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Examples for Consolidated Service Invoice/Statement (811)

Example 6 - Cancellation

Table 2 - Policy Detail

A Notice of Cancellation is created to advise an interested party that premium due has not been received and the policy will cancel if unpaid. State Farm will send the NPP Cancellation Reason Code for these types of cancel notifications. The Acknowledgement of Cancellation Request is sent when either State Farm or the insured has requested the insurance policy be cancelled. If the request comes from the insured, State Farm will send the CRQ Cancellation Reason Code.

811 Data Format

Description

HL*8*2*4*1;

HL segments represent a looping structure within the standard transaction set. This loop is for policy detail

LX*1;

Section separator. This field will increment with each new notification.

SI*AD*01*XLC*10*CRQ;

The transaction type for this request.

  • XLC Cancellation
    • NPP Cancel for non payment of premium
    • COC Cancelled by the company
    • CRQ Cancelled by the insured

PID*S*02*AD*IN;

The PID identifies the party responsible for paying the insurance premium.

  • IN Insured pays
  • MG Mortgagee pays

REF*TV*HOME;

Line of business identifies the type of policy.

  • HOME Homeowner’s policy

Other Lines of business are:

  • FLOOD Flood
  • RDP Rental dwelling
  • DFIRE Fire
  • EQKP Earthquake
  • FARM Farm
  • BOAT Boat owners
  • RCUP Rental condo unit owner
  • PPMBH Mobil Home
  • PPCHO Condominium
  • PPART Apartment
  • COTHR Business Other
  • BOP Business owner

REF*NF*25143;

The NAIC code identifies the State Farm affiliate underwriting the insurance policy.

  • 25143 State Farm Fire
  • 43419 State Farm Lloyds
  • 25151 State Farm General
  • 10739 State Farm Florida

REF*LD*120594856756453;

Loan number of the mortgaged property as identified on the insurance policy.

  • LD Loan Number

REF*IG*13GJ12139;

  • IG Insurance policy number

REF*ABC*01;

The Operation Center number is expected back with the 820 remittance advice (REF*32).

  • ABC State Farm Operation Center Number

REF*UA*1;

State Farm does not keep track of Loan Type. This is the order at which this lender appears on the insurance policy.

  • 1 First mortgagee
  • 2 Second mortgagee
  • 3 Third mortgagee

AMT*PE*585;

This is the cost of the insurance policy for the entire term. This is NOT the amount due.

  • PE Full term premium amount of the policy

DTM*007*20040130;

This is the beginning date of the insurance policy’s term.

  • 007 Policy effective date

DTM*036*20050130;

State Farm insurance policies are continuous until cancelled. This is when the insurance policy term expires unless renewed.

  • 036 Policy expiration date

NM1*U3*1*LITTLE, JOHN C;

  • U3 Insurance agent name

N3*42 NORTH MAIN STREET;

Insurance agent address

N4*LAPTON*AZ*85289;

Insurance agent city, state and zip

PER*AG**TE*5124984051;

  • AG Insurance agent telephone number

IT1**1*EA*0;

A cancellation for non pay may have a balance due amount. This policy should be paid using the 820 remittance advice.

  • EA Policy premium dollars

DTM*177*20040308;

  • 177 Insurance policy cancel effective date.

DTM*009*20040514;

  • 009 Insurance policy process date.

DTM*508*20040529;

This date will be sent for insurance policies cancelled at the request of the insured.

  • 508 Coverage cease date for those parties subject to the mortgagee clause condition of the policy.

NM1*IL*1*DOE, JOHN;

  • IL Insured name

N3*27 COURT STREET;

Insured mailing street address.

N4*SAN FRANCISCO*CA*94111;

Insured mailing city, state and zip

NX2*15*12 MARKET STREET;

Insured property street address.

  • 15 Unstructured street address

NX2*07*BLOOMINGTON;

Insured property city name.

  • 07 City name

NX2*08*IL;

Insured property state name.

  • 08 State abbreviation

NX2*19*617050001;

9 digit Insured property zip code if present.

  • 19 Insured property zip (9 digit)

III*CV*DWELL;

Insurance policy coverages.

  • DWELL Dwelling

AMT*2Y*92500;

  • 2Y Dwelling risk amount

 

 
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