List of claim status along with the PIC responsible for required actions to a specific status
Status | Definition | Action Required from |
---|---|---|
INITIATED | Claim has been created but will not be processed until the required data are submitted by the Claimant. | Claimant |
EXPIRED | The Claimant has not completed all of the necessary claim data within the agreed time frame based on the insurance product terms. | |
DATA_SUBMITTED | Claim data has been filled and submitted by the Claimant. | Cermati |
DATA_ON_REVIEW | Claim is under review by Cermati Claim Team. | Cermati |
DATA_INCOMPLETE | Claim has been reviewed by Cermati Claim Team but requires additional documents to proceed further. | Claimant |
DATA_COMPLETE | Claim has been reviewed by Cermati Claim Team and proceeded to the Insurer for further analysis and confirmation. | Insurer |
ADDITIONAL_DATA | Claim has been reviewed by the Insurer but requires additional documents to proceed further. | Claimant |
CLAIM_APPROVED_BUT_DOCUMENTS_FOR_CLAIM_PAYMENT_NEEDED | Claim has been approved by the Insurer, but requires documents from the Claimant to process the claim payment. | Claimant |
DOCUMENTS_FOR_CLAIM_PAYMENT_SUBMITTED | The required documents to process the claim payment have been submitted by the Claimant. | Insurer |
APPROVED | Claim and documents to process the claim payment have been approved by the Insurer. Claim is currently in the claim payment process. | |
REIMBURSEMENT_TRANSFERRED | Final status. Claim has been paid by the Insurer to the Claimant. | |
REJECTED | Claim has been rejected by the Insurer. | |
CANCELLED | Claim has been cancelled by the Claimant. Cancelled claims will not be processed any further. | |
JUNK | Junk or testing claim. |
PIC | Definition |
---|---|
Claimant | Insured of insurance product who files a claim for insurance coverage benefits. |
Insurer | Insurance Company that underwrites the insurance product. |
Cermati | Cermati internal team (e.g. Claim Ops, etc). |