Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p19
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 49098–51983

respect of those categories should be dealt with as follows:
(a)          Policy Benefits that can be added together, with the same claim conditions:
(i)            A single claim outcome should be reported, with the Claim Sum Insured and Claim Amount Paid calculated as the sum of the underlying Policy Benefits.
(b)          Policy Benefits that can be added together, with potentially different claim conditions:
(i)            If the claim outcome is the same for all the underlying Policy Benefits, a single claim outcome should be recorded, with the Claim Sum Insured and Claim Amount Paid calculated as the sum of the underlying Policy Benefits.
(ii)         If the claim outcome is not the same for all underlying Policy Benefits, separate claim outcomes should be recorded. One claim record should be reported for each claim outcome, with the Claim Sum Insured and Claim Amount Paid calculated as the sum of the underlying Policy Benefits with the given claim outcome.
(c)          Policy Benefits that cannot be added together and provide for benefits under different claim conditions:
    A single claim outcome should be reported. Specifically:
(i)            If the claim was admitted (including an ex-gratia admittance), or any other form of payment made, a single record should be reported in the appropriate category, reflecting the relevant Claim Sum Insured and Claim Amount Paid. The fact that there may have been a decline decision in respect of another Policy Benefit should not be reported.
(ii)         If the claim was declined (with no payment) under all Policy Benefits, a single decline decision should be reported. The Sum Insured should be appropriately apportioned among different Policy Benefits.
    The most common example is the structuring of TPD benefits with different definitions for disability. The Life Insured could then be assessed under multiple disability definitions, arising from the same claim submission.
53.         In respect of Claims Data, the detail set out in paragraphs 54 to 63 should be provided.
54.         The total number of claims that are undetermined at the start of the Reporting Period, split by Claim Incidence Year (labelled A on the various claims sheets in the reporting form). It is expected that numbers reported undetermined at the start of the Reporting Period would correspond to numbers reported undetermined at the end of the corresponding Claim Incidence Year in the previous Reporting Period. The classification of Claim Incidence Year should be based on the Claim Event Date of each individual claim received.
55.         The total number of Claims Notified during the Reporting Period (labelled B). Where the Claim Event Date is known, the notified claim should be allocated to the relevant Claim Incidence Year. Where the Claim Event Date is not known, the notified claim should be allocated to the most