Answer:
The business pattern can be modeled by using entities that are found in the Claim (Claim, Elementary Claim, Claim-Agreement Rlship) and Agreement (Agreement, Financial Services Agreement, Financial services agreement component, Top level financial services agreement, Insurance policy) packages of the Business Data Model as illustrated in the ERD example.
Figure 1. ERD example for Relating a claim to an insurance policy, using the Agreement and Claim packages in BDM
Claims
Agreement
An agreement represents a mutual understanding between two or more parties, each committing to the fulfillment of one or more obligations.
Financial Services Agreement
The Financial Services Agreements entity represents the agreements between financial services providers and their customers.
Insurance Policy
The insurance policy entity is a subtype of a Financial Services Agreement where the owner of the agreement is usually a policyholder, and the agreement specifies the obligations of the insurer to pay benefits and of the premium payer to pay premiums.
Coverage Component
The Coverage Component entity is an agreement component that details the circumstances under which a benefit (money or services) will be paid. For example, in case of fire, benefits will be payable to the policyholder.
Claim to Agreement Relationship
Recording a claim against a claim – you can record the relationship between a claim and policy.
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