Function: changeClaim

Submitting a change to the claim file while the claim handling and claim settlement processes are not complete.

Usage: changeClaim

At the early stage of claim handling the first notification of loss may have been linked to the wrong policy. In such a case the complete claim file can be overwritten with a new version.
Once the claim handling is started, the claim file is expanded with information like explication and specification from the policy holder, assessment of the damage by a loss adjuster, invoices from salvage and repair companies etc. In those cases the claim file can be appended with a partial update.
A specific situation is when occurs if a claim is of such significance that an MGA has to turn the handling over to the insurance provider.
Because each specific situation has its own requirements, the following function variants are provided to differentiate usage of the base function:

# Variant Description
1 correction Replace the entire claim file by a new version.
2 update Apply a partial change to the claim file.
3 transmitToCarrier Transfer the claim handling to the carrier of the policy.
4 reopen Reactivate a claim that has previously been closed.
5 close Close a claimfile (resetting settlement reserves to zero).
6 reject Closing of a claim due to absence of policy coverage.

All of these activities can lead to a full or partial update of the claim by using the changeClaim function. The choice for the technical implementation is addressed in this section.

As explained at the beginning of the chapter, the act of closing the claim results in a change of the claim’s status, i.e. ‘closed’ or ‘inactive’ without discarding the information. More information on this subject can be found in this section. The fact that the claim file remains available makes it possible to reopen a claim, if so required.

Technical specifications: changeClaim

Input: changeClaim

The changeClaim function uses the base-url and endpoint to address a specific claim, and the unique claim identification is part of the endpoint.
From a functional point of view there are no mandatory attributes, the body section can be used to provide a complete or partial set of claim information.

Name Variant Type Description
claimStructure
commonFunctional Entity for general information with regard to structure, handling and processing.
entityType all string Set to ‘default’.
dataCatalogVersion all ADNAFM Version of the data catalog on which the message is based.
functionVariant all APIVAR The function variant is used to determine the additional set of required and optional input and output data.
claim The claim entity is used for grouping claim-related data. A claim is a request made by the insured for insurer remittance of payment due to loss incurred, and covered under the policy agreement.
entityType all string Set to ‘default’.
status 3, 4, 5, 6 string Current status of the claim.
Any additional attributes within the claimStructure.

Output: changeClaim

There are three basic types of output which are described in the Output section of the Design principles chapter.

A positive response for the changeClaim function may contain a dataset.
In order to simplify processing it is advised that the input data is returned in the output for reference. As mentioned in the Usage section, any additional information that was collected during the transaction may also be added to the output for reference purposes.

Name Variant Type Description
claimStructure
commonFunctional Entity for general information with regard to structure, handling and processing.
entityType all string Set to ‘default’.
dataCatalogVersion all ADNAFM Version of the data catalog on which the message is based.
functionVariant all APIVAR The function variant is used to determine the additional set of required and optional input and output data.
claim The claim entity is used for grouping claim-related data. A claim is a request made by the insured for insurer remittance of payment due to loss incurred, and covered under the policy agreement.
entityType all string Set to ‘default’.
status 3, 4, 5, 6 string Current status of the claim.
object The entityType of an insured, named/regstered object on the policy, or ‘lossObject’ for unspecified objects.
party With entityType policyHolder.
Any additional attributes within the claimStructure.

Errors

When a negative response is generated, it follows the general rules as described in the Error section of the Status codes and error handling chapter.

Click below to see the Open Api Specification (3.0.0)

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