{
  "record": "RJL Studio demo evidence record (synthetic)",
  "claim": "CL-9055",
  "ontology": {
    "name": "Insurance claims (RJL demo)",
    "version": "1.0.0",
    "namespace": "https://rjlsol.com/ontology/demo/insurance-claims/"
  },
  "termsUsed": [
    "applicable-procedure",
    "claimant",
    "group-policy",
    "policy-date",
    "policyholder",
    "prior-claims"
  ],
  "steps": [
    {
      "step": "Identify the parties",
      "result": "Claimant: Dana Reyes (P-217), from the claims system. Policyholder: Northfield Logistics (P-100), from policy administration. Kept as separate roles.",
      "source": "claims_system.claims CL-9055 member_id; policy_administration.policies GP-2201"
    },
    {
      "step": "Select the procedure",
      "result": "DC-PROC v4, in force on the policy date of 15 January 2026.",
      "source": "procedure_library DC-PROC v4 and v5; policy_date 2026-01-15"
    },
    {
      "step": "Gather prior claims",
      "result": "2 prior claims for the claimant: CL-7012 and CL-8130.",
      "source": "claims_system.claims, filtered by member_id P-217 (the claimant)"
    },
    {
      "step": "Check the draft",
      "result": "3 of 3 checks pass: roles match the approved definitions, the procedure was in force on the policy date, and every listed claim belongs to the claimant.",
      "source": "Checks generated from the approved terms"
    },
    {
      "step": "Examiner review",
      "result": "The examiner reviews a cited case summary and accepts it. The decision on the claim stays with the examiner.",
      "source": "Review record"
    }
  ],
  "checks": [
    {
      "check": "Roles match approved definitions",
      "result": "pass"
    },
    {
      "check": "Procedure in force on policy date",
      "result": "pass"
    },
    {
      "check": "Listed claims belong to the claimant",
      "result": "pass"
    }
  ],
  "review": {
    "reviewer": "Examiner (synthetic)",
    "decision": "accepted case summary",
    "independentApproval": false
  },
  "externalWrites": false,
  "note": "Synthetic demonstration. Not an operational record, an authenticated approval or a statement of insurance rules."
}