Bridge User Guide - Claims - Oceanwide · Web view2019-07-21 · Automated e-mails can be sent in response to various events during the claim process, and manual e-mails can be

0Table of Contents

Version 2.4.76 Bridge User Guide User Guide - Claims

Bridge

User Guide - Claims

Version 2.4.76

iTable of Contents

Table of Contents

TABLE OF CONTENTS.........................................................................................I

INTRODUCTION...................................................................................................1

Guide...........................................................................................................................1

CLAIMS WORKFLOW..........................................................................................2

CLAIMS SCREEN ELEMENTS AND NAVIGATION............................................3

Moving Through the Claims Workflow.....................................................................4Sequential Navigation and Common Controls....................................................................4Jumping Directly to a Screen.............................................................................................5

Common Screens Widget..........................................................................................7Notes.................................................................................................................................. 7Documents......................................................................................................................... 7Attachments....................................................................................................................... 8E-mails............................................................................................................................... 8Audit Trail........................................................................................................................... 8Financial Summary............................................................................................................8

Claim Actions Widget..............................................................................................10Selecting the Policy for a Claim........................................................................................10Assigning an Adjuster......................................................................................................11

Claim Information Widget........................................................................................13Selecting the Claim Status...............................................................................................13

Policy Information Widget.......................................................................................15Viewing Policy Information...............................................................................................15Viewing Policy Participant Information.............................................................................16

Claim Parties Widget...............................................................................................21Attaching a Claim Party....................................................................................................21Creating a New Claim Party From Within a Claim............................................................22Editing a Claim Party From Within a Claim......................................................................26


iiTable of Contents

CLAIMS SEARCH / LIST....................................................................................31

OTHER CLAIMS FEATURES.............................................................................32

Managing Claim Payments......................................................................................32Adding a Payment to a Claim...........................................................................................33Viewing and Modifying a Claim Payment.........................................................................37Setting the Reserve and Estimate Values for a Claim......................................................38

Creating and Managing Notes and Follow-ups in a Claim...................................41Adding a Note or Follow-up to a Claim.............................................................................41Viewing and Editing a Note or Follow-up.........................................................................43Deleting a Note................................................................................................................43Marking a Follow-up as Resolved....................................................................................44

Generating and Managing Claims Documents.....................................................46Generating a Claim Document.........................................................................................46Viewing Saved Documents..............................................................................................47

Managing Claim Attachments.................................................................................49Attaching Files to a Claim................................................................................................49Viewing and Editing a Claim Attachment.........................................................................51Deleting a Claim Attachment............................................................................................53Certifying Claim Attachments...........................................................................................53

Sending and Managing Claim E-mails...................................................................55Viewing the E-mail History...............................................................................................55Sending E-mails...............................................................................................................56

Reviewing Claim Changes in the Audit Trail.........................................................59

Viewing the Claim Financial Summary Report......................................................62

CLAIMS CONFIGURATION................................................................................65

Adjuster Auto-Assignment......................................................................................65Creating a New Adjuster Auto-Assignment Rule..............................................................65Viewing and Modifying an Adjuster Auto-Assignment Rule..............................................67Deactivating an Adjuster Auto-Assignment Rule..............................................................68Deleting an Adjuster Auto-Assignment Rule....................................................................69

Document Templates...............................................................................................70


iiiTable of Contents

E-mail Templates......................................................................................................71Creating a New E-mail Template.....................................................................................71Viewing and Modifying an E-mail Template.....................................................................73Deactivating an E-mail Template.....................................................................................73Deleting an E-mail Template............................................................................................74

Claims General Settings..........................................................................................76Navigating Claims General Settings.................................................................................76General Settings – Claim Numbering...............................................................................76General Settings – Claim Sub-Statuses...........................................................................78Creating a New Claim Sub-Status....................................................................................78Viewing and Modifying a Claim Sub-Status.....................................................................80Deactivating a Claim Sub-Status......................................................................................81General Settings – Party Roles........................................................................................82Creating a New Party Role...............................................................................................82Viewing and Modifying a Party Role.................................................................................84Deactivating a Party Role.................................................................................................85General Settings – Additional Settings.............................................................................86

Payment Rules.........................................................................................................87Creating a New Payment Rule.........................................................................................87Viewing and Modifying a Payment Rule...........................................................................89Deactivating a Payment Rule...........................................................................................90Deleting a Payment Rule.................................................................................................91

Professional Service Companies...........................................................................93Creating a New Professional Service Company...............................................................93Viewing and Modifying a Professional Service Company................................................97

Custom Validation Rules.........................................................................................99Creating a New Custom Validation Rule..........................................................................99Viewing and Modifying a Custom Validation Rule..........................................................102Deleting a Custom Validation Rule.................................................................................103

Workflow Events....................................................................................................104Creating a New Workflow Event.....................................................................................104Viewing and Modifying a Workflow Event......................................................................106Deactivating a Workflow Event.......................................................................................107Deleting a Workflow Event.............................................................................................107

Configuring Claims Documents...........................................................................109Creating a New Claims Document Configuration...........................................................109Viewing and Modifying a Claim Document Configuration...............................................113Deactivating a Claim Document Configuration...............................................................114Managing Templates Within a Claim Document Configuration......................................115


ivTable of Contents

Configuring Claims E-mails..................................................................................117Creating a New Claims E-mail Configuration.................................................................117Viewing and Modifying a Claims E-mail Configuration...................................................122Deactivating a Claims E-mail Configuration...................................................................122Deleting a Claims E-mail Configuration..........................................................................123

INDEX................................................................................................................125


1Introduction

Introduction

Welcome to the Bridge insurance access portal. The system provides a full workflow, from the administration of products and coverage, to the submission and management of individual policies.

Access to all features, options, and data are controlled by the settings in your user account. This guide is for users with claims management rights, covering all aspects of configuring, submitting, and managing claims.

This guide assumes the user is familiar with the general functions of the system. For instructions on logging in and using common features throughout the system, see the User Guide - Introduction document.

Guide

Click a link to jump to the appropriate section.

Claims Workflow Submitting a First Notice of Loss.

Claims List View and manage claims.

Other Claims Features Working with features associated to individual claims. Includes payments, notes, documents, attachments, and e-mails.

Configuration Configure settings for the claims system.


2Introduction

Claims Workflow

In the event of an insured loss, the Claims module is used to submit and process a claim from the initial entry to final payment.

1. The claims process begins with a First Notice of Loss (FNOL). Under the Claims menu, select First Notice Of Loss. A new claim is created and the claims workflow screen opens.

The claims form is in the center of the screen, with widgets on either side containing additional information and controls. See the Claims Screen Elements and Navigation section for detailed descriptions of the screen components.

2. Work through the steps of the claim form, completing all necessary information. Fields marked with a red asterisk * are required.

3. Once enough information has been provided and saved, the Select Policy link may become available in the Claim Actions widget. This allows the claim to be associated to a specific policy valid at the date of loss. This step may be optional, or may be required before submitting the claim.

4. Once the first notice of loss is complete, click Submit Claim. The claim is assigned to an agent for handling.

5. Take note of the Claim No displayed in the Claim Information widget. This will be used to access the claim in the future.

6. To open an existing claim for review, open the Claims menu and select Search / List. The Claims page opens, listing all available claims.

7. Locate the Claim No in the System Number column and click the link. The claims workflow screen opens.


3Introduction

Claims Screen Elements and Navigation

This section details the layout and functions of the claims screen. This can be reviewed in advance of creating a claim, or can be used as a reference source when viewing or creating a claim.

The primary claims form is displayed in the center of the screen, with additional panels called Widgets to the left and right providing information and controls.

Click on a section of the screen below to jump to the appropriate section.


4Introduction

Moving Through the Claims Workflow

The workflow is divided into Steps displayed in the progress bar above the form. Each Step may contain several individual Screens, displayed in the Navigation widget.

The coloring of the steps indicate the current status.

Completed Step: Once all screens in a step have been completed and saved, that section of the progress bar changes to blue.

Incomplete Step: Any steps that have not yet been completed are shown in grey.

Current Step: When viewing a particular screen, the current step is highlighted in dark blue or dark grey, depending on whether the step is completed or not.

Sequential Navigation and Common Controls

All screens in the workflow are organized in a specific order. The Next and Previous buttons at the bottom of the page are used to move through the workflow sequentially, one screen at a time, while the Save button updates the current screen without moving. Additional options may be available, depending on the configuration of the workflow.

Next Saves the current screen and moves to the next screen in the workflow.

Clicking Next performs the recalculation and validation process. Calculated fields are refreshed and all data is checked against any rules defined for the completed screen. Some rules may provide warnings or information, while others require corrections to the data before allowing you to proceed to the next screen. Messages at the top of the page provide information about any validation results.


5Introduction

Previous Moves to the previous screen in the workflow. This is used to look back through previous screens, either for review or to make changes. Clicking Previous does not save the current screen. If any changes have been made, a message appears warning that changes will be lost.

Moving back through previous screens does not perform any validation or recalculate any values. However, using the Save or Next buttons activates the same validations and calculations that were performed the first time through each screen.

Save Saves the current screen and performs all validations and calculations that are associated with the current screen. This can be used to refresh calculations without having to proceed to the next screen and then return.

Jumping Directly to a Screen

The Navigation widget provides instant access to the entire workflow. While navigating through the workflow, the current step is expanded and all available screens within that step are displayed. All completed steps and screens are marked with a green checkmark icon, while incomplete steps and screens are marked with a red circle icon.

To jump to a different screen in the current step, click the name of the screen in the list. To jump to a screen in a different step, click the step name to expand the list of screens, then click the required screen.

Changes are not saved when jumping to a different screen. Use the Next or Save buttons to save the current screen before navigating away.

Note: When jumping forward to Incomplete steps and screens, be aware that some fields may be dependent on fields that were skipped over. Some values may not be completely calculated, and validations may require that the skipped fields be


6Introduction

completed before proceeding.

The Payments screen is a standard system screen, available if you have the necessary administration rights. See the section on Managing Claim Payments for more information.


7Introduction

Common Screens Widget

The Common Screens widget provides access to a variety of information related to the current claim.

Not all options are available at all times, and access to each option may be restricted if the user does not have the necessary security roles.

Notes

Notes can be added to a claim to provide additional information or to serve as a reminder if any actions need to be taken at a later date (Follow Ups).

The Notes option in the Common Screens widget opens the Notes and Follow-ups list. The list contains all notes currently attached to the claim, and options for creating and managing notes.

For more information, please see the section on Creating and Managing Notes and Follow-ups.

Documents

The system can produce a wide variety of documents, customized for the current claim and product. These may be generated manually, or automatically based on certain criteria within the claim.


8Introduction

The Documents option in the Common Screens widget opens the Documents list. The list contains all generated documents currently attached to the claim, and options for generating new documents.

For more information, please see the section on Generating and Managing Claims Documents.

Attachments

Files can be attached to a claim in order to provide additional information or to document details of the coverage. Many file types are supported, particularly image and document files.

The Attachments option in the Common Screens widget opens the Attachments list. The list contains all files attached to the current claim, and options for creating and managing attachments.

For more information, please see the section on Managing Claim Attachments.

E-mails

As e-mails are sent in relation to a claim, they are stored in the system.

The E-mails option in the Common Screens widget opens the E-mails list. The list contains all e-mails sent from the current claim, and the option to send new e-mails.

For more information, please see the section on Sending and Managing Claim E-mails.

Audit Trail

The system logs most activities related to a claim, with the old values, new values, dates and times, and the user who made the changes. This information is available through the Audit Trail report.

The Audit Trail option in the Common Screens widget opens the Audit Trail window.


9Introduction

For more information, please see the section on Reviewing Claim Changes in the Audit Trail.

Financial Summary

As reserves, estimates, and payments are created and modified in relation to a claim, a summary report is available to see a comparison of the totals.

The Financial Summary option in the Common Screens widget opens the Claim Financial Summary window.

For more information, please see the section on Viewing the Claim Financial Summary Report.


10Introduction

Claim Actions Widget

The Claim Actions widget lists the available actions that can be taken on the claim in its current status. Below are some general descriptions of each action.

The available actions are determined by the type of transaction, the status of the transaction, the availability of items to work with (such as e-mails and documents), and the user's security roles.

If no actions are available for the current claim, the Claim Actions widget is not displayed.

Select Policy Once the Date of Loss has been specified for the claim, click Select Policy to choose the appropriate policy for the claim. The Policy Selection window opens. See Selecting the Policy for a Claim for details.

Submit Claim Once all necessary claim information has been provided, click Submit Claim to submit the claim for processing.

Depending on the details of the claim, an adjuster may be assigned automatically.

Assign Adjuster Click Assign Adjuster to select or replace the adjuster for the claim. See Assigning an Adjuster for details.

Create Payment Click Create Payment to enter a payment for policy participants or claim parties. This is the same as entering a payment on the Payments screen. At least one policy participant or claim party must be attached to the claim for this option to be available. See Adding a Payment to a Claim for details.

Selecting the Policy for a Claim

Once the Date of Loss has been provided, displayed in the Claim Information widget, the Select Policy option becomes available in the Claim Actions widget. This option opens the Policy Selection window.


11Introduction

Date of Loss This field displays the date of loss provided for the claim.

Policy Number To select the appropriate policy for the claim, enter at least the first three characters of the policy number or assured name. Only policies that are valid for the date of loss will be available.

Click Save & Close to save the policy selection and close the window, or click Close to close the window without selecting a policy.

Once a policy has been selected, the Policy No: is displayed in the Policy Information widget.

Assigning an Adjuster

Submitting a claim may automatically assign an adjuster, replacing any previous adjuster assignment. The adjuster may be changed manually after automatic assignment.

If an adjuster has not already been assigned to a claim, click Assign Adjuster to add an adjuster to a claim. The Adjuster window opens.

Adjuster Select the adjuster to attach to the claim. The list includes all available users that have been defined as adjusters.


12Introduction

Click Save & Close to save the selection and close the window, or click Close to close the window without saving.


13Introduction

Claim Information Widget

The Claim Information widget displays information about the current claim.

The widget displays the following information:Claim No The system claim number.

Status The current status of the claim.

Date Reported The date that the claim was entered into the system.

Date of Loss The reported date of loss.

Adjuster Displays the adjuster assigned to the claim.

Selecting the Claim Status

To change the status and sub-status of a claim, click the Status link. The Claim Information details window opens.

Claim Status

Select one of the preset system statuses.

Sub-Status Select one of the custom status options.


14Introduction

Click Save & Close to save the settings and close the window, or click Close to close the window without saving.


15Introduction

Policy Information Widget

Once a policy has been associated to the claim, the Policy Information widget provides access to the policy information and policy participants.

The widget displays the following Policy No Displays the number of the associated policy.

Assured Displays the assured company or individual.

Distributor Displays the distributor company.

Insurer Displays the primary insuring company.

Viewing Policy Information

Click the Policy No link to open the Policy Information window.

The Policy Transaction Information panel lists the details of the transaction. Click the Policy Number link to open the full


16Introduction

policy workflow in a new tab or window (depending on your browser settings). Click the Insuring Conditions link to view the conditions for this transaction.

The Limits panel lists the limits associated to the different coverage types.

The Deductibles panel lists the deductibles associated to the different coverage types.

Click Close to close the window.

Viewing Policy Participant Information

Click a link for Assured, Distributor, or Insurer to view the details. The Policy Participant window opens.


17Introduction

The Policy Participant panel displays the information for the company or individual. The majority of this information comes directly from the policy, and cannot be changed. Some additional information can be provided.

GeneralField1/GeneralField2

These fields can be used to store any additional information related to the participant. The labels may have been customized to identify the information. This information is saved separately from the claim and will be persisted if this participant is attached to more than one claim.

Payment Method Select the preferred payment method for this participant. This information is saved separately from the claim and will be persisted if this participant is attached to more than one claim.


18Introduction

Reference No. Enter a code to identify the payee.

Name Enter the payee name.

Address and contact information

Enter the full address, phone and fax numbers, and email address for the payee.

Payment Method Select a payment method.

Currency Select a currency for transactions to this payee.

General Fields These fields can be used to enter any additional information related to the payee.


19Introduction

Account No. Enter the bank account number for transactions with this party.

Routing No. Enter the routing number identifying the bank.

Name Enter the name of the bank.

Address information Enter the full address of the bank.

General Fields These fields can be used to enter any additional information related to the bank.

Created By Identifies the date and time the party was created, and the user who created it.

Last Modified By Identifies the last date and time the party was changed, and the user who made the changes.


20Introduction

Click Save & Close to save the changes and close the window or click Close to close the window without saving.


21Introduction

Claim Parties Widget

The Claim Parties widget displays the various companies associated to the claim.

Each company is identified by the Party Role and Party name. Click a link to view the claim party. The Claim Parties window opens.

Party Displays the name of the claim party.

Party Role Displays the role of the selected party.

Party Claim Number An external claim number can be provided as a reference for the claim party.

Click Save & Close to save the changes and close the window or click Close to close the window without saving.

Click Edit Party to make changes to the Professional Service Companies entry for the party. Click Here for more information.

Click Delete to remove the company from the claim.

Attaching a Claim Party


22Introduction

Click Attach in the Claim Parties widget to add a claim party. The Claim Parties window opens.

Party Select a claim party to attach. Text can be entered into the field to search by name or type.

Party Role Select the role of the selected party. Only one claim party can be added for each role, with the exception of Additional Named Assured which can have as many as necessary.


Click Add & New to save the details and clear the form to enter another party, click Add & Close to save and close the window, or click Close to close the window without saving the party.

Click Create New Party to enter a new Professional Service Company to be attached, see here for details.

Creating a New Claim Party From Within a Claim

1. In the Claim Parties widget, click Attach. The Claim Parties window opens.

2. Click Create New Party. The Professional Service Companies window opens.

3. Complete the necessary information. Fields marked with a red asterisk * are required.


23Introduction

Company Name Enter the name of the company.

Company Code Enter a code to identify the company.

Company Type Select the company type from the list of industry presets.

The Additional Named Assured option defines the company as an assured for the purpose of indemnity payments.


24Introduction

Associated Company Some companies may be subsidiaries or partners of other companies. Select the parent or primary company in the association. This association will be displayed when attaching companies to a claim.

Contact Name Enter the name of the primary contact for the company.


Enter the full address, phone and fax numbers, and email address for the company.

General Fields These fields can be used to enter any additional information related to the company.

Payment Method Select the preferred payment method for this company.



25Introduction





Currency Select a currency for transaction to this payee.


Account No. Enter the bank account number for transactions with this company.





4. Click Add & Close to save the company and close the window, or click Close to close the window without saving the company.


26Introduction

5. If the company was saved, it will be automatically selected in the Claim Parties window. Complete the remaining information and click Add & New to save the details and clear the form to enter another party, click Add & Close to save and close the window, or click Close to close the window without saving the party.

If the Claim Parties window is closed without saving, the newly created company has still been saved and can be added at a later time.

Editing a Claim Party From Within a Claim

1. In the Claim Parties widget, click the name of a claim party. The Claim Parties window opens.

Party Displays the name of the claim party.

Party Role Displays the role of the selected party.


2. Click Edit Party to make changes to the Professional Service Companies entry for the party, click Save & Close to save the changes and close the window, or click Close to close the window without saving.

3. On clicking Edit Party, the Professional Service Companies window opens.

4. Make any necessary changes. Fields marked with a red asterisk * are required.


27Introduction










28Introduction






Currency Select a currency for transaction to this payee.



29Introduction






Active Marks the company as active and available for use. If unchecked, the company will no longer be available for new claims.


30Introduction

Created By Identifies the date and time the company was created, and the user who created it.

Last Modified By Identifies the last date and time the company was changed, and the user who made the changes.

5. Click Save & Close to save the changes and close the window, or click Close to close the window without saving the changes.

Note: Editing the claim party updates the stored Professional Service Companies entry for that party, affecting all existing claims to which the party is attached.


31Introduction

Claims Search / List

The Search / List page provides access to saved claims.

In the main menu, select Claims then Search / List. The Claims page opens.

The Claims page displays all available claims.

Some columns have been hidden.

The list of claims can be sorted, filtered, and exported, among other options. For more information on working with grids, see the Using Grids section of the User Guide - Introduction document.

Click a link in the System Number column to view the claim details.

Adjusters can be assigned directly from the list. Check the boxes for all appropriate claims, then click Assign Adjuster. An adjuster is selected for each claim according to the Adjuster Auto-Assignment Rules. For details on the auto-assignment rules, please see the Adjuster Auto-Assignment section.


32Introduction

Other Claims Features

The widgets alongside the claims form and the system screens within the workflow provide access to a variety of information and controls related to the current claim.

Managing Claim Payments

During the processing of a claim, a range of payments will be made and received. The Payments screen is automatically included in the published claim workflow, and is used to log and manage the payments related to the current claim.

In the claim workflow, navigate to the Payments screen.

The Payments panel provides the current account status of the claim.

Indemnity Reserve Displays the current amount reserved for indemnity payments.

Expense Reserve Displays the current amount reserved for expenses.

Salvage Estimate Displays the current estimated salvage value.

Recovery Estimate Displays the current estimated recovery value.

Click a link to view the recorded transactions for that reserve or estimate. The Reserve/Estimate History window opens.


33Introduction

The Reserve/Estimate History window lists the changes to the selected reserve or estimate from the time the claim was created. The Change Reason column identifies whether the change was an Automatic Adjustment calculated from a payment, or a Manual Adjustment where the value was set to a specific amount. The Amount column displays the new reserve or estimate total after each adjustment.


The payments grid lists all payments that have been created for this claim.

Click Create Payment to add a payment, see Adding a Payment to a Claim.

Click Set Estimate to adjust the estimate values, see Setting the Reserve and Estimate Values for a Claim.

Adding a Payment to a Claim

Claim payments can be created using the Create Payment option on the Payments screen or in the Claim Actions widget. At least one policy participant or claim party must be attached to the claim for this option to be available.


34Introduction

1. Click Create Payment. The Payment window opens.


Type Select the type of payment.

Expense An expense payment to a Claim Party attached to the claim.

Indemnity An indemnity payment to the Claimant. Salvage A salvage payment received from a Claim Party attached to the claim.

Salvage Disbursement A payment made from salvage values.

Recovery A recovery payment received from a Claim Party attached to the claim.

Recovery Disbursement A payment made from recovery values.


35Introduction

From/To Party Select the company making or receiving the payment. The company must first be attached to the claim as a Claim Party.

Payment Amount Enter the amount of the payment and select the currency. If any currency other than U.S. Dollars is selected, the Different Billing Currency box must be checked and a Billing Amount must be provided.

Different Billing Currency If the Payment Amount is provided in any currency other than U.S. Dollars, check this box to display the Billing Amount field and provide the converted amount in U.S. Dollars.

Billing Amount This field is available when Different Billing Currency is checked. This is the amount that will be tracked for billing and used to make any adjustments to the reserves and estimates.

If the Payment Amount is provided in U.S. Dollars, that value will be inserted in this field automatically on saving. If the Payment Amount is in any currency other than U.S. Dollars, the converted amount in U.S. Dollars must be provided here.

Date Enter the date of the payment, or select the date from the calendar lookup .

Coverage If a policy has been selected for the claim, a premium type from that policy can be associated to the payment.

Category Select a category for the payment.

Check Number If the payment is by check, enter the check number.

Reference Number Enter any necessary reference information.

Description Enter a description.

Status Select the status of the payment.

Draft This is the default status for new payments.

Approval Required Marks the payment as ready for review and approval.

Approved Marks the payment as approved and submits the information for accounting. The payment can no longer be edited or deleted once it has been saved with this status.

Paid The payment has been made. If the payment type has been configured for integration with the Billing module, the payment details are transferred for processing. The payment can no longer be edited or deleted once it has been saved with this status.


36Introduction

Void The payment is no longer valid, and will not be included in payment calculations. The payment can no longer be edited or deleted once it has been saved with this status.

Rejected Marks the payment as reviewed and rejected. The payment can still be edited and re-submitted for review and approval.

The Reserve/Estimate panel is not shown for Disbursement payment types.

Adjustment Select how the payment will be applied to the current Reserve and Estimate values.

Automatic Adjustment For Expense or Indemnity payments, the amount will be automatically deducted from the related reserve value.

For Salvage or Recovery payments, the related estimate value will be reset to zero.

This option is not available when editing a payment.

Manual Adjustment The related reserve or estimate value will be reset to the value specified in the Remaining Amount field below.

No Adjustment The related reserve or estimate value will not be changed.

Current Amount Once the Payment Type is selected, this field displays the current reserve or estimate amount.

Remaining Amount This field is available when Manual Adjustment has been selected for the Adjustment field. Enter the new amount for the related Reserve or Estimate value and select the currency.


37Introduction

Once a payment has been saved, the tracking history is added.

Approved By Identifies the date and time the payment was approved, and the user who approved it. This is not displayed until the payment has been approved.

Created By Identifies the date and time the payment was created, and the user who created it.

Last Modified By Identifies the last date and time the payment was changed, and the user who made the changes.

3. Click Add & New to save the payment and clear the form to enter another payment, click Add & Close to save and close the window, or click Close to close the window without saving the payment.

Viewing and Modifying a Claim Payment

1. In the claim workflow, navigate to the Payments screen.






38Introduction



2. Click a link in the Date column to view the payment details. If there are a large number of available payments, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate payments.

3. See the section on Adding a Payment to a Claim for a detailed description of the fields.

4. Click Save & New to save the payment and clear the form to enter another payment, click Save & Close to save and close the window, or click Close to close the window without saving the payment.

Click Delete to delete the payment. This will not remove any changes to the reserves or estimates.

Setting the Reserve and Estimate Values for a Claim

In general, when a claim is being handled, estimated reserves are set aside for payment of indemnities and expenses, as well as estimated salvage and recovery values. These amounts are set in the Payments screen, and can be adjusted automatically or manually when adding payments. A history of transactions is available for each value.

1. In the claim workflow, navigate to the Payments screen.


39Introduction







2. Click Set Estimate. The Reserve/Estimate window opens.



40Introduction

Reserve/Estimate Type Select the type of reserve or estimate value. The value for each individual type is saved separately, but entering a new value will replace any existing value for that type.

Expense The amount that has been reserved for expenses incurred by this claim.

Indemnity The amount that has been reserved for indemnity payments to the assured.

Recovery The estimated value that can be recovered.

Recovery Disbursement

This feature is unavailable.

Salvage The estimated value that can be salvaged.

Salvage Disbursement

This feature is unavailable.

Amount Enter the amount and select the currency.

Description Enter a description for the reserve or estimate value.

4. Click Add & New to save the value and clear the form to enter another value, click Add & Close to save and close the window, or click Close to close the window without saving the value.


41Introduction

Creating and Managing Notes and Follow-ups in a Claim

Notes can be added to a claim to provide additional information or to serve as a reminder if any actions need to be taken at a later date (Follow Ups).

Adding a Note or Follow-up to a Claim

When viewing a claim, select the Notes option in the Common Screens widget. The Notes and Follow-ups list opens, containing all available notes currently attached to the claim.

1. Click Add. The Note and Follow-up window opens.



42Introduction

Type Select the type of note.

Note This is a simple note to provide information.

Follow-up A follow-up note includes an expected follow-up date and can be assigned to a specific user. Reminder emails can be configured to notify the selected user.

Content Enter the note details.

Follow-up Date This field is only shown when Follow-up is selected as the type. Select the due date for the note. Enter the date or select it from the calendar lookup .

Assigned to This field is only shown when Follow-up is selected as the type. An adjuster user can be selected to handle the follow-up.

Resolution This field is only shown when viewing a saved follow-up. Enter a resolution and save to mark a follow-up as Resolved.

Resolved by This field is only shown once the note or follow-up has been saved. Once a follow-up has been marked as Resolved, this field displays the name of the user who resolved the follow-up, as well as the date and time it was resolved.

Created by This field is only shown once the note or follow-up has been saved, displaying the name of the user who created the note or follow-up, as well as the date and time it was created.


43Introduction

3. Click Save & New to save the note and clear the form to enter another note, click Save & Close to save the note and close the note window, or click Close to close the note window without saving the note.

The Notes and Follow-ups list is updated as new notes are added. Click Close to close the list and return to the claim.

Viewing and Editing a Note or Follow-up

When viewing a claim, select the Notes option in the Common Screens widget. The Notes and Follow-ups list opens, containing all notes currently attached to the claim.

1. Click a link in the Created On column. The Note and Follow-up window opens. If there are a large number of available notes, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate note.

2. See the section on Adding a Note or Follow-up to a Claim for a detailed description of the fields.

3. Click << or >> to navigate between notes. Click Save & New to save the note and clear the form to enter another note, click Save & Close to save the note and close the note window, or click Close to close the note window without saving the note.

Click Delete to delete the note.


44Introduction

Deleting a Note


1. Locate the note or notes to be deleted. If there are a large number of available notes, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate notes.

2. Check the boxes for all notes to be deleted.

3. Click Delete. All selected notes are deleted.

Tip: Individual notes can also be deleted directly through the Note and Follow-up window. See the section on Viewing and Editing a Note or Follow-up for details.

Marking a Follow-up as Resolved



45Introduction

1. Click a link in the Created On column. The Note and Follow-up window opens. If there are a large number of available notes, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate note.

2. In the Resolution field, add a resolution description.

3. Click << or >> to navigate between notes. Click Save & New to save the note and clear the form to enter another note, click Save & Close to save the note and close the note window, or click Close to close the note window without saving the note.

When the note is saved with a Resolution, the follow-up is considered complete and the Resolved By information becomes available.


46Introduction

Generating and Managing Claims Documents

The claims process may require a variety of documents. The system can generate documents from preconfigured templates, customized using system information and details from the claim. These documents may be generated automatically in response to events in the claim process, or may be generated manually as needed.

Access to generate or view certain documents may be restricted to specific user types, claim statuses, or other conditions. If no documents are available, the related features will be hidden.

Generating a Claim Document

1. When viewing a claim, select the Documents option in the Common Screens widget. The Documents list opens, containing all available documents currently attached to the claim.

2. Click Add. The Print Document window opens.



47Introduction

Document Select a document to generate.

File Name A default filename is generated based on the selected document, but can be replaced with a custom file name. The file extension should not be included.

Format Select if the document should be in PDF or Doc format.

Draft A draft version can be generated for review before producing the final version. A draft document will not be saved in the documents list, and will have a Draft watermark.

4. Click Print Document to generate the selected document, or click Close to close the window without generating the document.

5. A standard file download window opens to allow you to view the document or save it to your computer. Click Open to view the document, click Save to save the file, or click Cancel to close the window (if the download is cancelled for a non-draft document, the document is still generated and attached to the claim).

Viewing Saved Documents

When a final document is printed (not a Draft), a copy is saved with the claim. These documents can be opened for viewing or printing.

1. When viewing a claim, select the Documents option in the Common Screens widget. The Documents list opens.

The grid lists all available documents attached to the current claim, displaying the Filename entered at generation and the Document configuration name.

2. Click a link in the File Name column to open an existing document.


48Introduction

3. A standard file download window opens to allow you to view the document or save it to your computer. Click Open to view the document, click Save to save the file, or click Cancel to close the window.


49Introduction

Managing Claim Attachments

Files can be attached to a claim in order to provide additional information or to document details of the loss. Many file types are supported, particularly image and document files.

Attaching Files to a Claim

When viewing a claim, select the Attachments option in the Common Screens widget. The Attachments list opens, containing all available files currently attached to the claim.

1. Click Add. The Attach New Files window opens.

2. There are two methods for adding files to the list, browsing for files or drag-and-drop.


50Introduction

To browse for a file, click the Select or Drop Files to Upload button. A standard file selection window opens. Locate and select the appropriate file, then click Open.

To drag-and-drop files, drag the file into the window near the Select or Drop Files to Upload button. The area will be highlighted in green. The file can be dropped anywhere in the green area.

Note: Be sure to drop the files into the green area. If a file is dropped outside of the green area, the browser will attempt to open the file instead of adding it to the list.

3. As new files are added, they are listed in the window. The files have not yet been attached to the claim.


51Introduction

Additional information can be applied to the files as they are attached. This information can also be added or modified after the files are attached.

Description Enter a description of the file.

Type Select an attachment type.

Certified This box can be checked to certify the attachment.

Click Remove to remove a file from the list.

4. Click Add & Close to attach the listed files and close the window, or click Close to close the window without attaching any files.

The Attachments list is updated as files are added. Click Close to close the list and return to the claim.

Viewing and Editing a Claim Attachment

Once files have been attached to a claim, the settings can be modified and the attached file itself can be viewed.



52Introduction

To view or download attached files from the Attachments list, click a link in the Download column. A standard file download window opens to allow you to view the file or save it to your computer.

1. To view or edit the attachment settings, click a link in the File Name column. The Attachment window opens. If there are a large number of available attachments, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate attachment.

File Name Displays the name of the file.

Description Enter a description of the file.

Attachment Type Select an attachment type.

Certified This box can be checked to certify the attachment.

Click Download to view or download the attached file. A standard file download window opens to allow you to view the file or save it to your computer.

Created By Identifies the date and time the rule was created, and the user who created it.

Last Modified By Identifies the last date and time the rule was changed, and the user who made the changes.

2. Click Save & New to save the attachment settings and switch to add attachment mode, click Save & Close to save the


53Introduction

attachment settings and close the window, or click Close to close the window without saving changes.

To delete the attachment from the claim, click Delete, then confirm the deletion.

Deleting a Claim Attachment


1. Click a link in the File Name column. The Attachment window opens. If there are a large number of available attachments, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate attachment.

2. Click Delete, then confirm the deletion. The attached file is deleted from the claim.

Certifying Claim Attachments

While there may be many users who can attach files to a claim, it is common to have certain users with the authority to certify that the attachments are valid. Users with the necessary security roles can mark an attachment as certified, either as they are attaching files, or after files have been attached.


54Introduction


1. Locate the attachments to be certified. If there are a large number of available attachments, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate attachments.

2. Check the boxes for all attachments to be certified.

3. Click Certify. All selected attachments are updated, and the Certified status is set to True.

Tip: Individual attachment can also be certified directly through the Attachment detail window. See the section on Viewing and Editing a Claim Attachment for details.


55Introduction

Sending and Managing Claim E-mails

The Claims module includes an e-mail feature that supports the automatic or manual creation of e-mails, attachment of files and generated documents, and the tracking of the e-mail history.

Viewing the E-mail History

All e-mails sent through the system are tracked and linked to the claim from which they were sent. The E-mails list is available through the Common Screens widget.

Click E-mails in the Common Screens widget. The E-mails list window opens.

Click a link in the E-mail column to view the e-mail details. The E-mail window opens.

The first panel displays the selected E-mail template.


56Introduction

The Preview panel displays the details for the e-mail.

From The address used as the sending address.

To Includes all recipient e-mail addresses.

Send Me a Copy Displays whether or not a copy of the e-mail was sent to the user.

E-mail Subject The subject line of the e-mail.

E-mail Body The content of the e-mail.

Documents Lists all generated documents attached to the e-mail.

Attachments Lists all other files attached to the e-mail.

Click Close to close the e-mail window and return to the e-mail list. Click Close on the e-mail list to close the window and return to the claim.

Sending E-mails

Depending on your user rights and the current status of the claim, there may be a selection of e-mail templates available.


57Introduction

1. Click E-mails in the Common Screens widget. The E-mails window opens.

2. Click Add. The New E-mail window opens.


Select the E-mail template. The Preview panel will populate with the default settings for the e-mail.

From Displays the address to be used as the sending address. Any replies to the e-mail will go to this address. This is set in the e-mail template and cannot be changed.


58Introduction

To Displays the recipients of the e-mail. If editing is enabled, addresses can be added, edited, or deleted.

Send Me a Copy Check this box to send a copy of the e-mail to the e-mail address registered in your user account.

E-mail Subject Displays the subject line of the e-mail. If editing is enabled, the subject can be edited.

E-mail Body Displays the body text of the e-mail. If editing is enabled, the text can be edited.

The Documents and Attachments fields allow generated documents and files attached to the claim to be included with the e-mail as attachments. Some documents may be selected by default, according to the e-mail configuration.

4. Click Send to send the e-mail and return to the E-mails list, or click Close to return to the E-mails list without sending the e-mail.

All e-mails sent from a claim are logged in the E-mails list. Click E-mails in the Common Screens widget to view the e-mail history.


59Introduction

Reviewing Claim Changes in the Audit Trail

As changes are made to a claim, they are logged in the system. This includes changes to the fields in the workflow, attached items (such as e-mails, documents, and files), payments, and all the details in-between.

Note: The addition and removal of claim parties, changes to the claim parties, and notes or follow-ups are not tracked.

The old and new values, the date and time of the changes, and the users who made the changes are all tracked. This information can be filtered, sorted, and exported.

1. Click Audit Trail in the Common Screens widget. The Audit Trail window opens.

2. Fill in the necessary information. Fields marked with a red asterisk * are required.

Select an option in the Show changes to field to show results related to a specific category.

Claim Displays all changes to the basic claim itself, such as changes to fields in the workflow, status changes, and policy selection.

Claim Adjuster Displays changes to the adjuster assignment, either manual assignment or from automatic assignment rules.

Claim Attachment Displays changes to file attachments, including adding, deleting, or changing details.

Claim Document Displays new documents generated from the claim.

Claim Email Displays new e-mails sent from the claim.

Claim Payment Displays changes to payments, including adding, deleting, or changing details.

Claim Reserve / Estimate Displays changes to the claim reserves and estimates, either direct changes or changes from payments.


60Introduction

3. Click Search to generate the report. The results appear in the Audit Trail panel.

The Audit Trail panel lists all changes for the selected category. The changes are grouped by the Identifier and Modified On date.

Identifier Displays the code of the resource that was changed.

Field Name Identifies the detail or field that changed.

Previous Value Displays the previous value for the field.

Current Value Displays the new value for the field.

Action Identifies the type of change.

Add A new resource was added or a blank field was filled in.

Update An existing resource or field entry was changed.


61Introduction

Delete An existing resource was deleted or a field was cleared.

Modified By Displays the name of the user who made the change.

Modified On Displays the date and time that the changes were made. This is the system date and time, with no adjustments for region.

4. Click Close to close the window.


62Introduction

Viewing the Claim Financial Summary Report

Through the process of managing a claim, reserves and estimates are created and adjusted, and payments are made and received. The Claim Financial Summary report provides a comparative view of the current financial status of the claim.

Note: The report only includes payments in Paid status.

Click Financial Summary in the Common Screens widget. The Claim Financial Summary window opens.

The Indemnity and Expense panel presents reserve values and associated payments.

Type Displays the type of reserve and payments.

Original Reserve Displays the first reserve value set after creating the claim.

Current Reserve Displays the current reserve value, after all manual and automatic adjustments.

Total Payment Displays the total of all payments of this type.

Total Projected Liability Displays the sum of the Current Reserve and Total Payment columns.


63Introduction

The Salvage and Recovery panel presents estimated return values and associated payments.

Type Displays the type of estimate and payments.

Original Estimate Displays the first estimate value set after creating the claim.

Current Estimate Displays the current estimate value, after all manual and automatic adjustments.

Total Payment Displays the total of all payments of this type.

Total Projected Salvage & Recovery

Displays the sum of the Current Estimate and Total Payment columns.

The Financial Summary panel summarizes the current cost of the claim.

Total Indemnity and Expense Payments

Displays the total of outgoing payments.

Total Salvage and Recovery Payments

Displays the total of incoming payments.

Net Incurred Displays the total current cost, calculated from the Total Indemnity and Expense Payments minus the Total Salvage and Recovery Payments.


64Introduction



65Introduction

Claims Configuration

The Configuration menu includes sections for general claims settings and adding reference data for use throughout the system.

Adjuster Auto-Assignment

An adjuster can be assigned to a claim manually, or they can be assigned automatically when a claim is submitted. Adjuster Auto-Assignment rules define which adjusters are available at the time of submission.

If the auto-assignment rule is active and the associated trigger evaluates as true, then that adjuster is available for assignment.

If multiple adjusters are available, the adjuster with the least number of open claims will be selected.

If no adjusters are available, the claim will remain unassigned.

If the claim is submitted more than once, the assignment is re-evaluated each time. This ensures that any changes to the claim are taken into account.

Creating a New Adjuster Auto-Assignment Rule

1. In the main menu, select Claims, Configuration, then Adjuster Auto-Assignment. A list of all available assignment rules is displayed.


66Introduction

Tip: By default, only Active rules are displayed. Clear the filter in the Status column to view all rules.

2. Click Add. The Adjuster Auto-Assignment Management window opens.


Adjuster Select an adjuster. The list includes all available users that have been defined as adjusters.

Trigger Select a trigger to control if the adjuster is assigned or not. Only triggers attached to claims workflows are listed, "Universal" triggers are not available.

Description Enter a description for the rule.

4. Click Add & New to save the details and clear the form to enter another rule, click Add & Close to save and return to the Configure Adjuster Auto-Assignment list, or click Close to return to the Configure Adjuster Auto-Assignment list without saving the rule.


67Introduction

The Status panel is added to the page once the rule has been saved.

Active Marks the rule as active and available for use. If unchecked, the rule will no longer be applied for new claims.



Viewing and Modifying an Adjuster Auto-Assignment Rule




68Introduction

2. Click a link in the Adjuster Name column to view the rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. See the section on Creating a New Adjuster Auto-Assignment Rule for a detailed description of the fields.

4. Click Save & New to save the details and clear the form to enter another rule, click Save & Close to save and return to the Configure Adjuster Auto-Assignment list, or click Close to return to the Configure Adjuster Auto-Assignment list without saving the rule.

Deactivating an Adjuster Auto-Assignment Rule

If necessary, an adjuster auto-assignment rule can be deactivated. This will prevent any claims from being assigned to that adjuster. This option can be used if the adjuster will be unavailable for a period of time.

The rule remains in place and can be reactivated at any time.



2. Locate the rules to be deactivated. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rules.


69Introduction

3. Check the boxes for all rules to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected rules are deactivated. If the Configure Adjuster Auto-Assignment list is still defaulted to only show active rules, they disappear from the list.

Tip: Individual rules can also be deactivated or reactivated directly through the Adjuster Auto-Assignment Management window. See the section on Viewing and Modifying an Adjuster Auto-Assignment Rule for details.

Deleting an Adjuster Auto-Assignment Rule

If an adjuster will no longer be handling claims in the system, the auto-assignment rules can be deleted permanently. This does not affect the adjuster user account or any claims already assigned to that adjuster.



2. Click a link in the Adjuster Name column to view the rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. Click Delete to delete the rule.


70Introduction


71Introduction

Document Templates

The Claims system can generate documentation from templates, and substitute system data for placeholders within the content. The Document Templates section is for uploading templates to the system for use in document configurations.

See the Managing Document Templates for Billing and Claims section of the User Guide – Product Design document for instructions on adding templates to the system.


72Introduction

E-mail Templates

The system includes features for sending e-mails. Automated e-mails can be sent in response to various events during the claim process, and manual e-mails can be sent by users. All logged and tracked in the submission form.

First, an e-mail template is created. The template can contain placeholders, which pull in data from the system and claim form when the e-mail is sent. The template is then attached to the e-mail configuration.

Creating a New E-mail Template

1. In the main menu, select Claims, Configuration, then E-mail Templates. A list of all available templates is displayed.

Tip: By default, only Active templates are displayed. Clear the filter in the Status column to view all templates.

2. Click Add. The E-mail Template page opens.



73Introduction

Name Enter the name of the template. This is the internal name, used to select this template in the e-mail configuration. This name does not appear in the workflow itself.

E-mail Subject Enter the subject line of the e-mail.

E-mail Body Enter the body of the e-mail.

Both the subject line and body can contain placeholders to pull in extra information when the e-mail is sent. For more information on creating dynamically generated content, please see Appendix A - E-mail Syntax in the User Guide - Product Design document.

4. Click Save & New to save the template and clear the form to enter another template, click Save & Close to save and return to the E-mail Template List, or click Close to return to the E-mail Template List without saving the template.

The Status panel is added to the page once the template has been saved.

Active Marks the template as active and available for use. If unchecked, the template remains linked to any existing e-mail configurations, but cannot be used for new configurations.

Created By Identifies the date and time the template was created, and the user who created it.


74Introduction

Last Modified By Identifies the last date and time the template was changed, and the user who made the changes.

Viewing and Modifying an E-mail Template



2. Click a link in the Name column to view the template details. If there are a large number of available templates, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate template.

3. See the section on Creating a New E-mail Template for a detailed description of the fields. All fields may be edited, if necessary.

4. Click Save & New to save the template and clear the form to enter a new template, click Save & Close to save and return to the E-mail Template List, or click Close to return to the E-mail Template List without saving the template.

Deactivating an E-mail Template

An e-mail template can be temporarily deactivated. This leaves it linked to any existing e-mail configurations, but prevents it from being used for new configurations.


75Introduction



2. Locate the templates to be deactivated. If there are a large number of available templates, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate templates.

3. Check the boxes for all templates to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected templates are deactivated. If the template list is still defaulted to only show active templates, they disappear from the list.

Tip: Individual templates can also be deactivated or reactivated directly through the template record. See the section on Viewing and Modifying an E-mail Template for details.

Deleting an E-mail Template

An e-mail template can be permanently deleted. Any e-mail configurations using the template will no longer be available for the creation of manual or automatic emails.


76Introduction



2. Click a link in the Name column to view the template details. If there are a large number of available templates, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate template.

3. Click Delete to delete the configuration.


77Introduction

Claims General Settings

The General Settings section contains options and default settings controlling various parts of the system.

Navigating Claims General Settings

In the main menu, select Claims, Configuration, then General Settings. The General Settings page opens.

The information is divided into multiple pages. The pages are accessed through the General Settings Menu widget to the left of the screen.

Click a link to view the page details.

Claim Numbering Includes settings for claim numbering.

Claim Sub-Statuses Includes settings for managing claim Sub-Statuses.

Party Roles Includes settings for managing claim parties.

Additional Settings Includes miscellaneous claims settings.

General Settings – Claim Numbering

The General Settings - Sequence page provides options to set how claims are numbered.


78Introduction

The Claim Number Generation panel provides settings for the formatting and sequential numbering of claim numbers.

Prefix Enter any text that should precede the sequence number. Any separator characters should be included here.

Next Sequence Number

Enter the number to be assigned to the next claim created in the system. The number is incremented with each claim, and this field is automatically updated to show the next number to be assigned.

Zero Padding Adds leading zeroes to the sequence number to bring it to a set length. If unchecked, the entire claim number will gradually increase in length as more claims are created.

Length This field is available when Zero Padding is checked. Enter the required length of the sequence number, not including the prefix and suffix. Leading zeroes are added to the sequence number to bring it to this length. The minimum length is 2, and the maximum length is 20.

Note: The Sequence Number does not reset to zero when the selected length reaches its maximum value. The length is extended to continue counting in sequence.

Suffix Enter any text that should follow the sequence number. Any separator characters should be included here.

Examples:With the prefix set as "Pr-" (a sales code), the sequence number set as 2507 (picking up from previous business), and the suffix set as "/SA" (a regional code), the next three claims will have the following numbers.

Pr-2507/SAPr-2508/SA


79Introduction

Pr-2509/SAWith the prefix set as "Pr", the sequence number set as 1 with leading zeroes up to seven digits, and no suffix, the next three claims will have the following numbers.

Pr0000001Pr0000002Pr0000003

Click Save to save the settings.

General Settings – Claim Sub-Statuses

The General Settings – Claim Sub-Statuses page provides options for creating claim sub-statuses.

When changing the status of a claim, a core status and associated sub-status can be selected. The Claim Sub-Statuses panel lists all sub-statuses associated to the core claim statuses.

Tip: By default, only Active sub-statuses are displayed. Clear the filter in the Status column to view all sub-statuses.

Click Add to create a new sub-status, see Creating a New Claim Sub-Status. Click a link in the Name column to view an existing sub-status, see Viewing and Modifying a Claim Sub-Status. To deactivate sub-statuses, see Deactivating a Claim Sub-Status.


80Introduction

Creating a New Claim Sub-Status

1. In the main menu, select Claims, Configuration, then General Settings. The General Settings page opens. Navigate to the Claim Sub-Statuses page. See Navigating Claims General Settings for instructions. The Claim Sub-Statuses panel lists all sub-statuses associated to the core claim statuses.


2. Click Add. The Claim Sub-Status window opens.



81Introduction

Name Enter the name of the sub-status. This is the name that will be displayed when selecting the sub-status.

Code Enter a code to identify the sub-status internally.

Description Enter a description of the sub-status.

Sequence Enter a sequence number to define the order that the sub-statuses will appear in the list. Gaps can be left in sequence numbers (10, 20, 30, etc.) to allow additional sub-statuses to be inserted later.

Claim Status Select the core status for which the sub-status will be available.

4. Click Add & New to save the sub-status and clear the form to enter another sub-status, click Add & Close to save and close the window, or click Close to close the window without saving the sub-status.

The Status panel is added to the page once the sub-status has been saved.

Active Marks the sub-status as active and available for use. If unchecked, the sub-status will remain selected for existing claims, but can no longer be selected when changing status.

Viewing and Modifying a Claim Sub-Status


82Introduction



2. Click a link in the Name column to view the sub-status details. If there are a large number of available sub-statuses, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate sub-status.

3. See the section on Creating a New Claim Sub-Status for a detailed description of the fields.

4. Click Save & New to save the sub-status and clear the form to enter another sub-status, click Save & Close to save and close the window, or click Close to close the window without saving the sub-status.

Deactivating a Claim Sub-Status



83Introduction


2. Locate the sub-statuses to be deactivated. If there are a large number of available sub-statuses, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate sub-statuses.

3. Check the boxes for all sub-statuses to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected sub-statuses are deactivated. If the Claim Sub-Statuses list is still defaulted to only show active sub-statuses, they disappear from the list.

Tip: Individual sub-statuses can also be deactivated or reactivated directly through the Claim Sub-Status window. See the section on Viewing and Modifying a Claim Sub-Status for details.

General Settings – Party Roles

The General Settings – Party Roles page provides options for managing claim parties.


84Introduction

When attaching a claim party to a claim, a role can specified to identify how the party is involved in the claim process. While a single party can be attached under multiple roles, only one instance of each role can be attached to the claim. The Party Roles panel lists all available roles.

Tip: By default, only Active roles are displayed. Clear the filter in the Status column to view all roles

Click Add to create a new role, see Creating a New Party Role. Click a link in the Name column to view an existing role, see Viewing and Modifying a Party Role. To deactivate roles, see Deactivating a Party Role.

Creating a New Party Role

1. In the main menu, select Claims, Configuration, then General Settings. The General Settings page opens. Navigate to the Party Roles page. See Navigating Claims General Settings for instructions.


85Introduction



2. Click Add. The Party Role window opens.


Name Enter the name of the role. This is the name that will be displayed when selecting the role.

Code Enter a code to identify the role internally.

Description Enter a description of the role.

4. Click Add & New to save the role and clear the form to enter another role, click Add & Close to save and close the window, or click Close to close the window without saving the role.

The Status panel is added to the page once the role has been saved.


86Introduction

Active Marks the role as active and available for use. If unchecked, the role will remain selected for existing parties, but can no longer be selected when adding or editing parties.

Created By Identifies the date and time the role was created, and the user who created it.

Last Modified By Identifies the last date and time the role was changed, and the user who made the changes.

Viewing and Modifying a Party Role




2. Click a link in the Name column to view the role details. If there are a large number of available roles, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate role.

3. See the section on Creating a New Party Role for a detailed description of the fields.


87Introduction

4. Click Save & New to save the role and clear the form to enter another role, click Save & Close to save and close the window, or click Close to close the window without saving the role.

Deactivating a Party Role




2. Locate the roles to be deactivated. If there are a large number of available roles, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate roles.

3. Check the boxes for all roles to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected roles are deactivated. If the Party Roles list is still defaulted to only show active roles, they disappear from the list.


88Introduction

Tip: Individual roles can also be deactivated or reactivated directly through the Custom Party Role window. See the section on Viewing and Modifying a Party Role for details.

General Settings – Additional Settings

The General Settings – Additional Settings page provides miscellaneous claims options.

The Navigation Preferences panel controls access to policy information from within a claim.

Policy Navigation Preference When viewing a claim that has been associated to a policy, the Policy Information widget displays the policy number as a link. This option controls the functionality of that link.

Policy Summary Window

The link will open a detail window within the current page, containing a summary of the policy information. The summary window includes a link to open a new tab or window with the full policy workflow.

Policy Page The link will open a new tab or window with the full policy workflow.

Click Save to save the settings.


89Introduction

Payment Rules

Payment Rules define how claims payments are handled by the Billing module. Payments can be set to produce charges for invoicing, and can be tracked as general ledger entries.

Creating a New Payment Rule

1. In the main menu, select Claims, Integration, then Payment Rules. A list of all available rules is displayed.


2. Click Add. The Payment Integration Rules window opens.



90Introduction

Name Enter the name of the payment rule.

Code Enter a code to identify the rule internally.

Payment Type Select the payment type condition.

Category Select the category condition.

Currency Select the payment currency condition.

Trigger Select a trigger. The trigger must evaluate as true for this condition to be met.

Generate Charges If the payment meets all conditions, the details will be sent to the Billing module where charges will be generated and ready for invoicing.

Generate GL If the payment meets all conditions, the details will be sent to the Billing module where general ledger entries will be created. Checking this box opens the General Ledger panel below with additional settings.


91Introduction

The General Ledger panel becomes available when the Generate GL checkbox is selected.

Debit Account Select the general ledger account to be debited according to the payment details.

Credit Account Select the general ledger account to be credited according to the payment details.

Note: Payment Integration Rules must be unique. If another active rule exists with the same settings for Payment Type, Category, Currency, and Trigger, the new rule cannot be saved. The existing account would need to be modified or deactivated in order to save the new account.

4. Click Add & New to save the payment rule and clear the form to enter another rule, click Add & Close to save and close the window, or click Close to close the window without saving the rule.

The Status panel is added to the page once the payment rule has been saved.

Active Marks the payment rule as active and available for use. If unchecked, the rule will no longer be applied for new payments.



Viewing and Modifying a Payment Rule



92Introduction


2. Click a link in the Name column to view the payment rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. The Payment Integration Rules window opens. See the section on Creating a New Payment Rule for a detailed description of the fields.

4. Click Save & New to save the payment rule and clear the form to enter another rule, click Save & Close to save and close the window, or click Close to close the window without saving the rule.

Click Delete to permanently delete the rule.

Deactivating a Payment Rule

If necessary, a payment rule can be deactivated. This will temporarily prevent any matching payments from being transferred to the Billing module.

The rule remains in place and can be reactivated at any time by checking the Active checkbox in the Status panel.



93Introduction


2. Locate the payment rules to be deactivated. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rules.

3. Check the boxes for all rules to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected rules are deactivated. If the Payment Integration Rules List is still defaulted to only show active rules, they disappear from the list.

Tip: Individual rules can also be deactivated or reactivated directly through the Payment Integration Rules window. See the section on Viewing and Modifying a Payment Rule for details.

Deleting a Payment Rule

If a rule is no longer required, it can be deleted permanently. This will not affect any payments that have already been transferred to the Billing module, but will prevent any new payments from being transferred.



94Introduction


2. Click a link in the Name column to view the payment rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. Click Delete to delete the rule.


95Introduction

Professional Service Companies

Resolving a claim can require the services of several external companies such as surveyors, lawyers, and salvage agencies. These companies can be attached to a claim, simply for reference information or for tracking payments.

Companies can be created in the Professional Services Companies section, or they can be created as needed when attaching claim parties to a claim.

Creating a New Professional Service Company

1. In the main menu, select Claims, Reference, then Professional Service Companies. A list of all available companies is displayed.

2. Click Add. The Professional Service Company window opens.



96Introduction




The Additional Named Assured option defines the company as an assured for the purpose of indemnity payments.


97Introduction

Associated Company Some companies may be subsidiaries or partners of other companies. Select the parent or primary company in the association. This association will be displayed when attaching companies to a claim.








98Introduction





Currency Select a currency for transactions to this payee.








99Introduction

4. Click Add & New to save the details and clear the form to enter another company, click Add & Close to save and return to the Company list, or click Close to return to the Company list without saving the company.

The Status panel is added to the page once the company has been saved.

Active Marks the company as active and available for use. If unchecked, the company will no longer be available for new claims.

Created By Identifies the date and time the company was created, and the user who created it.

Last Modified By Identifies the last date and time the company was changed, and the user who made the changes.

Viewing and Modifying a Professional Service Company

1. In the main menu, select Claims, Reference, then Professional Service Companies. A list of all available companies is displayed.

2. Click a link in the Company Name column to view the company details. If there are a large number of available companies, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate company.


100Introduction

3. See the section on Creating a New Professional Service Company for a detailed description of the fields.

4. Click Save & New to save the company and clear the form to enter another company, click Save & Close to save and return to the Company list, or click Close to return to the Company list without saving the company.


101Introduction

Custom Validation Rules

As users navigate through the claim process, the system regularly checks the content of the submission against a series of defined rules. These rules can trigger warnings or require changes to the data.

Validations are associated to certain actions and screens in the workflow, such as saving or submitting the claim, and triggers control whether the rule is applied.

The custom validations are in addition to the basic system validations for required fields or invalid data.

Creating a New Custom Validation Rule

1. In the main menu, select Claims, Configuration, Workflow, then Custom Validation Rules. A list of all available validation rules is displayed.

2. Click Add. The Custom Validation Rule window opens.



102Introduction

Name Enter the name of the rule.

Code Enter the code of the rule.

Severity Select the effect of the validation.

Error If the conditions of this rule are met, an error appears and the user cannot save or proceed with the claim until the cause of the error has been resolved.

Warning If the conditions of this rule are met, a warning appears, providing information to the user. No action is required for this validation, and the user can proceed normally.

Warnings cannot be applied to the Import Bordereau action.

Message Enter a Message to be displayed at the top of the screen when the conditions for this rule are met.


103Introduction

The Validation Criteria panel determines when the validation will apply. All applicable criteria must pass or the rule will not be applied.

Actions Select the actions where the rule will be validated.

Screens Select the screens where the rule should be validated.

Trigger Select a Trigger to set the conditions for the rule. If the trigger evaluates as true, the rule is applied.

If no trigger is specified, the rule is always applied. Triggers should always be included for rules that stop the user from proceeding, or it becomes impossible to complete the claim process.

Effective Date The date fields for the Effective Date can be used together or separately to control when the rule is applied. If the Date of Loss is before the beginning date of the rule or after the end date of the rule, the rule is not applied. The dates can be entered manually or selected from the date picker .

4. Click Save to save the rule or click Close to return to the Custom Validations Rules list without saving.


104Introduction

The Status panel is added to the page once the rule has been saved.

Active Marks the rule as active and available for use. If unchecked, the rule will no longer be applied for new claims.



Viewing and Modifying a Custom Validation Rule


2. Click a link in the Name column to view the rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. See the section on Creating a New Custom Validation Rule for a detailed description of the fields.


105Introduction

4. Click Save to save the rule or click Close to return to the Custom Validations Rules list without saving.

Deleting a Custom Validation Rule


2. Click a link in the Name column to view the rule details. If there are a large number of available rules, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate rule.

3. Click Delete, then confirm the deletion when prompted. The rule is deleted and the Custom Validation Rules list opens.


106Introduction

Workflow Events

Various actions in the claim workflow, such as the automatic generation of documents and e-mails, can be set to activate on specific events. These events are configured here, and are based on specific actions that result in a change of claim status.

Creating a New Workflow Event

1. In the main menu, select Claims, Configuration, Workflow, then Events. A list of all available events is displayed.

2. Click Add. The Workflow Event window opens.



107Introduction

Name Enter the name of the event.

Code Enter the code of the event.

Action Select the action that will trigger the event.

Initial Status This field will become available if it is suitable for the selected Action. The event can be configured to only trigger if the claim begins in a certain status before the selected Action. Select Any if the event should be available regardless of the initial status.

Initial SubStatus This field will become available if it is suitable for the selected Action. If a specific Initial Status has been selected, a sub-status can be selected to further define the required initial status. Select Any if the event should be available regardless of the initial sub-status.

Final Status This field will become available if it is suitable for the selected Action. The event can be configured to only trigger if the claim ends in a certain status after the selected Action. Select Any if the event should be available regardless of the final status.

Final SubStatus This field will become available if it is suitable for the selected Action. If a specific Final Status has been selected, a sub-status can be selected to further define the required final status. Select Any if the event should be available regardless of the final sub-status.

4. Click Add & New to save the event and clear the form to enter another event, click Add & Close to save and return to the Workflow Events List, or click Close to return to the Workflow Events List without saving the event.


108Introduction

The Status panel is added to the page once the event has been saved.

Active Marks the event as active and available for use. If unchecked, the event will no longer trigger existing configurations and cannot be selected for new configurations.

Created By Identifies the date and time the event was created, and the user who created it.

Last Modified By Identifies the last date and time the event was changed, and the user who made the changes.

Viewing and Modifying a Workflow Event


2. Click a link in the Name column to view the event details. If there are a large number of available events, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate event.

3. See the section on Creating a New Workflow Event for a detailed description of the fields.


109Introduction

4. Click Save & New to save the event and clear the form to enter another event, click Save & Close to save and return to the Workflow Events List, or click Close to return to the Workflow Events List without saving the event.

Click Delete to delete the event from the system.

Deactivating a Workflow Event

Events can be deactivated in order to temporarily disable them. The event will no longer trigger existing configurations and cannot be selected for new configurations. The event can be reactivated to restore all functionality.


2. Locate the events to be deactivated. If there are a large number of available events, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate events.

3. Check the boxes for all events to be deactivated.

4. Click Deactivate. All selected events are deactivated.

Deleting a Workflow Event



110Introduction

2. Click a link in the Name column to view the event details. If there are a large number of available events, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate event.

3. Click Delete to delete the event from the system, then confirm the deletion when prompted to do so.


111Introduction

Configuring Claims Documents

Processing a claim will often require a range of documents, which can be produced from within the claims system. Document templates can be built in Microsoft Word, attached to the master cover, and then generated from within the claim workflow, manually or automatically.

When the document is generated, placeholders in the template are automatically replaced with the relevant data from the claim and related resources. Logic structures can be used to include or exclude content, from individual words to entire sections.

All generated documents are logged within the claim for reference, or draft versions may be generated for review, which are not attached.

Creating a New Claims Document Configuration

1. In the main menu, select Claims, Configuration, Workflow, then Documents. A list of all available document configurations is displayed.

Tip: By default, only Active configurations are displayed. Clear the filter in the Status column to view all configurations.

2. Click Add. The Claims Document Configuration window opens.



112Introduction

Name Enter the name of the configuration. This name will be used to select the document in the printing window, and will be part of the default name of the file.

Code Enter a code to identify the configuration internally.

Description Enter a description for the configuration.

Manual Users will be able to generate the document manually from the claims workflow, with multiple output options. The availability will be configured below.

Automatic The system will automatically generate the document as a PDF in response to events configured below.


113Introduction

The Manual Generation Criteria panel is available when Manual has been checked. These settings control the availability of the document in the claims workflow. All defined criteria must be met for the document configuration to be available for printing.

Trigger The trigger must evaluate as true for the document to be available.

Effective Date When attaching time-sensitive documents, a date range can be provided. This document will only be available during the defined period. Enter the dates or select them from the calendar lookups .

Security Roles Select the user security roles for which the document should be available. Once a document has been generated, a copy is stored in the system. The selected security roles also determine if the user can view the stored documents.

Claim Statuses Select the claim statuses for which the document should be available.


114Introduction

The Automatic Generation Criteria panel is available when Automatic has been checked. These settings control when the system will generate the document automatically. All defined criteria must be met for the document to generate.

Trigger The trigger must evaluate as true for the document to generate.

Effective Date When attaching time-sensitive documents, a date range can be provided. This document will only be generated during the defined period. Enter the dates or select them from the calendar lookups .

Workflow Events Select the Events where the document will be generated.

4. Click Save to save the configuration and reveal additional settings, or click Close to return to the Claim Document Configurations list without saving the configuration.

Additional panels are added to the page once the configuration has been saved.


115Introduction

A document configuration contains one or more templates, uploaded to the system in the Document Templates section. See the Managing Document Templates for Billing and Claims section of the User Guide – Product Design document for instructions on adding templates to the system. When a document is generated, the system processes each template, evaluating conditions and replacing placeholders. The final content is then output as a single document.

The Templates grid lists all templates currently attached to the configuration. See Managing Templates Within a Claim Document Configuration for details on adding, editing, and removing templates.

Active Marks the document configuration as active and available for use. If unchecked, any existing documents will remain attached to the claims, but this configuration will not be available to generate new documents.

Created By Identifies the date and time the configuration was created, and the user who created it.

Last Modified By Identifies the last date and time the configuration was changed, and the user who made the changes.

Viewing and Modifying a Claim Document Configuration


116Introduction



2. Click a link in the Name column to view the document configuration details. If there are a large number of available configurations, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate configuration.

3. See the section on Creating a New Claims Document Configuration for a detailed description of the fields. All fields may be edited, if necessary.

4. Click Save to save the configuration but keep the window open, or click Close to close the window without saving the configuration.

Deactivating a Claim Document Configuration

Once created, a document configuration cannot be deleted. It can be deactivated, which leaves any existing documents attached to the claims, but the configuration will not be available to generate new documents.



117Introduction


2. Locate the document configurations to be deactivated. If there are a large number of available configurations, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate configurations.

3. Check the boxes for all configurations to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected configurations are deactivated. If the configuration list is still defaulted to only show active configurations, they disappear from the list.

Tip: Individual document configurations can also be deactivated or reactivated directly through the configuration record. See the section on Viewing and Modifying a Claim Document Configuration for details.

Managing Templates Within a Claim Document Configuration

Once a claim document configuration has been created and saved, one or more templates must be added to define the content of the generated document. If multiple templates are added, they will all be merged into one document at generation.

Templates must be uploaded to the system before assigning them to a document configuration. See the Managing Document Templates for Billing and Claims section of the User Guide – Product Design document for instructions on adding templates to the system.

When viewing a saved claim document configuration, the Templates grid lists all templates currently attached to the


118Introduction

configuration.

1. Click Add to add a template, or click a link in the Template Name column to view the setup for an existing template. The Templates window opens.

Name Select the template to be attached.

Trigger A trigger can be selected to control whether this one template will be included in the generated document. The template will only be included if the trigger evaluates to true.

Sequence Enter a sequence number to define the order that the templates will appear in the generated document. Gaps can be left in sequence numbers (10, 20, 30, etc.) to allow additional templates to be inserted later.

2. Click Add & New or Save & New to save the template and clear the form to add another template, click Add & Close or Save & Close to save and close the window, or click Close to close the window without saving the template.

When viewing an existing template setup, click Delete to remove the template from the document configuration.


119Introduction

Configuring Claims E-mails

The claims process may require a library of pre-configured e-mails. These e-mails can be sent automatically in response to actions taken by the users, or can be made available within the claim workflow for users to send manually.

Creating a New Claims E-mail Configuration

1. In the main menu, select Claims, Configuration, Workflow, then E-mails. A list of all available e-mail configurations is displayed.


2. Click Add. The E-mail Configurations page opens.



120Introduction

Name Enter the name of the configuration. This name will be used to select the e-mail configuration in the e-mail screen.

Code Enter a code to identify the configuration internally.

Description Enter a description for the configuration.

Manual E-mail Users will be able to manually send the e-mail from the claims workflow. The availability will be configured below.

Automatic E-mail The system will generate and send the e-mail in response to events configured below.


121Introduction

E-mail Template Select an e-mail template to define the subject and body of the e-mail. See the E-mail Templates section for details on preparing templates.

From Enter the e-mail address that will appear as the sender of the e-mail.

Recipients Enter the e-mail addresses for any specific recipients. Multiple addresses should be separated by semicolons.

Recipient Parties Select any claims parties who should receive the e-mail. For the selected types, the e-mail will be sent to the primary e-mail address for each company attached to the claim.

Documents Select any documents that should be attached to the e-mail.

The documents must already be generated and attached to the claim before sending the e-mail, or it will not be attached. However when a document generation and automatic e-mail are triggered by the same event, the document generation will be completed first so the document will be available for e-mails. If more than one copy of the document exists, the most recent copy will be attached.

See the Configuring Claims Documents section for details on preparing document configurations.


122Introduction

The Manual E-mail Criteria panel is available when Manual E-mail has been checked, and controls when the e-mail will be available for users. All criteria must be met for the e-mail to be available.

Allow Manual Override

When checked, this option allows the user to edit the e-mail before sending. They can change, add, and remove recipient e-mail addresses, and they can edit the subject and body text of the e-mail. If unchecked, the recipients, subject, and body text are displayed, but cannot be edited.

Trigger A trigger can be selected to control the availability of the e-mail. The trigger must evaluate as true for the e-mail to be available. If no trigger is selected, this setting is ignored.

Claim Statuses Select one or more status and sub-status combinations where the e-mail should be available for users. At least one status must be selected.

Security Roles Select one or more user security roles to define which users have access to this e-mail. At least one role must be selected.


123Introduction

The Automatic E-mail Criteria panel is available when Automatic E-mail has been checked, and controls when the e-mail will be generated by the system. All criteria must be met for the e-mail to be generated.

Trigger A trigger can be selected to control the generation of the e-mail. The trigger must evaluate as true for the e-mail to be generated on the selected Workflow Event. If no trigger is selected, this setting is ignored.

Workflow Events Select one or more workflow events where the e-mail should be generated. At least one event must be selected.

4. Click Save to save the e-mail configuration or click Close to return to the E-mail Configuration List without saving.

The Status panel is added to the page once the configuration has been saved.

Active Marks the configuration as active and available for use. If unchecked, the configuration will no longer be available for user selection or will not produce automatic e-mails.

Created By Identifies the date and time the configuration was created, and the user who created it.


124Introduction

Last Modified By Identifies the last date and time the configuration was changed, and the user who made the changes.

Viewing and Modifying a Claims E-mail Configuration



2. Click a link in the Name column to view the e-mail configuration details. If there are a large number of available configurations, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate configuration.

3. See the section on Creating a New Claims E-mail Configuration for a detailed description of the fields. All fields may be edited, if necessary.

4. Click Save to save the configuration but keep the window open, or click Close to close the window without saving the configuration.

Deactivating a Claims E-mail Configuration


125Introduction

An e-mail configuration can be temporarily deactivated. The configuration will no longer be available for user selection or will not produce automatic e-mails.



2. Locate the e-mail configurations to be deactivated. If there are a large number of available configurations, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate configurations.

3. Check the boxes for all configurations to be deactivated.

4. Click Deactivate, then confirm the deactivation when prompted to do so. All selected configurations are deactivated. If the configuration list is still defaulted to only show active configurations, they disappear from the list.

Tip: Individual e-mail configurations can also be deactivated or reactivated directly through the configuration record. See the section on Viewing and Modifying a Claims E-mail Configuration for details.

Deleting a Claims E-mail Configuration

An e-mail configuration can be permanently deleted.


126Introduction



2. Click a link in the Name column to view the e-mail configuration details. If there are a large number of available configurations, see the Using Grids section of the User Guide - Introduction document for help on finding the appropriate configuration.

3. Click Delete to delete the configuration.


127Introduction

Index

AAccount No. field 19, 25, 29, 96Action column 60Action field 105Actions field 101Active checkbox 29, 67, 72, 80, 84, 89, 90, 97, 102, 106, 113, 121Add & Close button 22, 25, 26, 37, 40, 51, 66, 80, 83, 89, 90, 97, 105, 116Add & New button 22, 26, 37, 40, 66, 80, 83, 89, 90, 97, 105, 116Add button 41, 46, 49, 57, 66, 71, 78, 79, 82, 83, 87, 93, 99, 104, 109, 116, 117Add column 60Adding a Note or Follow-up to a Claim 41Adding a Payment to a Claim 33Additional Named Assured option 23, 94Additional Named Assured party role 22Address and contact information fields 18, 24, 25, 27, 28, 95, 96Address information fields 19, 25, 29, 96Adjuster 13Adjuster Assignment option 59Adjuster Auto-Assignment 65Adjuster Auto-Assignment Management window 66Adjuster Auto-Assignment menu item 65, 67, 68, 69Adjuster Auto-Assignment panel 66Adjuster Auto-Assignment Rules 31Adjuster field 11, 13, 66Adjuster Name column 67, 69Adjuster window 11Adjustment field 36Allow Manual Override checkbox 120Amount column 33Amount field 40Approval Required payment status 35Approved By field 37Approved payment status 35Assign Adjuster action 10


128Introduction

Assign Adjuster button 31Assign Adjuster link 11, 13Assign Adjuster panel 11Assigned to field 42Assigning an Adjuster 11Associated Company field 24, 95Assured field 15Assured link 16Attach Claim Party panel 21, 22, 26Attach Documents field 119Attach link 21, 22Attach New Files window 49, 50Attaching a Claim Party 21Attaching Files to a Claim 49Attachment Type field 52Attachment window 52, 53, 54Attachments 8, 49, 51, 53Attachments field 56, 58Attachments option 8Attachments window 8, 49, 51, 53, 54Audit Trail 8Audit Trail option 8, 59Audit Trail panel 59, 60Audit Trail report 8Automatic Adjustment change reason 33Automatic Adjustment option 36Automatic checkbox 110Automatic E-mail checkbox 118, 121Automatic Generation Criteria panel 112Automatic Send Criteria panel 121BBank Information panel 19, 25, 29, 96Billing Amount field 35CCancel button 47Category field 35, 88Certified field 51, 52Certified status 54


129Introduction

Certify button 54Certifying Claim Attachments 53Change Reason column 33Check Number field 35Claim Actions widget 2, 3, 10, 33Claim Attachment option 59Claim Audit Trail window 8, 59Claim Document option 59Claim Email option 59Claim Financial Summary window 9, 62Claim Information widget 2, 3, 10, 13Claim Information window 13Claim No field 2, 13Claim Number Generation panel 77Claim option 59Claim Parties widget 3, 21, 22, 26Claim Parties window 21, 22, 26Claim Party 35Claim Party field 34Claim Payment option 59Claim Reserve / Estimate option 59Claim Status field 13, 80Claim Statuses field 111, 120Claim Sub-Status window 79Claim Sub-Statuses panel 78, 79, 80, 81Claimant field 34Claims Configuration 65Claims Document Configuration window 109Claims Document Configurations panel 109, 114, 115Claims Form 3Claims General Settings 76Claims menu 2, 31, 65, 67, 68, 69, 71, 73, 74, 76, 79, 80, 81, 82, 84, 85, 87, 89, 90, 91, 93, 97, 99, 102, 103, 104, 106, 107, 109, 114,

117, 122, 123Claims page 2, 31Claims Screen Elements and Navigation 3Claims Search / List 31Claims Workflow 2Close button 11, 13, 16, 19, 21, 22, 25, 26, 30, 33, 37, 38, 40, 43, 45, 47, 51, 52, 56, 58, 61, 64, 66, 68, 72, 73, 80, 81, 83, 85, 89, 90,


130Introduction

97, 98, 101, 102, 105, 106, 112, 114, 116, 121, 122Code field 79, 83, 88, 100, 105, 110, 118Common Screens widget 3, 7, 8, 9, 41, 43, 44, 46, 47, 49, 51, 53, 55, 56, 58, 59, 62Company Code field 23, 27, 94Company Information panel 23, 27, 94Company List panel 93, 97Company Name column 97Company Name field 23, 27, 94Company Type field 23, 27, 94Configuration menu 65, 67, 68, 69, 71, 73, 74, 76, 79, 80, 81, 82, 84, 85, 99, 102, 103, 104, 106, 107, 109, 114, 117, 122, 123Configure Adjuster Auto-Assignment panel 66, 67, 68, 69Configuring Claims Documents 109Configuring Claims E-mails 117Contact Name field 24, 27, 95Content field 42Coverage field 35Create New Party button 22Create Payment action 10, 33Create Payment button 33Created by field 42Created By field 19, 29, 37, 52, 67, 72, 84, 89, 97, 102, 106, 113, 121Created On column 43, 45Creating a New Adjuster Auto-Assignment Rule 65Creating a New Claim Party From Within a Claim 22Creating a New Claim Sub-Status 79Creating a New Claims Document Configuration 109Creating a New Claims E-mail Configuration 117Creating a New Custom Validation Rule 99Creating a New E-mail Template 71Creating a New Party Role 82Creating a New Payment Rule 87Creating a New Professional Service Company 93Creating a New Workflow Event 104Creating and Managing Notes and Follow-ups in a Claim 41Credit Account field 89Currency field 18, 25, 28, 88, 96Current Amount field 36Current Estimate column 63


131Introduction

Current Reserve column 62Current Value column 60Custom Validation Rule window 99Custom Validation Rules 99Custom Validation Rules menu item 99, 102, 103Custom Validation Rules panel 99, 102, 103DDate column 38Date field 35Date of Loss 10Date of Loss field 11, 13Date Reported field 13Deactivate button 68, 74, 81, 86, 91, 107, 115, 123Deactivating a Claim Document Configuration 114Deactivating a Claim Sub-Status 81Deactivating a Claims E-mail Configuration 122Deactivating a Party Role 85Deactivating a Payment Rule 90Deactivating a Workflow Event 107Deactivating an Adjuster Auto-Assignment Rule 68Deactivating an E-mail Template 73Debit Account field 89Deductibles panel 16Delete button 21, 38, 43, 44, 52, 53, 69, 75, 90, 92, 103, 107, 108, 116, 124Delete column 61Deleting a Claim Attachment 53Deleting a Claims E-mail Configuration 123Deleting a Custom Validation Rule 103Deleting a Note 44Deleting a Payment Rule 91Deleting a Workflow Event 107Deleting an Adjuster Auto-Assignment Rule 69Deleting an E-mail Template 74Description field 35, 40, 51, 52, 66, 79, 83, 110, 118Different Billing Currency checkbox 35Disbursement 36Distributor field 15Distributor link 16


132Introduction

Document field 46, 47Document Templates 70Document Templates menu item 113Documents 7Documents field 56, 58Documents menu item 109, 114Documents option 7, 46, 47Documents window 7, 46, 47Download column 51Download link 52Draft checkbox 47Draft payment status 35Draft watermark 47EEdit Party button 21, 26Editing a Claim Party From Within a Claim 26Effective Date fields 101, 111, 112E-mail Body field 56, 58, 72E-mail column 55E-mail Configurations page 117E-mail Configurations panel 117, 122, 123, 124E-mail Details panel 119E-mail field 55, 57E-mail panel 55E-mail Subject field 56, 58, 72E-mail Template field 119E-mail Template page 71E-mail Templates 71E-mail Templates menu item 71, 73, 74E-mail Templates panel 71, 73, 74, 75E-mail window 55E-mails 8E-mails menu item 117, 122, 123E-mails option 8, 55, 56, 58E-mails window 8, 55, 56, 57, 58Error severity option 100Events menu item 104, 106, 107Expense payment type 34


133Introduction

Expense Reserve field 32, 37, 39Expense Reserve panel 33Expense type 39FField column 60File Name column 47, 52, 53File Name field 47, 52Filename field 47Final Status field 105Final SubStatus field 105Financial Summary 9Financial Summary option 9, 62Financial Summary panel 63First Notice Of Loss menu item 2Follow-up Date field 42Follow-up type 42Format field 47From field 56, 57, 119From/To Party field 35GGeneral Fields 18, 19, 24, 25, 27, 28, 29, 95, 96General Information panel 52, 72, 79, 83, 88, 110, 118General Ledger panel 88, 89General Settings – Additional Settings 86General Settings – Claim Numbering 76General Settings – Claim Sub-Statuses 78General Settings – Party Roles 82General Settings menu item 76, 79, 80, 81, 82, 84, 85General Settings Menu widget 76GeneralField1 field 17GeneralField2 field 17Generate Charges checkbox 88Generate GL checkbox 88Generating a Claim Document 46Generating and Managing Claims Documents 46Guide 1IIndemnity and Expense panel 62


134Introduction

Indemnity payment type 34Indemnity Reserve field 32, 37, 39Indemnity Reserve panel 33Indemnity type 39Initial Status field 105Initial SubStatus field 105Insurer field 15Insurer link 16Insuring Conditions link 15Integration menu 87, 89, 90, 91Introduction 1JJumping Directly to a Screen 5LLast Modified By field 19, 30, 37, 52, 67, 72, 84, 89, 97, 102, 106, 113, 122Length field 77Limits panel 16MManaging Claim Attachments 49Managing Claim Payments 32Managing Templates Within a Claim Document Configuration 115Manual Adjustment change reason 33Manual Adjustment option 36Manual checkbox 110Manual E-mail checkbox 118, 120Manual Generation Criteria panel 111Manual Send Criteria panel 120Marking a Follow-up as Resolved 44Message field 100Modified By column 61Modified On column 61Moving Through the Claims Workflow 4NName column 60, 73, 75, 78, 81, 82, 85, 90, 92, 102, 103, 106, 108, 114, 122, 124Name field 18, 19, 25, 28, 29, 72, 79, 83, 88, 96, 100, 105, 110, 116, 118Navigating Claims General Settings 76Navigation Preferences panel 86Navigation widget 3, 4, 5


135Introduction

Net Incurred field 63New E-mail panel 57New E-mail window 57Next button 4, 5Next Sequence Number field 77No Adjustment option 36Note and Follow-up window 41, 43, 45Note panel 42Note type 42Notes 7Notes and Follow-ups window 7, 41, 43, 44, 45Notes option 7, 41, 43, 44OOpen button 47, 50Original Estimate column 63Original Reserve column 62Other Claims Features 32PPaid payment status 35Paid status 62Party Claim Number field 21, 22, 26Party field 21, 22, 26Party Role field 21, 22, 26Party Role window 83Party Roles panel 82, 83, 84, 85Payee Information panel 18, 24, 28, 95Payment Amount field 35Payment Details panel 34Payment Integration Rules panel 87, 90, 91, 92Payment Integration Rules window 87, 90Payment Method field 17, 18, 24, 25, 27, 28, 95, 96Payment Rules 87Payment Rules menu item 87, 89, 90, 91Payment Type field 88Payment window 33Payments panel 32, 33, 37, 38, 39Payments screen 5, 10, 32, 33, 37, 38Policy Information widget 3, 11, 15, 86


136Introduction

Policy Information window 15Policy Navigation Preference field 86Policy No field 15Policy No link 15Policy Number field 11Policy Number link 15Policy Page navigation preference 86Policy Participant panel 17Policy Participant window 16Policy Selection window 10, 11Policy Summary Window navigation preference 86Policy Transaction Information panel 15Prefix field 77Preview panel 56, 57, 58Previous button 4Previous Value column 60Print Document button 47Print Document window 46Professional Service Companies 21, 26, 93Professional Service Companies menu item 93, 97Professional Service Companies window 22, 26Professional Service Company 22Professional Service Company window 93Progress Bar 3, 4RRecipient field 119Recipient Party field 119Recovery Disbursement payment type 34Recovery Disbursement type 40Recovery Estimate field 32, 37, 39Recovery Estimate panel 33Recovery payment type 34Recovery type 39Reference menu 93, 97Reference No. field 18, 24, 28, 95Reference Number field 35Rejected payment status 36Remaining Amount field 36


137Introduction

Remove button 51Reserve/Estimate Details panel 39Reserve/Estimate History window 32, 33Reserve/Estimate panel 36Reserve/Estimate Type field 39Reserve/Estimate window 39Resolution field 42, 45Resolved 42Resolved by field 42Resolved By field 45Reviewing Claim Changes in the Audit Trail 59Routing No. field 19, 25, 29, 96SSalvage and Recovery panel 63Salvage Disbursement payment type 34Salvage Disbursement type 40Salvage Estimate field 32, 37, 39Salvage Estimate panel 33Salvage payment type 34Salvage type 40Save & Close button 11, 13, 19, 21, 26, 30, 38, 43, 45, 52, 68, 72, 73, 81, 85, 98, 106, 116Save & New button 38, 43, 45, 52, 68, 72, 73, 81, 85, 98, 106, 116Save button 4, 5, 47, 78, 86, 101, 102, 112, 114, 121, 122Screens 4Screens field 101Search / List menu item 2, 31Search / List page 31Search button 59Search Criteria panel 59Security Roles field 111, 120Select or Drop Files to Upload button 49, 50Select Policy action 2, 10Selecting the Claim Status 13Selecting the Policy for a Claim 10Send button 58Send Me a Copy checkbox 56, 58Sending and Managing Claim E-mails 55Sending E-mails 56


138Introduction

Sequence field 80, 116Sequential Navigation and Common Controls 4Set Estimate button 33, 39Setting the Reserve and Estimate Values for a Claim 38Severity field 100Show changes to field 59Status field 13, 35Status link 13Status panel 19, 29, 36, 52, 67, 72, 80, 84, 89, 90, 97, 102, 106, 113, 121Steps 4Submit Claim action 2, 10Sub-Status field 13Suffix field 77System Number column 2, 31TTemplate Details panel 116Template Name column 116Templates panel 113, 115, 116Templates window 116To field 56, 57Total Indemnity and Expense Payments field 63Total Payment column 62, 63Total Projected Liability column 62Total Projected Salvage & Recovery column 63Total Salvage and Recovery Payments field 63Trigger field 66, 88, 101, 111, 112, 116, 120, 121Type column 62, 63Type field 34, 42, 51UUpdate column 60VValidation Criteria panel 101Validation Details panel 100Viewing and Editing a Claim Attachment 51Viewing and Editing a Note or Follow-up 43Viewing and Modifying a Claim Document Configuration 114Viewing and Modifying a Claim Payment 37Viewing and Modifying a Claim Sub-Status 80


139Introduction

Viewing and Modifying a Claims E-mail Configuration 122Viewing and Modifying a Custom Validation Rule 102Viewing and Modifying a Party Role 84Viewing and Modifying a Payment Rule 89Viewing and Modifying a Professional Service Company 97Viewing and Modifying a Workflow Event 106Viewing and Modifying an Adjuster Auto-Assignment Rule 67Viewing and Modifying an E-mail Template 73Viewing Policy Information 15Viewing Policy Participant Information 16Viewing Saved Documents 47Viewing the Claim Financial Summary Report 62Viewing the E-mail History 55Void payment status 36WWarning severity option 100Widgets 3Workflow Event Details panel 105Workflow Event field 121Workflow Event window 104Workflow Events 104Workflow Events field 112Workflow Events panel 104, 106, 107, 108Workflow menu 99, 102, 103, 104, 106, 107, 109, 114, 117, 122, 123ZZero Padding checkbox 77


Copyright Notice

Copyright © 1998 - 2016 Oceanwide Inc. All Rights Reserved.

All material in this document and on this website are protected by copyright and intellectual property laws and are the property of Oceanwide Inc. ®™

No part of this document may be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the owner Oceanwide Inc.®™ Printed and published in Montreal, Quebec CANADA.

Trademarks

All trademarks, registered trademarks and service marks in this document are exclusive to Oceanwide Inc. ®™.

Disclaimer

The publisher Oceanwide Inc. ®™ and authors specifically disclaim any responsibility for any liability, loss, or risk; whether corporate, personal or otherwise in whole or in part of which; is incurred as a consequence directly or indirectly of the application use; or reliance on or any of the contents of this document (documentation).