The story
One claim, three people, one decision.
The process starts when a customer reports damage to their car. A claims handler registers the claim in the claims system and asks the customer for what is missing: photos, the police report if there is one, the repair estimate. Only when the documents are in does the underwriter check coverage: is the damage covered under the policy as it stood on the day of the loss?
That check is the control step of the model. It is drawn in blue because it is the one point where the organisation has decided that a qualified person must look before money moves. Everything before it is intake; everything after it depends on its outcome.
The gateway asks a single question, covered or not. If yes, the handler approves the payout in the claims system and the customer receives the money. If no, the underwriter writes a decline with reasons, and the customer receives that instead. Two end events, both in the customer's lane, because the process ends when the customer has an answer, not when the file is closed.
This is a fictional example model. It is deliberately smaller than a real claims process, which would carry fraud checks, repair networks, reserves and reinsurance. The point of the example is to show how three roles, one decision and one control read in BPMN.
The diagram
The model as BPMN 2.0.
Read it left to right. Each horizontal band is a lane, one per role. The thin circle is the start, the thick circles are the ends, the diamond with the cross is the exclusive gateway, and the blue task is the control step. Small capitals under a task name the system that step uses.
Elements used
What is in the model, and why.
Every element in the diagram answers a question someone would ask in a workshop: who does this, what happens if, which system, and when are we done.
Lanes: Customer, Claims handler, Underwriter
Three roles, three bands. The customer has a lane of their own because the customer does real work in this process: reporting the claim and providing documents. Every hand-over is a line that crosses a lane border.
Gateway: Covered?
An exclusive gateway, marked with a cross. Exactly one of the two outgoing paths is taken. The question sits next to the diamond and the answers, yes and no, sit on the outgoing flows.
Control step: Check coverage
The blue task. In the .bpmn file the step carries the documentation "Control step" so that a BPMN tool, and later an AI agent, can tell it apart from ordinary work. It uses the policy file as its reference.
Systems: claims system, policy file
Register claim and Approve payout both touch the claims system; the coverage check reads the policy file. The system name under the task is enough to see which steps would be affected if one of them changed.
End events: Payout received, Decline received
Two ends, both with the customer. Naming the end from the customer's point of view keeps the model honest: the claim is not done when the handler closes the file, but when the customer has the money or the reasons.
Where the process waits
What to look at in a claims model.
Even a model this small shows the places where real claims processes lose days. They are all hand-overs across a lane border.
Waiting for documents
The step Provide documents is in the customer's lane. The organisation cannot speed it up directly; it can only make clear, in one message, what is needed, and remind.
The queue in front of the underwriter
Check coverage is a control step done by a scarcer role. Claims pile up in front of it. In a workshop this is where someone usually says "that is where it always sits".
Two systems, one claim
The claims system and the policy file are separate. If the coverage check means looking things up by hand, the model shows it: two different system names on two neighbouring steps.
The decline with reasons
A decline is written work, not a click. Models that draw it as a single arrow to an end event hide the effort and the complaints that follow a thin explanation.
Request the file
The model as a .bpmn file.
The file is a fictional example model in BPMN 2.0 XML. It opens in standard BPMN tools such as Camunda Modeler, Signavio or ADONIS, with lanes, the gateway, the control step and the diagram layout. It is sent by email on request; nothing is downloaded from this page.
The symbols in detail: the BPMN guide. The same process family with more roles: policy onboarding. How a diagram like this is drafted from a conversation: how patchley works.