claim-fnol-promote

{
  "query": "hail claim reported not heard back week follow up timeline FNOL OPEN",
  "limit": 8
}

{
  "results": [
    {
      "doc_id": "KB-CLAIMS-STATUS",
      "title": "Claim status: FNOL → OPEN → CLOSED, and who may move it",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "**FNOL** = loss reported, not yet accepted for handling. **OPEN** = accepted\nand with an adjuster (the adjuster sets the reserve). **CLOSED** = resolved.\nA service rep may promote FNOL → OPEN once the loss details are confirmed\nwith the cus…"
    },
    {
      "doc_id": "KB-DISC-HLTH-SUPP",
      "title": "Supplemental health: not major-medical; pre-existing limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"]}",
      "snippet": "Disclose and record that this is **supplemental** coverage (accident / critical\nillness / hospital indemnity) and **NOT ACA major-medical** — it does not satisfy a\ncoverage mandate and does not replace health insurance. Pre-existing conditi…"
    },
    {
      "doc_id": "KB-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "doc_id": "KB-WA-HOSP-INDEM",
      "title": "WA: hospital indemnity not available",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"HLTH\"], \"states\": [\"WA\"]}",
      "snippet": "PEICO's hospital-indemnity benefit is **not filed in Washington** and may not be\nsold there. Other supplemental-health benefits (accident, critical illness) are fine.\n"
    },
    {
      "doc_id": "KB-EVERGREEN-CLASSIC",
      "title": "Evergreen Classic (Home, retired 2018) — wind/hail math",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"HOME\"]}",
      "snippet": "Retired 2018-01-01. Uses a legacy flat-capped wind/hail deductible (1.5% of\ndwelling, capped) rather than the current percentage math. Not re-bindable.\n"
    },
    {
      "doc_id": "KB-LOYALTY-AUTHORITY",
      "title": "PineRewards points: what a service rep may post",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "Tiers (Seedling → Sprout → Timber → OldGrowth) are assigned annually from\ntenure and lifetime earning, **not** the current point balance. Points earned\n2019 or later expire **24 months** after the earn date; older entries were\nwritten witho…"
    },
    {
      "doc_id": "KB-DISC-WHOLE-LIFE",
      "title": "Whole life disclosures: surrender, cash value, not an investment",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"LIFE_W\"]}",
      "snippet": "Before binding whole life, disclose and record: (1) **surrender charges** apply for\nthe first several policy years and reduce early cash value; (2) cash value accrues\nslowly and may be borrowed against, reducing the death benefit; (3) whole…"
    },
    {
      "doc_id": "KB-HERITAGE",
      "title": "Heritage tier (retired 2009) — do not drop without disclosure",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Heritage was retired on 2009-07-01 and cannot be sold or re-bound. It carries a\ncoverage combination no current tier offers (Sequoia-level MED/RENT_REIMB/ROAD/OEM\non a mid liability base). A customer who drops Heritage **loses that combinat…"
    }
  ]
}

{
  "sql": "SELECT c.cust_id, c.first_name, c.last_name, p.policy_id, p.line, p.status, p.effective_date FROM customers c JOIN policies p ON p.cust_id = c.cust_id WHERE c.phone IS NOT NULL AND c.phone LIKE '%' LIMIT 1"
}

{
  "rows": [],
  "row_count": 0,
  "truncated": false
}

{
  "sql": "SELECT c.cust_id, c.first_name, c.last_name, a.line1, a.city, a.state, a.zip, p.policy_id, p.line, p.status FROM customers c JOIN addresses a ON a.address_id = c.address_id JOIN policies p ON p.cust_id = c.cust_id WHERE a.line1 LIKE '1247 Fairway Drive' AND a.city LIKE 'Naples' AND a.state LIKE 'FL' AND a.zip LIKE '34102' AND c.last_name LIKE 'Esposito' LIMIT 10"
}

{
  "rows": [],
  "row_count": 0,
  "truncated": false
}

{
  "sql": "SELECT cust_id, first_name, last_name, email, phone, address_id FROM customers WHERE email LIKE 'gloria.esposito@example.com' LIMIT 5"
}

{
  "rows": [
    {
      "cust_id": "CUST-fl-coastal-home",
      "first_name": "Gloria",
      "last_name": "Esposito",
      "email": "gloria.esposito@example.com",
      "phone": null,
      "address_id": "ADDR-fl-coastal-home"
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "sql": "SELECT p.policy_id, p.line, p.status, p.effective_date, p.expiration_date, a.line1, a.city, a.state, a.zip FROM policies p JOIN customers c ON c.cust_id = p.cust_id JOIN addresses a ON a.address_id = c.address_id WHERE c.email LIKE 'gloria.esposito@example.com' AND p.line LIKE 'HOME%' ORDER BY p.effective_date DESC LIMIT 5"
}

{
  "rows": [
    {
      "policy_id": "POL-fl-coastal-home-p_home",
      "line": "HOME",
      "status": "ACTIVE",
      "effective_date": "2025-04-01",
      "expiration_date": "2026-04-01",
      "line1": "12 Mangrove Way",
      "city": "Naples",
      "state": "FL",
      "zip": "34102"
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "sql": "SELECT claim_id, policy_id, reported_at, loss_date, type, status, reserve_cents, fraud_score FROM claims WHERE policy_id = 'POL-fl-coastal-home-p_home' ORDER BY reported_at DESC LIMIT 5"
}

{
  "rows": [
    {
      "claim_id": "CLM-fl-coastal-hail",
      "policy_id": "POL-fl-coastal-home-p_home",
      "reported_at": "2025-05-26",
      "loss_date": "2025-05-24",
      "type": "HAIL",
      "status": "FNOL",
      "reserve_cents": null,
      "fraud_score": 0.03
    }
  ],
  "row_count": 1,
  "truncated": false
}

{
  "doc_id": "KB-CLAIMS-STATUS"
}

{
  "doc_id": "KB-CLAIMS-STATUS",
  "title": "Claim status: FNOL → OPEN → CLOSED, and who may move it",
  "category": "POLICY",
  "applies_to": "{\"lines\": \"ALL\"}",
  "body_md": "**FNOL** = loss reported, not yet accepted for handling. **OPEN** = accepted\nand with an adjuster (the adjuster sets the reserve). **CLOSED** = resolved.\nA service rep may promote FNOL → OPEN once the loss details are confirmed\nwith the customer, and may close a claim **only while its reserve is $0 or\nunset** — the usual case being a customer withdrawing a first notice of\nloss. Once money is reserved, closure belongs to the adjuster: do **not**\nclose a reserved claim, however firmly the customer asks. Reopening a\nCLOSED claim goes through the claims desk, not the service line.\n"
}

{
  "claim_id": "CLM-fl-coastal-hail",
  "status": "OPEN"
}

{
  "ok": true,
  "rows_affected": 1,
  "changeset": {
    "claims": {
      "changed": [
        {
          "pk": {
            "claim_id": "CLM-fl-coastal-hail"
          },
          "fields": {
            "status": [
              "FNOL",
              "OPEN"
            ]
          }
        }
      ]
    }
  }
}

{
  "sql": "SELECT claim_id, policy_id, reserve_cents, status FROM claims WHERE claim_id = 'CLM-fl-coastal-hail'"
}

{
  "rows": [
    {
      "claim_id": "CLM-fl-coastal-hail",
      "policy_id": "POL-fl-coastal-home-p_home",
      "reserve_cents": null,
      "status": "OPEN"
    }
  ],
  "row_count": 1,
  "truncated": false
}

{}

{
  "ok": true,
  "note": "Deliver your closing message now."
}