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.

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

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.

Click Close to close the window.

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

Click Create Payment to add a payment. For additional information, see the Adding a Payment to a Claim section.

Click a link in the Date column to modify or reverse a payment. For additional information, see the Viewing and Modifying a Claim Payment section or the Reversing a Claim Payment section.

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

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.

1. Click Create Payment.  The Payment window opens.
2. Complete the necessary information.  Fields marked with a red asterisk * are required.



Type	Select the type of payment. The following options are available.
Expense	An expense payment to a Claim Party attached to the claim.
Indemnity	An indemnity payment to the Claimant.
Recovery	A recovery payment received from a Claim Party attached to the claim.
Recovery Disbursement	A payment made from recovery values.
Salvage	A salvage payment received from a Claim Party attached to the claim.
Salvage Disbursement	A payment made from salvage values.
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.
Payment Currency	Select the Payment Currency of the amount entered.
Different Billing Currency	If the Payment Amount is provided in a currency different from the currency configured for the From/To Party, check this box to display the Billing Amount field and provide the converted amount.
Billing Amount	This field is available when Different Billing Currency is checked.  This is the amount that will be tracked in the billing module and used to make any adjustments to the reserves and estimates.
Billing Currency	This field is available when Different Billing Currency is checked. Select the billing currency.
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.
Approval Required	Marks the payment as ready for review and approval.
Approved	Marks the payment as approved and submits the information for accounting.
Approved - Processing	Marks the payment as approved but still requiring processing time.
Draft	This is the default status for new payments.
Error	This status is applied when the payment does not successfully integrate with the billing module.  The payment will not be included in billing calculations.  The payment can no longer be edited or deleted once it has been saved with this status, or when the status has been applied automatically.
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.
Rejected	Marks the payment as reviewed and rejected.  The payment can still be edited and re-submitted for review and approval.
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.
Final Payment	When selected, the system marks the payment as final and depletes the remaining balance from the payment plan. At this point, the status can be changed to Paid.



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.

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



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.



The Reserves / Estimates 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.



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

2. Click a link in the Date column to view the payment details. The Payment Management window opens.
3. If the claim payment is in any Status other than Paid, the fields in the Payment Details panel and the Reserve / Estimate panel can be edited. See the section on Adding a Payment to a Claim for a detailed description of the fields.
4. Select an action.
• Click Save & New to save the payment and clear the form to enter another payment.
• Click Save & Close to save and close the window.
• 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.
• Click Reverse Payment to create a reversal payment. For additional information, see the Reversing a Claim Payment section.
5. If the claim payment is in Paid status, additional information is provided in tabbed format and the Payment Management window is locked from editing. If the claim payment must be reversed, see the Reversing a Claim Payment section.



6. The window opens on the Payment Details tab, with the option to navigate to the other by clicking Party Information, Payee Information, Bank Information, and back to Payment Details for users with the appropriate security role(s).

Viewing the Claim Payments List

The Claim Payments List, is accessible through the Claims menu item under Claim Payments, lists all payment types for all processed claims. Users can export this list as an excel file and make the necessary edits to the file before importing it back into the system. The Claim Payments List will be updated with the saved changes. Users can view a claim submission by clicking the link in the Claim Number column. The system will navigate to the claim transaction.

If there are a large number of available payments, see the Using Grids section for help on finding the appropriate payments. The system will navigate to the claim transaction.

Users can export the Claim Payment List and make modifications to certain columns based on the configuration in the General Settings - Additional Settings page.

1. From the Claims menu, select Claim Payments.
2. Select the claim or claims to be exported into Excel.
3. Click Export and open the downloaded list.
4. Make the necessary changes to the highlighted columns, as specified in the settings defined in the Claim Payment Export / Import File panel in the General Settings - Additional Settings section. All other columns will be read-only. Save the file locally so it is easy to retrieve for the import.

5. Navigate back to the Claim Payments page in the system. Click Import. The Claim Payment Import window will open.

   

6. Select or drag and drop the file to upload.
7. Click Import to import the updated excel document, or click Close to close the window without importing the file. The changes made in the excel file will populate in the grid.

Reversing a Claim Payment

If a claim payment was made in error and set to Paid status, or is otherwise invalid, it can be reversed.  This creates a negative matching payment, and negative entries in the tracking and accounting sections.

1. 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.



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

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 for help on finding the appropriate payments.
3. Click Reverse Payment. A new payment is created and opens in the Payment Management window.
4. Complete the necessary information. Fields marked with a red asterisk * are required.



Type	This is set as a Reversal of the original payment type, such as Indemnity Reversal.
From/To Party	Displays the From/To Party from the original payment.
Payment Amount	This is set to reverse the amount of the original payment.
Payment Currency	Select the Payment Currency of the amount entered.
Different Billing Currency	Displays the Different Billing Currency setting from the original payment.
Billing Amount	This field is available when Different Billing Currency is enabled.  This is set to reverse the amount of the original payment.
Billing Currency	This field is available when Different Billing Currency is checked. Select the billing currency.
Date	Enter the date of the reversal, or select the date from the calendar lookup .
Coverage	Displays the Coverage from the original payment.
Category	Displays the Category from the original payment.
Reversal Reason	Select a reason for the reversal.
Check Number	Displays the Check Number from the original payment.
Reference Number	Displays the Reference Number from the original payment.
Description	Enter a description for the reversal.
Status	This field is displayed after saving the reversal, and is automatically set to Paid.
Original Payment Details	This link is only displayed once the reversal has been confirmed. Click this link to view the original payment details.



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

Adjustment	Select how the reversal will be applied to the current Reserve and Estimate values.
Automatic Adjustment	For Expense or Indemnity payments, the amount will be automatically added to the related reserve value.
	For Salvage or Recovery payments, the related estimate value will be reset to the last estimate value from the original payment.
	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.



Once the reversal has been confirmed, the Status panel is added.

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

5. Click Confirm to complete the reversal.  Note that the reversal is final, and the original payment cannot be restored.  If a reversal is created in error, a new payment must be created.

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.



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.



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

2. Click Set Estimate.  The Reserve/Estimate window opens.
3. Complete the necessary information.  Fields marked with a red asterisk * are required.



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.
Salvage	The estimated value that can be salvaged.
Category	Select a category for the type of reserve or estimate.
Coverage	Select the type of coverage for the type of reserve or estimate.
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.