48. Insurance, loss assessment, repair authorization, and recovery

Insurance and repair workflows must join vehicle identity, as-operated configuration, incident evidence, condition, coverage assertions, professional roles, work packages, installed parts, invoices, settlements, and disputes without allowing one record to impersonate another.

#48.1 Insurance-contract assertions

InsuranceContractAssertion records insurer, native contract reference, insured principals, asset, configuration selector, operation/use and territory scopes, coverage interval, terms artifact, limits and deductibles, source assertion, and native status. An active-looking record is evidence only. Coverage for a specific loss MUST NOT be inferred from premium payment, vehicle telemetry, insurer relationship, or policy status alone.

#48.2 Loss notice and claim file

LossNotice binds incident, asset, as-operated configuration, notifier, claimants, occurrence interval, private location reference, damage/condition observations, evidence, external submissions, and state. The related insurance CaseFile controls parties, confidentiality, deadlines, authority, evidence, and appeal.

#48.3 Coverage decisions

CoverageDecision binds claim case, insurer, authority assignment, contract assertions, considered loss scopes, excluded or unresolved scopes, evidence and terms digests, result, conditions, amount caps, reason codes, effective time, and review/appeal policy. Results are ACCEPTED, PARTIAL, DECLINED, PENDING, or INDETERMINATE.

#48.4 Independent loss assessment

LossAssessment records assessor, qualifications, asset and configuration, inspection procedure, evidence, damage map, causal hypotheses, repairability class, repair and value estimates, uncertainty, limitations, and conflicts. A policy may require the assessor to be independent from the repairer, seller, owner, insurer claims handler, or platform.

#48.5 Repair estimate, authorization, and amendments

RepairEstimate is a proposal with work package, repairer, configuration, labor, parts, taxes/fees, currency total, assumptions, exclusions, and validity. RepairAuthorization is a separate mandate naming authorizer, authority basis, payer/beneficiaries, approved and excluded scope, caps, part/procedure constraints, deviation policy, interval, and amendment lineage.

Any changed scope, amount, parts class, procedure, or configuration outside the authorization enters AMENDMENT_REQUIRED before further governed work. Emergency physical work may still be recorded truthfully when external circumstances require it; the platform MUST NOT fabricate prior authorization or reimbursement.

#48.6 Repair execution, inspection, and release

RepairCompletion binds the executed work package, resulting immutable configuration, deviations, installed-part references, measurement and inspection evidence, invoices, release decision, and completion time. Completion, inspection, roadworthiness/fitness release, payment, reimbursement, warranty, and return to service are separate state transitions.

#48.7 Settlement, recovery interests, and disputes

Payments and journals append independently from coverage appeals, repair disputes, subrogation or recovery interests, salvage disposition, and title review. Provider timeout or ambiguous effect remains UNKNOWN_EFFECT with funds reservation and reconciliation duties. No accounting correction rewrites the incident, assessment, work, or prior decision.