Claim evidence request with overdue review

Track missing claim evidence with an internal deadline and distinguish a supportable decision from a case requiring an accountable determination. Editable collaboration with role lanes, decisions and an interrupting response timer. Illustrative policy and timing; adapt to local requirements.
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<?xml version="1.0" encoding="UTF-8"?>
<bpmn:definitions xmlns:bpmn="http://www.omg.org/spec/BPMN/20100524/MODEL" xmlns:bpmndi="http://www.omg.org/spec/BPMN/20100524/DI" xmlns:dc="http://www.omg.org/spec/DD/20100524/DC" xmlns:di="http://www.omg.org/spec/DD/20100524/DI" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="insurance_missing_evidence_definitions" targetNamespace="urn:flowss:advanced">
  <bpmn:message id="insurance_missing_evidence_message" name="Claim registered"/>
  
  <bpmn:process id="insurance_missing_evidence_process" name="Claim evidence request with overdue review" isExecutable="false">
    <bpmn:documentation>Track missing claim evidence with an internal deadline and distinguish a supportable decision from a case requiring an accountable determination. Inputs: Claim registered. All policy choices, durations and conditions are illustrative. Replace example rules with approved local policy; configure integrations and review before execution. This non-executable template does not assert legal compliance or a real completed case.</bpmn:documentation>
    <bpmn:laneSet id="insurance_missing_evidence_lanes"><bpmn:lane id="insurance_missing_evidence_lane_0" name="Claims handler"><bpmn:flowNodeRef>insurance_missing_evidence_start</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_intake_1</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_intake_2</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_wait</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_deadline</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_decision</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_success_1</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_success_rest_1</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_complete</bpmn:flowNodeRef></bpmn:lane><bpmn:lane id="insurance_missing_evidence_lane_1" name="Evidence reviewer"><bpmn:flowNodeRef>insurance_missing_evidence_checks_1</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_checks_2</bpmn:flowNodeRef></bpmn:lane><bpmn:lane id="insurance_missing_evidence_lane_2" name="Claims supervisor"><bpmn:flowNodeRef>insurance_missing_evidence_exception_entry</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_escalate</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_exception_1</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_exception_2</bpmn:flowNodeRef><bpmn:flowNodeRef>insurance_missing_evidence_alternate</bpmn:flowNodeRef></bpmn:lane></bpmn:laneSet>
    <bpmn:startEvent id="insurance_missing_evidence_start" name="Claim registered"><bpmn:messageEventDefinition id="insurance_missing_evidence_start_def" messageRef="insurance_missing_evidence_message"/></bpmn:startEvent>
    <bpmn:userTask id="insurance_missing_evidence_intake_1" name="Identify missing evidence"></bpmn:userTask>
    <bpmn:userTask id="insurance_missing_evidence_intake_2" name="Send focused evidence request"></bpmn:userTask>
    <bpmn:receiveTask id="insurance_missing_evidence_wait" name="Await requested evidence"></bpmn:receiveTask>
    <bpmn:boundaryEvent id="insurance_missing_evidence_deadline" name="Response deadline" attachedToRef="insurance_missing_evidence_wait" cancelActivity="true"><bpmn:timerEventDefinition id="insurance_missing_evidence_deadline_def"><bpmn:timeDuration xsi:type="bpmn:tFormalExpression">P21D</bpmn:timeDuration></bpmn:timerEventDefinition></bpmn:boundaryEvent>
    <bpmn:userTask id="insurance_missing_evidence_checks_1" name="Review coverage evidence"></bpmn:userTask>
    <bpmn:userTask id="insurance_missing_evidence_checks_2" name="Reconcile loss documentation"></bpmn:userTask>
    <bpmn:exclusiveGateway id="insurance_missing_evidence_decision" name="Evidence sufficient?" default="insurance_missing_evidence_flow_8"></bpmn:exclusiveGateway>
    <bpmn:userTask id="insurance_missing_evidence_success_1" name="Prepare assessed settlement"></bpmn:userTask>
    <bpmn:exclusiveGateway id="insurance_missing_evidence_exception_entry"></bpmn:exclusiveGateway>
    <bpmn:userTask id="insurance_missing_evidence_escalate" name="Escalate overdue case to owner"></bpmn:userTask>
    <bpmn:userTask id="insurance_missing_evidence_exception_1" name="Review available facts"></bpmn:userTask>
    <bpmn:userTask id="insurance_missing_evidence_exception_2" name="Issue documented next-step decision"></bpmn:userTask>
    <bpmn:endEvent id="insurance_missing_evidence_alternate" name="Supervisor decision recorded"></bpmn:endEvent>
    <bpmn:userTask id="insurance_missing_evidence_success_rest_1" name="Notify claimant of outcome"></bpmn:userTask>
    <bpmn:endEvent id="insurance_missing_evidence_complete" name="Assessment completed"></bpmn:endEvent>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_1" sourceRef="insurance_missing_evidence_start" targetRef="insurance_missing_evidence_intake_1"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_2" sourceRef="insurance_missing_evidence_intake_1" targetRef="insurance_missing_evidence_intake_2"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_3" sourceRef="insurance_missing_evidence_intake_2" targetRef="insurance_missing_evidence_wait"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_4" sourceRef="insurance_missing_evidence_wait" targetRef="insurance_missing_evidence_checks_1"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_5" sourceRef="insurance_missing_evidence_checks_1" targetRef="insurance_missing_evidence_checks_2"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_6" sourceRef="insurance_missing_evidence_checks_2" targetRef="insurance_missing_evidence_decision"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_7" sourceRef="insurance_missing_evidence_decision" targetRef="insurance_missing_evidence_success_1" name="Yes"><bpmn:conditionExpression xsi:type="bpmn:tFormalExpression">=evidenceSufficient = true</bpmn:conditionExpression></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_8" sourceRef="insurance_missing_evidence_decision" targetRef="insurance_missing_evidence_exception_entry" name="Otherwise"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_9" sourceRef="insurance_missing_evidence_deadline" targetRef="insurance_missing_evidence_escalate"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_10" sourceRef="insurance_missing_evidence_escalate" targetRef="insurance_missing_evidence_exception_entry"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_11" sourceRef="insurance_missing_evidence_exception_entry" targetRef="insurance_missing_evidence_exception_1"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_12" sourceRef="insurance_missing_evidence_exception_1" targetRef="insurance_missing_evidence_exception_2"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_13" sourceRef="insurance_missing_evidence_exception_2" targetRef="insurance_missing_evidence_alternate"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_14" sourceRef="insurance_missing_evidence_success_1" targetRef="insurance_missing_evidence_success_rest_1"></bpmn:sequenceFlow>
    <bpmn:sequenceFlow id="insurance_missing_evidence_flow_15" sourceRef="insurance_missing_evidence_success_rest_1" targetRef="insurance_missing_evidence_complete"></bpmn:sequenceFlow>
  </bpmn:process>
  <bpmn:collaboration id="insurance_missing_evidence_collaboration"><bpmn:participant id="insurance_missing_evidence_party" name="Claimant"/><bpmn:participant id="insurance_missing_evidence_pool" name="Claim evidence request with overdue review" processRef="insurance_missing_evidence_process"/><bpmn:messageFlow id="insurance_missing_evidence_request" sourceRef="insurance_missing_evidence_party" targetRef="insurance_missing_evidence_start"/><bpmn:messageFlow id="insurance_missing_evidence_response" sourceRef="insurance_missing_evidence_party" targetRef="insurance_missing_evidence_wait"/></bpmn:collaboration>
  <bpmndi:BPMNDiagram id="insurance_missing_evidence_diagram"><bpmndi:BPMNPlane id="insurance_missing_evidence_plane" bpmnElement="insurance_missing_evidence_collaboration">
    <bpmndi:BPMNShape id="insurance_missing_evidence_party_di" bpmnElement="insurance_missing_evidence_party" isHorizontal="true"><dc:Bounds x="20" y="20" width="2420" height="70"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_pool_di" bpmnElement="insurance_missing_evidence_pool" isHorizontal="true"><dc:Bounds x="20" y="180" width="2420" height="780"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_lane_0_di" bpmnElement="insurance_missing_evidence_lane_0" isHorizontal="true"><dc:Bounds x="50" y="180" width="2390" height="260"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_lane_1_di" bpmnElement="insurance_missing_evidence_lane_1" isHorizontal="true"><dc:Bounds x="50" y="440" width="2390" height="260"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_lane_2_di" bpmnElement="insurance_missing_evidence_lane_2" isHorizontal="true"><dc:Bounds x="50" y="700" width="2390" height="260"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_start_di" bpmnElement="insurance_missing_evidence_start"><dc:Bounds x="162" y="292" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="108" y="335" width="144" height="40"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_intake_1_di" bpmnElement="insurance_missing_evidence_intake_1"><dc:Bounds x="325" y="272" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_intake_2_di" bpmnElement="insurance_missing_evidence_intake_2"><dc:Bounds x="535" y="272" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_wait_di" bpmnElement="insurance_missing_evidence_wait"><dc:Bounds x="745" y="272" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_deadline_di" bpmnElement="insurance_missing_evidence_deadline"><dc:Bounds x="833" y="330" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="703" y="373" width="144" height="40"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_checks_1_di" bpmnElement="insurance_missing_evidence_checks_1"><dc:Bounds x="955" y="532" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_checks_2_di" bpmnElement="insurance_missing_evidence_checks_2"><dc:Bounds x="1165" y="532" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_decision_di" bpmnElement="insurance_missing_evidence_decision" isMarkerVisible="true"><dc:Bounds x="1416" y="286" width="48" height="48"/><bpmndi:BPMNLabel><dc:Bounds x="1368" y="236" width="144" height="40"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_success_1_di" bpmnElement="insurance_missing_evidence_success_1"><dc:Bounds x="1585" y="272" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_exception_entry_di" bpmnElement="insurance_missing_evidence_exception_entry" isMarkerVisible="true"><dc:Bounds x="1626" y="806" width="48" height="48"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_escalate_di" bpmnElement="insurance_missing_evidence_escalate"><dc:Bounds x="955" y="792" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_exception_1_di" bpmnElement="insurance_missing_evidence_exception_1"><dc:Bounds x="1795" y="792" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_exception_2_di" bpmnElement="insurance_missing_evidence_exception_2"><dc:Bounds x="2005" y="792" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_alternate_di" bpmnElement="insurance_missing_evidence_alternate"><dc:Bounds x="2262" y="812" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="2208" y="855" width="144" height="40"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_success_rest_1_di" bpmnElement="insurance_missing_evidence_success_rest_1"><dc:Bounds x="1795" y="272" width="130" height="76"/></bpmndi:BPMNShape>
    <bpmndi:BPMNShape id="insurance_missing_evidence_complete_di" bpmnElement="insurance_missing_evidence_complete"><dc:Bounds x="2052" y="292" width="36" height="36"/><bpmndi:BPMNLabel><dc:Bounds x="1998" y="335" width="144" height="40"/></bpmndi:BPMNLabel></bpmndi:BPMNShape>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_1_di" bpmnElement="insurance_missing_evidence_flow_1"><di:waypoint x="198" y="310"/><di:waypoint x="325" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_2_di" bpmnElement="insurance_missing_evidence_flow_2"><di:waypoint x="455" y="310"/><di:waypoint x="535" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_3_di" bpmnElement="insurance_missing_evidence_flow_3"><di:waypoint x="665" y="310"/><di:waypoint x="745" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_4_di" bpmnElement="insurance_missing_evidence_flow_4"><di:waypoint x="875" y="310"/><di:waypoint x="915" y="310"/><di:waypoint x="915" y="570"/><di:waypoint x="955" y="570"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_5_di" bpmnElement="insurance_missing_evidence_flow_5"><di:waypoint x="1085" y="570"/><di:waypoint x="1165" y="570"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_6_di" bpmnElement="insurance_missing_evidence_flow_6"><di:waypoint x="1295" y="570"/><di:waypoint x="1356" y="570"/><di:waypoint x="1356" y="310"/><di:waypoint x="1416" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_7_di" bpmnElement="insurance_missing_evidence_flow_7"><di:waypoint x="1464" y="310"/><di:waypoint x="1585" y="310"/><bpmndi:BPMNLabel><dc:Bounds x="1472" y="283" width="100" height="22"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_8_di" bpmnElement="insurance_missing_evidence_flow_8"><di:waypoint x="1464" y="310"/><di:waypoint x="1545" y="310"/><di:waypoint x="1545" y="830"/><di:waypoint x="1626" y="830"/><bpmndi:BPMNLabel><dc:Bounds x="1472" y="320" width="100" height="22"/></bpmndi:BPMNLabel></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_9_di" bpmnElement="insurance_missing_evidence_flow_9"><di:waypoint x="869" y="348"/><di:waypoint x="912" y="348"/><di:waypoint x="912" y="830"/><di:waypoint x="955" y="830"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_10_di" bpmnElement="insurance_missing_evidence_flow_10"><di:waypoint x="1085" y="830"/><di:waypoint x="1626" y="830"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_11_di" bpmnElement="insurance_missing_evidence_flow_11"><di:waypoint x="1674" y="830"/><di:waypoint x="1795" y="830"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_12_di" bpmnElement="insurance_missing_evidence_flow_12"><di:waypoint x="1925" y="830"/><di:waypoint x="2005" y="830"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_13_di" bpmnElement="insurance_missing_evidence_flow_13"><di:waypoint x="2135" y="830"/><di:waypoint x="2262" y="830"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_14_di" bpmnElement="insurance_missing_evidence_flow_14"><di:waypoint x="1715" y="310"/><di:waypoint x="1795" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_flow_15_di" bpmnElement="insurance_missing_evidence_flow_15"><di:waypoint x="1925" y="310"/><di:waypoint x="2052" y="310"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_request_di" bpmnElement="insurance_missing_evidence_request"><di:waypoint x="180" y="90"/><di:waypoint x="180" y="292"/></bpmndi:BPMNEdge>
    <bpmndi:BPMNEdge id="insurance_missing_evidence_response_di" bpmnElement="insurance_missing_evidence_response"><di:waypoint x="810" y="90"/><di:waypoint x="810" y="272"/></bpmndi:BPMNEdge>
  </bpmndi:BPMNPlane></bpmndi:BPMNDiagram>
</bpmn:definitions>