3.6. claimStructure

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 below on this page for a more detailed example. More information about functions related to claim is available in chapter Domain specific functions under Claim.

See AFD 2.0 Online for the complete and up-to-date data catalog with all entities, entityTypes and attributes, associated with the claimStructure. More documentation on the use of SIVI AFS is available in chapter Where to find elements of SIVI elements. A general description of AFD structures is provided in Introduction to AFD structures, while information on details of AFD structures is available in chapter Where to find details about AFD structures.

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. In XML, the structure is always explicitly defined (as claimStructure) at the highest level.

{
	"commonFunctional": [ {
		"entityType": "default",
		"function": "22",
		"dataCatalogVersion": "34C"
		"afdDefinitionName": "Goed verzekerd op weg",
		"afdDefinitionVersion": "001.00",
	} ],
	"claim": [ {
		"entityType": "default",
		"claimNumberCarrier": "85120919",
		"dateOfLoss": "2019-01-05",
		"useExpert": true,
		"policy": [ {
			"entityType": "policyDetails",
			"businessLine": "021",
			"porCompany": "A001",
			"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
	} ]
}