Claim

Question 1

How many ways are there to create a claim in ABS?

Answer 1

Four:

1- general search
2 - person file
3- contract file
4- claim search

Question 2

How do I create a claim from the general search?

Answer 2

Search - policy number/name/claim number - Results - List - New claim

Question 3

How do I create a claim from the person file?

Answer 3

Contract - List - New claim

Question 4

How do I create a claim from the contract file?

Answer 4

Claims - list - New

Question 5

How do I create a claim from the claim search?

Answer 5

Claim search - policy number/involved person/claim number - Results - List - New

Question 6

What are the minimum data required to create a claim?

Answer 6

Claim date
Class (Coverage)
Loss type
Loss cause

Question 7

When does the duplicate claim check happens?

Answer 7

Online and during batch processing, when the claim is created and when the claim date suffers any change

Question 8

What is the ‘dialog control’?

Answer 8

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.

Question 9

What are the four processes of claim?

Answer 9

Document and investigate
Evaluate
Settle
Conclude

Question 10

How many classes per claim can be captured?

Answer 10

Only one class per claim, except for multicoverage claims

Question 11

Which top tabs are part of the Document & Investigate meta-process?

Answer 11

Notice, Property, Person

Question 12

Which top tabs are part of the Evaluate meta-process?

Answer 12

Contract, Coverage

Question 13

Which top tabs are part of the Settle meta-process?

Answer 13

Claim, Settlement, Costing, Account

Question 14

Which top tabs are part of the Conclude meta-process?

Answer 14

Annuity, Recourse

Question 15

What are some entities to which the object Claim is related to?

Answer 15

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

Question 16

Name four business object functions used by a claim

Answer 16

Comments
Scheduled tasks (e.g. Follow up activity on a claim)
Process slip
Business objects activity
Documents

Question 17

What’s a “Further claim”?

Answer 17

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

Question 18

How can a further claim be created?

Answer 18

In an existing claim, top tab Further - Button new

Question 19

Why is the concept of event needed?

Answer 19

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

Question 20

What is a Claim event? (Loss event)

Answer 20

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

Question 21

Why is a mass event?

Answer 21

Is a loss event that triggers many claims (simultaneously or during the effectiveness of the corresponding policies)

Question 22

Where can we create a mass event?

Answer 22

In the “Claim/assignment maintenance file” in the “Mass event” top tab

Question 23

What are the attributes of a mass event?

Answer 23

The event description (Name)

The type: set to “mass event” with the exact start and end dates and times

Question 24

How do we set up the loss type and loss cause?

Answer 24

We have to set it up in PEX, it’s linked to the coverage.

Question 25

What are the “Event effects”?

Answer 25

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)

Question 26

What do the “Loss Event Type Regulation” links?

Answer 26

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.

Question 27

What is an “Event type”?

Answer 27

The event type is a functional and technical cluster bundling the combination of class product, loss event type regulation, loss type, and loss cause.

Question 28

What are event types used for?

Answer 28

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

Question 29

What are the types of coverage verification?

Answer 29

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

Question 30

Based on which checks is the “Reason-based Coverage verification” calculated?

Answer 30

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

Question 31

What is the purpose of the coverage verification concerning extent with regard to amount?

Answer 31

To verify if the contract covers the claim amount

Question 32

What is the purpose of the coverage verification concerning extent with regard to scope?

Answer 32

To verify that individual invoices and payment requests are all covered.

Question 33

What is the liability verification check?

Answer 33

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

Question 34

What are the different abs provision functionalities?

Answer 34

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

Question 35

What are the claim categories?

Answer 35

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

Question 36

What are the types of assignments? (type of settlements)

Answer 36

1 - Standard
2 - Inspection
3 - Restitution

4 - Audit
5 - Neutral

Question 37

What are the standard assignments?

Answer 37

Those received from external sources: payment request, invoice, cost estimate, expert opinion not assigned by the insurance company.

Question 38

What are the inspection assignments?

Answer 38

Those related to expert opinion vehicle, medical expert opinion, non-life expert opinion (e.g. onsite resolution, claim field service)

Question 39

What are the Restitution assignments?

Answer 39

Those related to active and passive Restitution. Usually start with a cost estimate and end up with an invoice.

Question 40

What are the audit assignments?

Answer 40

Another assignment is always needed for audit assignments - - > “desk inspection”.

There are two types:

1- property/vehicle audit

2 - medical audit

Question 41

What are neutral assignments?

Answer 41

Assignment person and assignment property - for those assignments not covered by other assignment types.

Question 42

What are some payment status?

Answer 42

Incomplete, approved, retained, rejected, booked/not paid out, paid-off

Question 43

How can a claim can be closed?

Answer 43

Via the checkbox “Close claim” or via the scheduled task “Automatic claim closure”

Question 44

What are some important claim post processing functionalities?

Answer 44

Claim closure
Processing of bookings
Adjustments to claims