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Loss summary maintenance

clsLossSummary is the persisted record of a claim's reportable loss totals. Beyond plain CRUD, it derives its medical and indemnity totals from the sum of its child LossCategories (each an US_LOSS_CATEGORY row with US_LOSS_CATEGORY_OFFSET children), applies a settlement/third-party-prediction floor to indemnity amounts, and determines whether a claim counts as "Part B only" by delegating to coverage-combination and claim-data lookups. Persisted totals always reflect the derived values rather than any raw amount a caller might otherwise set.

Field Value
Operation ID OP-USC-03
Trigger NewLossSummary(dpi, claimID) to create, GetLossSummary(dpi, claimID) to retrieve, followed by Save() or Delete()
Inputs ClaimID, ValueDate (optional override), child LossCategories collection
Outputs Persisted or retrieved US_LOSS_SUMMARY row with derived TotalIncurredMedicalAmount, TotalIncurredIndemnityAmount, TotalPaidMedicalAmount, TotalPaidIndemnityAmount
Primary components clsLossSummary, clsLossSummaryCollection
Entry point Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummary.vb, Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummaryCollection.vb

Steps

  1. Value-date resolution. clsLossSummary exposes a ValueDate property that defaults to the current retrieval/valuation date but can be overridden by the caller before a valuation pass — the override lookup allows callers (chiefly loss valuation orchestration) to value a summary as of an arbitrary historical date rather than "now".
  2. Coverage/claim delegation. CoverageCode and IsOnlyClaimPartB are computed by delegating to same-library helpers and an external claim-data object:
  3. IsOnlyClaimPartB calls clsCoverageCombination.IsNotCoverageCombinationPartA (see Coverage combination management) to determine whether the claim is excluded from being a Part-A member, then inspects the claim's coverage code.

  4. The underlying claim coverage code and related claim attributes are retrieved via clsClaimData.

    Origin: clsClaimData is implemented in SAIF.Business.View.Claim, which is documented in its previous (pre-migration) format and has no corresponding per-operation anchor for this specific lookup. See SAIF.Business.View.Claim operations and processes. 3. Derived totals. TotalIncurredMedicalAmount and TotalPaidMedicalAmount sum the corresponding amounts across all child LossCategories. TotalIncurredIndemnityAmount and TotalPaidIndemnityAmount do the same but additionally compute a floor from any SETL-category child offset whose OffsetTypeCode is TPN (third-party-prediction, non-lien): if the summed category total is below that floor, the floor is used instead; the final result is then clamped to a minimum of zero (BR-006). 4. Retrieve. BeforeRetrieve binds ClaimID and executes (SQL-011, DUAL — the retrieval select is built from dual plus inline package-function calls rather than a direct table join): 

    Select ... From dual Where ClaimID = :ClaimID
    - AfterRetrieve: loads the returned columns, retrieves the child LossCategories collection, and calls MarkOld(). 5. Insert / update. BeforeInsert (SQL-006) and BeforeUpdate (SQL-021) against US_LOSS_SUMMARY both bind the four derived total properties — TotalIncurredMedicalAmount, TotalIncurredIndemnityAmount, TotalPaidMedicalAmount, TotalPaidIndemnityAmount — as the parameter values for INCURRED_MEDICAL_AMOUNT, INCURRED_INDEMNITY_AMOUNT, PAID_MEDICAL_AMOUNT, and PAID_INDEMNITY_AMOUNT respectively, rather than any raw backing-field amount a caller might have set directly (BR-007). - AfterInsert/AfterUpdate: standard rows-affected check; on success cascades Save() to the child LossCategories collection and calls MarkOld(). 6. Delete. BeforeDelete executes (SQL-026, US_LOSS_SUMMARY): 
    DELETE us_loss_summary Where Claim_ID = :ClaimID
    - AfterDelete: standard rows-affected check; on success calls MarkNew(). 7. Validity quirk. clsLossSummary.IsValid overwrites rather than combines its base validity: it executes Valid = MyBase.IsValid followed immediately by Valid = IsChildValid(LossCategories), so the object's final validity reflects only the child-collection check — the base class's own broken-rules result is computed but then discarded rather than being AND-combined with the child result.*

Process flow

flowchart TD
    Start([Caller requests loss-summary operation]) --> Which{Create, retrieve,<br>update, or delete?}
    Which -->|Retrieve| Ret[Select via dual + package functions]
    Ret --> LoadCat[Retrieve child LossCategories]
    LoadCat --> Loaded([clsLossSummary populated])
    Which -->|Insert or Update| Derive[Compute derived totals from LossCategories]
    Derive --> Floor{Indemnity total below<br>SETL/TPN floor?}
    Floor -->|Yes| Clamp[Raise to floor, then clamp to >= 0]
    Floor -->|No| ClampOnly[Clamp to >= 0]
    Clamp --> Bind[Bind derived totals to SQL parameters]
    ClampOnly --> Bind
    Bind --> Exec[Execute insert or update]
    Exec --> CascadeSave[Cascade Save to LossCategories]
    CascadeSave --> Done([Persisted])
    Which -->|Delete| Del[Delete by ClaimID]
    Del --> DelDone([Deleted; marked new])

Failure and edge-case behavior

  • IsValid discarding the base-class validity result means any broken business rules registered directly against clsLossSummary itself (as opposed to its children) do not block a save through the normal validity gate; this is a real quirk in the object's dirty/valid tracking rather than intentional design, based on how the assignment sequence overwrites rather than combines results.*
  • The indemnity floor/clamp logic runs on every property read, not only at save time, so any UI or caller reading TotalIncurredIndemnityAmount mid-edit sees the same floored/clamped value that will ultimately be persisted.*
  • A rows-affected value other than 1 on insert, update, or delete adds the framework's standard error/broken-rule entry rather than throwing, consistent with the pattern used elsewhere in this library.*

Note: Statements marked with * were inferred from code structure, naming conventions, or contextual evidence where direct confirmation was not available in source artifacts. Statements marked with ** could not be confirmed; treat as unknown until verified.

Sources

  • Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummary.vb
  • Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossSummaryCollection.vb