5.3. Claim

Clusters are grouped functions with the same characteristics and use. The cluster claim contains all data needed for claims handling. An overview of the clusters can be found in the Overview of the API-framework.

The clusters are concentrated around AFD structures. The cluster claim is linked to the claimStructure (more information on the claimStructure is available in AFD structures). Thus, a cluster already indicates to a certain extent which data will be communicated. To indicate which data is communicated and to what purpose, an operation and a variant must be selected.

An insurance claim is a formal request by a policyholder for coverage or compensation of a loss or policy event covered by the insurance company. The loss that is sustained, or the event that occurred is the basis for filing a claim. The claim process starts when the policyholder submits a (first) notification of loss (FNOL) in order to inform the insurance provider.
The claims department of the insurance provider will create a claim file and verify whether the loss or event is actually covered by the policy. If it is not covered by the policy, the claim file is closed, else the claim handling process starts. In case this claim process involves third parties (e.g. salvage and repair activities), the cluster Task is used.

A claim is settled by payment(s) made by the insurance provider to compensate the cost of replacement and/or repair. Once a claim has been either rejected or completely settled, the claim file will be closed. Because a closed file cannot be deleted immediately (because of a mandatory retention period), the API-framework does not support the actual removal of the file. After the mandatory retention period the file can be removed. The removal of claims is part of database management, and does not necessarily require API access. A short explanation of the HTTP methode DELETE can be found in the section Design principles.

The different operations and variants of a claim are outlined in the following sections.