Guidewire Core Workflow B: Claims Processing

Guidewire Core Workflow B: Claims Processing

Overview

Master the complete claims lifecycle in ClaimCenter: First Notice of Loss (FNOL), claim investigation, reserve setting, payments, and settlement.

Prerequisites

• Completed guidewire-install-auth and guidewire-core-workflow-a
• Understanding of claims handling processes
• Valid API credentials with claims admin permissions

Claims Lifecycle States

FNOL → Open → Investigation → Evaluation → Negotiation → Settlement → Closed
  |      |          |              |             |            |          |
  v      v          v              v             v            v          v
[Draft] [Open]  [Reserve]    [Exposure]   [Payment]   [Settle]   [Closed]

Instructions

Step 1: Create FNOL (First Notice of Loss)

// Create a new claim via FNOL
interface FNOLRequest {
  data: {
    attributes: {
      lossDate: string;
      lossTime?: string;
      reportedDate: string;
      lossType: { code: string };
      lossCause: { code: string };
      description: string;
      policyNumber: string;
      lossLocation?: {
        addressLine1: string;
        city: string;
        state: { code: string };
        postalCode: string;
      };
      reporter?: {
        firstName: string;
        lastName: string;
        primaryPhone: string;
        relationship: { code: string };
      };
    };
  };
}

async function createFNOL(fnolData: FNOLData): Promise<Claim> {
  const request: FNOLRequest = {
    data: {
      attributes: {
        lossDate: fnolData.lossDate,
        lossTime: fnolData.lossTime,
        reportedDate: new Date().toISOString().split('T')[0],
        lossType: { code: fnolData.lossType }, // 'AUTO', 'PR', 'GL', 'WC'
        lossCause: { code: fnolData.lossCause },
        description: fnolData.description,
        policyNumber: fnolData.policyNumber,
        lossLocation: {
          addressLine1: fnolData.location.address,
          city: fnolData.location.city,
          state: { code: fnolData.location.state },
          postalCode: fnolData.location.zip
        },
        reporter: {
          firstName: fnolData.reporter.firstName,
          lastName: fnolData.reporter.lastName,
          primaryPhone: fnolData.reporter.phone,
          relationship: { code: 'insured' }
        }
      }
    }
  };

  const response = await claimCenterClient.request<{ data: Claim }>(
    'POST',
    '/​fnol/​v1/​fnol',
    request
  );

  console.log(`Created claim: ${response.data.claimNumber}`);
  return response.data;
}

Step 2: Add Exposures

// Add exposures (coverages that may apply)
interface ExposureRequest {
  data: {
    attributes: {
      exposureType: { code: string };
      lossParty: { code: string };
      primaryCoverage: { code: string };
      claimant?: { id: string };
      incident?: { id: string };
    };
  };
}

async function addExposure(
  claimId: string,
  exposureData: ExposureData
): Promise<Exposure> {
  const request: ExposureRequest = {
    data: {
      attributes: {
        exposureType: { code: exposureData.type }, // 'VehicleDamage', 'BodilyInjury', etc.
        lossParty: { code: exposureData.lossParty }, // 'insured', 'claimant'
        primaryCoverage: { code: exposureData.coverageCode },
        claimant: exposureData.claimantId ? { id: exposureData.claimantId } : undefined
      }
    }
  };

  const response = await claimCenterClient.request<{ data: Exposure }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​exposures`,
    request
  );

  return response.data;
}

Step 3: Add Incidents

// Add vehicle incident for auto claims
interface VehicleIncidentRequest {
  data: {
    attributes: {
      severity: { code: string };
      description: string;
      vehicle: {
        vin?: string;
        year: number;
        make: string;
        model: string;
        color?: string;
        licensePlate?: string;
      };
      damageDescription: string;
      airbagDeployed?: boolean;
      vehicleOperable?: boolean;
    };
  };
}

async function addVehicleIncident(
  claimId: string,
  vehicleData: VehicleIncidentData
): Promise<VehicleIncident> {
  const request: VehicleIncidentRequest = {
    data: {
      attributes: {
        severity: { code: vehicleData.severity }, // 'minor', 'moderate', 'major', 'total-loss'
        description: vehicleData.description,
        vehicle: {
          vin: vehicleData.vin,
          year: vehicleData.year,
          make: vehicleData.make,
          model: vehicleData.model,
          licensePlate: vehicleData.licensePlate
        },
        damageDescription: vehicleData.damageDescription,
        airbagDeployed: vehicleData.airbagDeployed,
        vehicleOperable: vehicleData.vehicleOperable
      }
    }
  };

  const response = await claimCenterClient.request<{ data: VehicleIncident }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​vehicle-incidents`,
    request
  );

  return response.data;
}

Step 4: Set Reserves

// Set reserve on exposure
interface ReserveRequest {
  data: {
    attributes: {
      reserveLine: { code: string };
      costType: { code: string };
      costCategory: { code: string };
      newAmount: { amount: number; currency: string };
      comments: string;
    };
  };
}

async function setReserve(
  claimId: string,
  exposureId: string,
  reserveData: ReserveData
): Promise<Reserve> {
  const request: ReserveRequest = {
    data: {
      attributes: {
        reserveLine: { code: reserveData.reserveLine }, // 'indemnity', 'expenses'
        costType: { code: reserveData.costType },
        costCategory: { code: reserveData.costCategory },
        newAmount: {
          amount: reserveData.amount,
          currency: 'usd'
        },
        comments: reserveData.comments
      }
    }
  };

  const response = await claimCenterClient.request<{ data: Reserve }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​exposures/​${exposureId}/​reserves`,
    request
  );

  console.log(`Set reserve: $${reserveData.amount} on exposure ${exposureId}`);
  return response.data;
}

Step 5: Create Payment

// Create claim payment
interface PaymentRequest {
  data: {
    attributes: {
      paymentType: { code: string };
      exposure: { id: string };
      payee: {
        payeeType: { code: string };
        claimContact?: { id: string };
        payeeName?: string;
      };
      reserveLine: { code: string };
      costType: { code: string };
      costCategory: { code: string };
      amount: { amount: number; currency: string };
      comments?: string;
      paymentMethod?: { code: string };
    };
  };
}

async function createPayment(
  claimId: string,
  paymentData: PaymentData
): Promise<Payment> {
  const request: PaymentRequest = {
    data: {
      attributes: {
        paymentType: { code: paymentData.paymentType }, // 'partial', 'final'
        exposure: { id: paymentData.exposureId },
        payee: {
          payeeType: { code: paymentData.payeeType },
          claimContact: paymentData.claimContactId
            ? { id: paymentData.claimContactId }
            : undefined
        },
        reserveLine: { code: 'indemnity' },
        costType: { code: paymentData.costType },
        costCategory: { code: paymentData.costCategory },
        amount: { amount: paymentData.amount, currency: 'usd' },
        comments: paymentData.comments,
        paymentMethod: { code: paymentData.method || 'check' }
      }
    }
  };

  const response = await claimCenterClient.request<{ data: Payment }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​payments`,
    request
  );

  console.log(`Created payment: $${paymentData.amount} - Check #${response.data.checkNumber}`);
  return response.data;
}

Step 6: Close Exposure

// Close exposure after settlement
async function closeExposure(
  claimId: string,
  exposureId: string,
  outcome: string
): Promise<Exposure> {
  const response = await claimCenterClient.request<{ data: Exposure }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​exposures/​${exposureId}/​close`,
    {
      data: {
        attributes: {
          closedOutcome: { code: outcome } // 'completed', 'denied', 'duplicate'
        }
      }
    }
  );

  return response.data;
}

Step 7: Close Claim

// Close claim when all exposures are closed
async function closeClaim(claimId: string): Promise<Claim> {
  const response = await claimCenterClient.request<{ data: Claim }>(
    'POST',
    `/​claim/​v1/​claims/​${claimId}/​close`,
    {
      data: {
        attributes: {
          closedOutcome: { code: 'completed' }
        }
      }
    }
  );

  console.log(`Closed claim: ${response.data.claimNumber}`);
  return response.data;
}

Gosu Implementation

// Complete claims workflow in Gosu
package gw.custom.claim

uses gw.api.util.Logger
uses gw.cc.claim.Claim
uses gw.cc.exposure.Exposure
uses gw.transaction.Transaction

class ClaimWorkflow {
  private static final var LOG = Logger.forCategory("ClaimWorkflow")

  static function createClaim(
    policyNumber : String,
    lossDate : Date,
    lossType : LossType,
    description : String
  ) : Claim {

    return Transaction.runWithNewBundle(\bundle -> {
      // Find policy
      var policy = findPolicy(policyNumber)
      if (policy == null) {
        throw new IllegalArgumentException("Policy not found: ${policyNumber}")
      }

      // Create claim
      var claim = new Claim(bundle)
      claim.Policy = policy
      claim.LossDate = lossDate
      claim.LossType = lossType
      claim.Description = description
      claim.ReportedDate = Date.Today
      claim.LossCause = LossCause.TC_VEHCOLLISION

      // Set claim to open
      claim.open()

      LOG.info("Created claim: ${claim.ClaimNumber}")
      return claim
    })
  }

  static function addVehicleExposure(
    claim : Claim,
    vehicle : Vehicle,
    coverageCode : String
  ) : Exposure {

    return Transaction.runWithNewBundle(\bundle -> {
      var claim = bundle.add(claim)

      // Create vehicle incident
      var incident = new VehicleIncident(bundle)
      incident.Claim = claim
      incident.Vehicle = vehicle
      incident.Description = "Vehicle damage from ${claim.LossCause.DisplayName}"

      // Create exposure
      var exposure = new Exposure(bundle)
      exposure.Claim = claim
      exposure.ExposureType = ExposureType.TC_VEHICLEDAMAGE
      exposure.LossParty = LossPartyType.TC_INSURED
      exposure.PrimaryCoverage = CoverageType.get(coverageCode)
      exposure.VehicleIncident = incident

      LOG.info("Created exposure: ${exposure.ExposureType.DisplayName}")
      return exposure
    })
  }

  static function setExposureReserve(
    exposure : Exposure,
    amount : java.math.BigDecimal,
    reserveLine : ReserveLine
  ) {
    Transaction.runWithNewBundle(\bundle -> {
      var exp = bundle.add(exposure)

      var reserve = new Reserve(bundle)
      reserve.Exposure = exp
      reserve.ReserveLine = reserveLine
      reserve.CostType = CostType.TC_CLAIMCOST
      reserve.CostCategory = CostCategory.TC_BODY
      reserve.NewAmount = new gw.api.financials.CurrencyAmount(amount, Currency.TC_USD)
      reserve.Comments = "Initial reserve set"

      LOG.info("Set reserve: ${amount} on ${exp.ExposureType.DisplayName}")
    })
  }

  static function createPayment(
    exposure : Exposure,
    amount : java.math.BigDecimal,
    payee : Contact,
    paymentType : PaymentType
  ) : Payment {

    return Transaction.runWithNewBundle(\bundle -> {
      var exp = bundle.add(exposure)

      var payment = new Payment(bundle)
      payment.Exposure = exp
      payment.Claim = exp.Claim
      payment.PaymentType = paymentType
      payment.ReserveLine = ReserveLine.TC_INDEMNITY
      payment.CostType = CostType.TC_CLAIMCOST
      payment.CostCategory = CostCategory.TC_BODY
      payment.Payee = payee
      payment.GrossAmount = new gw.api.financials.CurrencyAmount(amount, Currency.TC_USD)

      // Submit for approval
      payment.submit()

      LOG.info("Created payment: ${amount} to ${payee.DisplayName}")
      return payment
    })
  }

  static function closeClaim(claim : Claim, outcome : CloseOutcome) {
    Transaction.runWithNewBundle(\bundle -> {
      var c = bundle.add(claim)

      // Close all open exposures first
      c.Exposures
        .where(\e -> e.State == ExposureState.TC_OPEN)
        .each(\e -> {
          e.close(outcome)
        })

      // Close claim
      c.close(outcome)
      LOG.info("Closed claim: ${c.ClaimNumber}")
    })
  }
}

Output

• FNOL claim with claim number
• Exposures linked to coverages
• Reserves set on exposures
• Payments processed
• Claim closed with outcome

Error Handling

Claim Types and Loss Causes

// Common loss types
const lossTypes = {
  AUTO: ['vehcollision', 'vehglass', 'vehtheft', 'vehvandalism'],
  PROPERTY: ['fire', 'water', 'theft', 'weather'],
  LIABILITY: ['bodily_injury', 'property_damage', 'personal_injury'],
  WORKERS_COMP: ['injury', 'illness', 'death']
};

// Map loss cause to exposures
function getDefaultExposures(lossType: string, lossCause: string): string[] {
  if (lossType === 'AUTO' && lossCause === 'vehcollision') {
    return ['VehicleDamage', 'BodilyInjury', 'PropertyDamage'];
  }
  // Additional mappings...
  return [];
}

Resources

• ClaimCenter Cloud API
• Claims Workflow Guide
• Exposure Types Reference

Next Steps

For error handling patterns, see guidewire-common-errors.