Claim Flashcards
How many ways are there to create a claim in ABS?
Four:
1- general search
2 - person file
3- contract file
4- claim search
How do I create a claim from the general search?
Search - policy number/name/claim number - Results - List - New claim
How do I create a claim from the person file?
Contract - List - New claim
How do I create a claim from the contract file?
Claims - list - New
How do I create a claim from the claim search?
Claim search - policy number/involved person/claim number - Results - List - New
What are the minimum data required to create a claim?
Claim date
Class (Coverage)
Loss type
Loss cause
When does the duplicate claim check happens?
Online and during batch processing, when the claim is created and when the claim date suffers any change
What is the ‘dialog control’?
It’s a visual user guide, wizard-like, with questions to be answered in the first three top tabs (Notice, Property, Person). It’s used to guide the clerk through the conversion with the customer or reporting party.
The Black triangle with exclamation mark shows that the question has to be responded by the clerk and not to ask the customer that one.
What are the four processes of claim?
Document and investigate
Evaluate
Settle
Conclude
How many classes per claim can be captured?
Only one class per claim, except for multicoverage claims
Which top tabs are part of the Document & Investigate meta-process?
Notice, Property, Person
Which top tabs are part of the Evaluate meta-process?
Contract, Coverage
Which top tabs are part of the Settle meta-process?
Claim, Settlement, Costing, Account
Which top tabs are part of the Conclude meta-process?
Annuity, Recourse
What are some entities to which the object Claim is related to?
Claim, involved person, person, rel person-claim, loss event, property, involved property, rel property-claim, damage coverage, coverage
Event is connected to involved person and involved property, the are associated to claim
Name four business object functions used by a claim
Comments Scheduled tasks (e.g. Follow up activity on a claim) Process slip Business objects activity Documents
What’s a “Further claim”?
It’s a second and onwards claim crated underone event as the first claim. E.g. When multiple coverages are involved in the same event
How can a further claim be created?
In an existing claim, top tab Further - Button new
Why is the concept of event needed?
The event captures information which is valid for all claims attached to this event.
This data is captured only once, e.g. Involved properties, involved persons, event description
What is a Claim event? (Loss event)
An event that results in the immediate damage of an insured property/person and triggers a claim.
Happens during the effectiveneaa of an insurance policy
Why is a mass event?
Is a loss event that triggers many claims (simultaneously or during the effectiveness of the corresponding policies)
Where can we create a mass event?
In the “Claim/assignment maintenance file” in the “Mass event” top tab
What are the attributes of a mass event?
The event description (Name)
The type: set to “mass event” with the exact start and end dates and times
How do we set up the loss type and loss cause?
We have to set it up in PEX, it’s linked to the coverage.
What are the “Event effects”?
It refers to the values to be made available for selection in the claim file to describe in detail the possible damages for properties or the health status for a person
(Values for effects of a loss event on a property/person damages)
What do the “Loss Event Type Regulation” links?
The loss event type regulation links the class product and the loss type. The loss type is further linked to loss cause.
It bundles loss type and loss cause and be reused for different class products.
What is an “Event type”?
The event type is a functional and technical cluster bundling the combination of class product, loss event type regulation, loss type, and loss cause.
What are event types used for?
Event types are used as the basis for modelling event questions, event effects, which are to be answered only once per event, and not once per event-related claim
What are the types of coverage verification?
1- Check to verify if the loss event is covered in the contract
2 - Check to verify if there is coverage with respect to the premium
3 - Check to verify if the damage is covered or not
Most of the checks can be done automatically by the system
Based on which checks is the “Reason-based Coverage verification” calculated?
1 - Contractual coverage check - is the loss event covered by this contract?
2 - Risk based coverage check - is the risk-object covered by this contract?
3 - Premium based coverage check - has the premium been paid?
4 - Coverage check at damage level - always done manually - e.g. Small glasses in glass damage
What is the purpose of the coverage verification concerning extent with regard to amount?
To verify if the contract covers the claim amount
What is the purpose of the coverage verification concerning extent with regard to scope?
To verify that individual invoices and payment requests are all covered.
What is the liability verification check?
It’s the documentation of the fault or partial fault with fault-percentage values. This information can only be entered in claims related to a liability class. It includes the information regarding deductibles
What are the different abs provision functionalities?
1 - Initial provision - default provision
2 - Automatic provision - automatically overrides the initial provision after the payment was done
3 - Manual provision - manual amount entered by the clerk
4 - Individual provision - created in the background
5 - Lump sum provision - based on class, loss type, loss cause. Calculated in the background
What are the claim categories?
1 - Pending preliminary claim: structured via abs Internet portals
2 - Preliminary claim: lacks a provision
3 - Standard claim: Arrives via first level/team based processing
4 - Major loss: exceeding 100k EUR
What are the types of assignments? (type of settlements)
1 - Standard
2 - Inspection
3 - Restitution
4 - Audit
5 - Neutral
What are the standard assignments?
Those received from external sources: payment request, invoice, cost estimate, expert opinion not assigned by the insurance company.
What are the inspection assignments?
Those related to expert opinion vehicle, medical expert opinion, non-life expert opinion (e.g. onsite resolution, claim field service)
What are the Restitution assignments?
Those related to active and passive Restitution. Usually start with a cost estimate and end up with an invoice.
What are the audit assignments?
Another assignment is always needed for audit assignments - - > “desk inspection”.
There are two types:
1- property/vehicle audit
2 - medical audit
What are neutral assignments?
Assignment person and assignment property - for those assignments not covered by other assignment types.
What are some payment status?
Incomplete, approved, retained, rejected, booked/not paid out, paid-off
How can a claim can be closed?
Via the checkbox “Close claim” or via the scheduled task “Automatic claim closure”
What are some important claim post processing functionalities?
Claim closure
Processing of bookings
Adjustments to claims
