Genesis claims operations
Genesis Protect Acute does not present claim review as a black box.
The current launch model is explicit:
- Phase 0 is operator-backed review
- later AI recommendation is follow-on work
- more governance-visible dispute handling is roadmap, not a current public promise
Use this page when you need the Genesis Protect claim-review posture: what evidence is expected, what is reviewed by operators, what stays offchain, what gets anchored, and how holds or disputes should be described.
Genesis Protect Acute uses bounded, operator-backed review in Phase 0. AI recommendations and more governance-visible dispute handling may support later phases, but they are not the current public claim-review promise.
What members submit
For the current Genesis Protect Acute scope, members should expect to provide:
- invoice or itemized bill
- discharge summary or doctor note
- proof of payment
- location and date proof
Evidence expectations can vary by published SKU or cohort terms, but the public posture should stay simple: claims need enough evidence to connect the acute event, active cover window, location/date boundary, and claimed payout path.
Phase 0 review path
| Step | What happens | Public boundary |
|---|---|---|
| Submit | A member submits a claim for Travel 30 or Event 7. | Claim intake depends on active eligibility and product availability. |
| Package | Evidence is normalized against the published acute-claim schema. | Raw medical documents and personal details stay offchain. |
| Review | Operator-backed review checks evidence, waiting periods, exclusions, and payout posture. | This is not fully decentralized claim review today. |
| Hold or decide | A case can be approved, denied, or held for more review. | Holds are legitimate when evidence or boundary checks are incomplete. |
| Anchor | Approved economic consequences can be anchored into protocol state. | The protocol sees claim state, evidence references, adjudication, reserve, and payout effects rather than raw documents. |
| Resolve | Denied, held, or appealed cases remain part of the review trail. | The case should not disappear into hidden support workflow once economically material. |
What stays offchain
- Raw medical documents
- Personally identifying medical details
- Operator workflow notes
- Internal escalation context
- Full AI or human reasoning traces
What gets anchored into protocol state
- Claim-case state
- Evidence references or commitments
- Claim attestation and adjudication consequences
- Obligation reserve and payout state
OmegaX does not need raw evidence onchain to make the economic path legible.
Holds, disputes, and appeals
Not every claim should finalize immediately. Genesis Protect Acute can legitimately pause or challenge a claim when:
- required evidence is missing
- the event appears outside the waiting period or exclusion boundary
- the case is low-confidence and needs more review
- the evidence package conflicts with the claimed payout path
| State | Meaning |
|---|---|
| Submitted | The claim is ready for operator review. |
| Held | Evidence, confidence, or boundary issues need more review. |
| Disputed | The case needs a clearer operator decision. |
| Appealed or re-reviewed | New evidence or corrections materially change the case. |
| Resolved | The claim is approved, denied, or closed without payout. |
The important public point is that dispute handling exists, but it remains a bounded operator-governed process during the current launch window rather than a fully decentralized public review market.
Phase roadmap
| Phase | Public description |
|---|---|
| Phase 0 | Operator-backed oracle review for the bounded launch window |
| Phase 1 | AI recommendation can help classify and prioritize claims, with human review still available |
| Phase 2 | More explicit claims-operator and governance-visible dispute handling can emerge later |
What each reader should take away
- Members should expect a real evidence review path, not instant blind automation.
- Sponsors should expect claims to stay bounded by published terms, staffing readiness, and explicit evidence requirements.
- LPs should expect claim review, reserve booking, and payout state to remain legible enough to audit.
- Operators should not imply that claim review is already fully automated, fully decentralized, or hands-off.