Insurance domain reference · for the ontology team

The Insurance Workflow Atlas.

Every major process in a commercial P&C carrier, drawn as the state sequence it really is — because a workflow’s stages are exactly what a process ontology has to name.

Commercial P&C / specialty focus Read as lifecycles Companion to the CQ brief

How to read this atlas

Workflows are state machines

Each entry below is one workflow, shown as its lifecycle rail — the ordered states a case passes through. Those states become the controlled vocabulary of your process ontology; the arrows become allowed transitions; the off-ramps and branches become the axioms that make it realistic.

Entry state Intermediate state Successful terminal state Loop / optional re-entry off-ramp early exit branch parallel sub-workflow

The value chain these all hang from

Product & rating Distribution New business Policy servicing Billing Claims

… with reinsurance running underneath the whole chain, ceding risk at every stage.

A

New business & underwriting

The submission-to-issuance funnel — turning a broker’s risk into an in-force policy.

Underwriting funnel

Intake a risk, decide whether and how to cover it, price it, offer terms, and issue the contract. This is the pipeline that feeds everything downstream.

Submission Clearance Triage Risk assessment Rating & pricing Quote Negotiation Bind Issuance In-force
Artifact lineageSubmission → Quote → Binder → Policy
Off-rampsDeclinedNot-taken-upQuote expired
BranchesUW referral / authority
Maps to your modelpolicy.ttl, agreement.ttl

Clearance dedupes the risk (is another broker or underwriter already on it?). Bind creates temporary cover (a Binder) before the full policy document is produced at Issuance.

B

Policy servicing

Mid-term changes to an in-force policy. A family of small, distinct lifecycles — each an event on the policy timeline.

Endorsement a mid-term change to coverage, terms, or exposure
Requested Underwritten Rated Issued
Cancellation & reinstatement ending cover early — flat, pro-rata, or short-rate
Requested Notice issued Effective Reinstated
Renewal re-underwrite & re-rate at the end of a term
Renewal invited Re-rated Offered Accepted
Non-renewedLapsed
Premium audit reconcile estimated vs actual exposure (WC, GL)
Scheduled Data collected Audited Adjustment billed
Certificate of insurance proof-of-cover issued to a third party
Requested Issued
Maps to your modelpolicy:PolicyEndorsement, PolicyAmendment, claim:CancellationEvent
Modeling noteEach is a dated event on the policy — the reified time-indexed pattern earns its keep here.
C

Billing, collections & commission

Turning written premium into cash — and paying producers their share.

Premium billing agency-bill or direct-bill collection
Invoice Installment schedule Payment Reconciled
DunningCancel for non-payment
Premium recognition accounting state, earned over the term
Written premium Earned premium
Producer commission calculate & pay distribution
Calculated Statement Paid
Maps to your modelcoverage:WrittenPremium, EarnedPremium, Premium
Modeling noteYou already model the premium states; billing adds the process that moves between them.
D

Claims

First notice of loss to closure — the richest lifecycle, and usually the first one carriers model.

Claim lifecycle

Receive notice of a loss, confirm it’s covered, investigate, set money aside, decide, pay, and close — with the door left open to reopen.

FNOL Registration Coverage verification Triage / assignment Investigation Reserving Adjudication Settlement / payment Closed Reopened
Off-rampsDenied (no coverage)Withdrawn
Parallel branchesReserving (case / IBNR)Subrogation & salvageSIU / fraudLitigationLAE
Maps to your modelclaim:OpeningEvent, ClosingEvent, ReopeningEvent, CancellationEvent
The known gapa claim still has no status or incurred amount — this lifecycle needs both.

Reserving sets money aside before payment (case reserves per claim; actuarial IBNR across the book). Subrogation recovers from an at-fault third party; salvage recovers value from damaged property; SIU is the fraud-investigation branch.

E

Reinsurance

How the carrier lays off its own risk. Runs alongside every other workflow rather than after it.

Treaty automatic, portfolio-level cover agreed in advance

Proportional — quota share, surplus — shares premium and loss by percentage. Non-proportional — excess-of-loss, stop-loss — responds only above a retention.

Treaty placed Risks attach automatically Bordereaux reported Recoveries settled
Facultative one risk at a time — mirrors new business, from the ceding side
Submit to reinsurer Quote Bind Cover note
Recovery on a claim collecting the reinsurer’s share of a paid loss
Cession Recoverable identified Billed to reinsurer Recovered
AlsoRetrocession (the reinsurer’s own reinsurance)
Modeling noteReinsurance agreements are another agreement:Agreement subtype — it fits your existing layer.
F

Cross-cutting workflows

Patterns that apply inside all of the above. Model each once, reuse everywhere.

Referral / authority approval the most pervasive pattern — every stage has authority limits
Triggered Referred Reviewed Approved
DeclinedReturned for info
Product development & regulatory filing define coverages/forms/rates, then file with regulators (US: state DOIs)
Designed Filed Approved Effective
Distribution onboarding appointing & licensing producers/brokers
Appointment requested Licensed / verified Appointed Active
Compliance & straight-through processing

Compliance threads KYC / AML / sanctions screening, complaints handling, and regulatory reporting through new business and claims. STP is the auto-path for low-risk cases that skips human referral entirely — worth modeling as a first-class shortcut, not an afterthought.

Turning the atlas into ontology

Model the shape once, specialize many times

Notice how similar every rail is: a case moves through states, driven by activities, gated by authority, producing artifacts. That shared shape is the argument for one generic fnd/process.ttl — then each workflow above becomes a thin specialization in ins/.

Don’t model all of it

Match altitude to demand. If your competency questions only ask “what state is this in?” and “what came from what?”, you need the state pattern plus derivation links — not a process engine. Build the depth a CQ pays for, and no more.

A sensible build order

Claims (D). Richest analytics demand and you already have the lifecycle events — finish the status + amount gap first.
New business (A). High strategic value; the submission → quote → binder → policy lineage is clean to model.
Policy servicing (B). Endorsement, cancellation, renewal — extends the policy timeline you already have.
Billing (C) & Reinsurance (E). Add as the domain matures; both reuse your agreement and premium concepts.

Pick one and the next step is the same discipline as always: write its competency questions first, let them decide which pattern (state / activity / plan-vs-trace) you actually need, then build exactly that.