A determination result includes a range of decision information (provided by business rules) which can be broken down into the categories referred to as the 'three Es': eligibility, entitlement, and explanation.
The overall "yes" or "no" for whether the claimant is eligible for the product. Typically there will be business rules which either "rule in" or "rule out" the case according to details of the case (including personal details of the members of the case and evidence of their circumstances).
The objectives which the claimant (and possibly other parties) are entitled to. For benefit products, typically there will be monetary objectives, perhaps broken down into separate components. The case's entitlement is often an answer to the question "how much should the claimant receive?", but objectives can be used for other purposes too. Note that a case's entitlement only applies during periods of eligibility - whenever the case is ineligible, there is no entitlement.
The explanation (aimed at the case worker) for why the eligibility and entitlement calculation results are what they are. For periods of eligibility, the explanation typically contains a description of why the case is eligible, and for periods of ineligibility the explanation typically contains one or more reasons why the case is ineligible. The explanation (when shown to the case worker) contains a number of tabs for explaining entitlement calculations broken down into different categories, and also a display of important events which have a bearing on the case's eligibility and entitlement.
Visually, the Engine presents explanations in these ways:
It can be useful to observe that the requirements that underpin eligibility/entitlement and explanation calculations can come from very different sources:
The requirements for eligibility and entitlement calculation typically have their roots in legislation or policy documents, and thus are more-or-less "set in stone" when it comes to the implementation of CER rules for providing those calculations. The job of the rules analyst and developers is the science of translating "legalese" into CER rules, clarifying any uncertainties along the way. The acid test of the implemented CER rules is whether they meet the proscribed legislation and/or policy. The rules developer can exercise ingenuity in implementing the rules in the simplest way possible, but in the main there is little creativity involved in the implementation task.
By contrast, the requirements for explanation are much looser, and typically center around "whatever can be displayed in order to help the case worker understand the case, and/or help the case worker answer questions from claimants about the case". As such, the analysis and development of CER rules for explaining a determination are much more akin to art than science. The initial implementation of explanation rules may be based around the best guesses of what questions might be asked of case workers, and so it is recommended that explanation rules be implemented in such a way that they can be easily enhanced later without needing any changes to the underlying (set-in-stone) eligibility and entitlement rules.