Coverages on unverified policies

There are two types of coverages on a policy: policy-level coverages and risk unit coverages.

  • A policy-level coverage is a coverage that typically covers the policyholder or other additional insureds listed on the policy.
    • For example, personal auto policies typically come with a "Liability - Bodily Injury and Property Damage" coverage. This covers any damage to other people or other properties that is caused by the policyholder (or the additional insureds) while driving a vehicle. It does not matter which vehicle the policyholder was driving. The coverage applies to the policyholder.
  • A risk unit coverage is a coverage that covers an associated risk unit.
    • For example, every vehicle listed on a personal auto policy typically comes with a "Collision" coverage. This covers damage done to the associated vehicle. Suppose there is a policy with two vehicles and only the first vehicle has collision coverage. If the second vehicle is involved in a collision, the policyholder will not be able to file a claim for damages done to the second vehicle.

Within the context of underwriting policies, a given type of coverage is either a policy-level coverage (and never gets attached to a risk unit) or a risk unit coverage (and always gets attached to a risk unit). However, ClaimCenter does not store information about whether a given type of coverage ought to be policy-level or risk unit level. ClaimCenter typically gets policy information from the Policy Administration System, and it assumes coverages are attached to the policy at the appropriate place.

When you create an unverified policy, it is possible to attach a coverage that is normally policy-level to a risk unit, or to attach a coverage that is normally risk unit level to the policy. This is allowed both in the ClaimCenter application and through the system APIs. However, you cannot make payments on claims with unverified policies. In order to verify a policy, you must retrieve updated information from the Policy Administration System. So if an unverified policy has a coverage attached to the wrong location, an adjuster will need to address the error before payments on the claim can be made.

Creating an unverified policy with a policy coverage

To create or modify a policy coverage, use the following endpoints:

  • POST /claim/v1/unverified-policies/policyId/coverages
  • PATCH /claim/v1/unverified-policies/policyId/coverages/{coverageId}

The minimum amount of information for a policy coverage is the coverage type. This is a code from the CoverageType typelist. Coverage types are part of the ClaimCenter Line of Business Model, and only certain coverages can be attached to a policy based on its policy type. For more information, see the Application Guide.

The following example creates an unverified policy with a policy coverage.

POST /composite/v1/composite

{
  "requests": [
    {
      "method": "post",
      "uri": "/claim/v1/unverified-policies",
      "body": {
        "data": {
          "attributes": {
            "policyNumber": "unverified-with-policy-coverage",
            "policyType": {
              "code": "PersonalAuto"
            }
          }
        }
      },
      "vars": [
        {
          "name": "policyId",
          "path": "$.data.attributes.id"
        }
      ]
    },
    {
      "method": "post",
      "uri": "/claim/v1/unverified-policies/${policyId}/coverages",   
      "body": {       
        "data": {
          "attributes": {
              "coverageType" : {
                  "code": "PALiabilityCov"
              }
          }
        }
      }
    },
    {
      "method": "post",
      "uri": "/claim/v1/claims",
      "body": {
        "data": {
          "attributes": {
            "lossDate": "2021-03-04T07:00:00.000Z",
            "policyNumber": "unverified-with-policy-coverage"
            }            
          }
        }
    }
  ]
}

Creating an unverified policy with a risk unit coverage

To create a risk unit coverage, use the following endpoints:

  • POST /claim/v1/unverified-policies/{policyId}/location-based-risk-units/ location-based-risk-units/{locationBasedRiskUnitId}/coverages
  • POST /claim/v1/unverified-policies/{policyId}/vehicle-risk-units/{vehicleRiskUnitId}/coverages

To modify a risk unit coverage, use the following endpoints:

  • PATCH /claim/v1/unverified-policies/{policyId}/location-based-risk-units/{locationBasedRiskUnitId}/{coverageId}
  • PATCH /claim/v1/unverified-policies/{policyId}/vehicle-risk-units/{vehicleRiskUnitId}/{coverageId}

The minimum amount of information for a risk unit coverage is the coverage type. This is a code from the CoverageType typelist. Coverage types are part of the ClaimCenter Line of Business Model, and only certain coverages can be attached to a risk unit based on the policy's policy type. For more information, see the Application Guide.

The following example creates an unverified policy with a vehicle risk unit and a coverage for that risk unit.

POST /composite/v1/composite

{
  "requests": [
    {
      "method": "post",
      "uri": "/claim/v1/unverified-policies",
      "body": {
        "data": {
          "attributes": {
            "policyNumber": "unverified-with-risk-unit-coverage",
            "policyType": {
              "code": "PersonalAuto"
            }
          }
        }
      },
      "vars": [
        {
          "name": "policyId",
          "path": "$.data.attributes.id"
        }
      ]
    },
    {
      "method": "post",
      "uri": "/claim/v1/unverified-policies/${policyId}/vehicle-risk-units",   
      "body": {       
        "data": {
          "attributes": {
          }
        }
      },
      "vars": [
        {
          "name": "riskUnitId",
          "path": "$.data.attributes.id"
        }
      ]
    },

    {
      "method": "post",
      "uri": "/claim/v1/unverified-policies/${policyId}/vehicle-risk-units/${riskUnitId}/coverages",   
      "body": {       
        "data": {
          "attributes": {
              "coverageType" : {
                  "code": "PACollisionCov"
              }
          }
        }
      }
    },
    {
      "method": "post",
      "uri": "/claim/v1/claims",
      "body": {
        "data": {
          "attributes": {
            "lossDate": "2021-03-04T07:00:00.000Z",
            "policyNumber": "unverified-with-risk-unit-coverage"
            }            
          }
        }
    }
  ]
}