Description
Late-claim interest check — insurers owe STATUTORY INTEREST when they pay late, and most policyholders never collect it. Deterministic day-count math: TX 18%/yr + fees (weather claims prime+5 w/ 542A notice), FL property from the NOTICE date (CFO quarterly table), NY no-fault 2%/month, AZ 10%, GA health 12%, CA health 15% + auto-include penalty. ERISA self-funded gate, clean-claim assumptions stated, limitations gates. Honest-no where the interest belongs to the provider. No LLM.
Parameters
{
"properties": {
"acted_within_30_of_denial": {
"description": "NY-PIP: was arbitration/suit filed within 30 days of denial",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"all_items_date": {
"description": "TX: date all requested items were provided",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"amount_paid": {
"description": "USD partial payment",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"claim_amount": {
"description": "USD claim amount from your records",
"required": true,
"type": "string",
"x-parameter-location": "query"
},
"claim_received_date": {
"description": "YYYY-MM-DD the insurer received the claim/notice/proof of loss",
"required": true,
"type": "string",
"x-parameter-location": "query"
},
"claim_type": {
"description": "property | auto | health | disability | life",
"required": true,
"type": "string",
"x-parameter-location": "query"
},
"date_of_loss": {
"description": "FL: the 5-yr limitations clock runs from the date of loss",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"denial_date": {
"description": "NY-PIP: denial date (drives the 65-3.9(c) interest toll)",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"hmo_plan": {
"description": "CA: true for Knox-Keene/DMHC plans",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"interest_included": {
"description": "auto-pay lanes: did the payment include the interest",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"paid_date": {
"description": "YYYY-MM-DD paid (omit if unpaid)",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"plan_funding": {
"description": "health: fully_insured | self_funded | government | church | unknown (ERISA gate)",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"state": {
"description": "US state code (TX|FL|NY|AZ|GA|CA computed; LA|CO flagged; NJ|WA honest-no)",
"required": true,
"type": "string",
"x-parameter-location": "query"
},
"submission_method": {
"description": "GA: electronic | paper (deadline fork)",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"submitted_by": {
"description": "insured_reimbursement | provider_assigned",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"third_party": {
"description": "true if claiming against someone ELSE's insurer (honest-no)",
"required": false,
"type": "string",
"x-parameter-location": "query"
},
"weather_related": {
"description": "TX property: true for hail/wind/hurricane (ch. 542A lane) — REQUIRED for TX property",
"required": false,
"type": "string",
"x-parameter-location": "query"
}
},
"required": [
"state",
"claim_type",
"claim_received_date",
"claim_amount"
],
"type": "object"
}
