D11B | EDIFACTORY

Message D11B/RECLAM

Reinsurance claims message

A reinsurance claims message is exchanged between insurers, professional intermediaries, reinsurers to send information concerning a loss and/or to request settlement (payment or refund) concerning the loss.

Message description

UNH

M(1) : Message header

A service segment starting and uniquely identifying a message. The message type code for the Reinsurance claims message is RECLAM. Note: Reinsurance claims messages conforming to this document must contain the following data in segment UNH, composite S009: Data element 0065 RECLAM 0052 D 0054 11B 0051 UN

SG1 M(99) : GEI-FTX

A group of segments to transmit general processing indicators and to specify loss or event details.

GEI

M(1) : Processing information

A segment to give a processing indicator relating to the whole message.

FTX

C(1) : Free text

A segment to give free format text regarding type of participation, type of risk, cause of loss, consequence of loss.

SG2 M(999) : NAD-PCD-CTA-COM-RFF-GEI-FTX-DTM

A group of segments to specify relevant parties for the whole transaction.

NAD

M(1) : Name and address

A segment to specify the name and address and the related function of the party involved.

PCD

C(1) : Percentage details

A segment to specify the producing or the placing intermediary's or broker's order percentage in the reinsurance, and to give the reinsurer's share in this intermediary's or broker's order.

CTA

C(1) : Contact information

A segment to identify a person or department to whom the communication should be directed.

COM

C(5) : Communication contact

A segment to identify a communication number of a department or a person to whom communication should be directed.

RFF

C(5) : Reference

A segment to specify the references of the party identified in the leading NAD segment.

GEI

C(2) : Processing information

A segment to give a processing indicator relating to the consequence of loss.

FTX

C(2) : Free text

A segment to provide the ceding company details, leading reinsurer's comments, claimant information.

DTM

C(9) : Date/time/period

A segment to give information dates regarding claimants in medical malpractice.

UNS

M(1) : Section control

A segment placed at the start of the detail section to avoid segment collision.

DTM

M(8) : Date/time/period

A segment to specify pertinent dates and periods relating to the RECLAM.

FTX

C(999) : Free text

A segment to provide free format information regarding the loss, the risk or the reinsurance contract.

SG3 C(9) : RFF-DTM-COM-FTX

A group of segments to provide information concerning the loss or event, and the reinsurance contract.

RFF

M(1) : Reference

A segment to provide references concerning the loss or event, reinsurance contract detail references, and for attached documents.

DTM

C(1) : Date/time/period

A segment to specify the transaction date of the attached document or message.

COM

C(1) : Communication contact

A segment to identify the means by which the attached document or message was transmitted.

FTX

C(1) : Free text

A segment to provide free text regarding the document or message that is being referenced.

LOC

C(1) : Place/location identification

A segment to identify the geographical scope to which the loss pertains.

MOA

C(1) : Monetary amount

A segment to specify the possible maximum loss amount.

PCD

C(1) : Percentage details

A segment to specify the possible maximum loss as a percentage.

SG4 C(99) : GEI-RFF-LOC-DTM-FTX-PCD-SG5-SG7

A group of segments to specify the class, line or sub-line of business.

GEI

M(1) : Processing information

A segment to give a processing indicator relating to the policy breakdown.

RFF

C(8) : Reference

A segment to specify references of the original insurance policy contract.

LOC

C(9) : Place/location identification

A segment to identify the geographical scope to which the risk pertains.

DTM

C(1) : Date/time/period

A segment to give the original insurance policy effective period.

FTX

C(3) : Free text

A segment used to provide additional free text information about the policy effective period, the whole policy contract and the class or line of business.

PCD

C(2) : Percentage details

A segment used to give the percentage of the original insurance policy contract ceded to one or more reinsurance contract(s).

SG5 C(3) : CUX-GEI-FTX-SG6-PCD

A group of segments to specify the amounts of the original insurance policy contract in three non-equivalent currencies.

CUX

M(1) : Currencies

A segment to specify the appropriate non-equivalent currency being used to report the amounts in the original insurance policy contract section.

GEI

C(1) : Processing information

A segment to indicate whether the following amounts are annuities.

FTX

C(1) : Free text

A segment to provide additional free text information regarding the annuities.

SG6 M(99) : MOA-GEI-CUX-FTX

A group of segments to provide all the information regarding amounts and converted amounts of the original insurance policy contract.

MOA

M(1) : Monetary amount

A segment to specify the amounts of the original insurance policy contract.

GEI

M(3) : Processing information

A segment to provide the entries expression flag.

CUX

C(1) : Currencies

A segment to specify the reference and target currencies and the rate of exchange, in case a currency conversion is required.

FTX

C(2) : Free text

A segment to provide free text information regarding policy contract amounts.

PCD

M(1) : Percentage details

A segment to specify the cedent's share percentage.

SG7 C(99) : NAD-PCD

A group of segments to identify the parties involved in the original insurance policy section.

NAD

M(1) : Name and address

A segment to specify the name and address and the related function of the party involved.

PCD

C(1) : Percentage details

A segment to give the percentage in the original insurance policy of the party identified in the leading NAD segment.

UNS

M(1) : Section control

A segment used to prevent collision between the detail and the summary sections of the message.

SG8 C(3) : CUX-SG9

A group of segments to specify the amounts of the reinsurance contract in three non-equivalent currencies.

CUX

M(1) : Currencies

A segment to specify the appropriate non-equivalent currency used to report the amounts in the reinsurance contract section.

SG9 M(999) : MOA-PCD-CUX-FTX-SG10-GEI

A group of segments to provide all the information related to the amounts and their currency conversion for the reinsurance contract.

MOA

M(1) : Monetary amount

A segment to specify the amounts of the reinsurance contract.

PCD

C(2) : Percentage details

A segment to specify the reinsurer's share percentage or the applicable reinsurance contract retention.

CUX

C(1) : Currencies

A segment to specify the reference and target currencies and the rate of exchange, in case a currency conversion is required.

FTX

C(10) : Free text

A segment to provide free text information regarding the reinsurance contract amounts.

SG10 C(99) : RFF-DTM-COM-FTX

A group of segments to make reference to previous loss notifications in case an aggregate deductible is applicable.

Message structure

UNH, Message header                           M        1

--- Segment Group 1 ------------------------- M       99 -------+
GEI, Processing information                   M        1        |
FTX, Free text                                C        1        |
---- -----------------------------------------------------------+

--- Segment Group 2 ------------------------- M      999 -------+
NAD, Name and address                         M        1        |
PCD, Percentage details                       C        1        |
CTA, Contact information                      C        1        |
COM, Communication contact                    C        5        |
RFF, Reference                                C        5        |
GEI, Processing information                   C        2        |
FTX, Free text                                C        2        |
DTM, Date/time/period                         C        9        |
---- -----------------------------------------------------------+
UNS, Section control                          M        1
DTM, Date/time/period                         M        8
FTX, Free text                                C      999

--- Segment Group 3 ------------------------- C        9 -------+
RFF, Reference                                M        1        |
DTM, Date/time/period                         C        1        |
COM, Communication contact                    C        1        |
FTX, Free text                                C        1        |
---- -----------------------------------------------------------+
LOC, Place/location identification            C        1
MOA, Monetary amount                          C        1
PCD, Percentage details                       C        1

--- Segment Group 4 ------------------------- C       99 -------+
GEI, Processing information                   M        1        |
RFF, Reference                                C        8        |
LOC, Place/location identification            C        9        |
DTM, Date/time/period                         C        1        |
FTX, Free text                                C        3        |
PCD, Percentage details                       C        2        |
                                                                |
--- Segment Group 5 ------------------------- C        3 ------+|
CUX, Currencies                               M        1       ||
GEI, Processing information                   C        1       ||
FTX, Free text                                C        1       ||
                                                               ||
--- Segment Group 6 ------------------------- M       99 -----+||
MOA, Monetary amount                          M        1      |||
GEI, Processing information                   M        3      |||
CUX, Currencies                               C        1      |||
FTX, Free text                                C        2      |||
---- ---------------------------------------------------------+||
PCD, Percentage details                       M        1       ||
---- ----------------------------------------------------------+|
                                                                |
--- Segment Group 7 ------------------------- C       99 ------+|
NAD, Name and address                         M        1       ||
PCD, Percentage details                       C        1       ||
---- ----------------------------------------------------------++
UNS, Section control                          M        1

--- Segment Group 8 ------------------------- C        3 -------+
CUX, Currencies                               M        1        |
                                                                |
--- Segment Group 9 ------------------------- M      999 ------+|
MOA, Monetary amount                          M        1       ||
PCD, Percentage details                       C        2       ||
CUX, Currencies                               C        1       ||
FTX, Free text                                C       10       ||
                                                               ||
--- Segment Group 10 ------------------------ C       99 -----+||
RFF, Reference                                M        1      |||
DTM, Date/time/period                         C        1      |||
COM, Communication contact                    C        1      |||
FTX, Free text                                C        1      |||
---- ---------------------------------------------------------+||
GEI, Processing information                   M       99       ||
---- ----------------------------------------------------------++
UNT, Message trailer                          M        1