FNOL Coverage Checks

Overview

With a First Notice of Loss, Coverage Checks can be automatically performed to validate whether coverage could apply to the loss. This is done by finding the segment of the policy that is active at the time of the loss (if any), and optionally checking the contents of that segment for coverage information.

Process

When an FNOL is created, the system will set the FNOL’s segmentLocator automatically, based on the state of the policy as of the incidentTime, and excluding any segments created atfer the incident time. This ensures that policy changes made after the incident time are not considered for purposes of checking coverage.

Note

The segmentLocator will only be set for non-gap segments. If the segment found is a gap type, the locator will remain null.

After creating the FNOL, you may add Losses. The coverage check process will update the fnolLossState for each pending loss to either valid or excluded based on the coverage check.

The following steps are conducted in the coverage check process:

  • First, the system will check whether, for the time of the incident time of the FNOL, that there is a non-null, non-gap segment on the policy, created before the indident time, that is not superceded by a gap segment. If there is no such segment, all losses with state pending will be updated to become excluded.

  • Otherwise, for each loss that has pending state, the system will check whether a corresponding coverage element is available.

The coverage element check for a loss is as follows:

  • If the loss’s coverageElementLocator is not null, and the segment contains an element with that locator, the loss is valid.

  • If the loss type is configured with an empty array of coverage types, the loss is valid.

  • If the loss’s exposureElementLocator is null:

    • If there is an element anywhere in the segment with type equal to any of the coverage types configured for the loss, the loss is valid.

    • Otherwise the loss is excludded.

  • If the loss’s exposureElementLocator is not null:

    • If the coverageElementLocator is null and there is an element that has that a type matching any of the configured coverage types for the loss which is a direct or indirect ancestor or descendant of the exposure element (that is, no horizontal traversals are needeed to find the coverage element from the exposure element), the loss will be valid.

    • If such an element is identified, its locator will be used to set the coverageElementLocator for the loss.

  • If none of the above scenarios apply, the loss will be excluded.

Note

You may manually override the coverage check determination with the Include Loss and Exclude Loss endpoints.

See Also