
skos:inScheme crole: ;
skos:notation "VEN" ;
skos:prefLabel "Vendor"@en ;
skos:topConceptOf crole: .
crole:Witness a skos:Concept ;
skos:inScheme crole: ;
skos:notation "WIT" ;
skos:prefLabel "Witness"@en ;
skos:topConceptOf crole: .
paymeth:Card a skos:Concept ;
skos:inScheme paymeth: ;
skos:notation "CAR" ;
skos:prefLabel "Card"@en ;
skos:topConceptOf paymeth: .
paymeth:Check a skos:Concept ;
skos:inScheme paymeth: ;
skos:notation "CHE" ;
skos:prefLabel "Check"@en ;
skos:topConceptOf paymeth: .
paymeth:EFT a skos:Concept ;
skos:inScheme paymeth: ;
skos:notation "EFT" ;
skos:prefLabel "EFT"@en ;
skos:topConceptOf paymeth: .
paymeth:StructuredAnnuity a skos:Concept ;
skos:inScheme paymeth: ;
skos:notation "STRANN" ;
skos:prefLabel "Structured Annuity"@en ;
skos:topConceptOf paymeth: .
premcond:IceOrSnow a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "ICEORSNO" ;
skos:prefLabel "Ice Or Snow"@en ;
skos:topConceptOf premcond: .
premcond:InadequateLighting a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "INALIG" ;
skos:prefLabel "Inadequate Lighting"@en ;
skos:topConceptOf premcond: .
premcond:MissingHandrail a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "MISHAN" ;
skos:prefLabel "Missing Handrail"@en ;
skos:topConceptOf premcond: .
premcond:Obstruction a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "OBS" ;
skos:prefLabel "Obstruction"@en ;
skos:topConceptOf premcond: .
premcond:UnevenSurface a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "UNESUR" ;
skos:prefLabel "Uneven Surface"@en ;
skos:topConceptOf premcond: .
premcond:WetFloor a skos:Concept ;
skos:inScheme premcond: ;
skos:notation "WETFLO" ;
skos:prefLabel "Wet Floor"@en ;
skos:topConceptOf premcond: .
rcvreason:PartiallyRecovered a skos:Concept ;
skos:inScheme rcvreason: ;
skos:notation "PARREC" ;
skos:prefLabel "Partially Recovered"@en ;
skos:topConceptOf rcvreason: .
rcvreason:Recovered a skos:Concept ;
skos:inScheme rcvreason: ;
skos:notation "REC" ;
skos:prefLabel "Recovered"@en ;
skos:topConceptOf rcvreason: .
rcvreason:TimeBarred a skos:Concept ;
skos:inScheme rcvreason: ;
skos:notation "TIMBAR" ;
skos:prefLabel "Time Barred"@en ;
skos:topConceptOf rcvreason: .
rcvreason:Uncollectible a skos:Concept ;
skos:inScheme rcvreason: ;
skos:notation "UNC" ;
skos:prefLabel "Uncollectible"@en ;
skos:topConceptOf rcvreason: .
rcvreason:Waived a skos:Concept ;
skos:inScheme rcvreason: ;
skos:notation "WAI" ;
skos:prefLabel "Waived"@en ;
skos:topConceptOf rcvreason: .
rsvreason:Closure a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "CLO" ;
skos:prefLabel "Closure"@en ;
skos:topConceptOf rsvreason: .
rsvreason:DemandReceived a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "DEMREC" ;
skos:prefLabel "Demand Received"@en ;
skos:topConceptOf rsvreason: .
rsvreason:Drawdown a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "DRA" ;
skos:prefLabel "Drawdown"@en ;
skos:topConceptOf rsvreason: .
rsvreason:InitialSet a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "INISET" ;
skos:prefLabel "Initial Set"@en ;
skos:topConceptOf rsvreason: .
rsvreason:LiabilityChange a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "LIACHA" ;
skos:prefLabel "Liability Change"@en ;
skos:topConceptOf rsvreason: .
rsvreason:MediationOutcome a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "MEDOUT" ;
skos:prefLabel "Mediation Outcome"@en ;
skos:topConceptOf rsvreason: .
rsvreason:MedicalUpdate a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "MEDUPD" ;
skos:prefLabel "Medical Update"@en ;
skos:topConceptOf rsvreason: .
rsvreason:SettlementAgreed a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "SETAGR" ;
skos:prefLabel "Settlement Agreed"@en ;
skos:topConceptOf rsvreason: .
rsvreason:SuitFiled a skos:Concept ;
skos:inScheme rsvreason: ;
skos:notation "SUIFIL" ;
skos:prefLabel "Suit Filed"@en ;
skos:topConceptOf rsvreason: .
stlmeth:LumpSum a skos:Concept ;
skos:inScheme stlmeth: ;
skos:notation "LUMSUM" ;
skos:prefLabel "Lump Sum"@en ;
skos:topConceptOf stlmeth: .
stlmeth:Periodic a skos:Concept ;
skos:inScheme stlmeth: ;
skos:notation "PER" ;
skos:prefLabel "Periodic"@en ;
skos:topConceptOf stlmeth: .
stlmeth:Structured a skos:Concept ;
skos:inScheme stlmeth: ;
skos:notation "STR" ;
skos:prefLabel "Structured"@en ;
skos:topConceptOf stlmeth: .
siuout:Cleared a skos:Concept ;
skos:inScheme siuout: ;
skos:notation "CLE" ;
skos:prefLabel "Cleared"@en ;
skos:topConceptOf siuout: .
siuout:Confirmed a skos:Concept ;
skos:inScheme siuout: ;
skos:notation "CON" ;
skos:prefLabel "Confirmed"@en ;
skos:topConceptOf siuout: .
siuout:NoBasisFound a skos:Concept ;
skos:inScheme siuout: ;
skos:notation "NOBASFOU" ;
skos:prefLabel "No Basis Found"@en ;
skos:topConceptOf siuout: .
siuout:Pending a skos:Concept ;
skos:inScheme siuout: ;
skos:notation "PEN" ;
skos:prefLabel "Pending"@en ;
skos:topConceptOf siuout: .
siusrc:Adjuster a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "ADJ" ;
skos:prefLabel "Adjuster"@en ;
skos:topConceptOf siusrc: .
siusrc:AutomatedTrigger a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "AUTTRI" ;
skos:prefLabel "Automated Trigger"@en ;
skos:topConceptOf siusrc: .
siusrc:ClaimSearch a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "CLASEA" ;
skos:prefLabel "Claim Search"@en ;
skos:topConceptOf siusrc: .
siusrc:ExternalTip a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "EXTTIP" ;
skos:prefLabel "External Tip"@en ;
skos:topConceptOf siusrc: .
siusrc:StateBureau a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "STABUR" ;
skos:prefLabel "State Bureau"@en ;
skos:topConceptOf siusrc: .
siusrc:Supervisor a skos:Concept ;
skos:inScheme siusrc: ;
skos:notation "SUP" ;
skos:prefLabel "Supervisor"@en ;
skos:topConceptOf siusrc: .
stpdisp:AutoProcessed a skos:Concept ;
skos:editorialNote "GAP-04: seed value; enumerate from the source once confirmed."@en ;
skos:inScheme stpdisp: ;
skos:notation "AUTPRO" ;
skos:prefLabel "Auto Processed"@en ;
skos:topConceptOf stpdisp: ;
adjmeta:openQuestion true .
stpdisp:Eligible a skos:Concept ;
skos:editorialNote "GAP-04: seed value; enumerate from the source once confirmed."@en ;
skos:inScheme stpdisp: ;
skos:notation "ELI" ;
skos:prefLabel "Eligible"@en ;
skos:topConceptOf stpdisp: ;
adjmeta:openQuestion true .
stpdisp:FellOut a skos:Concept ;
skos:editorialNote "GAP-04: seed value; enumerate from the source once confirmed."@en ;
skos:inScheme stpdisp: ;
skos:notation "FELOUT" ;
skos:prefLabel "Fell Out"@en ;
skos:topConceptOf stpdisp: ;
adjmeta:openQuestion true .
stpdisp:Ineligible a skos:Concept ;
skos:editorialNote "GAP-04: seed value; enumerate from the source once confirmed."@en ;
skos:inScheme stpdisp: ;
skos:notation "INE" ;
skos:prefLabel "Ineligible"@en ;
skos:topConceptOf stpdisp: ;
adjmeta:openQuestion true .
stpdisp:PartiallyProcessed a skos:Concept ;
skos:editorialNote "GAP-04: seed value; enumerate from the source once confirmed."@en ;
skos:inScheme stpdisp: ;
skos:notation "PARPRO" ;
skos:prefLabel "Partially Processed"@en ;
skos:topConceptOf stpdisp: ;
adjmeta:openQuestion true .
taskstat:Cancelled a skos:Concept ;
skos:inScheme taskstat: ;
skos:notation "CAN" ;
skos:prefLabel "Cancelled"@en ;
skos:topConceptOf taskstat: .
taskstat:Completed a skos:Concept ;
skos:inScheme taskstat: ;
skos:notation "COM" ;
skos:prefLabel "Completed"@en ;
skos:topConceptOf taskstat: .
taskstat:InProgress a skos:Concept ;
skos:inScheme taskstat: ;
skos:notation "INPRO" ;
skos:prefLabel "In Progress"@en ;
skos:topConceptOf taskstat: .
taskstat:Open a skos:Concept ;
skos:inScheme taskstat: ;
skos:notation "OPE" ;
skos:prefLabel "Open"@en ;
skos:topConceptOf taskstat: .
taskstat:Overdue a skos:Concept ;
skos:inScheme taskstat: ;
skos:notation "OVE" ;
skos:prefLabel "Overdue"@en ;
skos:topConceptOf taskstat: .
tasktype:Coverage a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "COV" ;
skos:prefLabel "Coverage"@en ;
skos:topConceptOf tasktype: .
tasktype:Diary a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "DIA" ;
skos:prefLabel "Diary"@en ;
skos:topConceptOf tasktype: .
tasktype:Financial a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "FIN" ;
skos:prefLabel "Financial"@en ;
skos:topConceptOf tasktype: .
tasktype:Investigation a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "INV" ;
skos:prefLabel "Investigation"@en ;
skos:topConceptOf tasktype: .
tasktype:Legal a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "LEG" ;
skos:prefLabel "Legal"@en ;
skos:topConceptOf tasktype: .
tasktype:Medical a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "MED" ;
skos:prefLabel "Medical"@en ;
skos:topConceptOf tasktype: .
tasktype:Specialty a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "SPE" ;
skos:prefLabel "Specialty"@en ;
skos:topConceptOf tasktype: .
tasktype:SystemGenerated a skos:Concept ;
skos:inScheme tasktype: ;
skos:notation "SYSGEN" ;
skos:prefLabel "System Generated"@en ;
skos:topConceptOf tasktype: .
trtstat:AtMMI a skos:Concept ;
skos:inScheme trtstat: ;
skos:notation "MMI" ;
skos:prefLabel "At MMI"@en ;
skos:topConceptOf trtstat: .
trtstat:Completed a skos:Concept ;
skos:inScheme trtstat: ;
skos:notation "COM" ;
skos:prefLabel "Completed"@en ;
skos:topConceptOf trtstat: .
trtstat:Discontinued a skos:Concept ;
skos:inScheme trtstat: ;
skos:notation "DIS" ;
skos:prefLabel "Discontinued"@en ;
skos:topConceptOf trtstat: .
trtstat:Ongoing a skos:Concept ;
skos:inScheme trtstat: ;
skos:notation "ONG" ;
skos:prefLabel "Ongoing"@en ;
skos:topConceptOf trtstat: .
adj:AdjudicationCase a owl:Class ;
rdfs:label "Adjudication case"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The adjudication view of a claim: the case as it moves through the ten stages. Linked to claim:Claim by adj:adjudicationOf; deliberately not a subclass of it."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:AdjudicationDecisionProposal a owl:Class ;
rdfs:label "Adjudication decision proposal"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A recommended decision produced by a system or model, awaiting human accept or reject. Distinct from the decision itself."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:AdjudicationProcess a owl:Class ;
rdfs:label "Adjudication process"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf proc:ProcessDefinition ;
skos:definition "The prospective definition of the GL/Auto claim adjudication process: ten ordered stages and eleven decision gates. One individual per published process version. The plan, not a run."@en ;
adjmeta:acordAlignment "ACORD Capability — Claims Lifecycle Management; BPMN process" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:DecisionRationale a owl:Class ;
rdfs:label "Decision rationale"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The stated reason for a decision. Abstract parent; the concrete, extractable form is dtr:RationaleStatement in the decision-trace module."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:Stage-ClosurePostSettlement a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Closure & Post-Settlement"@en ;
dct:source "Adjudication Process Flow tab, row 10"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which the claim is closed, recovery (subrogation and salvage) is pursued where warranted, and regulatory requirements are confirmed met."@en ;
adj:acordProcessRef "ACORD Capability — Claims Recovery; Claims Lifecycle Management" ;
adj:hasGate adj:Gate-ClosureRecovery ;
adj:precededByStage adj:Stage-SettlementPayment ;
adj:stageOrdinal 10 ;
adjmeta:anchoringReadiness adjmeta:Partial ;
adjmeta:buildPriority adjmeta:Low ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:ClosurePostSettlement .
adj:Stage-ExclusionLimitCalculation a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Exclusion & Limit Calculation"@en ;
dct:source "Adjudication Process Flow tab, row 6"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which policy exclusions, limits, deductibles and coordination of benefits are applied to compute what is payable. The gross-to-net computation chain is not stored in any source."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling; OMG DMN decision table" ;
adj:precededByStage adj:Stage-HistoricalAssessment ;
adj:stageOrdinal 6 ;
adjmeta:anchoringReadiness adjmeta:ExtractionNeeded ;
adjmeta:buildPriority adjmeta:High ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:ExclusionLimitCalculation .
adj:StageExecution a owl:Class ;
rdfs:label "Stage execution"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Activity,
proc:StageExecution ;
skos:definition "A concrete occurrence of one stage on one claim, with start, end, performer and inputs."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
asg:Authority a owl:Class ;
rdfs:label "Authority"@en ;
dct:source "Source tables AUTHORITY, LINE_AUTHORITY, CLM_LIN_AUTH; ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf proc:Authority ;
skos:definition "An authorisation threshold governing when escalation to a supervisor is required."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
asg:RoutingRationale a owl:Class ;
rdfs:label "Routing rationale"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf dtr:RationaleStatement ;
skos:definition "Why a specific adjuster or queue was selected. Not persisted per claim today — modelled so the gap is visible rather than silently absent."@en ;
skos:editorialNote "Gap — no source. Routing rationale is not persisted per claim."@en ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
asg:adjudicator a owl:ObjectProperty ;
rdfs:label "adjudicator"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isAdjudicatorFor ;
skos:definition "The adjudicator acting on a claim."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:adjuster a owl:ObjectProperty ;
rdfs:label "adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isAdjusterFor ;
skos:definition "The adjuster handling a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:auditor a owl:ObjectProperty ;
rdfs:label "auditor"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isAuditorFor ;
skos:definition "The auditor of a claim file."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:catAdjuster a owl:ObjectProperty ;
rdfs:label "CAT adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isCATAdjusterFor ;
skos:definition "The CAT adjuster on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:fnolHandlerParty a owl:ObjectProperty ;
rdfs:label "FNOL handler party"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isFNOLHandlerFor ;
skos:definition "The FNOL handler on a claim (role-realising property; the intake module's itk:fnolHandler carries the FNOL-report-level link)."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:insured a owl:ObjectProperty ;
rdfs:label "insured"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isInsuredOn ;
skos:definition "The insured party on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:lineOwner a owl:ObjectProperty ;
rdfs:label "line owner"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isLineOwnerFor ;
skos:definition "The owner of a coverage line."@en ;
schema:domainIncludes cvp:CoverageLine ;
schema:rangeIncludes core:SocialAgent .
asg:payeeParty a owl:ObjectProperty ;
rdfs:label "payee party"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isPayeeOn ;
skos:definition "A payee on a claim (role-realising property; fin:payee carries the payment-level link)."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:publicAdjuster a owl:ObjectProperty ;
rdfs:label "public adjuster"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isPublicAdjusterFor ;
skos:definition "The public adjuster on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:siuInvestigator a owl:ObjectProperty ;
rdfs:label "SIU investigator"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isSIUInvestigatorFor ;
skos:definition "The SIU investigator on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:supervisor a owl:ObjectProperty ;
rdfs:label "supervisor"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isSupervisorFor ;
skos:definition "The supervisor of a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:vendorParty a owl:ObjectProperty ;
rdfs:label "vendor party"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isVendorPartyFor ;
skos:definition "A vendor engaged on a claim."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
asg:witness a owl:ObjectProperty ;
rdfs:label "witness"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf asg:isWitnessFor ;
skos:definition "A witness on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
cmp:ComplianceBreach a owl:Class ;
rdfs:label "Compliance breach"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A missed deadline or violated requirement, with its consequence."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cmp:Penalty a owl:Class ;
rdfs:label "Penalty"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The penalty attaching to a breach."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:DeductibleApplication a owl:Class ;
rdfs:label "Deductible application"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The application of a deductible, with the amount and the basis."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
cvp:PayableAmount a owl:Class ;
rdfs:label "Payable amount"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The net payable after deductible, exclusions and coordination."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:coverageCounsel a owl:ObjectProperty ;
rdfs:label "coverage counsel"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf cvp:isCoverageCounselFor ;
skos:definition "The coverage counsel engaged on a claim or coverage line."@en ;
schema:domainIncludes cvp:CoverageLine,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
evd:Citation a owl:Class ;
rdfs:label "Citation"@en ;
dct:source "ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A pointer from a decision or rationale to the specific document passage relied upon. The unit of \"show me why\"."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:Correspondence a owl:Class ;
rdfs:label "Correspondence"@en ;
dct:source "ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A communication document exchanged with a party. Direction and channel are properties, never subclasses. Emails are embedded in file-note text today and can be identified but have no discrete structured entity — this class is a target of the extraction."@en ;
adjmeta:acordAlignment "ACORD AIM Communication" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:Extraction a owl:Class ;
rdfs:label "Extraction"@en ;
dct:source "ONTOSPEC §5.1.1; §14.5"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf prov:Activity ;
skos:definition "The activity that produced one or more extracted facts from a document or note. Records the model and version (as prov:hadPlan), the operator, and the time. Every extraction run lands its output in its own named graph with PROV on the graph IRI."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:FileNoteAssociation a owl:Class ;
rdfs:label "File note association"@en ;
dct:source "Source table FILE_NOTE_ASSOCIATION; ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A reified link between a file note and the claim artefact it concerns — line, task, payment, reserve, participant. Reified because the association carries its own attributes and history."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fin:ClaimFinancialSummary a owl:Class ;
rdfs:label "Claim financial summary"@en ;
dct:source "Question-bank entity Outcome (Total Incurred); ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Total incurred and its components at a point in time."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fra:ClaimSearchInquiry a owl:Class ;
rdfs:label "ClaimSearch inquiry"@en ;
dct:source "Source table CLAIM_SEARCH; ISO ClaimSearch (Verisk); ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf prov:Activity ;
skos:definition "A prior-claim-history lookup against ISO ClaimSearch across carriers. The primary structured cross-carrier fraud signal."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fra:FraudFactor a owl:Class ;
rdfs:label "Fraud factor"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One weighted factor contributing to a fraud assessment."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:SIUOutcome a owl:Class ;
rdfs:label "SIU outcome"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf adj:DecisionOutcome ;
skos:definition "Confirmed / Cleared / No basis found, plus the close timestamp. The outcome code gives the binary result but not the evidence that produced it — insufficient for regulatory defence or law-enforcement referral."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:IncidentProfile a owl:Class ;
rdfs:label "Incident profile"@en ;
dct:source "ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The structured description of what happened: incident type, narrative, circumstances, claimant detail. Distinct from the loss event and from the claim."@en ;
adjmeta:acordAlignment "ACORD AIM Loss Event" ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv:InvestigationFinding a owl:Class ;
rdfs:label "Investigation finding"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One finding produced by an investigation, with its evidence chain."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
inv:expertWitness a owl:ObjectProperty ;
rdfs:label "expert witness"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf inv:isExpertWitnessFor ;
skos:definition "An expert witness engaged on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
itm:VehicleDriverAssignment a owl:Class ;
rdfs:label "Vehicle driver assignment"@en ;
dct:source "Source table VEHICLE_DRIVER; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A reified driver-of-vehicle-at-time-of-loss link. A reified relationship, never a role subclass of Person."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
lia:CausationOpinion a owl:Class ;
rdfs:label "Causation opinion"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "An opinion on whether the incident caused the claimed loss or injury. Extracted from IME and expert reports."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
lia:LiabilityDetermination a owl:Class ;
rdfs:label "Liability determination"@en ;
dct:source "ONTOSPEC §5.8; Gate 7"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-7 decision that fixes the liability position. Distinct from the assessment record it rests on."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
lia:NegligenceBasis a owl:Class ;
rdfs:label "Negligence basis"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The stated basis for negligence — premises condition, product defect, operator error. Extracted from the incident report."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
ltg:coDefendant a owl:ObjectProperty ;
rdfs:label "co-defendant"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:isCoDefendantIn ;
skos:definition "A co-defendant in a matter."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes core:SocialAgent .
ltg:defenseCounsel a owl:ObjectProperty ;
rdfs:label "defense counsel"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:isDefenseCounselFor ;
skos:definition "The defense counsel on a claim or matter."@en ;
schema:domainIncludes ltg:LitigationMatter,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
ltg:inCourt a owl:ObjectProperty ;
rdfs:label "in court"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:hearsMatter ;
skos:definition "The court hearing the matter. Part of the matter's compound key."@en ;
schema:domainIncludes ltg:LitigationMatter ;
schema:rangeIncludes ltg:Court .
ltg:plaintiffAttorney a owl:ObjectProperty ;
rdfs:label "plaintiff attorney"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf ltg:isPlaintiffAttorneyFor ;
skos:definition "The plaintiff's attorney on a claim or matter."@en ;
schema:domainIncludes ltg:LitigationMatter,
claim:Claim ;
schema:rangeIncludes core:SocialAgent .
med:IndependentMedicalExamination a owl:Class ;
rdfs:label "Independent medical examination"@en ;
dct:source "Workbook IME record; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf inv:ClaimInvestigation ;
skos:definition "A physician's examination commissioned by the insurer."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
med:MaximumMedicalImprovement a owl:Class ;
rdfs:label "Maximum medical improvement"@en ;
dct:source "INJURY MMI fields; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The determination that the claimant's condition has stabilised, with its date."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:MedicalInvoice a owl:Class ;
rdfs:label "Medical invoice"@en ;
dct:source "Source tables INV, INV_DTL; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A medical bill with billed and allowed amounts."@en ;
adjmeta:acordAlignment "X12 837/835" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:MedicalLineAdjudication a owl:Class ;
rdfs:label "Medical line adjudication"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The adjudication of a single medical line item: category, amount, and reason. The one place FHIR's model is a direct design reference — categories align by skos:exactMatch to the HL7 adjudication code system."@en ;
adjmeta:acordAlignment "FHIR ClaimResponse.item.adjudication; AdjudicationValueCodes, AdjudicationReasonCodes" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
med:MedicalOpinion a owl:Class ;
rdfs:label "Medical opinion"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Abstract parent: a clinical opinion attributable to an identified physician. Parent of the IME opinion and the treating physician's opinion, for the contradiction query (CQ-5)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
med:MedicalValuation a owl:Class ;
rdfs:label "Medical valuation"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf val:Valuation,
core:InformationEntity ;
skos:definition "Future medical costs and pain-and-suffering estimate. Not in any source. Intended ⊑ val:Valuation — the bridge axiom is declared in the valuation module (which imports this one) to keep the import DAG acyclic."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
med:independentMedicalExaminer a owl:ObjectProperty ;
rdfs:label "independent medical examiner"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf med:isIndependentMedicalExaminerFor ;
skos:definition "The independent medical examiner on a claim."@en ;
schema:domainIncludes claim:Claim ;
schema:rangeIncludes core:SocialAgent .
med:treatingPhysician a owl:ObjectProperty ;
rdfs:label "treating physician"@en ;
dct:source "ONTOSPEC §5.6.2"@en ;
rdfs:isDefinedBy med: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf med:isTreatingPhysicianFor ;
skos:definition "The treating physician of an injury."@en ;
schema:domainIncludes med:Injury ;
schema:rangeIncludes core:SocialAgent .
adjmeta:ExternalReference a owl:NamedIndividual ;
rdfs:label "External reference"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Process knowledge grounded in external references only; not SME-validated as of 2026-07-31."@en .
rcv:subrogationTargetParty a owl:ObjectProperty ;
rdfs:label "subrogation target party"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subPropertyOf core:isRelatedTo ;
owl:inverseOf rcv:subrogationTargetOf ;
skos:definition "The responsible third party a subrogation record pursues, via the subrogation-target role."@en ;
schema:domainIncludes rcv:SubrogationRecord ;
schema:rangeIncludes core:SocialAgent .
stl:NegotiationRound a owl:Class ;
rdfs:label "Negotiation round"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One round within a negotiation. Enables round-count analytics."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:Offer a owl:Class ;
rdfs:label "Offer"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The insurer's counter-offer, with amount and date."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:SettlementAgreement a owl:Class ;
rdfs:label "Settlement agreement"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The signed legal instrument."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stl:SettlementRange a owl:Class ;
rdfs:label "Settlement range"@en ;
dct:source "Source tables SETTLEMENT_RANGE, STLMNT_RNG; ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The from/to settlement range."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stp:STPAuditLog a owl:Class ;
rdfs:label "STP audit log"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The regulatory audit trail confirming no-human-touch processing and that the claim met STP criteria at the time of automated closure. Not persisted today. Without it, STP cannot be demonstrated to regulators. First-class by design (NAIC AI Model Bulletin)."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:acordAlignment "NAIC AI Model Bulletin documentation expectation" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:DepreciationSchedule a owl:Class ;
rdfs:label "Depreciation schedule"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The asset value reduction applied to a property loss."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
proc:Authority a owl:Class ;
rdfs:label "Authority"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A delegated limit within which an agent-in-role may act without escalation."@en .
proc:ProcessDefinition a owl:Class ;
rdfs:label "Process definition"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf p-plan:Plan,
prov:Plan,
core:InformationEntity ;
skos:definition "The prospective definition of a business process — the recipe, not a run. One individual per published process version. Not an activity: an execution links back to it via prov:hadPlan / proc:conformsToPlan."@en .
proc:ProcessExecution a owl:Class ;
rdfs:label "Process execution"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf prov:Activity ;
skos:definition "A concrete run of a process definition for one case, with a start, an end, agents and inputs."@en .
proc:precededBy a owl:ObjectProperty ;
rdfs:label "preceded by"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subPropertyOf p-plan:isPrecededBy ;
owl:inverseOf proc:precedes ;
skos:definition "Stage ordering within a process definition: the stage that comes immediately before this one in the plan."@en ;
schema:domainIncludes proc:ProcessStage ;
schema:rangeIncludes proc:ProcessStage .
cplx:Complex a skos:Concept ;
skos:inScheme cplx: ;
skos:notation "COM" ;
skos:prefLabel "Complex"@en ;
skos:topConceptOf cplx: .
cplx:HighComplexity a skos:Concept ;
skos:inScheme cplx: ;
skos:notation "HIGCOM" ;
skos:prefLabel "High complexity"@en ;
skos:topConceptOf cplx: .
cplx:Simple a skos:Concept ;
skos:inScheme cplx: ;
skos:notation "SIM" ;
skos:prefLabel "Simple"@en ;
skos:topConceptOf cplx: .
cplx:Standard a skos:Concept ;
skos:inScheme cplx: ;
skos:notation "STA" ;
skos:prefLabel "Standard"@en ;
skos:topConceptOf cplx: .
gate:ClaimRegistration a skos:Concept ;
skos:inScheme gate: ;
skos:notation "CLAREG" ;
skos:prefLabel "Claim Registration"@en ;
skos:topConceptOf gate: .
gate:ClosureRecovery a skos:Concept ;
skos:inScheme gate: ;
skos:notation "CLOREC" ;
skos:prefLabel "Closure and Post-Settlement Recovery"@en ;
skos:topConceptOf gate: .
gate:CoverageDetermination a skos:Concept ;
skos:inScheme gate: ;
skos:notation "COVDET" ;
skos:prefLabel "Coverage Determination"@en ;
skos:topConceptOf gate: .
gate:CoveragePosition a skos:Concept ;
skos:inScheme gate: ;
skos:notation "COVPOS" ;
skos:prefLabel "Coverage Position / ROR / Denial"@en ;
skos:topConceptOf gate: .
gate:DemandEvaluation a skos:Concept ;
skos:inScheme gate: ;
skos:notation "DEMEVA" ;
skos:prefLabel "Demand Evaluation and Negotiation"@en ;
skos:topConceptOf gate: .
gate:GuidedAdjudication a skos:Concept ;
skos:inScheme gate: ;
skos:notation "GUIADJ" ;
skos:prefLabel "Guided Adjudication Decision"@en ;
skos:topConceptOf gate: .
gate:InitialReserveSetting a skos:Concept ;
skos:inScheme gate: ;
skos:notation "INIRESSET" ;
skos:prefLabel "Initial Reserve Setting"@en ;
skos:topConceptOf gate: .
gate:LiabilityAssessment a skos:Concept ;
skos:inScheme gate: ;
skos:notation "LIAASS" ;
skos:prefLabel "Liability Assessment"@en ;
skos:topConceptOf gate: .
gate:SIUReferral a skos:Concept ;
skos:inScheme gate: ;
skos:notation "SIUREF" ;
skos:prefLabel "SIU Referral Decision"@en ;
skos:topConceptOf gate: .
gate:SettlementAuthorization a skos:Concept ;
skos:inScheme gate: ;
skos:notation "SETAUT" ;
skos:prefLabel "Settlement Authorization"@en ;
skos:topConceptOf gate: .
gate:TriageAssignment a skos:Concept ;
skos:inScheme gate: ;
skos:notation "TRIASS" ;
skos:prefLabel "Triage and Assignment"@en ;
skos:topConceptOf gate: .
liadesc:Clear a skos:Concept ;
skos:definition "Liability is not in reasonable dispute; the insured's fault is established."@en ;
skos:inScheme liadesc: ;
skos:notation "CLR" ;
skos:prefLabel "Clear"@en ;
skos:topConceptOf liadesc: .
liadesc:Disputed a skos:Concept ;
skos:inScheme liadesc: ;
skos:notation "DSP" ;
skos:prefLabel "Disputed"@en ;
skos:topConceptOf liadesc: .
liadesc:Probable a skos:Concept ;
skos:inScheme liadesc: ;
skos:notation "PRB" ;
skos:prefLabel "Probable"@en ;
skos:topConceptOf liadesc: .
liadesc:Questionable a skos:Concept ;
skos:inScheme liadesc: ;
skos:notation "QST" ;
skos:prefLabel "Questionable"@en ;
skos:topConceptOf liadesc: .
ltgstat:Answered a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "ANS" ;
skos:prefLabel "Answered"@en ;
skos:topConceptOf ltgstat: .
ltgstat:Appealed a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "APP" ;
skos:prefLabel "Appealed"@en ;
skos:topConceptOf ltgstat: .
ltgstat:Discovery a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "DIS" ;
skos:prefLabel "Discovery"@en ;
skos:topConceptOf ltgstat: .
ltgstat:Mediation a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "MED" ;
skos:prefLabel "Mediation"@en ;
skos:topConceptOf ltgstat: .
ltgstat:Resolved a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "RES" ;
skos:prefLabel "Resolved"@en ;
skos:topConceptOf ltgstat: .
ltgstat:SuitFiled a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "SUIFIL" ;
skos:prefLabel "Suit Filed"@en ;
skos:topConceptOf ltgstat: .
ltgstat:TrialSet a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "TRISET" ;
skos:prefLabel "Trial Set"@en ;
skos:topConceptOf ltgstat: .
ltgstat:Verdict a skos:Concept ;
skos:inScheme ltgstat: ;
skos:notation "VER" ;
skos:prefLabel "Verdict"@en ;
skos:topConceptOf ltgstat: .
adj:AdjudicationStep a owl:Class ;
rdfs:label "Adjudication step"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One step in the decision trail leading to a decision — the ordered reasoning record, distinct from the stage plan and from the activity."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:ComplexityAssessment a owl:Class ;
rdfs:label "Complexity assessment"@en ;
dct:source "CLAIM complexity score; ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The assessed complexity of a claim, carrying a tier value and the automated complexity score. Drives triage and STP eligibility."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
adj:GateEvaluation a owl:Class ;
rdfs:label "Gate evaluation"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Activity,
proc:GateEvaluation ;
skos:definition "A concrete evaluation of one gate on one claim, producing exactly one outcome. A prov:Activity, not a plan."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:RuleApplication a owl:Class ;
rdfs:label "Rule application"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The per-claim record that a specific rule version fired and what it concluded. This is the gap: rule configuration exists; per-claim rule outcomes do not exist in any source."@en ;
skos:editorialNote "Either instrument the rules engine or accept that \"which rule fired\" is unanswerable. Open question carried in the conformance report."@en ;
adjmeta:openQuestion true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:Stage-EvaluationValuation a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Evaluation & Valuation"@en ;
dct:source "Adjudication Process Flow tab, row 8"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which damages, medical exposure and the claimant's demand are evaluated and a fair settlement value determined."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling / Determine Claim Settlement" ;
adj:hasGate adj:Gate-DemandEvaluation ;
adj:precededByStage adj:Stage-Adjudication ;
adj:stageOrdinal 8 ;
adjmeta:anchoringReadiness adjmeta:ExtractionNeeded ;
adjmeta:buildPriority adjmeta:High ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:EvaluationValuation .
adj:Stage-FNOLIntake a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "FNOL & Intake"@en ;
dct:source "Adjudication Process Flow tab, row 1"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which a loss is first reported and the claim is registered: the FNOL record, intake channel, basic loss facts and claim number."@en ;
adj:acordProcessRef "ACORD Capability — Claims Lifecycle Management / Claims Inquiry (intake)" ;
adj:hasGate adj:Gate-ClaimRegistration ;
adj:stageOrdinal 1 ;
adjmeta:anchoringReadiness adjmeta:AnchoringReady ;
adjmeta:buildPriority adjmeta:Medium ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:FNOLIntake .
adj:Stage-HistoricalAssessment a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Historical Assessment"@en ;
dct:source "Adjudication Process Flow tab, row 5"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which prior loss history for the insured, claimant, asset and location informs reserving. Cross-claim history requires an aggregation query; no cross-claim history table exists."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling" ;
adj:hasGate adj:Gate-InitialReserveSetting ;
adj:precededByStage adj:Stage-Investigation ;
adj:stageOrdinal 5 ;
adjmeta:anchoringReadiness adjmeta:Partial ;
adjmeta:buildPriority adjmeta:Medium ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:HistoricalAssessment .
adj:Stage-Investigation a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Investigation"@en ;
dct:source "Adjudication Process Flow tab, row 4"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which the facts of the loss are established: statements, scene inspection, expert reports, fraud screening. No structured investigation records exist in either source — this stage is almost entirely an extraction specification."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling; Fraud Management" ;
adj:hasGate adj:Gate-SIUReferral ;
adj:precededByStage adj:Stage-TriageAssignment ;
adj:stageOrdinal 4 ;
adjmeta:anchoringReadiness adjmeta:ExtractionNeeded ;
adjmeta:buildPriority adjmeta:High ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:Investigation .
adj:Stage-SettlementPayment a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Settlement & Payment"@en ;
dct:source "Adjudication Process Flow tab, row 9"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which the settlement is negotiated, authorised and paid."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling; Dispute Resolution" ;
adj:hasGate adj:Gate-SettlementAuthorization ;
adj:precededByStage adj:Stage-EvaluationValuation ;
adj:stageOrdinal 9 ;
adjmeta:anchoringReadiness adjmeta:Partial ;
adjmeta:buildPriority adjmeta:Medium ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:SettlementPayment .
adj:Stage-TriageAssignment a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Triage & Assignment"@en ;
dct:source "Adjudication Process Flow tab, row 3"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which claim complexity is classified and the claim is routed to the right adjuster or queue."@en ;
skos:editorialNote "SME (Jos): triage happens earlier than the model suggests — a policy document may be consulted here for a coverage pre-check before formal Stage-2 verification. The stage ordering is a hypothesis."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling" ;
adj:hasGate adj:Gate-TriageAssignment ;
adj:precededByStage adj:Stage-CoverageVerification ;
adj:stageOrdinal 3 ;
adjmeta:anchoringReadiness adjmeta:Partial ;
adjmeta:buildPriority adjmeta:Medium ;
adjmeta:openQuestion true ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:TriageAssignment .
asg:ParticipantRecord a owl:Class ;
rdfs:label "Participant record"@en ;
dct:source "Source tables PARTICIPANT, PARTICIPANT_AH; ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A reified party-role assignment on a coverage line: who is involved, in what capacity, over what period, with re-assignment history."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
asg:Performer a owl:Class ;
rdfs:label "Performer"@en ;
dct:source "Source tables PERFORMER, ORG_ENTITY, V_CFN_PERFORMER; ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:SocialAgent ;
skos:definition "An individual or system that takes action on a claim — adjuster, supervisor, attorney, or automated process. The anchor of the assignment module: the strongest-validated entity in the ontology, confirmed across three independent data sources."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
cmp:Jurisdiction a owl:Class ;
rdfs:label "Jurisdiction"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf core:Location ;
skos:definition "A legal jurisdiction — state, county, venue — governing a claim. Modelled against OMG LCC country and subdivision concepts; never a private geography."@en ;
adjmeta:acordAlignment "OMG LCC" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
dtr:AIModel a owl:Class ;
rdfs:label "AI model"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Plan,
prov:SoftwareAgent ;
skos:definition "The model that produced an AI output, versioned. Needed so historical scores can be compared across vintages. Both an agent (it acts) and a plan (an output's prov:hadPlan)."@en ;
adjmeta:acordAlignment "NAIC AIS Programme" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fin:FinancialTransaction a owl:Class ;
rdfs:label "Financial transaction"@en ;
dct:source "Source table FINANCIAL_TX; ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The common parent of reserve and payment movements."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:CatastropheDesignation a owl:Class ;
rdfs:label "Catastrophe designation"@en ;
dct:source "ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The designation of a claim as catastrophe-related, carrying the CAT event reference, severity rating and CAT-specific closure reason. A designation, never a subclass of Claim (PIT-2)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:CatastropheEvent a owl:Class ;
rdfs:label "Catastrophe event"@en ;
dct:source "ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf core:Event ;
owl:hasKey ( itk:catEventId ) ;
skos:definition "The catastrophe itself, identified by CAT ID and linked to many claims."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv:ExpertOpinion a owl:Class ;
rdfs:label "Expert opinion"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The extractable opinion within an expert report: the conclusion, the basis, and whether it contradicts another account. Feeds CQ-15 and CQ-25."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
itm:ItemSite a owl:Class ;
rdfs:label "Item site"@en ;
dct:source "Source table ITEM_SITE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The location of an item, including the insured premises."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
itm:PropertyLoss a owl:Class ;
rdfs:label "Property loss"@en ;
dct:source "Source table PROPERTY_LOSS; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf itm:ClaimItem ;
skos:definition "Property damaged or lost. Property and occupancy TYPE are SKOS values on this one structural class, never subclasses (PIT-5)."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
ltg:LegalActivity a owl:Class ;
rdfs:label "Legal activity"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf prov:Activity ;
skos:definition "An activity within a matter: deposition, mediation, discovery, motion, trial. TYPE is a SKOS value, never a subclass (PIT-2)."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:Diagnosis a owl:Class ;
rdfs:label "Diagnosis"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A clinical diagnosis, carrying an ICD-10-CM concept and a narrative. The code is a skos:Concept with skos:notation, never a class."@en ;
adjmeta:acordAlignment "ICD-10-CM; FHIR Condition.code" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
med:IMEOpinion a owl:Class ;
rdfs:label "IME opinion"@en ;
dct:source "ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf med:MedicalOpinion ;
skos:definition "The IME's opinion: causation, treatment appropriateness, MMI date, future treatment. An IME disputing causation can eliminate medical exposure."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
rcv:SubrogationDemand a owl:Class ;
rdfs:label "Subrogation demand"@en ;
dct:source "ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The letter demanding reimbursement from a responsible third party."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stl:Negotiation a owl:Class ;
rdfs:label "Negotiation"@en ;
dct:source "Source tables NEGOTIATION, NGTTN; ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf prov:Activity,
core:InformationEntity ;
skos:definition "The negotiation between demand and settlement."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stp:AutomatedRouting a owl:Class ;
rdfs:label "Automated routing"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf asg:AssignmentRecord ;
skos:definition "Routing produced by STP, with which rule fired and why. Routing rationale is not persisted per claim. STP's disposition governs which routing fires; the routing record itself is an assignment-module term."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stp:GateCriterionResult a owl:Class ;
rdfs:label "Gate criterion result"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The reified per-criterion outcome for one claim. Without it the gate cannot be tuned."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:STPGate a owl:Class ;
rdfs:label "STP gate"@en ;
dct:source "Workbook clm:ClaimSTPGate; ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf adj:DecisionGate ;
skos:definition "The per-claim STP gate: pass or fail, and the timestamp of evaluation. Gate results are transient and not persisted."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
stp:ScoringFactor a owl:Class ;
rdfs:label "Scoring factor"@en ;
dct:source "ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One weighted input to the STP score, with the weight and its contribution."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
proc:GateEvaluation a owl:Class ;
rdfs:label "Gate evaluation"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf prov:Activity ;
skos:definition "A concrete evaluation of a decision gate on one case, producing an outcome."@en .
proc:StageExecution a owl:Class ;
rdfs:label "Stage execution"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf prov:Activity ;
skos:definition "A concrete run of one stage on one case. Distinct from the stage in the plan: confusing them makes \"how long did this stage take on this case?\" unanswerable."@en .
adjstage:Adjudication a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "ADJ" ;
skos:prefLabel "Adjudication"@en ;
skos:topConceptOf adjstage: .
adjstage:ClosurePostSettlement a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "CLOPOSSET" ;
skos:prefLabel "Closure & Post-Settlement"@en ;
skos:topConceptOf adjstage: .
adjstage:CoverageVerification a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "COVVER" ;
skos:prefLabel "Coverage Verification"@en ;
skos:topConceptOf adjstage: .
adjstage:EvaluationValuation a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "EVAVAL" ;
skos:prefLabel "Evaluation & Valuation"@en ;
skos:topConceptOf adjstage: .
adjstage:ExclusionLimitCalculation a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "EXCLIMCAL" ;
skos:prefLabel "Exclusion & Limit Calculation"@en ;
skos:topConceptOf adjstage: .
adjstage:FNOLIntake a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "FNOLINT" ;
skos:prefLabel "FNOL & Intake"@en ;
skos:topConceptOf adjstage: .
adjstage:HistoricalAssessment a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "HISASS" ;
skos:prefLabel "Historical Assessment"@en ;
skos:topConceptOf adjstage: .
adjstage:Investigation a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "INV" ;
skos:prefLabel "Investigation"@en ;
skos:topConceptOf adjstage: .
adjstage:SettlementPayment a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "SETPAY" ;
skos:prefLabel "Settlement & Payment"@en ;
skos:topConceptOf adjstage: .
adjstage:TriageAssignment a skos:Concept ;
skos:inScheme adjstage: ;
skos:notation "TRIASS" ;
skos:prefLabel "Triage & Assignment"@en ;
skos:topConceptOf adjstage: .
doctype:MedicalDocument0 a skos:Concept ;
skos:definition "Grouping: medical documents."@en ;
skos:inScheme doctype: ;
skos:notation "MEDGRP" ;
skos:prefLabel "Medical Document (grouping)"@en ;
skos:topConceptOf doctype: .
adj:Stage-Adjudication a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Adjudication"@en ;
dct:source "Adjudication Process Flow tab, row 7"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which liability is determined and the guided-adjudication recommendation is accepted or rejected — the decision heart of the process."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling / Determine Claim Settlement" ;
adj:hasGate adj:Gate-GuidedAdjudication,
adj:Gate-LiabilityAssessment ;
adj:precededByStage adj:Stage-ExclusionLimitCalculation ;
adj:stageOrdinal 7 ;
adjmeta:anchoringReadiness adjmeta:ExtractionNeeded ;
adjmeta:buildPriority adjmeta:High ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:Adjudication .
adj:Stage-CoverageVerification a owl:NamedIndividual,
adj:AdjudicationStage ;
rdfs:label "Coverage Verification"@en ;
dct:source "Adjudication Process Flow tab, row 2"@en ;
rdfs:isDefinedBy adj: ;
skos:definition "The stage in which the insurer confirms that a policy is in force covering this type of loss, identifies the applicable coverage type and trigger, and takes a formal coverage position."@en ;
adj:acordProcessRef "ACORD Capability — Claims Handling" ;
adj:hasGate adj:Gate-CoverageDetermination,
adj:Gate-CoveragePosition ;
adj:precededByStage adj:Stage-FNOLIntake ;
adj:stageOrdinal 2 ;
adjmeta:anchoringReadiness adjmeta:ExtractionNeeded ;
adjmeta:buildPriority adjmeta:High ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation ;
core:hasClassifier adjstage:CoverageVerification .
asg:QueueAssignment a owl:Class ;
rdfs:label "Queue assignment"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A time-indexed assignment of a claim to a queue, supporting dwell-time analytics."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
cmp:ComplianceRequirement a owl:Class ;
rdfs:label "Compliance requirement"@en ;
dct:source "Question-bank entity Compliance Requirement; ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A regulatory obligation applying to a claim in a jurisdiction: rule type, deadline, penalty."@en ;
adjmeta:acordAlignment "NAIC Model #900" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:ExclusionApplication a owl:Class ;
rdfs:label "Exclusion application"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The record that a specific policy exclusion was invoked, with its basis and the policy section cited."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
cvp:LimitApplication a owl:Class ;
rdfs:label "Limit application"@en ;
dct:source "ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The application of a coverage limit to a claim: agreed, applied and excess amounts. Agreed limit is mapped; applied and excess are not in the analytical layer."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
dtr:AuditFinding a owl:Class ;
rdfs:label "Audit finding"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A single deficiency or observation within an audit record."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:DecisionTrace a owl:Class ;
rdfs:label "Decision trace"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The complete, auditable record of how one decision at one gate on one claim was reached: the evidence consulted, what was taken from it, what was recorded, and the stated rationale."@en ;
adjmeta:acordAlignment "NAIC AI Model Bulletin documentation expectation" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:HumanOverride a owl:Class ;
rdfs:label "Human override"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Activity ;
skos:definition "The act of an adjuster or Line Owner rejecting or amending an AI output, with a reason. The override rationale lives in the file note and must be extracted."@en ;
adjmeta:acordAlignment "NAIC AI Model Bulletin" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:Attachment a owl:Class ;
rdfs:label "Attachment"@en ;
dct:source "Source table FN_ATCH; ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A file attached to a note. Carries format, size and a resolvable content reference — never the content itself."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
evd:DocumentAnchor a owl:Class ;
rdfs:label "Document anchor"@en ;
dct:source "ONTOSPEC §5.1.1; anchoring pattern §7.3"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The link that binds an extracted fact to the exact document and, where available, page or offset it came from. Makes every extracted assertion defensible: the full text stays in the document, reachable through the anchor."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fin:ReserveTransaction a owl:Class ;
rdfs:label "Reserve transaction"@en ;
dct:source "ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf fin:FinancialTransaction ;
skos:definition "One reserve movement: initial set, increase, decrease, or drawdown to closure. The versioned history grain — reserve v1 → v2 → v3 is a prov:wasRevisionOf chain."@en ;
adjmeta:sourceAvailability adjmeta:Partial .
fra:FraudAssessment a owl:Class ;
rdfs:label "Fraud assessment"@en ;
dct:source "Workbook clm:FraudAssessment; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A numeric fraud-risk score WITH its factor breakdown, plus, at resolution, the confirmed fraud amount and financial impact. Computed externally; the factor breakdown is not persisted. Without it the model cannot be tuned or audited."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:NetworkLink a owl:Class ;
rdfs:label "Network link"@en ;
dct:source "ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One reified link in a fraud network, with the shared attribute (bank account, phone, address) and a confidence."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:SIUReferral a owl:Class ;
rdfs:label "SIU referral"@en ;
dct:source "Source table SIU_REFERRAL; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf proc:Referral ;
skos:definition "A referral of a claim to the Special Investigations Unit, with date, source and outcome."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv:PriorLossProfile a owl:Class ;
rdfs:label "Prior loss profile"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Aggregated prior loss history for the same insured across claims. Not pre-computed in either source — requires a join, not a direct entity."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
lia:LiabilityApportionment a owl:Class ;
rdfs:label "Liability apportionment"@en ;
dct:source "ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The reified share of fault attributed to one party — a percentage and a party. The source supports up to four parties; the model supports any number."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
ltg:AttorneyAssignment a owl:Class ;
rdfs:label "Attorney assignment"@en ;
dct:source "Source table ATTRNY_LTGTN; ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf asg:AssignmentRecord ;
skos:definition "Assignment of an attorney to a matter, with side."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
ltg:Venue a owl:Class ;
rdfs:label "Venue"@en ;
dct:source "ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The jurisdiction and venue of a matter. Aligns to OMG LCC subdivisions and to the compliance module's jurisdiction."@en ;
adjmeta:acordAlignment "OMG LCC" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
adjmeta:Medium a owl:NamedIndividual ;
rdfs:label "Medium"@en ;
rdfs:isDefinedBy adjmeta: .
rcv:RecoveryAction a owl:Class ;
rdfs:label "Recovery action"@en ;
dct:source "Source table RECOVERY; ONTOSPEC §5.14"@en ;
rdfs:isDefinedBy rcv: ;
rdfs:subClassOf prov:Activity,
core:InformationEntity ;
skos:definition "The pursuit of reimbursement after payment, via subrogation or salvage."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:Release a owl:Class ;
rdfs:label "Release"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "The signed release of future liability. Exists only as a file-note attachment today. A claim cannot be fully closed without one."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
proc:ProcessStage a owl:Class ;
rdfs:label "Process stage"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf p-plan:Step,
core:InformationEntity ;
skos:definition "An ordered stage within a process definition. A plan concept: its instances are the stages themselves, shared by every case — never per-case occurrences (those are proc:StageExecution)."@en .
doctype:CorrespondenceDocument a skos:Concept ;
skos:definition "Grouping: correspondence."@en ;
skos:inScheme doctype: ;
skos:notation "CORDOC" ;
skos:prefLabel "Correspondence Document"@en ;
skos:topConceptOf doctype: .
dtr:AuditRecord a owl:Class ;
rdfs:label "Audit record"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A claim-file audit: area, question, outcome, source reference, date. A genuinely new entity, not present in the raw or refined layer."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:ExtractedFact a owl:Class ;
rdfs:label "Extracted fact"@en ;
dct:source "ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "An assertion lifted from unstructured text or a document by an extraction activity, carrying its method, confidence and anchor. Distinguishes \"stated by a source system\" from \"read out of a note\". Never overwrites a source-of-record fact: extracted facts are additive and separately attributed."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fra:FraudIndicator a owl:Class ;
rdfs:label "Fraud indicator"@en ;
dct:source "Question-bank entity Fraud Indicator; ONTOSPEC §5.16"@en ;
rdfs:isDefinedBy fra: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A detected indicator with type, confidence score and detection date."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
itm:Vehicle a owl:Class ;
rdfs:label "Vehicle"@en ;
dct:source "Source table VEHICLE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf itm:ClaimItem ;
owl:hasKey ( itm:vin ) ;
skos:definition "A vehicle involved in an Auto claim. Identity by VIN via owl:hasKey — never a datatype inverse-functional property."@en ;
adjmeta:acordAlignment "schema:Vehicle at the serving edge (identifier for VIN)" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
lia:LiabilityAssessment a owl:Class ;
rdfs:label "Liability assessment"@en ;
dct:source "Source tables LIABILITY, LIAB, LINE at-fault indicators; ONTOSPEC §5.8"@en ;
rdfs:isDefinedBy lia: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The adjuster's formal determination of fault: the degree attributed to the insured versus other parties."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
adjmeta:ExtractionNeeded a owl:NamedIndividual ;
rdfs:label "Extraction needed"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "The term's data exists only in unstructured text or documents and must be extracted."@en .
adjmeta:High a owl:NamedIndividual ;
rdfs:label "High"@en ;
rdfs:isDefinedBy adjmeta: .
stp:STPScore a owl:Class ;
rdfs:label "STP score"@en ;
dct:source "Workbook clm:ClaimSTPScore; ONTOSPEC §5.17"@en ;
rdfs:isDefinedBy stp: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The automated STP eligibility score and its percentile rank. Score and percentile are present; the factor breakdown driving them is not persisted at claim level."@en ;
skos:editorialNote "External reference; not SME-validated (2026-07-31)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
proc:StatusAssignment a owl:Class ;
rdfs:label "Status assignment"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A time-indexed assignment of a status value to a case, so state history is preserved rather than overwritten. Present state is derived from the latest assignment."@en .
cmp:StatutoryDeadline a owl:Class ;
rdfs:label "Statutory deadline"@en ;
dct:source "ONTOSPEC §5.18"@en ;
rdfs:isDefinedBy cmp: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A dated obligation derived from a compliance requirement and a triggering event. Modelled with OWL-Time so \"days from proof of loss\" is computable (a time:DurationDescription makes \"working days\" explicit)."@en ;
adjmeta:acordAlignment "NAIC Model #900" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:AIOutput a owl:Class ;
rdfs:label "AI output"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A prediction, score or recommendation produced by a model, with its type, model version, generation time and — where available — its cited evidence."@en ;
adjmeta:acordAlignment "NAIC AI Model Bulletin, 2023-12-04" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:FileNoteText a owl:Class ;
rdfs:label "File note text"@en ;
dct:source "Source table FILE_NOTE_TEXT; ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "One text block of a file note. A note may carry several; the note header and its text are separate grains in the source (FILE_NOTE / FILE_NOTE_TEXT)."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv:ClaimInvestigation a owl:Class ;
rdfs:label "Claim investigation"@en ;
dct:source "Workbook clm:ClaimInvestigation; ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf prov:Activity,
core:InformationEntity ;
skos:definition "A structured investigation with a scope, activities, findings and a summary. The investigation narrative lives in file-note text; no structured investigation entity exists in either source."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adjmeta:Partial a owl:NamedIndividual ;
rdfs:label "Partial"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Some of the term's data is refined; the remainder is operational-only or unstructured."@en .
stl:Settlement a owl:Class ;
rdfs:label "Settlement"@en ;
dct:source "ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The agreed resolution: amount, date, method, form. Allocation between multiple claimants is one settlement per claimant, linked to a common negotiation."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
doctype:FinancialDocument a skos:Concept ;
skos:definition "Grouping: financial documents."@en ;
skos:inScheme doctype: ;
skos:notation "FINDOC" ;
skos:prefLabel "Financial Document"@en ;
skos:topConceptOf doctype: .
fincat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Financial categories of reserves and payments."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #26"@en ;
dct:title "Chubb Claims Financial Category"@en ;
vann:preferredNamespacePrefix "fincat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/financial-category/" ;
owl:versionIRI fincat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept fincat:Expense,
fincat:Indemnity,
fincat:Medical ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
stlmeth: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Settlement method values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #30"@en ;
dct:title "Chubb Claims Settlement Method"@en ;
vann:preferredNamespacePrefix "stlmeth" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/settlement-method/" ;
owl:versionIRI stlmeth:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept stlmeth:LumpSum,
stlmeth:Periodic,
stlmeth:Structured ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adj:DecisionOutcome a owl:Class ;
rdfs:label "Decision outcome"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The result of a gate evaluation, carrying an outcome value, a date and a decider. Reified because it is n-ary and time-indexed."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
asg:AssignmentRecord a owl:Class ;
rdfs:label "Assignment record"@en ;
dct:source "ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The record of a performer being assigned to a claim or coverage line, with the routing basis. The routing rationale is not persisted per claim — this class is the target."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
dtr:EvidenceUse a owl:Class ;
rdfs:label "Evidence use"@en ;
dct:source "ONTOSPEC §5.3.1; §10"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The unit of the decision trace. A reified statement that a document or document category was — or was not, or sometimes is — consulted at a specified gate, with what was referenced and what was recorded. Exactly one row of the Decision Tracing template: n-ary, with a global IRI, never a junction-table-shaped blank node and never flattened to a datatype property."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
itm:DamageItem a owl:Class ;
rdfs:label "Damage item"@en ;
dct:source "Source table DAMAGE; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A structured damage record: claimed, approved and verified values, and repair status. The output of a formal damage assessment, not a document reference."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
med:MedicalTreatment a owl:Class ;
rdfs:label "Medical treatment"@en ;
dct:source "Source tables INJURY, INV, INV_DTL; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A treatment or procedure, carrying a CPT/HCPCS concept, type, provider, dates and billed/allowed amounts. IME is a treatment-type VALUE, not a subclass."@en ;
adjmeta:acordAlignment "CPT; FHIR Procedure" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
stl:Demand a owl:Class ;
rdfs:label "Demand"@en ;
dct:source "Source tables DEMAND_OFFER, DMND_OFFR; ONTOSPEC §5.13"@en ;
rdfs:isDefinedBy stl: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The claimant's formal request for a settlement amount, with type, amount and date."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
doctype:CoverageDocument a skos:Concept ;
skos:definition "Grouping: documents bearing on coverage."@en ;
skos:inScheme doctype: ;
skos:notation "COVDOC" ;
skos:prefLabel "Coverage Document"@en ;
skos:topConceptOf doctype: .
adj:AdjudicationRule a owl:Class ;
rdfs:label "Adjudication rule"@en ;
dct:source "Source tables FC_RULE, NODE_RULE, TE_RULE et al.; ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Plan,
core:InformationEntity ;
skos:definition "A rule definition governing an adjudication decision — coverage logic, task triggering, loss classification, routing. Sourced from the CCS 5 configuration tables. Configuration records, not per-claim outcomes. The decision logic itself lives in OMG DMN, referenced by adj:dmnDecisionRef — OWL is not a rules engine."@en ;
adjmeta:acordAlignment "OMG DMN decision; OMG SBVR rule statement" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
cvp:CoveragePositionStatement a owl:Class ;
rdfs:label "Coverage position statement"@en ;
dct:source "ONTOSPEC §5.5.1; Gate 3"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf adj:AdjudicationDecision ;
skos:definition "The Gate-3 formal coverage position: confirm, reserve rights, deny, or partially confirm. SME note (2026-07-31): the reason for the position is in the note, not in any structured field."@en ;
adjmeta:acordAlignment "ACORD AIM Coverage Decision" ;
adjmeta:primaryExtractionTarget true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
itm:ClaimItem a owl:Class ;
rdfs:label "Claim item"@en ;
dct:source "Source table ITEM; ONTOSPEC §5.10"@en ;
rdfs:isDefinedBy itm: ;
rdfs:subClassOf core:PhysicalEntity ;
owl:disjointWith claim:Claim ;
skos:definition "A specific physical item involved in the loss. Parent of vehicle and property items."@en ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
proc:Referral a owl:Class ;
rdfs:label "Referral"@en ;
dct:source "ONTOSPEC §4.1.1"@en ;
rdfs:isDefinedBy proc: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A request to route a decision to a higher authority or a specialist function."@en .
audout: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Outcomes of a claim-file audit."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #44"@en ;
dct:title "Chubb Claims Audit Outcome"@en ;
vann:preferredNamespacePrefix "audout" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/audit-outcome/" ;
owl:versionIRI audout:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept audout:Deficiency,
audout:MaterialDeficiency,
audout:Pass,
audout:PassWithObservation ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
cfregime: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Jurisdictional fault regimes. A jurisdiction attribute, never a claim subclass (PIT-2)."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #40"@en ;
dct:title "Chubb Claims Comparative Fault Regime"@en ;
vann:preferredNamespacePrefix "cfregime" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/comparative-fault-regime/" ;
owl:versionIRI cfregime:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept cfregime:ContributoryNegligence,
cfregime:ModifiedComparative50,
cfregime:ModifiedComparative51,
cfregime:PureComparative ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
cplx: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Claim complexity tiers driving triage and STP eligibility."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #15"@en ;
dct:title "Chubb Claims Complexity Tier"@en ;
vann:preferredNamespacePrefix "cplx" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/complexity-tier/" ;
owl:versionIRI cplx:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept cplx:Complex,
cplx:HighComplexity,
cplx:Simple,
cplx:Standard ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ctrig: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Coverage trigger values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #6"@en ;
dct:title "Chubb Claims Coverage Trigger"@en ;
vann:preferredNamespacePrefix "ctrig" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/coverage-trigger/" ;
owl:versionIRI ctrig:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept ctrig:ClaimsMade,
ctrig:ClaimsMadeAndReported,
ctrig:Manifestation,
ctrig:Occurrence ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
evduse: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Whether a document was consulted at a gate: the Y / N / Sometimes column of the Decision Tracing template."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Decision Tracing tab; ONTOSPEC Part 11 #45"@en ;
dct:title "Chubb Claims Evidence-Use Disposition"@en ;
vann:preferredNamespacePrefix "evduse" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/evidence-use/" ;
owl:versionIRI evduse:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept evduse:NotUsed,
evduse:PendingSMEConfirmation,
evduse:Sometimes,
evduse:Used ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
liadesc: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "The certainty of the liability position."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Question_Bank_Themes_2026-08-04_v2.xlsx — Themes!R0006 (Theme 3); ONTOSPEC §11.2"@en ;
dct:title "Chubb Claims Liability Descriptor"@en ;
vann:preferredNamespacePrefix "liadesc" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/liability-descriptor/" ;
owl:versionIRI liadesc:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept liadesc:Clear,
liadesc:Disputed,
liadesc:Probable,
liadesc:Questionable ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
paymeth: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Payment method values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #27"@en ;
dct:title "Chubb Claims Payment Method"@en ;
vann:preferredNamespacePrefix "paymeth" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/payment-method/" ;
owl:versionIRI paymeth:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept paymeth:Card,
paymeth:Check,
paymeth:EFT,
paymeth:StructuredAnnuity ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
siuout: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "SIU investigation outcomes."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #37"@en ;
dct:title "Chubb Claims SIU Outcome"@en ;
vann:preferredNamespacePrefix "siuout" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/siu-outcome/" ;
owl:versionIRI siuout:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept siuout:Cleared,
siuout:Confirmed,
siuout:NoBasisFound,
siuout:Pending ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
trtstat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Treatment status values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #25"@en ;
dct:title "Chubb Claims Treatment Status"@en ;
vann:preferredNamespacePrefix "trtstat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/treatment-status/" ;
owl:versionIRI trtstat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept trtstat:AtMMI,
trtstat:Completed,
trtstat:Discontinued,
trtstat:Ongoing ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
asg:Task a owl:Class ;
rdfs:label "Task"@en ;
dct:source "Source tables TASK, SPECIALTY_TASK, TASK_NOTIFY; ONTOSPEC §5.6.1"@en ;
rdfs:isDefinedBy asg: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A task or diary item on a claim or line: due date, status, type, memo. Task memo text is short-form — lower extraction value than file notes but important for workflow rationale."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
fin:Payment a owl:Class ;
rdfs:label "Payment"@en ;
dct:source "Source tables PAYMENT, PAYMENT_DTL, PAYMENT_AH; ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A payment on a coverage line, by financial category, with method and authorising performer."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
itk:FNOLReport a owl:Class ;
rdfs:label "FNOL report"@en ;
dct:source "Source tables LOSS, FNOL_HANDLER; ONTOSPEC §5.4.1"@en ;
rdfs:isDefinedBy itk: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "The First Notice of Loss intake record: when and how a loss was first reported. Distinct from the claim header — this is the intake event record, not the claim processing record."@en ;
adjmeta:acordAlignment "ACORD AIM First Notice of Loss; ACORD FNOL message (terminology only)" ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv:Statement a owl:Class ;
rdfs:label "Statement"@en ;
dct:source "ONTOSPEC §5.7.1"@en ;
rdfs:isDefinedBy inv: ;
rdfs:subClassOf evd:ClaimDocument ;
skos:definition "A recorded account given by a person. Abstract parent of recorded statement, examination under oath and witness statement."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
val:Valuation a owl:Class ;
rdfs:label "Valuation"@en ;
dct:source "ONTOSPEC §5.11"@en ;
rdfs:isDefinedBy val: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "Abstract parent: an assessed monetary value of some element of a claim, with its basis and date."@en ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
evd:FileNote a owl:Class ;
rdfs:label "File note"@en ;
dct:source "Source tables FILE_NOTE, FILE_NOTE_TEXT; ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
owl:hasKey ( evd:noteId ) ;
skos:altLabel "Claim Note"@en ;
skos:definition "An adjuster-authored or system-generated note on a claim or coverage line. The primary unstructured record of claim handling. Not a kind of claim — related by evd:hasFileNote."@en ;
adjmeta:acordAlignment "ACORD AIM Claim Note" ;
adjmeta:sourceAvailability adjmeta:AvailableNow ;
adjmeta:workbookRef "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx#Subject Areas!R21" .
cvpos: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "The formal coverage position values taken at Gate 3."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #4"@en ;
dct:title "Chubb Claims Coverage Position"@en ;
vann:preferredNamespacePrefix "cvpos" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/coverage-position/" ;
owl:versionIRI cvpos:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept cvpos:Confirmed,
cvpos:Denied,
cvpos:Partial,
cvpos:Reserved,
cvpos:UnderReview ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ltgdisp: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Litigation disposition values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #33"@en ;
dct:title "Chubb Claims Litigation Disposition"@en ;
vann:preferredNamespacePrefix "ltgdisp" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/litigation-disposition/" ;
owl:versionIRI ltgdisp:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept ltgdisp:Arbitrated,
ltgdisp:Dismissed,
ltgdisp:Settled,
ltgdisp:Trial,
ltgdisp:Verdict ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
rcvreason: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Why a recovery closed."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #31"@en ;
dct:title "Chubb Claims Recovery Close Reason"@en ;
vann:preferredNamespacePrefix "rcvreason" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/recovery-close-reason/" ;
owl:versionIRI rcvreason:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept rcvreason:PartiallyRecovered,
rcvreason:Recovered,
rcvreason:TimeBarred,
rcvreason:Uncollectible,
rcvreason:Waived ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
stpdisp: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "STP gate dispositions. GAP-04: observed blank on a real claim; enumerate from the source once confirmed."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #38"@en ;
dct:title "Chubb Claims STP Disposition"@en ;
vann:preferredNamespacePrefix "stpdisp" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/stp-disposition/" ;
owl:versionIRI stpdisp:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept stpdisp:AutoProcessed,
stpdisp:Eligible,
stpdisp:FellOut,
stpdisp:Ineligible,
stpdisp:PartiallyProcessed ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
taskstat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Task status values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #13"@en ;
dct:title "Chubb Claims Task Status"@en ;
vann:preferredNamespacePrefix "taskstat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/task-status/" ;
owl:versionIRI taskstat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept taskstat:Cancelled,
taskstat:Completed,
taskstat:InProgress,
taskstat:Open,
taskstat:Overdue ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
dtr:RationaleStatement a owl:Class ;
rdfs:label "Rationale statement"@en ;
dct:source "ONTOSPEC §5.3.1"@en ;
rdfs:isDefinedBy dtr: ;
rdfs:subClassOf adj:DecisionRationale,
evd:ExtractedFact ;
skos:definition "The stated reason for a decision, as written by the adjuster. Carries the text, the note it came from, the extraction method and a confidence. This is what \"the reason is in the note, not in any structured field\" becomes as data."@en ;
adjmeta:primaryExtractionTarget true ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
doctype:LegalDocument a skos:Concept ;
skos:definition "Grouping: legal and litigation documents."@en ;
skos:inScheme doctype: ;
skos:notation "LEGDOC" ;
skos:prefLabel "Legal Document"@en ;
skos:topConceptOf doctype: .
fin:Reserve a owl:Class ;
rdfs:label "Reserve"@en ;
dct:source "Source tables RESERVE, RESERVE_DTL, RESERVE_AH; ONTOSPEC §5.12"@en ;
rdfs:isDefinedBy fin: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "The insurer's estimated liability for a coverage line, by financial category."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
med:Injury a owl:Class ;
rdfs:label "Injury"@en ;
dct:source "Source tables INJURY, CLMNT_DTL; ONTOSPEC §5.9"@en ;
rdfs:isDefinedBy med: ;
rdfs:subClassOf core:InformationEntity ;
skos:definition "A bodily injury sustained in the loss, with its clinical classification."@en ;
adjmeta:acordAlignment "HL7 FHIR Condition (design reference)" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
aipred: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Kinds of AI output acting on claims (NAIC AI Model Bulletin documentation)."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #41"@en ;
dct:title "Chubb Claims AI Prediction Type"@en ;
vann:preferredNamespacePrefix "aipred" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/ai-prediction-type/" ;
owl:versionIRI aipred:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept aipred:AdjudicationRecommendation,
aipred:CoveragePrediction,
aipred:FraudScore,
aipred:ReserveRecommendation,
aipred:STPEligibility,
aipred:SeverityPrediction ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
chan: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "How a loss was reported."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #16"@en ;
dct:title "Chubb Claims Intake Channel"@en ;
vann:preferredNamespacePrefix "chan" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/intake-channel/" ;
owl:versionIRI chan:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept chan:Agent,
chan:Broker,
chan:Email,
chan:Mobile,
chan:Phone,
chan:Web ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
jrule: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Types of jurisdictional compliance rules, per NAIC Model #900."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #39"@en ;
dct:title "Chubb Claims Jurisdiction Rule Type"@en ;
vann:preferredNamespacePrefix "jrule" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/jurisdiction-rule-type/" ;
owl:versionIRI jrule:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept jrule:AcceptOrDeny,
jrule:Acknowledgement,
jrule:ClaimFormsSupply,
jrule:FraudReporting,
jrule:InvestigationStatusNotice,
jrule:Payment ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ovrsn: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Seed reasons for human override of an AI output. THE REAL DISTRIBUTION IS THE ANSWER TO CQ-QB-27 and must be derived from extracted note text, not invented."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #42"@en ;
dct:title "Chubb Claims Override Reason"@en ;
vann:preferredNamespacePrefix "ovrsn" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/override-reason/" ;
owl:versionIRI ovrsn:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept ovrsn:CoverageConcern,
ovrsn:LiabilityDisagreement,
ovrsn:MissingEvidence,
ovrsn:Other,
ovrsn:PolicyInterpretation,
ovrsn:ValuationDisagreement ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
premcond: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Premises conditions cited in negligence findings. Defined once; shared by the investigation and liability modules."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #19; Question 11"@en ;
dct:title "Chubb Claims Premises Condition"@en ;
vann:preferredNamespacePrefix "premcond" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/premises-condition/" ;
owl:versionIRI premcond:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept premcond:IceOrSnow,
premcond:InadequateLighting,
premcond:MissingHandrail,
premcond:Obstruction,
premcond:UnevenSurface,
premcond:WetFloor ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
siusrc: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Sources of an SIU referral."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #36"@en ;
dct:title "Chubb Claims SIU Referral Source"@en ;
vann:preferredNamespacePrefix "siusrc" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/siu-referral-source/" ;
owl:versionIRI siusrc:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept siusrc:Adjuster,
siusrc:AutomatedTrigger,
siusrc:ClaimSearch,
siusrc:ExternalTip,
siusrc:StateBureau,
siusrc:Supervisor ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
doctype:EvidenceDocument a skos:Concept ;
skos:definition "Grouping: investigative and evidentiary documents."@en ;
skos:inScheme doctype: ;
skos:notation "EVIDOC" ;
skos:prefLabel "Evidence Document"@en ;
skos:topConceptOf doctype: .
audarea: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Areas of a claim-file audit."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #43"@en ;
dct:title "Chubb Claims Audit Area"@en ;
vann:preferredNamespacePrefix "audarea" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/audit-area/" ;
owl:versionIRI audarea:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept audarea:Compliance,
audarea:Coverage,
audarea:Documentation,
audarea:Fraud,
audarea:Liability,
audarea:Reserving,
audarea:Settlement ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
outcome: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Outcome values of a gate evaluation."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #3"@en ;
dct:title "Chubb Claims Decision Outcome"@en ;
vann:preferredNamespacePrefix "outcome" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/decision-outcome/" ;
owl:versionIRI outcome:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept outcome:Approved,
outcome:Deferred,
outcome:Denied,
outcome:PartiallyApproved,
outcome:Referred,
outcome:Rejected,
outcome:Withdrawn ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
dmdtype: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Demand type values. May not be coded in the source — adjuster notes or letter text may be the origin (Question 6)."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #29"@en ;
dct:title "Chubb Claims Demand Type"@en ;
vann:preferredNamespacePrefix "dmdtype" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/demand-type/" ;
owl:versionIRI dmdtype:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept dmdtype:FutureMedical,
dmdtype:GeneralDamages,
dmdtype:LostWages,
dmdtype:MedicalSpecials,
dmdtype:PainAndSuffering,
dmdtype:PropertyDamage,
dmdtype:TimeLimit ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
excl: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Policy exclusion type taxonomy."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #7"@en ;
dct:title "Chubb Claims Exclusion Type"@en ;
vann:preferredNamespacePrefix "excl" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/exclusion-type/" ;
owl:versionIRI excl:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept excl:Contractual,
excl:Employment,
excl:ExpectedOrIntended,
excl:Pollution,
excl:PriorKnowledge,
excl:ProfessionalServices,
excl:WearAndTear ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
injnature: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Nature-of-injury taxonomy. Special-category health data at the instance level."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #21; Question 1"@en ;
dct:title "Chubb Claims Injury Nature"@en ;
vann:preferredNamespacePrefix "injnature" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/injury-nature/" ;
owl:versionIRI injnature:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept injnature:Burn,
injnature:Fracture,
injnature:Laceration,
injnature:Psychological,
injnature:SoftTissue,
injnature:Sprain,
injnature:TraumaticBrainInjury ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
legalact: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Types of legal activity within a matter. Values, never subclasses (PIT-2)."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #34"@en ;
dct:title "Chubb Claims Legal Activity Type"@en ;
vann:preferredNamespacePrefix "legalact" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/legal-activity-type/" ;
owl:versionIRI legalact:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept legalact:Appeal,
legalact:Arbitration,
legalact:Deposition,
legalact:Discovery,
legalact:Mediation,
legalact:Motion,
legalact:Trial ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ltg:LitigationMatter a owl:Class ;
rdfs:label "Litigation matter"@en ;
dct:source "Source tables LITIGATION, LINE_LITIGATION; ONTOSPEC §5.15"@en ;
rdfs:isDefinedBy ltg: ;
rdfs:subClassOf core:InformationEntity ;
owl:hasKey ( ltg:caseNumber ltg:inCourt ) ;
skos:definition "A formal legal proceeding arising from a claim: status, type, disposition, venue, dates. Not a kind of claim (PIT-4) — a legal proceeding ABOUT a claim."@en ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
covtype: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Coverage type taxonomy for GL and Auto coverage lines."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #5"@en ;
dct:title "Chubb Claims Coverage Type"@en ;
vann:preferredNamespacePrefix "covtype" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/coverage-type/" ;
owl:versionIRI covtype:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept covtype:BodilyInjury,
covtype:Liability,
covtype:MedicalPayments,
covtype:PhysicalDamage,
covtype:Premises,
covtype:Products,
covtype:PropertyDamage,
covtype:UninsuredMotorist ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
hstat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Handling status values for a coverage line, including the pre-push and push-pending states."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Source LINE_AH; ONTOSPEC Part 11 #8"@en ;
dct:title "Chubb Claims Handling Status"@en ;
vann:preferredNamespacePrefix "hstat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/handling-status/" ;
owl:versionIRI hstat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept hstat:Closed,
hstat:Investigating,
hstat:Litigated,
hstat:Open,
hstat:PrePush,
hstat:PushPending,
hstat:Reopened,
hstat:Settled ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ltgstat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Litigation status values, in procedural order."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #32"@en ;
dct:title "Chubb Claims Litigation Status"@en ;
vann:preferredNamespacePrefix "ltgstat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/litigation-status/" ;
owl:versionIRI ltgstat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept ltgstat:Answered,
ltgstat:Appealed,
ltgstat:Discovery,
ltgstat:Mediation,
ltgstat:Resolved,
ltgstat:SuitFiled,
ltgstat:TrialSet,
ltgstat:Verdict ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
tasktype: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Task/diary type values."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #12"@en ;
dct:title "Chubb Claims Task Type"@en ;
vann:preferredNamespacePrefix "tasktype" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/task-type/" ;
owl:versionIRI tasktype:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept tasktype:Coverage,
tasktype:Diary,
tasktype:Financial,
tasktype:Investigation,
tasktype:Legal,
tasktype:Medical,
tasktype:Specialty,
tasktype:SystemGenerated ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adj:AdjudicationStage a owl:Class ;
rdfs:label "Adjudication stage"@en ;
dct:source "ONTOSPEC §5.2.1; Part 6"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf proc:ProcessStage ;
skos:definition "One of the ten named stages of the adjudication process. A plan concept: instances are the ten stages themselves, shared by every claim — never per-claim occurrences (those are adj:StageExecution)."@en ;
adjmeta:acordAlignment "ACORD Capability — Claims Handling" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adj:DecisionGate a owl:Class ;
rdfs:label "Decision gate"@en ;
dct:source "ONTOSPEC §5.2.1; §6.3"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf proc:DecisionGate ;
skos:definition "One of the eleven formal determinations the adjudication process requires. A plan concept; per-claim evaluations are adj:GateEvaluation activities."@en ;
adjmeta:acordAlignment "BPMN gateway; OMG DMN decision" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
fraind: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Fraud indicator types. External reference; not SME-validated (2026-07-31)."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #35"@en ;
dct:title "Chubb Claims Fraud Indicator Type"@en ;
vann:preferredNamespacePrefix "fraind" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/fraud-indicator/" ;
owl:versionIRI fraind:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept fraind:DocumentAnomaly,
fraind:EarlyAttorneyInvolvement,
fraind:InflatedDamages,
fraind:NetworkAssociation,
fraind:PriorClaimPattern,
fraind:PublicAdjusterInvolvement,
fraind:StagedLoss,
fraind:StatementInconsistency,
fraind:Velocity ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
rsvreason: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Why a reserve moved. Reconcile against the structured code where one exists; the rationale narrative remains the Theme-6 extraction target."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #28"@en ;
dct:title "Chubb Claims Reserve Change Reason"@en ;
vann:preferredNamespacePrefix "rsvreason" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/reserve-change-reason/" ;
owl:versionIRI rsvreason:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept rsvreason:Closure,
rsvreason:DemandReceived,
rsvreason:Drawdown,
rsvreason:InitialSet,
rsvreason:LiabilityChange,
rsvreason:MediationOutcome,
rsvreason:MedicalUpdate,
rsvreason:SettlementAgreed,
rsvreason:SuitFiled ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
val: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 8 — Damage and Evaluation: damage evaluation, claim item valuation, medical valuation, business interruption, depreciation schedule, claim valuation worksheet, demand evaluation, wage-loss valuation. Subject area 8."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.11"@en ;
dct:title "Chubb Claims Valuation Ontology"@en ;
vann:preferredNamespacePrefix "val" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/valuation/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
itm:0.1,
med:0.1,
coverage:0.1 ;
owl:versionIRI val:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adjstage: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "The ten stages of the GL/Auto claim adjudication process. Ordered by a skos:OrderedCollection, never by skos:broader."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Adjudication Process Flow tab; ONTOSPEC Part 6, Part 11 #1"@en ;
dct:title "Chubb Claims Adjudication Stage"@en ;
vann:preferredNamespacePrefix "adjstage" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/adjudication-stage/" ;
owl:versionIRI adjstage:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept adjstage:Adjudication,
adjstage:ClosurePostSettlement,
adjstage:CoverageVerification,
adjstage:EvaluationValuation,
adjstage:ExclusionLimitCalculation,
adjstage:FNOLIntake,
adjstage:HistoricalAssessment,
adjstage:Investigation,
adjstage:SettlementPayment,
adjstage:TriageAssignment ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
fncat: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "File note categories. GAP-06: the official code table is unknown — seeded from three partial lists; every concept is an open question."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "ONTOSPEC Part 11 #10"@en ;
dct:title "Chubb Claims File-Note Category"@en ;
vann:preferredNamespacePrefix "fncat" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/file-note-category/" ;
owl:versionIRI fncat:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept fncat:Coverage,
fncat:General,
fncat:Investigation,
fncat:Legal,
fncat:Liability,
fncat:Medical,
fncat:Payment,
fncat:Recovery,
fncat:Reserve,
fncat:Settlement ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
gate: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "The eleven formal decision gates of the adjudication process."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Decision Tracing tab; ONTOSPEC §6.3, Part 11 #2"@en ;
dct:title "Chubb Claims Decision Gate"@en ;
vann:preferredNamespacePrefix "gate" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/decision-gate/" ;
owl:versionIRI gate:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept gate:ClaimRegistration,
gate:ClosureRecovery,
gate:CoverageDetermination,
gate:CoveragePosition,
gate:DemandEvaluation,
gate:GuidedAdjudication,
gate:InitialReserveSetting,
gate:LiabilityAssessment,
gate:SIUReferral,
gate:SettlementAuthorization,
gate:TriageAssignment ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
lia: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 7's liability gate: liability assessment, determination, apportionment, comparative negligence, at-fault parties, causation opinion, negligence basis and premises condition. Subject area 7. Amber: the assessment is in CCS 5 but not yet in the refined layer."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.8"@en ;
dct:title "Chubb Claims Liability Ontology"@en ;
vann:preferredNamespacePrefix "lia" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/liability/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation. SME belief that liability assessment is in the analytical layer proved wrong — it is operational-only and needs Fractal mapping."@en ;
owl:imports adj:0.1,
itm:0.1,
claim:0.1 ;
owl:versionIRI lia:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
cmp: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The jurisdictional questions and the regulatory deadline family: compliance requirement, jurisdiction rule, statutory deadline, acknowledgment deadline, compliance breach, penalty, regulatory filing, jurisdiction. Grounded in NAIC Model #900 (Unfair Claims Settlement Practices Act). The canonical deadline family is MODEL timing — the jurisdiction-specific value is data on a cmp:JurisdictionRule, never hard-coded."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.18; NAIC Model #900"@en ;
dct:title "Chubb Claims Compliance Ontology"@en ;
vann:preferredNamespacePrefix "cmp" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/compliance/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports evd:0.1,
proc:0.1,
claim:0.1 ;
owl:versionIRI cmp:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 3 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
proc: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The generic shape of a governed business process: prospective definitions (process, stage, decision gate) distinct from retrospective executions (process execution, stage execution, gate evaluation), with time-indexed status assignment, delegated authority and referral. Minimal by design — only what a competency question pays for."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC 1.0.0 §4.1.1"@en ;
dct:title "Chubb Foundation Process Ontology (change-request draft)"@en ;
vann:preferredNamespacePrefix "proc" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/fnd/process/" ;
rdfs:comment "CHANGE-REQUEST DRAFT. Ownership: Information Architecture. Authored by the Claims Data & Semantics team as the proposed content; do not treat as published foundation until IA accepts."@en ;
owl:imports core:0.1 ;
owl:versionIRI proc:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
evd:ClaimDocument a owl:Class ;
rdfs:label "Claim document"@en ;
dct:source "Document Inventory tab; ONTOSPEC §5.1.1"@en ;
rdfs:isDefinedBy evd: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A document that evidences some aspect of a claim. One class, categorised by evd:documentType pointing at a doctype: concept — never one class per document category (P-2)."@en ;
adjmeta:acordAlignment "ACORD AIM Document; schema:CreativeWork at the serving edge only" ;
adjmeta:sourceAvailability adjmeta:PendingMapping .
rcv: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 10 — Recovery and Subrogation: recovery action, recovery credit, subrogation demand and record, salvage, recovery negotiation, lien waiver, arbitration, reopen, closure. Subject area 13."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.14"@en ;
dct:title "Chubb Claims Recovery Ontology"@en ;
vann:preferredNamespacePrefix "rcv" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/recovery/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
fin:0.1,
stl:0.1,
claim:0.1 ;
owl:versionIRI rcv:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 3 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adj:AdjudicationDecision a owl:Class ;
rdfs:label "Adjudication decision"@en ;
dct:source "ONTOSPEC §5.2.1"@en ;
rdfs:isDefinedBy adj: ;
rdfs:subClassOf prov:Entity,
core:InformationEntity ;
skos:definition "A formal determination reached at a decision gate: what was decided, by whom, when, on what basis. The generic parent of every stage-specific decision. Not a document and not a rule."@en ;
adjmeta:acordAlignment "ACORD AIM Claim Decision; HL7 FHIR ClaimResponse.item.adjudication as design reference" ;
adjmeta:sourceAvailability adjmeta:NotInAnySource .
adjmeta: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "A small annotation vocabulary that carries the source workbooks' own metadata into the graph so the build state is queryable: readiness, source availability, priority, wave, extraction targets, open questions, gap and workbook references, ACORD alignment, mapping and validation status. All terms are owl:AnnotationProperty or named individuals; none participates in reasoning."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC 1.0.0 §4.7"@en ;
dct:title "Chubb Claims Build-Metadata (adjmeta) Vocabulary"@en ;
vann:preferredNamespacePrefix "adjmeta" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/meta/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:versionIRI adjmeta:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
itk: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 1 — FNOL and intake — plus the catastrophe designation that governs handling from intake onward. FNOL report, intake channel, loss event detail, reporting lag, claim registration, incident profile, catastrophe designation and workforce. Subject areas 1, 3, 15."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — subject areas 1, 3, 15"@en ;
dct:title "Chubb Claims Intake Ontology"@en ;
vann:preferredNamespacePrefix "itk" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/intake/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
evd:0.1,
claim:0.1 ;
owl:versionIRI itk:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
itm: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The physical things a claim is about: claim item, vehicle, vehicle damage, vehicle driver, property loss, item article, item site, item involvement, damage item, repair estimate. Subject areas 8, 9 (vehicle and property halves)."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.10"@en ;
dct:title "Chubb Claims Item Ontology"@en ;
vann:preferredNamespacePrefix "itm" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/item/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports core:0.1,
claim:0.1 ;
owl:versionIRI itm:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 3 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
fin: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Reserves and payments — the money spine. Wave 1, because \"why is the reserve $1,000 and not $1,500\" is one of the questions the decision trace exists to answer. Subject areas 10, 11."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — subject areas 10, 11"@en ;
dct:title "Chubb Claims Financial Ontology"@en ;
vann:preferredNamespacePrefix "fin" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/financial/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
biz:0.1,
claim:0.1,
coverage:0.1 ;
owl:versionIRI fin:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adjmeta:AvailableNow a owl:NamedIndividual ;
rdfs:label "Available now"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "CDS refined layer; queryable today."@en .
stl: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 9's demand/offer/negotiation/authorisation chain: demand, time-limit demand, offer, negotiation, negotiation round, settlement range, settlement authorization, settlement agreement, release, structured settlement. Subject area 12."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.13"@en ;
dct:title "Chubb Claims Settlement Ontology"@en ;
vann:preferredNamespacePrefix "stl" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/settlement/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
evd:0.1,
fin:0.1 ;
owl:versionIRI stl:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
cvp:CoverageLine a owl:Class ;
rdfs:label "Coverage line"@en ;
dct:source "Source tables LINE, LINE_AH; ONTOSPEC §5.5.1"@en ;
rdfs:isDefinedBy cvp: ;
rdfs:subClassOf core:InformationEntity ;
owl:disjointWith claim:Claim ;
skos:definition "The intersection of a specific coverage type and a claim — a claim exposure. Carries handling status, agreed limit and deductible, and is the grain reserves, payments, notes, tasks and participants link to. Not a kind of claim and not a kind of coverage:Coverage."@en ;
adjmeta:acordAlignment "ACORD AIM Claim Exposure" ;
adjmeta:sourceAvailability adjmeta:AvailableNow .
inv: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 4 (Investigation) and Stage 5 (Historical Assessment). There are no structured investigation records in either source: this module is almost entirely extraction-only — a specification for what extraction must produce."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.7"@en ;
dct:title "Chubb Claims Investigation Ontology"@en ;
vann:preferredNamespacePrefix "inv" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/investigation/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
evd:0.1,
claim:0.1 ;
owl:versionIRI inv:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
crole: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "Participant-role code values on a coverage line. These classify participant RECORDS; the reified role individuals of the role triangles live in the ontology modules."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Source PARTICIPANT; ONTOSPEC Part 11 #11"@en ;
dct:title "Chubb Claims Participant Role"@en ;
vann:preferredNamespacePrefix "crole" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/participant-role/" ;
owl:versionIRI crole:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept crole:Adjudicator,
crole:Adjuster,
crole:Auditor,
crole:CATAdjuster,
crole:Claimant,
crole:CoDefendant,
crole:CoverageCounsel,
crole:DefenseCounsel,
crole:ExpertWitness,
crole:FNOLHandler,
crole:IndependentMedicalExaminer,
crole:Insured,
crole:LineOwner,
crole:Payee,
crole:PlaintiffAttorney,
crole:PublicAdjuster,
crole:SIUInvestigator,
crole:SubrogationTarget,
crole:Supervisor,
crole:TreatingPhysician,
crole:Vendor,
crole:Witness ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
stp: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "All five STP automation stages: STP score, scoring factor, model version, STP gate, gate criterion, disposition, complexity tier, automated routing, auto-reserve setting, STP exception, STP audit log. Subject areas 18, 19, 20. stp:STPAuditLog is a first-class class, not an annotation, because of the NAIC AI Model Bulletin's documentation expectation."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.17"@en ;
dct:title "Chubb Claims Straight-Through-Processing Ontology"@en ;
vann:preferredNamespacePrefix "stp" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/stp/" ;
rdfs:comment "DRAFT — External Reference grounding, not SME-validated. The three highest-priority STP gaps (factor breakdown, per-criterion gate outcomes, audit log) are the same gaps a market-conduct examiner will ask about: building them is regulatory readiness, not just analytics."@en ;
owl:imports adj:0.1,
asg:0.1,
fin:0.1,
proc:0.1,
claim:0.1 ;
owl:versionIRI stp:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:editorialNote "External reference; not SME-validated (2026-07-31). Applies to EVERY term in this module."@en ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 3 ;
adjmeta:processGrounding adjmeta:ExternalReference ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
evd: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The unstructured record and its anchors: file notes, note text, attachments, claim documents, document anchors, extracted facts, citations and correspondence. Wave 1 and imported by almost everything, because in this domain the evidence IS the reasoning. Subject area 21 (File Note, 217 fields)."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — File Note subject area; Document Inventory"@en ;
dct:title "Chubb Claims Evidence Ontology"@en ;
vann:preferredNamespacePrefix "evd" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/evidence/" ;
rdfs:comment "DRAFT. Working hypotheses pre-filled from the SME session of 2026-07-31; do not treat any axiom as validated until SME review completes."@en ;
owl:imports core:0.1,
claim:0.1 ;
owl:versionIRI evd:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
doctype: a owl:Ontology,
skos:ConceptScheme ;
dct:creator ;
dct:description "The 34+3 claim document categories as a thesaurus with skos:broader groupings. Never one OWL class per category (P-2). LOB and stage applicability are annotations, not subclasses."@en ;
dct:issued "2026-08-06"^^xsd:date ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Document Inventory tab; Decision Tracing tab; ONTOSPEC §7.1, Part 11 #9"@en ;
dct:title "Chubb Claims Document Type"@en ;
vann:preferredNamespacePrefix "doctype" ;
vann:preferredNamespaceUri "https://data.chubb.com/vocabulary/claims/claim-document-type/" ;
owl:versionIRI doctype:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:hasTopConcept doctype:CorrespondenceDocument,
doctype:CoverageDocument,
doctype:EvidenceDocument,
doctype:FinancialDocument,
doctype:LegalDocument,
doctype:MedicalDocument0 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
ltg: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The litigation branch: litigation matter, lawsuit filing, court, venue, legal activity (deposition, mediation, trial), attorney roles, verdict, judgment, legal pleading, defence strategy. A litigation matter is NOT a kind of claim — it is a legal proceeding about a claim. Named law firms are instances, never classes. Subject area 14."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.15"@en ;
dct:title "Chubb Claims Litigation Ontology"@en ;
vann:preferredNamespacePrefix "ltg" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/litigation/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation. Verdict and judgment amounts are confirmed NOT available as structured fields."@en ;
owl:imports adj:0.1,
asg:0.1,
evd:0.1,
claim:0.1 ;
owl:versionIRI ltg:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
fra: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "All five fraud detection stages: fraud trigger, assessment, indicators, velocity alert, document fraud flag, network fraud record, SIU referral and investigation, SIU outcome, state fraud referral, DOI complaint, statutory claim report, law-enforcement referral, ISO ClaimSearch inquiry. Subject areas 16, 17. Anchored to ISO ClaimSearch and state DOI filings."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.16"@en ;
dct:title "Chubb Claims Fraud / SIU Ontology"@en ;
vann:preferredNamespacePrefix "fra" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/fraud/" ;
rdfs:comment "DRAFT — External Reference grounding, not SME-validated. Network/link data is the highest-sensitivity content in the model: named-graph isolation and ODRL policy required (see §15)."@en ;
owl:imports adj:0.1,
dtr:0.1,
inv:0.1,
proc:0.1,
claim:0.1 ;
owl:versionIRI fra:0.1.0 ;
owl:versionInfo "0.1.0" ;
skos:editorialNote "External reference; not SME-validated (2026-07-31). Applies to EVERY term in this module."@en ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 3 ;
adjmeta:processGrounding adjmeta:ExternalReference ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
dtr: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The reason this ontology programme exists: the complete, auditable record of how each decision at each gate on each claim was reached — which evidence was consulted, what was referenced from it, what was recorded as a result, and why — plus the AI recommendation, the human override, and the audit finding. Grounded in the NAIC AI Model Bulletin's documentation expectation."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — Decision Tracing tab"@en ;
dct:title "Chubb Claims Decision-Trace Ontology"@en ;
vann:preferredNamespacePrefix "dtr" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/decision-trace/" ;
rdfs:comment "DRAFT. The Decision Tracing tab header is explicit: these are WORKING HYPOTHESES — not a confirmed record of how Chubb adjusters operate."@en ;
owl:imports adj:0.1,
evd:0.1 ;
owl:versionIRI dtr:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adjmeta:PendingMapping a owl:NamedIndividual ;
rdfs:label "Pending mapping"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "In CCS 5 operationally; not yet refined. Needs Fractal mapping."@en .
cvp: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 2 (Coverage Verification) and Stage 6 (Exclusion & Limit Calculation): coverage line, coverage determination, coverage position, Reservation of Rights, denial, exclusion application, condition assessment, coordination of benefits, limit and deductible application, payable amount, valuation chain and coverage rule application. Also owns the coverage line — the grain at which reserves, payments, notes, tasks and participants attach. Subject areas 2, 4."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — subject areas 2, 4"@en ;
dct:title "Chubb Claims Coverage-Position Ontology"@en ;
vann:preferredNamespacePrefix "cvp" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/coverage-position/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
claim:0.1,
coverage:0.1,
policy:0.1 ;
owl:versionIRI cvp:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
med: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The medical branch: injury, diagnosis, body part, treatment, provider, MMI, disability rating, medical invoice, IME opinion, pre-existing condition, medical line adjudication. Anchored to HL7 FHIR Condition/Procedure and to ICD-10-CM and CPT via skos:notation + skos:exactMatch — never a class per code, and FHIR structure never imported into the P&C spine. Dense with special-category personal data."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "CHUBB-CLAIMS-ADJ-ONTOSPEC §5.9"@en ;
dct:title "Chubb Claims Medical Ontology"@en ;
vann:preferredNamespacePrefix "med" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/medical/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation. Health data is special-category: every PII-bearing predicate carries dpv:hasPersonalDataCategory."@en ;
owl:imports adj:0.1,
evd:0.1,
inv:0.1,
claim:0.1 ;
owl:versionIRI med:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adjmeta:DraftPendingSMEValidation a owl:NamedIndividual ;
rdfs:label "Draft pending SME validation"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Working hypotheses pre-filled from the SME session of 2026-07-31; not a confirmed record of operations."@en .
adj: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "The process spine of claim adjudication: ten stages, eleven decision gates, decisions, outcomes, steps, rules, guided adjudication, partial approval and rationale, for GL and Auto, North America. Every other claims module hangs its stage-specific decisions off these terms."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — Adjudication Process Flow; Decision Tracing"@en ;
dct:title "Chubb Claims Adjudication Ontology"@en ;
vann:preferredNamespacePrefix "adj" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/adjudication/" ;
rdfs:comment "DRAFT. Every decision gate, document association and sequence in this module was pre-filled from the adjudication SME session of 2026-07-31. These are WORKING HYPOTHESES, not a confirmed record of how Chubb adjusters operate."@en ;
owl:imports proc:0.1,
claim:0.1,
coverage:0.1,
policy:0.1 ;
owl:versionIRI adj:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 1 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
asg: a owl:Ontology ;
dct:created "2026-08-06"^^xsd:date ;
dct:creator ;
dct:description "Stage 3 — Triage and Assignment — plus the cross-cutting task/diary and authority machinery: performer, participant roles, authority, referral and escalation, triage severity, routing, queue, task and diary, assignment history, vendor assignment. PERFORMER is the strongest-validated entity in the estate, confirmed across three independent sources. Subject areas 5, 6, 19, 22."@en ;
dct:modified "2026-08-06"^^xsd:date ;
dct:source "Claims_Adjudication_Ontology_Framework_2026-07-31.xlsx — subject areas 5, 6, 19, 22"@en ;
dct:title "Chubb Claims Assignment Ontology"@en ;
vann:preferredNamespacePrefix "asg" ;
vann:preferredNamespaceUri "https://data.chubb.com/ontology/claims/assignment/" ;
rdfs:comment "DRAFT. Working hypotheses pending SME validation."@en ;
owl:imports adj:0.1,
dtr:0.1,
proc:0.1,
claim:0.1 ;
owl:versionIRI asg:0.1.0 ;
owl:versionInfo "0.1.0" ;
prov:generatedAtTime "2026-08-06T00:00:00+00:00"^^xsd:dateTime ;
prov:wasAttributedTo ;
adjmeta:buildWave 2 ;
adjmeta:validationStatus adjmeta:DraftPendingSMEValidation .
adjmeta:NotInAnySource a owl:NamedIndividual ;
rdfs:label "Not in any source"@en ;
rdfs:isDefinedBy adjmeta: ;
skos:definition "Absent from both sources; requires extraction from documents/notes or new capture."@en .
[] a owl:AllDisjointClasses ;
owl:members ( adj:AdjudicationDecision evd:ClaimDocument adj:AdjudicationRule ) .
[] a owl:AllDisjointClasses ;
owl:members ( adj:AdjudicationDecision adj:AdjudicationRule adj:DecisionOutcome ) .