Creating basic workers' comp claims

Create and submit requirements

There are multiple requirements for creating and submitting a workers' comp claim. These requirements come from different aspects of ClaimCenter.

Requirements to create

In Cloud API, to create a draft workers' comp claim (without necessarily submitting it):

• The claim itself must specify lossDate and policyNumber.

• There must be exactly one injury incident whose mainWorkersCompIncident property is set to true.

• This requirement is configurable. For more information, see Configuring Cloud API behavior with workers' comp claims.

A workers' comp claim cannot be created without a main injury incident. Therefore, workers' comp claims can be created only in the context of a composite request.

Requirements to submit

The base configuration of ClaimCenter includes a series of validation rules. Each rule can throw an error that is tied to a specific level of claim maturity. The two lowest levels are LoadSave and NewLossCompletion. The /submit endpoint will not succeed if the claim violates any rule at either of these levels.

In the base configuration, in addition to lossDate, policyNumber and mainWorkersCompIncident, you must also specify a reporter for the claim and a claimant for the exposure. These requirements are enforced by the "CLV04000 - ClaimContact Role Configuration" validation rule, which throws an error at the NewLossCompletion level if the claim reporter or exposure claimant is null.

The additional injury exposure

In the base configuration, the ClaimCenter presetup rules create the injury exposure automatically. They also create an "additional injury incident". The injury exposure is associated with the additional injury incident, not the main injury incident. However, no information is stored on the additional injury incident. All of the injury information shown in the user interface and used in the claim process comes from the main injury incident.

Be aware that after you create a workers' comp claim, the claim has at least two injury incidents:

• The "main injury incident". This stores information about the injury.

• The "additional injury incident". This typically does not store any information of value and can usually be ignored.

Minimal basic workers' comp claim: Example

The following is an example of the minimum amount of information needed to create a workers' comp claim. Note the following:

• It uses policy 32-300869, which is part of the sample data.

• It specifies two contacts: Susan Sarcosky and Jennifer Albee. These contacts are created solely to pass the base configuration validation rules for submitting a claim.

Command

POST /composite/v1/composite

Request payload

{
  "requests": [
    {
      "body": {
        "data": {
          "attributes": {
            "lossDate": "2024-06-09",
            "policyNumber": "32-300869"
          }
        }
      },
      "method": "post",
      "uri": "/claim/v1/claims",
      "vars": [
        {
          "name": "claimId",
          "path": "$.data.attributes.id"
        }
      ]
    },
    {
      "body": {
        "data": {
          "attributes": {
            "firstName": "Sue",
            "lastName": "Sarcosky",
            "contactSubtype": "Person"
          }
        }
      },
      "method": "post",
      "uri": "/claim/v1/claims/${claimId}/contacts",
      "vars": [
        {
          "name": "sueId",
          "path": "$.data.attributes.id"
        }
      ]
    },
    {
      "body": {
        "data": {
          "attributes": {
            "firstName": "Jennifer",
            "lastName": "Albee",
            "contactSubtype": "Person"
          }
        }
      },
      "method": "post",
      "uri": "/claim/v1/claims/${claimId}/contacts",
      "vars": [
        {
          "name": "jenniferId",
          "path": "$.data.attributes.id"
        }
      ]
    },
    {
      "body": {
        "data": {
          "attributes": {
            "reporter": {
              "id": "${sueId}"
            },
            "claimant": {
              "id": "${jenniferId}"
            }
          }
        }
      },
      "method": "patch",
      "uri": "/claim/v1/claims/${claimId}"
    },
    {
      "body": {
        "data": {
          "attributes": {
            "mainWorkersCompIncident": true
          }
        }
      },
      "method": "post",
      "uri": "/claim/v1/claims/${claimId}/injury-incidents"
    },
    {
      "method": "post",
      "uri": "/claim/v1/claims/${claimId}/submit"
    }
  ]
}