Claims Structure

Claims Manager is a claims handling platform that services a wide variety of different clients and brokers. The following section describes how the claims data is structured in Claims Manager.

Programme

A programme represents a distinct business unit; some clients will have just one programme while others may split different business areas out into their own programmes. Each programme has a set of policy types which represent the types of claims that are handled (Motor, General Liability, Property etc.) and each of these policy types will have a list of policy countries where the policy is sold. You can see this information for the programmes that you have access to by using the metadata/programmes endpoint.

Incident

An incident represents the set of circumstances that led to a claim or claims to be made against the policy. It will contain details such as when and where the incident occurred and a description of what happened. It also contains information such as the current status of the incident and any external references you may have passed to us.

Claimant

A claimant is an entity (either a person or an organisation) who has, or is likely to, made a claim against the incident policy. It will contain details about who the claimant is, their contact details as well as any other information relevant to the incident. Each claimant can make one or more claims against the relevant policy section(s). All financial information, be they reserves or payments etc., are stored against the individual claims.

Party

A party is a person or organisation related to the incident who has no intention of making a claim against the incident policy. This could be a witness, solicitor, police officer or expert for example. It will contain details about who the party is and their contact details. A party can also be linked to a claimant, for instance a solicitor can be linked to a claimant to signify that they are representing them for this incident.

Event

Each incident contains an event log that lists important milestones that occur over the lifetime of the incident. These events can be further categorised into one of the three event classes listed below:

Event Log Entry

This is a record of something happening on the incident. It could be a change in the current status of the incident, or a record that a request for further information has been sent to the claimant for example. It can contain attachments where these are useful and relevant to the event log entry.

Reminder

This is a reminder for someone, generally the claims handler assigned to the file, to do something at a particular date and time. For example, when an incident is first created an initial review reminder is created to prompt the file handler to review the file within the defined time period. These reminders appear on the assignee's task list within Claims Manager and are a way of allowing users an overview of the work assigned to them in the system.

Correspondence Entry

This is a record of a piece of correspondence either having been received on the file or sent out to a claimant or party. It contains the category of the correspondence and generally will also contain one or more attachments with further details of what that correspondence was.