Document ID: chunk:federal_register_of_legislation:F2018L01496:body:0:p20
Version: federal_register_of_legislation:F2018L01496
Segment Type: other
Provision Reference: 
Character Range: 51747–54742

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 recent Claim Incidence Year.
56.         The total number of claims that have been received during the Reporting Period, split by Claim Incidence Year (labelled C).
57.         The total number of claims that have been re-opened (subsequent to being withdrawn) during the Reporting Period, split by Claim Incidence Year (labelled D).
58.         The total number of claims that have been withdrawn during the Reporting Period, split by Claim Incidence Year (labelled E). Claims withdrawn should be split between the following withdrawal reasons:
(a)          'Withdrawn by the claimant' (labelled E.1).
(b)          'Withdrawn by the insurer' (labelled E.2).
(c)          'Other reasons for withdrawal' (labelled E.3).
59.         The total number of claims that have been finalised during the Reporting Period, split by Claim Incidence Year (labelled G). Claims finalised should be split between the following categories:
(a)          'Claims admitted (excluding ex-gratia payments)' (labelled G.1). This includes claims where the full benefit that the claimant was entitled to in terms of the Policy Contract was paid (or is payable). Where the Policy Contract makes provision for the payment of a portion of the full Sum Insured (e.g. severity-based Trauma or Accidental Injury benefits, or reductions in income benefits in lieu of other income received by the claimant), and such reductions were applied, the claim should be reflected in this category. No ex-gratia payments should be included here, even where the full benefit was paid.
(b)          'Claims declined (with no payment)' (labelled G.2). This includes outcomes where the claim is declined, with no benefit paid (or payable) to the claimant. Claims declined should be split between the categories defined in paragraph 61.
(c)          'Claims admitted fully on an ex-gratia basis' (labelled G.3). These are claims that technically do not meet the Policy Contract definition for a claim, but the insurer has decided to pay the claim in full.
(d)          'All other ex-gratia payments, settlements or premium refunds' (labelled G.4). These are claims where the full claim has not been admitted, but where the insurer has decided or agreed to make some form of payment, including ex-gratia payments, commercial settlements, and premium refunds or non-cash benefits. Note the treatment of different types of premium refunds as explained in paragraph 72.
60.         Total number of claims that are undetermined at the end of the Reporting Period, split by Claim Incidence Year (labelled H).
61.         Claims declined (with no payment) should be split between the following categories:
(a)          'Contractual definition not met (including eligibility criteria)' (labelled G.2.1). These are