Claim, exposure, incident
ClaimCenter separates what happened from what the insurer may owe and to whom:
Claim- One loss event: loss date, loss cause, description, location, the policy, the reporter, and an optional catastrophe code.
Incident- Something damaged or someone injured: a vehicle incident, property incident or injury incident.
Exposure- One potential payment obligation: one claimant + one coverage (+ the incident). Exposures are the unit that gets assigned, reserved and paid.
- Contacts & roles
- Insured, claimant, driver, witness, vendor, lawyer — the same person can play different roles on different claims.
Mette rear-ends a van at a junction in Aarhus. The van's driver hurts his neck.
| Exposure | Claimant | Coverage | Incident |
|---|---|---|---|
| 1 · Own vehicle damage | Mette | Kasko | Vehicle incident (Mette's car) |
| 2 · Third-party vehicle damage | Van owner (company) | Ansvar | Vehicle incident (van) |
| 3 · Bodily injury | Van driver | Ansvar | Injury incident (neck) |
Each exposure can go to a different handler (the injury to a personal-injury specialist) and has its own reserves and payments.
FNOL, policy and assignment
Claims arrive through the New Claim wizard (handlers on the phone) or the Cloud API (web and app self-service). At FNOL, ClaimCenter:
- Finds the policy through the policy system integration, retrieving the version in force on the loss date. The relevant policy data is copied onto the claim, so the claim keeps what applied even if the policy changes later. If the policy can't be found yet, an unverified policy can be used and verified later.
- Segments the claim (simple / complex, fast-track / standard) using rules.
- Assigns the claim and exposures to a group and user by rules: glass claims to the fast-track team, injuries to personal-injury handlers, storm claims to the CAT team.
- Generates the workplan: activities (tasks with due dates) such as "contact claimant within 24 hours" or "request police report".
LossCause typelist is extended with Danish causes such as skybrud (cloudburst), stormflod (storm surge), rørskade and svamp/insekt. Storm-surge claims follow the public Naturskaderådet scheme, so a rule can route them to a separate process.Financials: reserves, payments, recoveries
Money in ClaimCenter is always recorded on a reserve line, the combination of:
- Exposure (or claim level, for some expenses)
- Cost type: claim cost (indemnity paid to claimants) vs expense (adjuster fees, lawyers, experts)
- Cost category: body, rental car, towing, pain and suffering, and so on
Four transaction types live on reserve lines:
| Transaction | Meaning |
|---|---|
| Reserve | Sets the expected remaining cost |
| Payment | Money paid out, grouped on a check (the payment instruction, in Denmark normally a bank transfer). Eroding payments reduce the open reserve. |
| Recovery reserve | Expected money back |
| Recovery | Money received: subrogation (regres), salvage (provenu), deductible collected, other |
Each transaction is checked against the user's authority limits. A handler might pay up to DKK 100,000 alone; above that an approval activity goes to a supervisor. That's the four-eyes control auditors expect.
| Business event | ClaimCenter transaction |
|---|---|
| Initial reserve DKK 25,000 | Reserve on Exposure (building) / Claim cost / Dwelling |
| Drying company invoice DKK 8,000 | Payment to vendor (eroding) — open reserve falls to 17,000 |
| Adjuster raises estimate | Reserve change to 52,000 open |
| Contractor paid net of selvrisiko | Final payment, deductible applied; reserve closes to 0 |
| Adjuster's fee | Payment on an expense reserve line, not claim cost |
Working the claim
Activities & notes
Every task is an activity with an owner and due date; every conversation becomes a note. Supervisors manage teams through activity queues and overdue lists.
Documents
Photos, police reports, invoices, medical records, AES decisions, attached through the document-management integration.
Service requests
Instructions to vendors (repair shop, restoration company, adjuster) with quotes and invoices tracked on the claim.
Matters & SIU
Litigation is tracked as matters. Rules calculate fraud indicators and can refer claims to the special investigation unit.
When everything is settled, exposures are closed first and then the claim, with a closing reason. A claim can be reopened if new information arrives, which is common with long-tail injury claims.
Catastrophes
A catastrophe record defines an event with a name, peril, dates and affected area: "Storm, 28–29 Oct 2027, Jutland". During a storm, claims are tagged with that catastrophe code, either automatically by rules (loss cause + date + postcode) or by handlers. That enables:
- Dedicated CAT assignment and simplified workflows for high volumes
- Real-time event dashboards for management
- Reinsurance recoveries under the cat XL treaty, using the event definition and hours clause
Danish specifics
| Topic | How it shows up in ClaimCenter |
|---|---|
| Personal injury | Cost categories for tabt arbejdsfortjeneste, svie og smerte, varigt mén, erhvervsevnetab; long-running exposures with periodic reserve reviews |
| Workers' injury | AES decisions arrive as documents/events and drive reserves and payments; the claim may stay open for years |
| Motor recoveries | Recovery reserves and recoveries against the other party's insurer |
| Bonus impact | A claims-history feed tells PolicyCenter which claims affect the bonus step at renewal |
| Personal data | CPR numbers and health data are sensitive under GDPR: role-based access, masking and retention rules |
| Payments | Payments by bank transfer to verified accounts; payment files to the bank or payment platform |
Key takeaways
- Claim = the event; incident = what was damaged; exposure = one claimant + one coverage, the unit of work and money.
- FNOL retrieves the policy version on the loss date, then rules segment, assign and create activities.
- Reserve line = exposure + cost type + cost category; transactions are reserves, payments, recovery reserves and recoveries.
- Authority limits enforce approvals; activities, notes, documents and service requests drive daily work.
- Catastrophe codes power CAT handling and reinsurance recoveries.