insurance::claim
Claim
A formal request by a policyholder to the insurer for payment under the terms of an in-force policy.
Canonical Definition
Claim bezeichnet die formelle Schadenmeldung eines Versicherungsnehmers gegenüber dem Versicherer.
Alternative Interpretations
Why the same term causes confusion across teams.
General English
Any assertion or statement of fact.
Legal
A demand for a remedy or recognised right.
Insurance
A formal payout request made under an insurance policy.
Business Impact
What happens when different meanings of Claim are used in parallel.
Operational Risk
Customer service may treat informal complaints as 'claims', distorting metrics.
AI Risk
Triage agents misclassify enquiries vs notifications of loss.
Compliance Risk
Claims registers diverge from regulatory definitions of complaint vs claim.
Integration Risk
Downstream reserving and reinsurance receive non-claims as claims.
Related Entities
- insurance::claim → made under → insurance::policy
- insurance::claim → evaluated against → insurance::coverage
- insurance::claim → triggered by → insurance::insured-event
Governance Metadata
This definition is governed. Not merely documented.
- Owner
- Chief Product Officer
- Status
- aligned
- Version
- 1.0
- Effective Date
- 2025-01-15
- Source
- WikiSure Insurance Working Group
- Domain
- Insurance