General properties

The claimStructure is made up of entities used to notify and register a loss, process a claim and create settlements. Given the fact that a claim is made against the cover of a policy, the policy and coverage entities are available in the claimStructure for reference purposes. The party entity is mandatory for the claimant, and can be repeated for all different kinds of parties involved in the claim process; experts, loss adjusters, repair, salvage companies etc. The financialTransaction entity is not required at the time of the first notification of loss, but will be necessary as soon as a reserve is calculated and payments are made for reimbursement or to cover costs. The document entity can be used in the notification process to provide copies of purchase receipts and pictures of the damage. The document entity can also be used for the subsequent claim handling work orders sent to contractors, who may in turn send in reports and invoices.

Mandatory components

The table below contains the mandatory entities and attributes of the claimStructure. Please note: these are only the mandatory components; in this case only the presence of a claim entity. In many functions and messages, the message will be more extensive, including incident, party and policy entities, and often a commonFunctional entity. See later in this section for a more detailed example.

Name Occur. Type Description
claimStructure 1..1 entity Structure of claim related data, based on AFD attributes.
claim 1..1 entity The main entity of the claim structure.
entityType 1..1 string Set to ‘default’.

JSON example

Below is an example of a claimStructure, including details about the corresponding incident. Note that at the top level within JSON, the claimStructure entity is not explicitly mentioned. When the claimStructure is nested within other structures, the claimStructure is given an explicit tag. In XML, the structure is always explicitly defined at the highest level as well.

{
	"commonFunctional": [ {
		"entityType": "default",
		"function": "22",
		"dataCatalogVersion": "34C"
	} ],
	"claim": [ {
		"entityType": "default",
		"claimNumberCarrier": "85120919",
		"dateOfLoss": "2019-01-05",
		"useExpert": true,
		"policy": [ {
			"entityType": "policyDetails",
			"businessLine": "021",
			"porCompany": "A001",
			"afdDefinitionName": "Goed verzekerd op weg",
			"afdDefinitionVersion": "001.00",
			"contractNumber": "P20190101-010"
		} ],
		"incident": [ {
			"entityType": "default",
			"claimRef": "S20200101-001",
			"processingCode": "1",
			"adnCauseOfLoss": "H103",
			"causeOfLossDescription": "Aanrijding met voertuig op autoweg",
			"city": "Almere",
			"party": [ {
				"entityType": "regularDriver",
				"surname": "De Vries",
				"firstName": "Johan",
				"partyDetails": [ {
					"entityType": "incident",
					"drivingOnRoundabout": false,
					"changedLanes": false,
					"wentRight": true,
					"reversed": false,
					"skippedRedLight": false
				} ]
			},
			{
				"entityType": "counterparty",
				"surname": "Wieringa",
				"firstName": "Marieke"
			},
			{
				"entityType": "witness",
				"surname": "De Jong",
				"firstName": "Otto"
			} ]
		} ],
		"party": [ {
			"entityType": "policyHolder",
			"surname": "De Jong"
		} ],
		"object": [ {
			"entityType": "motorVehicle",
			"licensePlate": "SIVI20"
		} ],
		"coverage": [ {
			"entityType": "hullVehicle"
		} ]
	} ],
	"document": [ {
		"entityType": "default",
		"sequenceNumber": 1
	} ]
}

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