To let an assistant use these tools, grant Insurance operations on the consent screen, or just
Claims under its Fine-tune. The scope is claims.
Read tools work with Read only or Read & write access; write tools only with
Read & write.
Your assistant doesn't see these tools straight away. It finds them with search_tools or
describe_tools, and runs one with use_tool, passing its name and
arguments. Most assistants do this for you: just ask for what you want.
What your assistant is told about this group
The claims process: register, review, approve, settle (or decline, or withdraw), plus income protection benefits (start paying the benefit, confirm or skip each monthly payment, end it when they return to work) and case notes. Decisions affect the customer and mostly can't be undone: confirm with the user before approving, declining or settling.
The descriptions below are the ones your assistant reads, so they're written for it. When a connection covers more than one
organisation, the assistant passes org (the organisation's slug, from list_orgs) to say which one.
list_claims
Read List claims
Claims against the org's policies, newest first. Filter by status or policy.
Arguments
| Field | Type | Description |
|---|---|---|
| status | string |
One of: "registered", "review_started", "approved", "declined", "paid", "withdrawn", "in_payment"
|
| policy_id | string | Only claims on this policy |
| limit | integer | Max rows (1-100, default 25) |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
get_claim
Read Get a claim
Full claim detail: workflow status, case notes, benefit payment schedule and event timeline.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
register_claim
Write Register a claim
Open a new claim against a policy. The claim type must match one of the policy's covers.
Arguments
| Field | Type | Description |
|---|---|---|
| policy_id required | string | Policy the claim is against |
| claim_type required | string |
One of: "death", "terminal_illness", "critical_illness", "income_protection", "child_benefit", "healthcare"
|
| event_date required | string | Date of the insured event (YYYY-MM-DD) |
| claimant_name | string | Who is claiming, if not the policyholder |
| notes | string | Registration notes |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
start_claim_review
Write Start claim review
Move a registered claim into review.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
approve_claim
Write Approve a claim
Approve a registered or in-review claim, ready for settlement (or benefit start for income protection).
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
decline_claim
Write Decline a claim
Decline a registered or in-review claim with a reason the customer will see.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| reason required | string | Why the claim is declined |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
withdraw_claim
Write Withdraw a claim
Withdraw a claim at the claimant's request. Allowed before settlement.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
settle_claim
Write Settle a claim
Mark an approved claim paid, recording the settlement amount. Irreversible: confirm the amount with the operator before calling.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| amount_pence required | integer | Settlement amount in pence |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
start_claim_benefit
Write Start benefit payments
Put an approved income-protection claim into payment: applies the deferred period, raises the monthly benefit schedule and pauses premium collection.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
end_claim_benefit
Write End benefit payments
End an in-payment benefit on return to work; premium collection resumes. Idempotent for claims already out of payment.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| ended_on | string | Return-to-work date (YYYY-MM-DD, default today) |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
confirm_claim_benefit_payment
Write Confirm a benefit payment
Confirm one due month of an in-payment benefit as paid to the claimant.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| payment_id required | string | Benefit payment id (from get_claim) |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
skip_claim_benefit_payment
Write Skip a benefit payment
Skip one due month of an in-payment benefit with a reason (e.g. partial return to work).
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| payment_id required | string | Benefit payment id (from get_claim) |
| reason required | string | Why this month is skipped |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |
add_claim_note
Write Add a claim note
Append a case note to the claim's file.
Arguments
| Field | Type | Description |
|---|---|---|
| id required | string | Claim id |
| body required | string | Note text |
| org | string | Organisation slug: required when this authorization covers more than one organisation (see list_orgs) |