Claim schema

The Claim document (packages/shared/src/claim.ts) is the contract between the generator, the stores, the claim screens, the chat tools and every embedding host. This is its input shape: what a host or the generator must supply. Fields marked required must be present; everything else is filled with an empty, honest default when the document is parsed, so every consumer still receives a complete claim.

Money is a plain number in the claim's currency. Dates are YYYY-MM-DD strings. "Required" inside an optional section means required when that section is supplied. See The Claim contract for why it is shaped this way.

Generated from the code

This page is generated by docusaurus/scripts/generate-reference.ts from the source it describes. Edit the source, then run npm run docs:reference.

Top-level sections

Section	Required	What it holds
id	yes	Claim reference, e.g. CP-AUT-260381
lineOfBusiness	yes	auto · property · workers_compensation · general_liability
title	yes	Banner title, e.g. "Priya Natarajan v Halden Logistics Ltd"
status	yes	filed · under_review · approved · paid · denied · closed · reopened · reclosed
currency	yes	GBP · USD
claimant	yes	object
incident	yes	object
policy	yes	object
scenario		Short slug naming the demo scenario this claim exists to exercise
restricted		boolean
product		Product hierarchy shown under KEY FACTS
client		object
loss		object
diagnosis		object
adjuster		object
statusHistory		list
dates		object
financials		object
payments		list
reimbursements		list
recovery		object
involvements		list
serviceProviders		list
litigation		object
investigation		object
riskFlags		list
compliance		object
feedback		object
diary		list
tasks		list
documents		list
mi		object
metadata		object

Sections in detail

id

Required. Claim reference, e.g. CP-AUT-260381

Type: string.

lineOfBusiness

Required.

Type: auto · property · workers_compensation · general_liability.

title

Required. Banner title, e.g. "Priya Natarajan v Halden Logistics Ltd"

Type: string.

status

Required.

Type: filed · under_review · approved · paid · denied · closed · reopened · reclosed.

currency

Required.

Type: GBP · USD.

claimant

Required.

Field	Type	Required	Notes
claimant.name	string	yes
claimant.type	individual · organisation	yes
claimant.dateOfBirth	date (YYYY-MM-DD)
claimant.contact	object
claimant.contact.phone	string
claimant.contact.email	string
claimant.contact.address	object
claimant.contact.address.line1	string
claimant.contact.address.line2	string
claimant.contact.address.city	string
claimant.contact.address.region	string
claimant.contact.address.postalCode	string
claimant.contact.address.country	string
claimant.relationshipToPolicyholder	string		Default "".
claimant.representation	object
claimant.representation.firm	string
claimant.representation.contact	string
claimant.wage	object
claimant.wage.weeklyWage	number
claimant.wage.occupation	string
claimant.wage.employer	string
claimant.wage.hoursPerWeek	number
claimant.injury	object
claimant.injury.bodyPart	string
claimant.injury.natureOfInjury	string
claimant.injury.severity	minor · moderate · severe · catastrophic
claimant.injury.description	string
claimant.returnToWork	object
claimant.returnToWork.status	not_applicable · off_work · light_duties · returned · unable
claimant.returnToWork.expectedDate	date (YYYY-MM-DD)
claimant.returnToWork.actualDate	date (YYYY-MM-DD)
claimant.returnToWork.restrictions	string

incident

Required.

Field	Type	Required	Notes
incident.dateOfLoss	date (YYYY-MM-DD)	yes
incident.timeOfLoss	string
incident.dateReported	date (YYYY-MM-DD)	yes
incident.dateReceived	string		Default "".
incident.occurrenceNumber	string		Default "".
incident.location	object
incident.location.description	string		Default "".
incident.location.address	object
incident.location.address.line1	string
incident.location.address.line2	string
incident.location.address.city	string
incident.location.address.region	string
incident.location.address.postalCode	string
incident.location.address.country	string
incident.description	string	yes	Narrative of what happened
incident.cause	string		Default "".
incident.policeReference	string
incident.weather	string
incident.witnesses	object[]
incident.witnesses[].name	string
incident.witnesses[].contact	string
incident.witnesses[].statement	string

policy

Required.

Field	Type	Required	Notes
policy.policyNumber	string	yes
policy.insuranceType	string		Insurance Types: health, life, auto, property, liability … Default "".
policy.policyType	string		Policy Types: individual, group, commercial, fleet … Default "".
policy.insurer	string		Default "".
policy.policyholder	object	yes
policy.policyholder.name	string	yes
policy.policyholder.type	individual · organisation	yes
policy.policyholder.contact	object
policy.policyholder.contact.phone	string
policy.policyholder.contact.email	string
policy.policyholder.contact.address	object
policy.policyholder.contact.address.line1	string
policy.policyholder.contact.address.line2	string
policy.policyholder.contact.address.city	string
policy.policyholder.contact.address.region	string
policy.policyholder.contact.address.postalCode	string
policy.policyholder.contact.address.country	string
policy.policyholder.dateOfBirth	date (YYYY-MM-DD)
policy.effectiveFrom	date (YYYY-MM-DD)	yes
policy.effectiveTo	date (YYYY-MM-DD)	yes
policy.state	active · lapsed · cancelled · expired · pending_renewal	yes
policy.policyClass	string		Policy Class: rating class / occupation class / property class Default "".
policy.coverages	object[]
policy.coverages[].code	string
policy.coverages[].name	string
policy.coverages[].limit	number or null		Default null.
policy.coverages[].deductible	number or null		Default null.
policy.coverages[].description	string
policy.exclusions	string[]		Default [].
policy.endorsements	string[]		Default [].
policy.additionalInsured	string[]		Default [].
policy.scheduleItems	object[]
policy.scheduleItems[].item	string
policy.scheduleItems[].description	string
policy.scheduleItems[].sumInsured	number
policy.premium	object
policy.premium.annual	number
policy.premium.paidToDate	number
policy.premium.outstanding	number
policy.premium.paymentFrequency	string
policy.conditions	string[]		Policy conditions that could affect this claim (e.g. notification within 30 days) Default [].

scenario

Short slug naming the demo scenario this claim exists to exercise

Type: string.

restricted

Type: boolean.

product

Product hierarchy shown under KEY FACTS

Type: string[].

client

Field	Type	Required	Notes
client.id	string
client.name	string
client.abbreviation	string
client.programme	string		The programme / scheme this claim is handled under
client.contact	object
client.contact.phone	string
client.contact.email	string
client.contact.address	object
client.contact.address.line1	string
client.contact.address.line2	string
client.contact.address.city	string
client.contact.address.region	string
client.contact.address.postalCode	string
client.contact.address.country	string
client.handlingRules	string[]
client.slaDays	object
client.slaDays.acknowledge	number
client.slaDays.firstContact	number
client.slaDays.reserveReview	number
client.authorityLimit	number		Handler authority limit set by this client

loss

Field	Type	Required	Notes
loss.type	string
loss.description	string
loss.estimatedValue	number
loss.items	object[]
loss.items[].description	string
loss.items[].category	string
loss.items[].amount	number
loss.items[].coverageCode	string

diagnosis

Field	Type	Required	Notes
diagnosis.icd10	object[]
diagnosis.icd10[].code	string
diagnosis.icd10[].description	string
diagnosis.drgCode	string
diagnosis.treatingProvider	string
diagnosis.treatmentPlan	string
diagnosis.prognosis	string
diagnosis.maximumMedicalImprovement	date (YYYY-MM-DD)

adjuster

Field	Type	Required	Notes
adjuster.id	string
adjuster.firstName	string
adjuster.lastName	string
adjuster.team	string
adjuster.teamLeader	string
adjuster.dateAssigned	date (YYYY-MM-DD)
adjuster.authorityLimit	number

statusHistory

Field	Type	Required	Notes
statusHistory[].status	filed · under_review · approved · paid · denied · closed · reopened · reclosed
statusHistory[].date	date (YYYY-MM-DD)
statusHistory[].note	string

dates

Field	Type	Required	Notes
dates.made	string		Default "".
dates.received	string		Default "".
dates.assigned	string		Default "".
dates.instruction	string		Default "".
dates.closed	date (YYYY-MM-DD)
dates.denied	date (YYYY-MM-DD)
dates.reopened	date (YYYY-MM-DD)

financials

Field	Type	Required	Notes
financials.reserves	object
financials.reserves.indemnity	number
financials.reserves.expense	number
financials.reserves.legal	number
financials.paid	object
financials.paid.indemnity	number
financials.paid.expense	number
financials.paid.legal	number
financials.byCoverage	object[]
financials.byCoverage[].coverageCode	string
financials.byCoverage[].reserve	number
financials.byCoverage[].paid	number
financials.byCoverage[].recovered	number
financials.byCoverage[].firstPaymentDate	date (YYYY-MM-DD)
financials.byCoverage[].lastPaymentDate	date (YYYY-MM-DD)

payments

Field	Type	Required	Notes
payments[].id	string
payments[].date	date (YYYY-MM-DD)
payments[].type	indemnity · expense · legal · reimbursement · reversal
payments[].coverageCode	string
payments[].payee	string
payments[].amount	number
payments[].status	pending · issued · cleared · voided
payments[].method	string
payments[].description	string
payments[].approvedBy	string
payments[].approvedDate	date (YYYY-MM-DD)

reimbursements

Field	Type	Required	Notes
reimbursements[].id	string
reimbursements[].provider	string
reimbursements[].invoiceReference	string
reimbursements[].serviceStart	date (YYYY-MM-DD)
reimbursements[].serviceEnd	date (YYYY-MM-DD)
reimbursements[].billed	number
reimbursements[].ppoDiscount	number
reimbursements[].allowed	number
reimbursements[].paid	number
reimbursements[].billStatus	received · in_review · paid · disputed · unpaid

recovery

Field	Type	Required	Notes
recovery.subrogation	object
recovery.subrogation.potential	boolean
recovery.subrogation.target	string
recovery.subrogation.amountSought	number
recovery.subrogation.status	string
recovery.salvage	object
recovery.salvage.potential	boolean
recovery.salvage.estimatedValue	number
recovery.amountRecovered	number

involvements

Field	Type	Required	Notes
involvements[].id	string
involvements[].role	claimant · defendant · policyholder · insurer · solicitor · repairer · physician · hospital · pharmacy · expert · witness · court · employer · broker · contractor · loss_adjuster · other
involvements[].name	string
involvements[].organisation	string
involvements[].reference	string
involvements[].contact	object
involvements[].contact.phone	string
involvements[].contact.email	string
involvements[].contact.address	object
involvements[].contact.address.line1	string
involvements[].contact.address.line2	string
involvements[].contact.address.city	string
involvements[].contact.address.region	string
involvements[].contact.address.postalCode	string
involvements[].contact.address.country	string
involvements[].status	active · settled · closed
involvements[].notes	string

serviceProviders

Field	Type	Required	Notes
serviceProviders[].id	string
serviceProviders[].type	string
serviceProviders[].name	string
serviceProviders[].registrationNumber	string		NPI / licence / company number
serviceProviders[].contact	object
serviceProviders[].contact.phone	string
serviceProviders[].contact.email	string
serviceProviders[].contact.address	object
serviceProviders[].contact.address.line1	string
serviceProviders[].contact.address.line2	string
serviceProviders[].contact.address.city	string
serviceProviders[].contact.address.region	string
serviceProviders[].contact.address.postalCode	string
serviceProviders[].contact.address.country	string
serviceProviders[].onPanel	boolean

litigation

Field	Type	Required	Notes
litigation.status	none · pre_litigation · proceedings_issued · defended · trial_listed · settled · judgment
litigation.proceedings	object[]
litigation.proceedings[].claimNumber	string
litigation.proceedings[].type	string
litigation.proceedings[].claimant	string
litigation.proceedings[].defendant	string
litigation.proceedings[].court	string
litigation.proceedings[].issuedDate	date (YYYY-MM-DD)
litigation.proceedings[].nextHearing	date (YYYY-MM-DD)
litigation.proceedings[].nextHearingType	string
litigation.appearances	object[]
litigation.appearances[].date	date (YYYY-MM-DD)
litigation.appearances[].type	string
litigation.appearances[].outcome	string
litigation.counsel	string

investigation

Field	Type	Required	Notes
investigation.coverage	confirmed · pending · disputed · declined
investigation.liability	accepted · denied · split · pending · not_applicable
investigation.liabilitySplit	number		Percentage attributed to the insured, when split
investigation.employment	confirmed · pending · not_applicable
investigation.companyRecords	received · requested · not_applicable
investigation.medical	received · requested · not_applicable
investigation.findings	object[]
investigation.findings[].date	date (YYYY-MM-DD)
investigation.findings[].summary	string
investigation.outstanding	string[]

riskFlags

Field	Type	Required	Notes
riskFlags[].code	LATE_REPORTING · PRIOR_CLAIMS_HISTORY · INCONSISTENT_STATEMENTS · DUPLICATE_INVOICE · PROVIDER_WATCHLIST · POLICY_INCEPTION_PROXIMITY · SOCIAL_MEDIA_CONTRADICTION · UNUSUAL_TREATMENT_PATTERN · REPAIR_COST_ABOVE_MARKET · NO_POLICE_REPORT
riskFlags[].severity	low · medium · high
riskFlags[].description	string
riskFlags[].raisedOn	date (YYYY-MM-DD)
riskFlags[].source	string

compliance

Field	Type	Required	Notes
compliance.jurisdiction	string
compliance.regulatoryDeadlines	object[]
compliance.regulatoryDeadlines[].name	string
compliance.regulatoryDeadlines[].due	date (YYYY-MM-DD)
compliance.regulatoryDeadlines[].met	boolean or null
compliance.sanctionsCheck	object
compliance.sanctionsCheck.performed	boolean
compliance.sanctionsCheck.date	date (YYYY-MM-DD)
compliance.sanctionsCheck.flagged	boolean
compliance.auditNotes	string[]

feedback

Field	Type	Required	Notes
feedback.satisfactionScore	number or null
feedback.complaints	object[]
feedback.complaints[].date	date (YYYY-MM-DD)
feedback.complaints[].summary	string
feedback.complaints[].status	open · resolved

diary

Field	Type	Required	Notes
diary[].id	string
diary[].date	date (YYYY-MM-DD)
diary[].author	string
diary[].type	note · call · email · letter · meeting · system
diary[].content	string

tasks

Field	Type	Required	Notes
tasks[].id	string
tasks[].dueDate	date (YYYY-MM-DD)
tasks[].category	string
tasks[].name	string
tasks[].owner	string
tasks[].status	open · done · overdue
tasks[].critical	boolean

documents

Field	Type	Required	Notes
documents[].id	string
documents[].date	date (YYYY-MM-DD)
documents[].direction	inbound · outbound
documents[].type	string
documents[].title	string
documents[].from	string
documents[].to	string
documents[].summary	string		What the document says — the chat reads this in place of the file

mi

Field	Type	Required	Notes
mi.initialReported	boolean
mi.resolutionReported	boolean
mi.costsReported	boolean

metadata

Field	Type	Required	Notes
metadata.generatedBy	string		Default "".
metadata.generatedAt	string		Default "".
metadata.taxonomyVersion	string		Default "".
metadata.scenarioNotes	string		What this claim is designed to demonstrate in Claimpilot Chat Default "".
metadata.demo	object
metadata.demo.hint	string		One sentence shown as a floating hint on the claim screen, e.g. "Try Validate policy — cover lapsed a week before the loss."
metadata.demo.showcases	string[]		Capability ids this claim is built to demonstrate
metadata.demo.gotchas	string[]		The traps planted in the record, in plain words, so a presenter knows what the assistant should find