List of claim statuses along with the entity capable of updating the claim to particular statuses
Status | Definition | PIC |
---|---|---|
INITIATED | Claim has been created but will not be processed until the required data are submitted by the Insured. | Insured |
DATA_SUBMITTED | Claim data (forms, and files) has been filled and submitted by the Insured. | Insured |
EXPIRED | Insured has not completed all of the necessary claim data within agreed time frame based on the insurance product terms. | Insured |
DATA_ON_REVIEW | Claim has been successfully submitted by the Insured and is under review by Cermati Claim Team. | Cermati/Insured |
DATA_COMPLETE | Claim has been reviewed by Cermati and proceeded to the Insurer for further analysis and confirmation. | Cermati/Insured |
DATA_INCOMPLETE | Submitted claim has been reviewed by Cermati Claim Team but requires additional documents to proceed further. | Cermati |
APPROVED | Claim has been reviewed and approved by the Insurer. | Insurer |
REJECTED | Claim has been reviewed and rejected by the Insurer. | Insurer |
ADDITIONAL_DATA | Claim has been reviewed by Insurer but requires additional documents to proceed further. | Insurer |
REIMBURSEMENT_TRANSFERRED | Final status. Claim has been paid by the Insurer to the Insured. | Insurer |
CANCELLED | Claim has been cancelled by the Insured. Cancelled claims will not be processed any further. | Insured |
JUNK | Junk or testing claim. | Cermati |
PIC | Definition |
---|---|
Insured | Customer(s) or organization whose name(s) is under the policy issuance and/or covered by the insurance. |
Insurer | Insurance Company that underwrites the insurance product (insurance risks). |
Cermati | Cermati internal team (e.g. Claim Analyst, etc). |