Appendix - General Insurance Discussion Paper Insurance Data Transformation

1

Policy number

A unique policy identifier (which may relate to several separate risk records) by which the exposure and premium information on each individual record can be identified.

2

Risk number

A unique risk identifier (which may be the same as the policy number if the policy contains a single risk) by which the exposure and premium information on each individual record can be identified.

3

Insurance class

Insurance class means a category used to aggregate data about similar types of general insurance products.

Retail Insurance* means a general insurance product that is provided to, or to be provided to, an individual or for use in connection with a Small Business, and is one of the following types:
a) a motor vehicle insurance product (Regulation 7.1.11);
b) a home building insurance product (Regulation 7.1.12);
c) a home contents insurance product (Regulation 7.1.13);
d) a sickness and accident insurance product (Regulation 7.1.14);
e) a consumer credit insurance product (Regulation 7.1.15);
f) a travel insurance product (Regulation 7.1.16); or
g) a personal and domestic property insurance product (Regulation 7.1.17),
as defined in the Corporations Act 2001 and the relevant Regulations.

Wholesale Insurance* means a general insurance product covered by the Code which is not Retail Insurance.
h) Business 
i) Business Pack
j) Contractors All Risks
k) Industrial Special Risks
l) Liability
m) Motor Wholesale
n) Other 
o) Primary Industries 
p) Primary Industries Pack

4

APRA insurance class

Per APRA GPS001

5

Policy type (e.g., home building, contents)

Intent is to capture in line with Insurers own systems. For particular classes of business, we would require a minimum level of granularity (e.g., for Householders - Home, Contents, Combined, Landlords should be separately identifiable).

6

Insured type

Group or Individual

7

Insurance brand

The brand name that the insurance policy is marketed under and which appears on the Product Disclosure Statement (where relevant).

8

Gross Written Premium

In this field insert (your co-insured share of) the gross written premium for the exposure of this policy (in whole $, no decimal points). Exclude all statutory charges (Stamp Duty, GST, and also exclude Fire Service Levies) but include other costs (such as commissions and instalment charges).

9

FSL/ESL

This is the value of insurance premium revenue derived from fire service and other state and territory government levies (FSL) that was earned during the relevant period.  This item is gross of any associated outwards reinsurance expense.

10

Stamp Duty

Amount of Stamp Duty paid by the insured

11

GST

Amount of GST paid by the insured

12

Other Charges

Other levies or duties imposed by federal, state and territory governments

13

Sum insured

Insert your (share of the) limit of indemnity/sum insured in whole dollars disregarding any excess payments by the insured.

14

Standard Excess

How much of any claim that an insured must bear before the insurer becomes liable (in whole dollars). Where different levels exist for different causes of claim, enter the excess that is most commonly applied for such policies, or where that is not available, the minimum applied.

15

Catastrophe Excess

Excess for any cyclone or catastrophe event

16

Other Excess

All other excesses applicable that aren't standard or catastrophe excesses.

17

Other Excess Description

Free text field – description of Other Excess amount declared

18

Risk postcode

Enter the Postcode of the location of the principal risk. If not available, enter the postcode of the head office or the postal address of the policyholder.

19

Policy start date

Enter as DDMMYYYY the start date of the reported policy term.

20

Initial policy inception date

Enter as DDMMYYYY the date when cover under this policy was first issued to the client.

21

Policy lapse/end date

Enter as DDMMYYYY the end date of the reported policy term.

22

Lapse reason

If applicable, the reason policy was discontinued.

- Discontinued due to a claim event
- Cancellation of the policy during the cooling off period
- Policies later cancelled by the insurer from inception, e.g., in the event of misrepresentation or non-disclosure
- Policy cancelled and replaced by a new Policy Contract
- Full Discontinuance of benefit, including due to non-payment of premiums

23

Distribution channel

Distribution channel the policy was sold through. 

Direct

Comparator website,

Broker, 

Underwriting Agent, 

Delegated Underwriting Authority

Other channels

24

Commission

This is the value, for the duration of the relevant period, of commission or brokerage paid for obtaining business for the insurer.

25

Claim number

A unique identifier of a claim.   This information is only used for cross-referencing by APRA – it will not be published except in any individual data reports prepared for the insurer concerned. 

26

Incident date

The date on which the incident that triggered the claim occurred or is deemed to have occurred.
For a ‘loss incurred (or occurrence based) policy’, the Incident date should be the date of the event that gave rise to the claim, or the best estimate of the date of that event(s), 
regardless of when this was reported to the insurer. 
For a ‘claims made policy’ where an actual date of loss is not available, code this field as the date that the claim is notified to the insurer.

27

Claim notified date 

This is the date on which initial contact is made by the claimant, their authorised representative or relevant other party, informing the insurer of the claimant's intention to lodge a claim. This could take the form of a physical submission (e.g., letter, email, online) or a telephone call.

28

Claim registered date

Enter as DDMMYYYY the date on which the claim was reported (not processed) to the agent or insurer. 

29

Claim decision date

Refers to when the insurer has made a final decision on the claim (e.g., whether to admit or decline the claim) and communicated this decision to the claimant.  It is the date on which the insurer’s claim decision is communicated to the claimant. This is not dependent on payment to the insured having been made. Communication by email, text message, facsimile or telephone is deemed to have occurred on the date it was sent. Communication by postal service is deemed to have occurred three business days after it was sent.

30

Claim finalised date

Enter as DDMMYYYY the date on which the claim was finalised.  This field should only be completed when all payments to the claimant(s) and any third-party suppliers are believed to have been made and all recoveries expected from third parties (ignoring reinsurers) have been received.  Note that a claim may be recorded as finalised even if recoveries from reinsurers have not been received.  

Reopened claims that are still open at the end of the reporting period must not have a “date finalised”.

31

Claim status (open/closed)

The status of the claim at the end of the reporting period.
Current
Finalised
Withdrawn
Re-opened
In Dispute - IDR
In Dispute - EDR

32

Loss type (total or partial)

Flag for if the claim is a total loss
Total
Partial
Definition of total loss required - e.g., > 90% sum insured

33

Claim outcome

The outcome of the claim for claims that have been determined by the insurer.
Accepted claim means that the insurer has accepted responsibility for all aspects of a consumer’s claim for coverage. This does not include partially accepted claims or claims paid on an ex-gratia basis.

Declined claim means a claim on a general insurance policy that the insurer has declined or not accepted. 

Partially accepted claim is a claim where the Insurer determines that part falls within the terms and conditions of the policy and part is not accepted. It does not include an accepted claim, a declined claim or an ex-gratia claim. It does not include caps and limits within the policy. Claims paid to the limits and sub-limits of the policy are not deemed partially accepted and are not required as part of this data set. They can be recorded under accepted claims.

Withdrawn claim means a claim that for various reasons does not proceed to a decision to accept or deny it and includes a claim that may be described as "cancelled”, “closed”, “discontinued” or “withdrawn”.

The claim outcome is to be one of the following:
Accepted in Full
Partially Accepted
Accepted in Full ex-gratia
Partially accepted ex-gratia
Withdrawn by Insured
Withdrawn by Insurer
Declined - due to policy conditions
Declined - due to innocent non-disclosure
Declined - fraudulent

34

Gross amount paid

The amount of payments made on this claim since the claim was first reported, net of GST in whole dollars, no decimal point.  Includes payments made to claimant and to third-party service providers (medical, legal, investigation) that are attributed to the claim

35

Estimated amount (Case estimate)

Total of all payments expected to be made in future to the claimant(s) and third-party providers at the end of the reporting period, net of GST in whole dollars, no decimal point. Will be zero if the claim is finalised.

36

Withdraw reason

If applicable, the primary reason the claim was withdrawn.
The reason for withdrawing is to be one of the following: 

Claim below excess/amount too small
Claimant could not provide information
Claimant not a beneficiary
Decline Reasons
Duplicate Claim / lodged incorrectly
Fraudulent / Misconduct
No policy cover
No response from claimant
Not a claim/ settled elsewhere
Other/Unknown
Potential denial
Returned to work
Withdrawn during or after investigation
Withdrawn by claimant
Not applicable

37

Decline reason

If applicable, the primary reason why the claim is not covered under the terms and conditions of the policy.

Claim under excess
Exclusions
Failure to Establish an Incident took Place / Lack of Evidence
Fraudulent
Indemnity Denied
Innocent Misrepresentation/Non-disclosure
No cover under policy
Not a claim/ settled elsewhere
Other/Unknown
Outside Policy Period/Expired
Pre-existing Condition
Review with no decision
Terms & Conditions
Withdrawn
Declined - Other exclusion (PDS) (Specify)
Declined - Other underwriting issue (specify)
Declined - Outside period of cover
Declined - Terrorism or war
Not applicable

38

Type of third-party service provider appointed

Service provider means an Investigator, Loss Assessor or Loss Adjuster, Collection Agent, Claims Management Service (including a broker who manages claims on behalf of an insurer) or its approved sub-contractors acting on behalf of the Insurer.

Loss Assessor or Loss Adjuster* means a person, company or entity who is not an Insurer's employee that is contracted by the Insurer to examine the circumstances of a claim, assess the damage or loss, determine whether the claim is covered under the policy, and assist in obtaining repair/replacement quotes to help settle the claim.
The type of third-party service provider appointed is to be one of the following:
1) Investigator, 
2) Loss Assessor or Loss Adjuster, 
3) Collection Agent, 
4) Claims Management Service, 
5) Engineers, 
6) Builders, 
7) Repairers
8) other 
9) not applicable

39

Claim channel (e.g., online, app, phone)

How the claimant lodged the claim with the insurer.
The type of claim channel is to be one of the following:
1) Online form
2) Claims App
3) Phone
4) In person

40

Claims handling management - internal or external to firm

Claims Management Service means a person, company or entity who is not an Insurer’s employee that is contracted by the Insurer to manage a claim on its behalf.
The type of claims handling management is to be one of the following:
1) Internal
2) External
3) Both 
4) Not applicable

41

Type of consumer representative appointed (assistance in claim process)

If applicable, the relationship between the claimant and the representative that has been appointed to act on the claimant's behalf during the claims process.
The type of third party is to be one of the following:
1) Family
2) Lawyer
3) Broker
4) Claims handling firm 
5) Other
6) Not applicable

42

CAT code

ICA catastrophe code if claim is for an event declared a catastrophe.
Catastrophe means an event declared by the Insurance Council of Australia to be a Catastrophe - for example fire, flood, earthquake, cyclone, severe storm, or hail, resulting in a large number of insurance claims and involving multiple insurers.

43

Non-reinsurance recoveries (i.e., from third parties)

Non-reinsurance recoverables comprise recoverables for current and prior years from subrogation, salvage, sharing arrangements etc, net of provision for doubtful debts and includes input tax credits.

44

IDR disputes (Firm identifier)

List of IDR Complaint Reference Numbers for all disputes related to the claim

45

EDR disputes (AFCA identifier)

List of EDR Complaint Reference Numbers for all disputes related to the claim

45

Policy number 

A unique policy identifier (which may relate to several separate risk records) by which the exposure and premium information on each individual record can be identified.

ID

Data point

Proposed definition/description

Policy data

1

PDS Name

Title of the Product Disclosure Statement for the policy under which the claim was made.

2

PDS Effective Date

Date the Product Disclosure Statement came into effect for the policy under which the claim was made.

3

Product variant

(Suitable definition to be determined - for PDS' that cover more than one product or level of cover)

4

Cooling off period

Number of days for cooling period

5

Risk Street

Street address of insured property including number, street name and street type

6

Risk Suburb 

The suburb of the address where the insured risk is located

7

Total Replacement Cover

Flag for policy being Total Replacement cover, or Sum Insured policy

8

Temporary Accommodation Benefit Type

Structure of Temporary Accommodation benefit
a) Additional Benefit
b) Included in Sum Insured

9

Removal of Debris Benefit Type

Structure of removal of debris benefit
a) Additional Benefit
b) Included in Sum Insured

10

Sum Insured - Building

The insured amount of the insured property. If total replacement cover, the nominal sum insured on which premium calculation is based.

11

Sum Insured - Contents

The insured amount of the contents of the insured property

12

Sum Insured – Public Liability

The insured amount of public liability cover relating to the insured property

13

Year of Construction

Year of construction of main building of insured property

14

Construction Type

Brick/Double Brick/Fibro etc. as per Insurers system

15

Flood Cover

Policy covers flood peril, YES or NO

16

G-NAFID

Geocoded National Address File. Geocoded address data 

17

Building type

The type of building insured

18

Roof type

As per Insurer's system

19

Mitigation factors

Roller door, Window Protection, Roof replacement

20

Premium revenue attributable to public liability insurance

Portion of premium attributed to public liability

21

Temporary Accommodation Start

Date any emergency accommodation started

22

Temporary Accommodation Finish

Date any emergency accommodation finished

23

Emergency Cash

Dollar value of any emergency cash paid

24

Cause of Loss

The cause of loss for which the claim has been made.

25

Form of settlement selected

The type of settlement that is accepted by the insured/ claimant as a resolution for the claim.

The form of settlement is to be one of the following:

1) Cash Settlement
2) Manage repair/rebuild
3) Both (Combination of both cash settlement and manage a repair/ rebuild)
4) Replacement

26

Offer Accepted Date

The date the claimant accepts the insurers offer of settlement.

27

Cash Settlement Fact Sheet Date

The date the cash settlement fact sheet was sent to the claimant

28

Reinsurance recoveries

Total of all amounts that have been received under reinsurance contracts.

29

Investigation

Flag for if surveillance activities were conducted by the insurer or a third party.

30

Fraud flags

Flag for when the Insurer has identified anomalies or fraud investigation indicators that suggest that the claim involves a high risk of insurance fraud warranting further inquiries or examination

31

Repairer Selected

Field to flag whether the repairer/builder was selected by the insurer or chosen by the claimant

32

Removal of Debris Benefit

Maximum Value of debris removal benefit

33

Claims Expenses attributable to public liability insurance

Claim amount attributed to public liability