Claim Status

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.
PICDefinition
ClaimantInsured of insurance product who files a claim for insurance coverage benefits.
InsurerInsurance Company that underwrites the insurance product.
CermatiCermati internal team (e.g. Claim Ops, etc).