Claims & Settlement
OmegaX supports reward outcomes and coverage payouts. Coverage requires more than a payout trigger: it needs claim state, evidence references, review authority, reserve booking, and settlement.
Use this page to understand how claims become auditable economic objects.
The current public protocol surface supports claim cases, evidence references, claim attestations, adjudication, obligations, reserve booking, and settlement paths. Product availability and claim-review staffing are still product-specific boundaries.
Reward versus coverage claims
Reward claims are usually:
- faster
- simpler
- tied to recognized outcome completion
Coverage claims are often:
- more stateful
- more evidence-sensitive
- more connected to reserve and review logic
Both reconcile to one shared accounting foundation.
One accounting layer keeps rewards and coverage from splitting into separate products with inconsistent reserve truth.
What a claim needs to express
A serious claim object may carry:
- intake status
- review state
- approval or denial outcome
- payout consequence
- reserve booking and release
- appeal or recovery context
The point is to make the lifecycle visible. Once a claim becomes economically important, its status, reserve effect, and settlement consequence should be legible from the protocol model.
How a claim moves through the system
While products differ, the current reviewed coverage-claim flow in the public protocol surface follows this shape:
| Step | What happens |
|---|---|
| 1 | A member submits a coverage claim. |
| 2 | Evidence and decision-support references are attached to the claim case. |
| 3 | One or more schema-bound oracle attestations can be anchored against the active claim case. |
| 4 | An authorized adjudicator reviews the claim in light of the claim state and attestation path. |
| 5 | If approved, the protocol reserves and settles the related obligation through the supported payout path. |
| 6 | The claim is closed once the case is resolved. |
In the current public protocol, day-to-day claim actions are delegated through approved oracle and adjudicator keys. Governance remains the control layer for broader protocol and pool policy. SDK claim-intent validation and protocol-bound oracle attestations help intake services reject replayed, stale, wrong-signer, or wrong-context evidence before settlement.
For the current Genesis Protect launch wording around evidence review, disputes, and reserve-backed payouts, use:
Interoperability and coding for richer claims
Not every OmegaX claim needs the deepest healthcare-administration model. Published coverage workflows anchor normalized references and commitments, not raw medical records. Any clinical coding stays offchain inside approved evidence workflows.
The protocol anchors:
- references
- commitments
- adjudication consequences
- reserve and payout effects
That keeps OmegaX interoperable without turning it into a raw medical-record database.
Why premium records matter
Claims do not stand alone.
Coverage products also depend on explicit premium or contribution records:
- what was due
- what was paid
- what was attested offchain
- what grace or delinquency state applies
That is what makes claims enforceable instead of interpretive.
Why reserve-aware settlement matters
Settlement does not pay from ambiguous balances.
Claims and payouts need to reconcile against:
- explicit reserve state
- plan risk controls
- free-capital constraints
- policy-valid status transitions
That is how OmegaX stays economically honest as product depth increases.
Claim funding checks
Claim approval and claim funding are separate checks.
Funding checks distinguish:
- direct capacity in the settlement mint
- available funding-line capacity
- already reserved or payable obligations
- pending obligations
- queued LP redemptions
- LP allocation capacity that can be reserved before settlement
- other reserve assets that may provide context but cannot settle the claim until a priced, haircut-aware conversion or funding action happens
Other reserve assets do not increase immediately settleable settlement-mint capacity by themselves.
Why this matters to members and sponsors
Members need a system where claim rights are legible and review does not feel arbitrary.
Sponsors and operators need a system where reserve, payout, and denial behavior can be explained and audited.
That is why claims and settlement are central to the public OmegaX story, not only an implementation detail.