Claim

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/aflac/refs/heads/main/json-schema/enterprise-connect-claim-schema.json",
  "title": "Claim",
  "description": "A supplemental insurance claim record.",
  "type": "object",
  "properties": {
    "claim_id": {
      "type": "string",
      "description": "Unique claim identifier.",
      "example": "CLM-112233"
    },
    "policy_id": {
      "type": "string",
      "description": "Policy associated with the claim.",
      "example": "POL-987654"
    },
    "employee_id": {
      "type": "string",
      "description": "Claimant employee identifier.",
      "example": "EMP-789012"
    },
    "claim_type": {
      "type": "string",
      "description": "Type of claim event.",
      "enum": [
        "accident",
        "critical_illness",
        "cancer_diagnosis",
        "hospitalization",
        "disability"
      ],
      "example": "accident"
    },
    "status": {
      "type": "string",
      "description": "Current claim processing status.",
      "enum": [
        "submitted",
        "in_review",
        "approved",
        "denied",
        "paid"
      ],
      "example": "approved"
    },
    "incident_date": {
      "type": "string",
      "format": "date",
      "description": "Date of the qualifying event.",
      "example": "2025-02-10"
    },
    "submission_date": {
      "type": "string",
      "format": "date-time",
      "description": "Timestamp when the claim was submitted.",
      "example": "2025-02-15T09:30:00Z"
    },
    "benefit_amount": {
      "type": "number",
      "description": "Approved benefit payment amount in USD.",
      "example": 1500.0
    },
    "denial_reason": {
      "type": "string",
      "description": "Reason for denial if the claim was denied.",
      "example": "Condition not covered under policy terms."
    }
  }
}