259 lines
11 KiB
Python
259 lines
11 KiB
Python
# -*- coding: utf-8 -*-
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"""通用模块"""
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from decimal import Decimal, ROUND_HALF_UP
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from pathlib import Path
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import sys
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from typing import Any, Dict, List
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from common import masterdata, rules_engine
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sys.path.append(Path(__file__).parent.parent.as_posix())
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from utils.html_render import HTMLRenderer
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def case_adjust(dossier: Dict[str, Any]) -> None:
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"""
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理算赔案并整合至赔案档案
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:param dossier: 赔案档案
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:return: 无
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"""
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# 基于拒付决策规则评估
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if not (result := rules_engine.evaluate(decision="拒付", inputs=dossier)):
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raise RuntimeError("该保险分公司未配置拒付规则")
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dossier["adjustment_layer"].update(
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{
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"conclusion": (conclusion := result["conclusion"]), # 理赔结论
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"explanation": result["explanation"], # 结论说明
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}
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)
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if conclusion == "拒付":
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return
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# 就票据层按照开票日期和票据号顺序排序
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dossier["receipts_layer"].sort(key=lambda x: (x["date"], x["number"]))
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# 遍历票据层内所有票据，票据理算并添加理算记录
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for idx, receipt in enumerate(dossier["receipts_layer"]):
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# 添加理算记录
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dossier["receipts_layer"][idx]["adjustments"] = receipt_adjust(
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receipt=receipt, liabilities=dossier["liabilities_layer"]
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)
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# 票据理算金额
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dossier["receipts_layer"][idx]["adjustment_amount"] = Decimal(
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sum(
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[
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adjustment["adjustment_amount"]
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for adjustment in dossier["receipts_layer"][idx]["adjustments"]
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]
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)
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 赔案理算金额
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dossier["adjustment_layer"]["adjustment_amount"] = Decimal(
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sum(
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[
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adjustment["adjustment_amount"]
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for receipt in dossier["receipts_layer"]
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for adjustment in receipt["adjustments"]
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]
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)
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 实例化HTML渲染器
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html_renderer = HTMLRenderer(template_path=Path(__file__).parent / "template.html")
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# 根据赔案档案渲染HTML文档
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html_renderer.render(
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obj=dossier,
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output_path=Path(__file__).parent
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/ "dossiers"
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/ f"{dossier["report_layer"]["case_number"]}.html",
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)
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def receipt_adjust(
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receipt: Dict[str, Any], liabilities: List[Dict[str, Any]]
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) -> List[Dict[str, Any]]:
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"""
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理算票据
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:param receipt: 票据数据字典
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:param liabilities: 理算责任
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:return: 理算记录
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"""
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# 初始化理算记录
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adjustments = []
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# 初始化票据剩余理算金额
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remaining_adjustment_amount = masterdata.query_remaining_adjustment_amount(
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receipt_number=receipt["number"],
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)
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if remaining_adjustment_amount is None:
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remaining_adjustment_amount = (
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receipt["personal_self_payment"] # 个人自费金额
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+ receipt["non_medical_payment"] # 个人自付金额
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+ receipt["reasonable_amount"] # 合理金额
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 遍历所有理赔责任，根据出险人、理赔类型、查验状态和出险日期匹配理赔责任
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for liability in liabilities:
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if (
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receipt["payer"]
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in [liability["insured_person"] for liability in liabilities]
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and receipt["accident"] == liability["accident"]
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and receipt["verification"] in ["真票", "无法查验"]
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and liability["commencement_date"]
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<= receipt["date"]
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<= liability["termination_date"]
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):
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# 个单剩余保额
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remaining_coverage_amount = masterdata.query_after_change_amount(
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person_policy_guid=liability["person_policy_guid"],
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)
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# 个人自费可理算金额
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personal_self_adjustable_amount = (
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receipt["personal_self_payment"] # 个人自费金额
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* liability["personal_self_ratio"] # 个人自费理算比例
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* Decimal("0.01")
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 个人自付可理算金额
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non_medical_adjustable_amount = (
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receipt["non_medical_payment"] # 个人自付金额
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* liability["non_medical_ratio"] # 个人自付理算比例
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* Decimal("0.01")
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 合理可理算金额
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reasonable_adjustable_amount = (
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receipt["reasonable_amount"] # 合理金额
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* liability["reasonable_ratio"] # 合理理算比例
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* Decimal("0.01")
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).quantize(
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exp=Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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# 理算金额
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adjustment_amount = max(
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Decimal("0.00"),
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min(
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remaining_adjustment_amount, # 剩余理算金额
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remaining_coverage_amount, # 个单剩余保额
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adjustable_amount := (
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(
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personal_self_adjustable_amount # 个人自费可理算金额
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+ non_medical_adjustable_amount # 个人自付可理算金额
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+ reasonable_adjustable_amount # 合理可理算金额
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).quantize(
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Decimal("0.00"),
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rounding=ROUND_HALF_UP,
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)
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), # 可理算金额
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),
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)
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# 若理算金额大于0则新增保额扣减记录
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if adjustment_amount > Decimal("0.00"):
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masterdata.add_coverage_change(
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person_policy_guid=liability["person_policy_guid"],
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before_change_amount=remaining_coverage_amount,
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change_amount=adjustment_amount,
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)
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adjustments.append(
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{
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"group_policy": liability["group_policy"], # 团单号
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"person_policy": liability["person_policy"], # 个单号
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"liability": liability["liability"], # 理赔责任名称
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"accident": liability["accident"], # 理赔类型
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"personal_self_payment": receipt[
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"personal_self_payment"
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], # 个人自费金额
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"personal_self_ratio": liability[
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"personal_self_ratio"
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], # 个人自费理算比例
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"personal_self_adjustable_amount": personal_self_adjustable_amount, # 个人自费可理算金额
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"non_medical_payment": receipt[
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"non_medical_payment"
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], # 个人自付金额
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"non_medical_ratio": liability[
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"non_medical_ratio"
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], # 个人自付理算比例
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"non_medical_adjustable_amount": non_medical_adjustable_amount, # 个人自付可理算金额
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"reasonable_amount": receipt["reasonable_amount"], # 合理金额
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"reasonable_ratio": liability["reasonable_ratio"], # 合理理算比例
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"reasonable_adjustable_amount": reasonable_adjustable_amount, # 合理可理算金额
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"remaining_adjustment_amount": remaining_adjustment_amount, # 剩余理算金额
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"remaining_coverage_amount": remaining_coverage_amount, # 个单剩余保额
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"adjustable_amount": adjustable_amount, # 可理算金额
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"adjustment_amount": adjustment_amount, # 理算金额
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"adjustment_explanation": f"""
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1、剩余理算金额：{remaining_adjustment_amount:.2f}；
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2、个单剩余保额：{remaining_coverage_amount:.2f}；
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3、可理算金额：{adjustable_amount:.2f}，其中：
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1）个人自费可理算金额：{personal_self_adjustable_amount:.2f}={receipt['personal_self_payment']:.2f}*{liability['personal_self_ratio']:.2f}%；
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2）个人自付可理算金额：{non_medical_adjustable_amount:.2f}={receipt['non_medical_payment']:.2f}*{liability['non_medical_ratio']:.2f}%；
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3）合理部分可理算金额：{reasonable_adjustable_amount:.2f}={receipt['reasonable_amount']:.2f}*{liability['reasonable_ratio']:.2f}%；
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4、理算金额：{adjustment_amount:.2f}，即上述应理算金额、个人余额和可理算金额的最小值。
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""".replace(
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"\n", ""
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).replace(
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" ", ""
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), # 理算说明
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}
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)
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remaining_adjustment_amount -= adjustment_amount
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# 若剩余理算金额小于等于0则跳出循环
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if remaining_adjustment_amount <= Decimal("0.00"):
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break
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if not adjustments:
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adjustments.append(
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{
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"group_policy": None, # 团单号
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"person_policy": None, # 个单号
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"liability": None, # 理赔责任名称
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"accident": None, # 理赔类型
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"personal_self_payment": receipt[
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"personal_self_payment"
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], # 个人自费金额
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"personal_self_ratio": None, # 个人自费理算比例
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"personal_self_adjustable_amount": None, # 个人自费可理算金额
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"non_medical_payment": receipt["non_medical_payment"], # 个人自付金额
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"non_medical_ratio": None, # 个人自付理算比例
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"non_medical_adjustable_amount": None, # 个人自付可理算金额
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"reasonable_amount": receipt["reasonable_amount"], # 合理金额
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"reasonable_ratio": None, # 合理理算比例
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"reasonable_adjustable_amount": None, # 合理可理算金额
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"remaining_adjustment_amount": remaining_adjustment_amount, # 剩余理算金额
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"remaining_coverage_amount": None, # 个单剩余保额
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"adjustable_amount": None, # 可理算金额
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"adjustment_amount": Decimal("0.00"), # 理算金额
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"adjustment_explanation": "票据不予理算", # 理算说明
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}
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)
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# 新增理算记录
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masterdata.add_ajustment(
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receipt_number=receipt["number"],
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remaining_adjustment_amount=remaining_adjustment_amount,
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)
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return adjustments
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