保險理賠處理

osop_version: "1.0"
id: "claim-processing"
name:"保險理賠處理"
description:"保險理賠生命週期，從申請、文件收集、調查、和解協商到付款。"

nodes:
  - id: "file_claim"
    type: "human"
    subtype: "input"
    name: "提出理賠"
    description: "被保險人提交理賠申請，附上事故詳情、日期及佐證照片。"

  - id: "collect_docs"
    type: "human"
    subtype: "input"
    name: "收集文件"
    description: "理賠專員請求並彙整警察報告、醫療記錄或維修估價單。"

  - id: "adjuster_investigation"
    type: "human"
    subtype: "review"
    name: "理賠調查員勘查"
    description: "現場調查員檢驗損害、訪問目擊者，並評估責任歸屬。"

  - id: "settlement_offer"
    type: "human"
    subtype: "input"
    name: "和解提案"
    description: "理賠經理計算賠付金額，並向被保險人提出和解方案。"

  - id: "negotiation"
    type: "human"
    subtype: "input"
    name: "議價協商"
    description: "被保險人與理賠經理就最終和解金額進行協商。"

  - id: "payment"
    type: "system"
    subtype: "action"
    name: "核發賠款"
    description: "系統透過直接存款或支票處理已核准的賠款。"

edges:
  - from: "file_claim"
    to: "collect_docs"
    mode: "sequential"
  - from: "collect_docs"
    to: "adjuster_investigation"
    mode: "sequential"
  - from: "adjuster_investigation"
    to: "settlement_offer"
    mode: "sequential"
  - from: "settlement_offer"
    to: "negotiation"
    mode: "conditional"
    when: "policyholder_accepts == false"
    label: "Policyholder disputes offer"
  - from: "settlement_offer"
    to: "payment"
    mode: "conditional"
    when: "policyholder_accepts == true"
    label: "Offer accepted"
  - from: "negotiation"
    to: "payment"
    mode: "sequential"