Demo Horizon Shield: insurance operations day

Demo Horizon Shield Insurance PJSC writes commercial motor and property policies across Dubai and Abu Dhabi. Premiums are billed in AED, a reinsurer settles in USD, brokers earn commissions, and claims may remain open for months. OSERP is used as the operational and financial control layer: policy data creates receivables, claims create controlled liabilities, and every settlement can be traced to a customer, risk, document, approval, and journal.

Set up the insurance operating model

Create one legal company with branches DXB-INS and AUH-INS. Use departments for underwriting, claims, finance, actuarial, and broker management. A policy is a commercial contract; a claim is an event against that contract; a payment is not proof that the claim is valid.

Master / field	Demo entry	Impact
Policy number	HS-MTR-2026-004281	Primary operational and API key
Product	Commercial motor fleet	Coverage, rates, and claim rules
Insured	Desert Star Logistics LLC	Receivable and communication owner
Broker	Crescent Risk Advisors	Commission and statement reconciliation
Currency	AED	Policy and statutory ledger currency
Effective dates	01-Jan-2026 to 31-Dec-2026	Coverage validation
Deductible	AED 10,000 per occurrence	Customer share of loss
Credit term	Net 30	Collection and suspension policy
Reinsurance treaty	Motor quota-share 20%	Recoverable and ceded premium
Claim severity	P1 total loss / P2 repair / P3 glass	Queue, reserve, and approval route

1. Create a policy and calculate premium

Open Insurance → Policy → New. The header records product, insured, broker, branch, currency, effective dates, payment plan, tax treatment, underwriter, approval status, and source quotation. Risk detail records vehicle or property, registration, location, insured value, driver or hazard attributes, deductible, exclusions, and beneficiary.

For Desert Star's 20 trucks, the annual technical premium is AED 240,000. Add a 5% risk surcharge, an AED 12,000 policy fee, and VAT according to the configured tax policy. The policy schedule shows each vehicle, chassis or registration identifier, sum insured, rate, deductible, and premium allocation. A policy cannot be bound if the effective period overlaps a cancelled policy for the same risk without an authorised endorsement.

The billing schedule creates twelve monthly installments. Store installment number, due date, amount, tax, branch, revenue dimension, and source policy. Posting the first invoice debits receivable and credits written premium, policy fee revenue, and output tax. If the product requires deferred or earned premium accounting, map the invoice to an unearned-premium account and release it by coverage period rather than recognising the whole year immediately.

2. Broker commission and receivables

The broker agreement records commission percentage, tier thresholds, withholding rules, settlement frequency, and clawback treatment. At 12% commission on AED 240,000, the expected commission is AED 28,800 before any tax or adjustment. OSERP should calculate the commission from the approved policy version, not from a spreadsheet edited after invoicing.

When the broker invoice arrives, match it to policy, period, and commission statement. A three-way check compares policy premium, broker statement, and payable calculation. Differences become a dispute case. Posting debits commission expense or acquisition cost and credits broker payable. A cancellation or endorsement creates a proportional reversal or clawback with a linked reason.

The collection dashboard shows issued, due, paid, unapplied, disputed, and overdue installments. If Desert Star pays AED 21,000 against two invoices, import the bank receipt with value date and reference, allocate by invoice, and leave any remainder unapplied. A failed payment may trigger a grace period and suspension workflow; do not silently delete the installment.

3. Endorsement and mid-term change

On 15 March, the customer adds a truck and increases the fleet sum insured. Create an endorsement rather than editing the original policy. Header fields include endorsement type, request date, effective date, initiator, approval, reason, and source policy version. Detail shows old value, new value, premium delta, tax delta, commission delta, and affected risk identifiers.

The endorsement adds AED 18,000 annualised premium. For the remaining 292 days, OSERP calculates the pro-rata delta and creates an invoice or credit according to the change. The policy timeline must show quotation, bound version, endorsement, invoice, receipt, and approval. A backdated endorsement after period lock requires a controlled reopen or adjustment journal.

4. Register and triage a claim

A customer reports a motor accident on 22 April. Create Claims → First Notice of Loss with policy number, claimant, event date, report date, location, incident type, police reference, injured-party flag, driver, vehicle registration, description, and attachments. OSERP validates that the policy was active on the event date, the vehicle was insured, and the claim is not a duplicate.

The claim header adds handler, branch, severity, coverage decision, fraud indicator, reserve currency, SLA, and status. A P2 repair claim starts with an estimated gross reserve of AED 42,000 and a deductible of AED 10,000. The net expected indemnity is AED 32,000, subject to coverage and final assessment. The handler must record why a reserve changed, who approved it, and which evidence supports the decision.

5. Reserve, assess, and approve

Create reserve lines for repair, towing, medical, legal, and external assessor costs. Each line includes amount, currency, coverage, cost centre, payee type, confidence, expected payment date, and approval. Initial reserve posting may debit claims expense and credit outstanding claims liability. A later increase from AED 42,000 to AED 55,000 posts only the delta; it must not duplicate the original reserve.

The assessor uploads estimate, photographs, and workshop quotation. The claim checklist validates policy excess, excluded damage, police report, fraud review, and customer identity. A settlement cannot be approved while a mandatory document is missing or a fraud hold is open. Role separation ensures the handler prepares, the claims manager approves, and finance releases payment.

6. Settle the claim and recover salvage

The approved settlement is AED 48,000 gross less AED 10,000 deductible, payable to the workshop. Create a payment instruction linked to claim, payee, bank account, approval, and currency. Posting debits outstanding claims liability and credits bank or claims payable when paid. If the workshop invoice includes VAT, retain the tax document and map recoverable tax according to policy.

The damaged truck has salvage value AED 6,000. Record salvage recovery as a claim recovery with buyer, expected receipt, auction reference, and status. When cash arrives, debit bank and credit recovery income or reduce claims expense based on the configured accounting policy. A recovery must be linked to the claim and not netted invisibly against the payment.

7. Reinsurance and foreign currency

Under the quota-share treaty, 20% of eligible premium and claim exposure is ceded to NorthStar Re in USD. The reinsurance record stores treaty, cession percentage, coverage, currency, effective dates, counterparty, and settlement terms. On the AED 55,000 gross reserve, the ceded share is AED 11,000. OSERP records the recoverable and ceded expense with treaty and claim dimensions.

When NorthStar settles USD 2,950, import the receipt with bank rate and treaty reference. The system applies the transaction rate, posts realised FX difference where needed, and leaves unmatched amounts in a controlled suspense account. Month-end revaluation covers open USD recoverables and payables. Never use the customer exchange rate for a reinsurer balance unless the policy explicitly requires it.

8. Fraud, privacy, and audit controls

Claims contain identity documents, medical details, and bank information. Permissions should separate view, edit, approve, export, and payment release. Mask sensitive fields in general reports. Every attachment needs document type, source, upload time, uploader, retention class, and checksum or reference.

Use duplicate detection on policy, claimant, event date, vehicle, bank account, and invoice. A fraud flag changes status to investigation and blocks settlement until an authorised reviewer clears it. The audit report should show old and new reserve, coverage decision, beneficiary change, payment approval, and any override of a validation.

9. Month-end close and management view

The controller reconciles policy billing to receivables, earned and unearned premium schedules, broker commissions, open claim reserves, paid claims, recoveries, reinsurance balances, bank, tax, and FX. A claim cannot be closed while a payment, recovery, litigation reserve, or document request remains open.

KPI	Baseline	After OSERP discipline	Improvement
Quote-to-bind turnaround	2.8 days	6 hours	91% faster
Installments matched automatically	68%	96%	+28 points
Claim first response within SLA	74%	95%	+21 points
Reserve changes without reason	11%	0.8%	93% lower
Broker statement variance	AED 420k / quarter	AED 58k	86% lower
Claim file audit retrieval	3 hours	12 minutes	93% faster

Treat these as demonstration metrics. Store the query definition and period so finance, claims, and auditors measure the same population.

Practice challenge

Create a fleet policy, generate installments and commission, post a partial receipt, add an endorsement, register a P2 claim, create two reserve revisions, approve a workshop settlement, record salvage and reinsurance recovery, and close the month. Explain every field, status, permission, journal, tax treatment, FX effect, and audit evidence. Then attempt to settle a claim with an expired policy and prove OSERP blocks it with a visible reason.

Related: Advanced GL Mapping, Multi-currency settlement, Month-end close, API library, and Coverage and verification.