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ClaimHub Wiki
Claims knowledge, organised around the claim.
A native ClaimHub reference for understanding policy wording, evidence, work and function, health information, decisions and the claims process.
01 · Claims terms
Core claim language
Claimant
The person whose entitlement to the insured benefit is being assessed.
Waiting period
The policy period that generally must pass after the relevant disablement or absence date before benefit payments may become payable, subject to the wording.
Date of absence / disablement
A potentially important policy date. Keep the claimant’s understanding and any insurer-stated date separately when they differ.
Benefit percentage
The policy formula used to calculate the insured proportion of eligible income, subject to caps, offsets and other terms.
02 · Policy language
The test comes from the actual wording
Disability definition
The contract’s test for entitlement. The relevant wording may focus on the claimant’s own occupation, material duties, another occupation test, or another defined standard.
Material duties
The substantive duties that matter to performing the real occupation—not merely the job title.
Exclusion
A policy provision that may remove or limit cover in defined circumstances. Record the exact clause before drawing conclusions.
Policy test
A structured comparison between the contractual definition and the evidence in the case record.
03 · Evidence
Source, provenance and relevance matter
Evidence Register
The shared index of source records in a claim, including document type, source, holder, status and provenance.
Evidence gap
A missing record or unresolved fact that may matter to the current policy test, chronology or decision.
Provenance
Where a record came from, who supplied it and how it entered the case. ClaimHub preserves this separately from later interpretation.
Evidence request
A tracked request for information with an assignee and lifecycle such as open, viewed, supplied and closed.
04 · Function & work
Connect health information to real-world capacity
Functional capacity
What the claimant can and cannot do reliably, safely, repeatedly and over a sustainable period.
Symptom → function
A useful bridge from the health story to concrete restrictions, such as concentration, mobility, stamina, attendance or tolerance.
Function → duty
The next bridge: identify which material job duties are affected by the functional restriction and how.
Reliability
Being able to do something once does not necessarily show capacity to perform it consistently throughout the demands of work.
05 · Health terminology
Clinical facts stay distinct from claim conclusions
Diagnosis
A clinical label or finding. A diagnosis alone does not establish the functional or policy test; its practical effects still need evidence.
Clinical chronology
A dated sequence of consultations, diagnoses, treatment, admissions, certificates and relevant clinical events.
Medical certificate
A source record that may support dates or work-capacity information. Its weight depends on its content and the policy issue being considered.
Treatment history
The recorded course of management, including medication, therapy, procedures and clinical follow-up.
06 · Decisions & disputes
Keep the reasoning traceable
Decision trail
The auditable sequence of requests, evidence considered, policy tests, reasons, decisions and subsequent review activity.
Review / reconsideration
A process for asking the decision-maker to reconsider a claim using the applicable internal process and additional or clarified material.
Complaint
A formal escalation about the handling or outcome of a claim. The relevant pathway depends on the institution, decision and jurisdiction.
Reason for decision
The stated basis for the outcome. Compare it with the exact policy test and the evidence actually considered.
07 · Claim process
One record through the claim lifecycle
PrepareCapture the persistent profile and source documents.
OrganiseIndex evidence, chronology, policy wording and participants.
Resolve gapsTrack evidence requests, tasks and missing records.
AssessConnect health → function → duties → policy test.
DecideKeep reasons and evidence considered in the decision trail.
ReviewPrepare reconsideration, complaint or claim-pack material from the same record.
08 · Common claim traps
Patterns worth checking early
Date trap
Different records may use different onset, absence, notification or disablement dates. Preserve each source and resolve the policy significance rather than averaging them.
Diagnosis = disability trap
A diagnosis is not automatically the policy conclusion. The functional impact and wording still need to be addressed.
Job-title trap
A title can hide the actual work. Record material duties and demands instead of relying on the title alone.
Missing-source trap
Summaries are useful, but decisions should stay traceable to source evidence wherever possible.
Using the Wiki in a live claim
The Wiki explains concepts; the ClaimHub case record stores claimant-specific facts, evidence, permissions and decisions. Reference material is not legal or medical advice.