Motor vehicle claims: policy, coverage, claim, incident, handling, money in and out.
by Cynergis · embeds the ontology auto-claims@2 · engine >=0.4
/plugin marketplace add Cynergis/oto-registry
/plugin install auto-claims@cynergisThe engine plugin oto comes with it. Then the pack's start skill begins a project from the installed copy: oto init --name "<project>" --pack "${CLAUDE_PLUGIN_ROOT}" --project <root>. At a terminal: oto registry add https://github.com/Cynergis/oto-registry, oto pack add auto-claims, oto init --pack auto-claims.
auto-claims@2: 17 classes, 27 relations, 1 rules, 0 actions, extends oto-core.
| Class | What it is | The question it answers | Why it exists |
|---|---|---|---|
| Document | A source document in the corpus: a policy wording, a bulletin, a procedure, a transcript. | Where is this written down? | Every fact needs a source that can be checked, and the source is a file with its own date. |
| Action | Something that can be done about an entity, described the way an MCP server describes a tool and bound to the graph. Oto lists it; the caller invokes it; the recorded run is evidence. | What can be done about this, and how? | The binding between an entity, the tool that acts on it, its inputs, its credentials by name and its preconditions is otherwise tribal knowledge in an agent's prompt; as a fact it is versioned, reviewed and shared. Oto never invokes it. |
| Policy | A contract of insurance, identified by a policy number and effective period. | Which policy was in force when this loss happened? | Cover is decided against a policy at a moment in time, so the policy must be a thing with a period, not a field on a claim. |
| Coverage | One protection within a policy, with its own limit and deductible. | Which coverage is this claim being paid under, and what limit applies? | Limits, deductibles and exclusions attach to a coverage rather than a policy, and payments are charged against one. |
| Endorsement | A change to a policy: an addition, removal or amendment of terms. | What changed on this policy, and from when? | A mid-term change alters cover for part of the period only, so it needs its own dates and its own source. |
| Claim | A request for payment made under a policy after an incident. | What is being asked for, under which policy, and what state is it in? | The claim is the unit of work and the unit of reporting, and it exists from first notice until closure. |
| Incident | The loss event itself: what happened, when and where. Distinct from the Claim reporting it. | What actually happened, and how many claims came out of it? | One event can produce several claims, and it happens before any of them is reported, so it needs its own date. |
| Vehicle | A motor vehicle, identified by its vehicle identification number. | Which vehicle was involved, and what has been claimed on it before? | A vehicle outlives any single policy or claim, so history attaches to it rather than to either. |
| Party | A person or organization involved: policyholder, claimant, third party, witness, repairer, medical provider. | Who is involved, and in what capacity? | Policyholder, claimant, third party, witness, repairer and provider all need to be referenced, and the same person can be more than one. |
| Role | A defined function in claims handling, such as adjuster, appraiser or examiner. A role is filled by a party. | Who is accountable for handling this, without naming a person? | Handling authority and workload attach to a function, and the person filling it changes while the history must stay correct. |
| Task | A unit of handling work on a claim, with an owner and a state. | What still has to happen on this claim, and who owns it? | Handling is a sequence of committed pieces of work with owners and states, which an attribute cannot carry. |
| Assessment | A damage appraisal, estimate or expert opinion supporting a decision. | What evidence supports the decision on quantum or damage? | An estimate or expert opinion has its own author and date, and a decision must be able to cite it. |
| Decision | A determination on a claim: coverage, liability, quantum, or a denial, with the reason recorded. | What was determined, when, and on what basis? | A determination has a date, a reason, evidence it relied on, and it can be superseded by a later one. |
| Payment | Money paid out, whether indemnity to a claimant or expense to a vendor. | What has been paid out, to whom, and against which coverage? | Each payment is charged to a coverage and made to a party, and the total is a question about many of them. |
| Recovery | Money recovered, whether by subrogation from a responsible party or by salvage disposal. | What came back in, and from whom? | Net cost is a question about money in and money out, and a model with only payments cannot answer it. |
| Procedure | A documented internal way of handling something: a guideline, a checklist, a service standard. | How are we supposed to handle this? | The documented way of working is what handling is measured against, and it changes over time. |
| Regulation | An external rule that constrains handling: a statute, a regulator's guidance, an industry standard. | What external rule constrains how we handle this? | An external rule has a source outside the organization and cannot be changed by it, which makes it a different kind of thing from a procedure. |
| Relation | From | To | Meaning |
|---|---|---|---|
cites | Document | Document | This document refers to that one, so a fact traced to it can be traced one step further. |
acts_on | Action | The entity a recorded run of this action read or changed. | |
executed_by | Action | Who is accountable for invoking this action: a team, never a person. | |
covers | Policy | Coverage | A policy provides this coverage. |
amended_by | Policy | Endorsement | An endorsement changes this policy. |
insures | Policy | Vehicle|Party | A policy insures this vehicle or party. |
held_by | Policy | Party | The party that holds the policy. |
claims_under | Claim | Policy | The policy a claim is made under. |
arises_from | Claim | Incident | The incident a claim arises from. |
filed_by | Claim | Party | The party who made the claim. |
claims_against | Claim | Coverage | The coverage a claim is made against. |
involves | Incident | Vehicle|Party | A vehicle or party involved in the incident. |
part_of_claim | Task|Assessment|Decision|Payment|Recovery | Claim | This item belongs to that claim. |
assigned_to | Task | Role | The role responsible for a task. |
filled_by | Role | Party | The party performing a role. |
follows | Task | Procedure | The procedure a task follows. |
assesses | Assessment | Vehicle | The vehicle an assessment examines. |
supports | Assessment|Document | Decision | Evidence relied on for a decision. |
decides | Decision | Claim | The claim a decision is about. |
authorizes | Decision | Payment | A decision that authorizes a payment. |
paid_to | Payment | Party | Who a payment was made to. |
charged_to | Payment | Coverage | The coverage a payment is charged against. |
recovered_from | Recovery | Party | The party a recovery came from. |
governs | Regulation | Procedure | A rule that constrains a procedure. |
documented_in | Procedure|Regulation|Policy | Document | Where this is written down. |
supersedes | Procedure|Regulation|Policy|Coverage | Procedure|Regulation|Policy|Coverage | This replaced that. Use with the temporal fields, never by overwriting. |
performs | Role | Procedure | The role that carries out this procedure. |
The pack's sample graph, 14 nodes and 21 edges, in the explorer every project gets: open it full size.
/auto-claims:start Start or extend an Oto knowledge project in this domain: Motor vehicle claims: policy, coverage, claim, incident, handling, money in and out. The pack 'auto-claims' (release 2) embeds the ontology 'auto-claims' (release 2), which declares Policy, Coverage, Endorsement, Claim, Incident, Vehicle, Party, Role and more. Use when someone wants a knowledge graph, a vocabulary or an interview for this domain.Motor vehicle claims: policy, coverage, claim, incident, handling, money in and out.
This skill comes with the auto-claims pack. The ontology is inside the pack, so nothing is fetched.
1. Start a project from this pack.
oto init --name "<project name>" --pack "${CLAUDE_PLUGIN_ROOT}" --project <root>${CLAUDE_PLUGIN_ROOT} is this pack's directory; Claude Code fills it in. Outside Claude Code, with the pack on the machine (oto pack add auto-claims from the cynergis registry), oto init --pack auto-claims does the same. The project records the ontology's origin, so oto status says when a newer release exists and oto ontology diff shows what changed.
2. Run the ontology-interview skill to fit the vocabulary to the documents at hand.
3. Hand over to the build-knowledge-base skill for the documents, and to the query-knowledge skill for questions. The engine plugin oto comes with this pack: the kg_* tools and the generic skills are available once it is installed.
None yet: the explorer and the reader every project has.