Large Loss Workflow

The ClaimsEventsConsumer creates a policy.agent_tasks row when isLargeLoss = true. This page explains what that task means, how underwriters action it, and what downstream effects it can trigger.

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What Is a Large Loss?

A large loss is a claim settlement where the total settlement amount meets or exceeds the LARGE_LOSS_THRESHOLD (configured in ClaimsOne, default $100,000). These settlements warrant underwriting review because they:

Signal elevated risk on the policy (and potentially on the account or territory)
May affect renewal pricing, surcharges, or non-renewal decisions
Can trigger reinsurance notifications
May indicate fraud patterns that need SIU escalation

The Agent Task

When a large-loss event arrives, PolicyOne inserts exactly one policy.agent_tasks row per event:

{
  taskKind: 'large_loss_review',
  entityType: 'policy',
  entityId: policy.id,              // the PolicyOne policy UUID
  agentKind: 'deterministic',       // not AI-driven; requires human review
  status: 'pending',
  triggerEvent: 'claim.settled',
  triggerSource: 'claims_one',
  humanReviewRequired: true,
  humanReviewNote: `Large loss settlement: ${claimNumber}, amount: $${formatCents(settlementAmountCents)}`,
  inputs: {
    claimId,
    claimNumber,
    policyNumber,
    settlementAmountCents,
    deductibleCents,
    isLargeLoss: true,
    settlementDate
  }
}

Field	Value	Why
`taskKind`	`large_loss_review`	Identifies the task type for UW queue routing
`agentKind`	`deterministic`	No AI automation — a human underwriter must review
`humanReviewRequired`	`true`	Blocks automated close; UW must take action
`status`	`pending`	Initial state; transitions to `in_review` → `completed` or `escalated`
`triggerSource`	`claims_one`	Audit trail — this task originated from a ClaimsOne event

Underwriter Workflow

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Task Status Transitions

Status	Meaning	Who sets it
`pending`	Task created, awaiting UW pick-up	`ClaimsEventsConsumer` (on creation)
`in_review`	Underwriter has opened the task	PolicyOne UI (when UW clicks "Start Review")
`completed`	UW took action and closed the task	PolicyOne UI
`escalated`	Referred to senior UW or committee	PolicyOne UI
`cancelled`	Task voided (e.g. duplicate, error)	PolicyOne admin

Data Available to the Underwriter

The inputs JSONB column stores the full claim context. When the UW opens the task in PolicyOne, the UI can display:

Data point	Source
Claim number & link to ClaimsOne	`inputs.claimNumber`, `inputs.claimId`
Settlement amount	`inputs.settlementAmountCents` (formatted from cents)
Deductible applied	`inputs.deductibleCents`
Settlement date	`inputs.settlementDate`
Policy number	`inputs.policyNumber` (join to `policy.policies`)
Policy inception, expiry, coverage	Join `policy.policies` via `entityId`
Prior claims on this policy	Query `policy.agent_tasks WHERE entity_id = entityId`

SQL: Query Pending Large Loss Tasks

-- All pending large-loss review tasks, newest first
SELECT
  at.id,
  at.human_review_note,
  at.created_at,
  p.policy_number,
  p.insured_name,
  at.inputs->>'settlementAmountCents' AS settlement_cents,
  at.inputs->>'claimNumber' AS claim_number
FROM policy.agent_tasks at
JOIN policy.policies p ON p.id = at.entity_id
WHERE at.task_kind = 'large_loss_review'
  AND at.status = 'pending'
  AND at.tenant_id = $1
ORDER BY at.created_at DESC;

-- Large loss task volume by week (last 90 days)
SELECT
  date_trunc('week', created_at) AS week,
  COUNT(*) AS task_count,
  AVG((inputs->>'settlementAmountCents')::numeric) AS avg_settlement_cents
FROM policy.agent_tasks
WHERE task_kind = 'large_loss_review'
  AND created_at > now() - interval '90 days'
  AND tenant_id = $1
GROUP BY 1
ORDER BY 1;

Relationship to ClaimsOne SIU Referrals

A single claim settlement may trigger reactions in both PolicyOne and ClaimsOne simultaneously:

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These are independent reactions. PolicyOne's agent task is about the policy (renewal decision). ClaimsOne's SIU referral is about the claim (fraud investigation). They do not block or depend on each other.

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