# WIA-FIN-005: InsurTech Standard Specification v1.0

**Status**: Final
**Version**: 1.0.0
**Published**: 2025-01-01
**Authors**: WIA Standards Committee
**License**: MIT

---

## Abstract

This document specifies the WIA-FIN-005 InsurTech Standard, a comprehensive framework for implementing insurance technology solutions. It defines standardized data formats, API interfaces, security protocols, and integration patterns for insurance operations including policy management, claims processing, underwriting, and risk analytics.

## Table of Contents

1. [Introduction](#1-introduction)
2. [Scope](#2-scope)
3. [Data Models](#3-data-models)
4. [API Specification](#4-api-specification)
5. [Security](#5-security)
6. [Integration](#6-integration)
7. [Compliance](#7-compliance)
8. [Implementation](#8-implementation)

---

## 1. Introduction

### 1.1 Purpose

The WIA-FIN-005 standard enables interoperability in the insurance technology ecosystem by providing standardized interfaces for:

- Policy lifecycle management
- Claims processing and settlement
- Automated underwriting and risk assessment
- Real-time analytics and reporting
- Integration with IoT devices and blockchain networks

### 1.2 Philosophy

Built on the principle of **弘益人間 (Benefit All Humanity)**, this standard aims to make insurance more accessible, affordable, transparent, and efficient for everyone.

### 1.3 Key Benefits

- **Interoperability**: Seamless integration across insurance platforms
- **Automation**: AI-powered underwriting and claims processing
- **Transparency**: Blockchain-based immutable records
- **Innovation**: Support for new insurance models (parametric, P2P, on-demand)
- **Compliance**: Built-in regulatory compliance mechanisms

---

## 2. Scope

### 2.1 Covered Areas

This standard covers:

- **Policy Management**: Creation, modification, renewal, cancellation
- **Claims Processing**: Filing, validation, fraud detection, settlement
- **Underwriting**: Risk assessment, pricing, approval decisions
- **Customer Management**: Identity verification, profile management
- **Analytics**: Risk modeling, performance metrics, reporting
- **Integration**: IoT devices, blockchain, legacy systems

### 2.2 Insurance Types

Supported insurance products:

- Life Insurance (term, whole, universal, variable)
- Auto Insurance (liability, collision, comprehensive, telematics-based)
- Health Insurance (individual, group, supplemental)
- Property Insurance (homeowners, renters, commercial)
- Travel Insurance (trip cancellation, medical, baggage)
- Cyber Insurance (data breach, business interruption)

---

## 3. Data Models

### 3.1 Policy Object

```json
{
  "policyId": "string (POL-YYYY-XXXXXX)",
  "type": "enum (life|auto|health|property|travel|cyber)",
  "status": "enum (pending|active|suspended|cancelled|expired)",
  "holder": {
    "customerId": "string",
    "name": "string",
    "dateOfBirth": "date (YYYY-MM-DD)",
    "contact": {
      "email": "string",
      "phone": "string",
      "address": {
        "street": "string",
        "city": "string",
        "state": "string",
        "zipCode": "string",
        "country": "string"
      }
    }
  },
  "coverage": {
    "amount": "number",
    "currency": "string (ISO 4217)",
    "deductible": "number",
    "effectiveDate": "date",
    "expirationDate": "date",
    "limits": {
      "annual": "number",
      "perIncident": "number"
    }
  },
  "premium": {
    "annual": "number",
    "monthly": "number",
    "paymentFrequency": "enum (monthly|quarterly|annually)",
    "paymentMethod": "enum (credit_card|bank_transfer|crypto)",
    "nextPaymentDue": "date"
  },
  "underwriting": {
    "riskScore": "number (0-100)",
    "riskLevel": "enum (low|medium|high)",
    "factors": ["array of strings"],
    "assessedBy": "enum (human|ai|hybrid)",
    "assessmentDate": "datetime"
  },
  "beneficiaries": [{
    "name": "string",
    "relationship": "string",
    "percentage": "number (0-100)"
  }],
  "riders": [{
    "type": "string",
    "description": "string",
    "premium": "number"
  }],
  "metadata": {
    "createdAt": "datetime",
    "updatedAt": "datetime",
    "version": "number"
  }
}
```

### 3.2 Claim Object

```json
{
  "claimId": "string (CLM-YYYY-XXXXXX)",
  "policyId": "string",
  "type": "enum (accident|health|property|life|cyber)",
  "status": "enum (submitted|reviewing|approved|denied|paid)",
  "incidentDate": "date",
  "reportedDate": "datetime",
  "description": "string",
  "amount": {
    "claimed": "number",
    "approved": "number",
    "deductible": "number",
    "payout": "number"
  },
  "assessment": {
    "fraudScore": "number (0-100)",
    "fraudRisk": "enum (low|medium|high)",
    "autoApproved": "boolean",
    "assessor": "string (human|ai)",
    "reviewedDate": "datetime",
    "notes": "string"
  },
  "documents": [{
    "type": "enum (photo|receipt|report|medical)",
    "url": "string",
    "uploadedAt": "datetime"
  }],
  "payment": {
    "method": "enum (check|bank_transfer|crypto)",
    "status": "enum (pending|processing|completed|failed)",
    "transactionId": "string",
    "paidAt": "datetime"
  },
  "metadata": {
    "createdAt": "datetime",
    "updatedAt": "datetime",
    "version": "number"
  }
}
```

### 3.3 Customer Object

```json
{
  "customerId": "string (CUST-XXXXXX)",
  "profile": {
    "name": "string",
    "dateOfBirth": "date",
    "gender": "enum (male|female|other|prefer_not_to_say)",
    "occupation": "string",
    "contact": { /* same as policy holder */ }
  },
  "riskProfile": {
    "overallScore": "number (0-100)",
    "healthRisk": "number",
    "drivingRisk": "number",
    "lifestyleRisk": "number",
    "lastAssessed": "datetime"
  },
  "policies": ["array of policyIds"],
  "claims": ["array of claimIds"],
  "preferences": {
    "communicationChannel": "enum (email|sms|app)",
    "language": "string (ISO 639-1)"
  },
  "consent": {
    "dataProcessing": "boolean",
    "marketingCommunications": "boolean",
    "iotDataCollection": "boolean",
    "consentDate": "datetime"
  },
  "metadata": {
    "createdAt": "datetime",
    "updatedAt": "datetime"
  }
}
```

### 3.4 Underwriting Assessment

```json
{
  "assessmentId": "string",
  "applicationId": "string",
  "applicant": { /* customer profile */ },
  "insuranceType": "string",
  "requestedCoverage": "number",
  "riskFactors": [{
    "category": "string",
    "factor": "string",
    "impact": "enum (positive|neutral|negative)",
    "score": "number"
  }],
  "mlModelResults": {
    "modelVersion": "string",
    "prediction": "string",
    "confidence": "number (0-1)",
    "features": { /* model features */ }
  },
  "decision": {
    "approved": "boolean",
    "riskScore": "number",
    "recommendedPremium": "number",
    "conditions": ["array of strings"],
    "decisionDate": "datetime"
  }
}
```

---

## 4. API Specification

### 4.1 Base URL

```
Production: https://api.wia.org/v1/insurtech
Sandbox: https://sandbox-api.wia.org/v1/insurtech
```

### 4.2 Authentication

All API requests require Bearer token authentication:

```
Authorization: Bearer YOUR_API_KEY
```

### 4.3 Policy Endpoints

#### 4.3.1 Generate Quote

```
POST /quotes
```

**Request:**
```json
{
  "type": "auto",
  "applicant": {
    "age": 35,
    "location": "New York, NY",
    "occupation": "Software Engineer"
  },
  "coverage": {
    "amount": 100000,
    "deductible": 500
  },
  "term": 12
}
```

**Response:**
```json
{
  "quoteId": "QTE-2025-ABC123",
  "premium": {
    "annual": 1200.00,
    "monthly": 105.00
  },
  "riskScore": 28,
  "riskLevel": "low",
  "validUntil": "2025-02-01T00:00:00Z"
}
```

#### 4.3.2 Create Policy

```
POST /policies
```

**Request:**
```json
{
  "quoteId": "QTE-2025-ABC123",
  "holder": { /* customer details */ },
  "paymentMethod": "credit_card",
  "startDate": "2025-01-15"
}
```

**Response:**
```json
{
  "policyId": "POL-2025-XYZ789",
  "status": "active",
  "coverage": { /* coverage details */ },
  "premium": { /* premium details */ }
}
```

#### 4.3.3 Get Policy

```
GET /policies/{policyId}
```

#### 4.3.4 Update Policy

```
PUT /policies/{policyId}
```

#### 4.3.5 Cancel Policy

```
DELETE /policies/{policyId}
```

### 4.4 Claims Endpoints

#### 4.4.1 File Claim

```
POST /claims
```

**Request:**
```json
{
  "policyId": "POL-2025-XYZ789",
  "type": "accident",
  "incidentDate": "2025-12-20",
  "description": "Minor collision at intersection",
  "claimedAmount": 5000,
  "documents": [{
    "type": "photo",
    "url": "https://storage.example.com/photos/abc123.jpg"
  }]
}
```

**Response:**
```json
{
  "claimId": "CLM-2025-999",
  "status": "reviewing",
  "assessment": {
    "fraudScore": 12.5,
    "fraudRisk": "low",
    "autoApproved": false
  },
  "estimatedProcessingTime": "2-4 hours"
}
```

#### 4.4.2 Get Claim Status

```
GET /claims/{claimId}
```

#### 4.4.3 Update Claim

```
PATCH /claims/{claimId}
```

### 4.5 Underwriting Endpoints

#### 4.5.1 Request Underwriting

```
POST /underwriting
```

#### 4.5.2 Get Assessment

```
GET /underwriting/{assessmentId}
```

### 4.6 Analytics Endpoints

#### 4.6.1 Get Risk Profile

```
GET /customers/{customerId}/risk-profile
```

#### 4.6.2 Get Policy Analytics

```
GET /analytics/policies
```

---

## 5. Security

### 5.1 Authentication

- OAuth 2.0 / OAuth 2.1
- API Keys with rate limiting
- Multi-factor authentication for sensitive operations

### 5.2 Encryption

- TLS 1.3 for data in transit
- AES-256 for data at rest
- End-to-end encryption for PII fields
- Field-level encryption for sensitive data

### 5.3 Access Control

- Role-Based Access Control (RBAC)
- Principle of least privilege
- Audit logging for all operations
- Session management and timeout

### 5.4 Data Privacy

- GDPR compliance mechanisms
- Right to erasure implementation
- Data portability support
- Consent management

---

## 6. Integration

### 6.1 IoT Integration

Support for telematics devices, smart home sensors, wearables:

```json
{
  "deviceId": "string",
  "policyId": "string",
  "dataType": "enum (telematics|health|property)",
  "readings": [{
    "timestamp": "datetime",
    "metrics": { /* device-specific metrics */ }
  }]
}
```

### 6.2 Blockchain Integration

Smart contract templates for parametric insurance:

- Oracle integration for external data
- Automated claim settlement
- Immutable policy records

### 6.3 Legacy Systems

Integration patterns for existing insurance core systems:

- API adapters
- Data transformation
- Event streaming
- Batch processing

---

## 7. Compliance

### 7.1 Regulatory Requirements

- GDPR (EU General Data Protection Regulation)
- HIPAA (Health Insurance Portability and Accountability Act)
- CCPA/CPRA (California privacy laws)
- Insurance-specific regulations by jurisdiction

### 7.2 Audit Trail

All operations must maintain:

- User identity
- Timestamp
- Action performed
- Data before/after
- IP address
- Success/failure status

---

## 8. Implementation

### 8.1 SDK Support

Official SDKs available for:

- TypeScript/JavaScript
- Python
- Java
- Go
- Rust

### 8.2 Testing

- Sandbox environment for testing
- Mock data generators
- Integration test suites
- Load testing tools

### 8.3 Deployment

- Docker containers
- Kubernetes manifests
- Terraform configurations
- CI/CD pipelines

---

## Appendix A: Error Codes

| Code | Description |
|------|-------------|
| 400 | Bad Request - Invalid input |
| 401 | Unauthorized - Missing or invalid authentication |
| 403 | Forbidden - Insufficient permissions |
| 404 | Not Found - Resource does not exist |
| 409 | Conflict - Resource already exists |
| 422 | Unprocessable Entity - Validation failed |
| 429 | Too Many Requests - Rate limit exceeded |
| 500 | Internal Server Error |
| 503 | Service Unavailable |

## Appendix B: Glossary

- **Underwriting**: Process of evaluating risk and determining premium
- **Premium**: Amount paid for insurance coverage
- **Claim**: Request for payment under an insurance policy
- **Deductible**: Amount policyholder pays before insurance covers remainder
- **Risk Score**: Numerical assessment of insurance risk (0-100)
- **Telematics**: Technology that monitors vehicle usage and driving behavior

---

**© 2025 SmileStory Inc. / WIA**
**弘益人間 (홍익인간) · Benefit All Humanity**