Loss valuation orchestration

clsLossValuation.ValueLossSummary is the central orchestration point of this library: given a claim ID, it determines the claim's cost basis, computes non-duplication (ND) reimbursement, and creates the offset rows (fraud recovery, refund, third-party prediction, and either voided-claim or ND-reimbursement offsets) that ultimately drive the Loss summary maintenance totals. Several helper classes (clsFraudRecovery, clsRefund, clsThirdPartyPrediction, clsNDReimbursement, clsVoidedClaimOffsets) each implement one stage of this pipeline via a shared CreateOffsets convention.

Field	Value
Operation ID	OP-USC-05
Trigger	clsLossValuation.ValueLossSummary(dpi, claimID)
Inputs	ClaimID
Outputs	A set of US_LOSS_CATEGORY_OFFSET rows attached to the claim's loss categories, ready to be summed by Loss summary maintenance
Primary components	clsLossValuation, clsFraudRecovery, clsRefund, clsThirdPartyPrediction, clsNDReimbursement, clsVoidedClaimOffsets
Entry point	Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsLossValuation.vb

Steps

1. Load claim data and reserves. ValueLossSummary retrieves the claim's core data and reserve history to establish context for the rest of the pipeline.

Origin: clsClaimData and clsClaimReservesCollection are implemented in SAIF.Business.View.Claim, documented in its previous (pre-migration) format with no matching per-operation anchor for these specific retrievals. See SAIF.Business.View.Claim operations and processes. 2. Determine claim cost basis. GetClaimCostsBasis computes the basis amounts used later for offset math. This method contains a comparison bug: the branch intended to distinguish "chargeable expense greater than reserve" from the opposite case repeats the same > operator in both branches of the conditional, so the "less than or equal" branch is unreachable/never taken as written — the intended <= case is masked by the duplicated > comparison.* 3. Determine valuation dates. GetValuationDates and GetLastReserveChange establish the as-of dates used to bound the offset calculations that follow, delegating in part to UnitStatServices.

Origin: UnitStatServices is implemented in SAIF.Business (migrated to the new format), but no operation on that page specifically matches this valuation-date helper. See SAIF.Business operations and processes. 4. Reset prior offsets. Before recomputing, the valuation pipeline resets/clears any previously-created offsets for the categories it is about to recompute, so repeated valuation runs do not stack duplicate offsets from prior passes.* 5. Compute ND reimbursement basis. The non-duplication reimbursement amount is computed from the cost basis and reserve data established in steps 1–3, feeding into the later clsNDReimbursement.CreateOffsets call (step 8, non-void branch only). 6. Create fraud-recovery offsets (always). clsFraudRecovery.CreateOffsets is called unconditionally, delegating to GetFraudRecoveryDate (SQL-010, PK73304_LOSS_SUMMARY.get_fraud_recovery_date). However, CreateFullyFraudulentOffsets and CreatePartialFraudulentOffsets both begin with an always-true early-return guard — If Not clmData.PolicyNumber = 2 Or Not clmData.PolicyNumber = 3 Then Return True is true for every possible single-valued PolicyNumber (a policy number cannot simultaneously equal both 2 and 3, so at least one Not term is always true), so these two methods return immediately and never create an offset row in current code — they are effectively dead/no-op logic despite being called on every valuation.* 7. Create refund offsets (always). clsRefund.CreateOffsets is called unconditionally, delegating to GetRefundDates (SQL-013, PK73304_LOSS_SUMMARY.get_refund_dates) to determine the applicable refund date window before creating offset rows. 8. Create third-party-prediction offsets (always). clsThirdPartyPrediction.CreateOffsets is called unconditionally. It retrieves prediction data via PK73304_LOSS_SUMMARY.get_thirdparty_prediction (SQL-014 / SQL-015, duplicate-named overloads for different parameter sets) and an inline lookup against dual (SQL-016). It also consults case and lien/settlement data from a sibling library:

Origin: clsThrdpartyPredictionDetailCollection and clsThrdpartyLienCategoryCollection are implemented in SAIF.Business.Claim.ThirdParty (migrated to the new format). See Run case search and predictions and Manage liens and settlements.

CreateNonLienOffsets contains an unreachable branch: a condition guarding one of its offset-creation paths is structured so that the alternate path can never be reached given the values it is compared against, meaning only one of the two intended offset-creation code paths is ever exercised.* 9. Branch on claim status: void vs. active. After the three unconditional offset-creation calls above, ValueLossSummary branches on the claim's status code (BR-008): - If claimData.StatusCode = "V" (Void): calls clsVoidedClaimOffsets.CreateOffsets only, which creates a single reversal-style offset from the claim's most recent payment (offset type VoidedClaims) rather than layering further amounts. - Otherwise: calls clsNDReimbursement.CreateOffsets, which uses the ND reimbursement basis computed in step 5 (SQL-012, PK73304_LOSS_SUMMARY.get_final_denial_dates) to create the final layer of offsets for an active claim. 10. Downstream consumption. The offsets created in steps 6–9 are attached as US_LOSS_CATEGORY_OFFSET children of the claim's US_LOSS_CATEGORY rows and are summed (with the SETL/TPN floor logic) by Loss summary maintenance when the loss summary's derived totals are next computed or persisted.

Process flow

flowchart TD
    Start([ValueLossSummary invoked]) --> Load[Load claim data and reserves]
    Load --> Basis[Compute claim cost basis]
    Basis --> Dates[Determine valuation dates]
    Dates --> Reset[Reset prior offsets for recomputed categories]
    Reset --> NDBasis[Compute ND reimbursement basis]
    NDBasis --> Fraud[Create fraud-recovery offsets - unconditional, effectively no-op]
    Fraud --> Refund[Create refund offsets - unconditional]
    Refund --> ThirdParty[Create third-party-prediction offsets - unconditional]
    ThirdParty --> StatusCheck{Claim status = Void?}
    StatusCheck -->|Yes| Voided[Create voided-claim offset only]
    StatusCheck -->|No| NDReimb[Create ND reimbursement offsets]
    Voided --> Done([Offsets attached to loss categories])
    NDReimb --> Done

Failure and edge-case behavior

• GetClaimCostsBasis's duplicated > comparison means the branch intended for the "less than or equal to reserve" case is unreachable as written; downstream cost-basis values may not reflect the originally-intended logic for that scenario.*
• CreateFullyFraudulentOffsets and CreatePartialFraudulentOffsets never execute their offset-creation logic due to an always-true early-return guard — fraud-recovery offsets from these two paths do not currently get created regardless of claim data, even though the surrounding orchestration calls them on every valuation.*
• CreateNonLienOffsets's unreachable branch means only one of its two intended offset-creation paths is exercised in current code.*
• The void/active branch is mutually exclusive per BR-008: a voided claim never receives ND-reimbursement offsets, and an active claim never receives the voided-claim reversal offset.

Related documentation

• Operations and processes
• Business rules
• SQL catalog
• Database tables

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\clsLossValuation.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsFraudRecovery.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsRefund.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsThirdPartyPrediction.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsNDReimbursement.vb
• Business\SAIF.Business.UnitStat.Claim\Loss Summary\clsVoidedClaimOffsets.vb