Claims and pre-approvals

A claim follows the same path every time: register, review, approve, pay, close. Claims are under Claims > Claims.

Register a claim

1. Choose New claim, or New claim on the policy.
2. Choose the policy: type a policy number or a customer name. For a fleet or group policy, choose the insured item concerned.
3. Enter the date of loss, the kind of loss, where it happened, a description, and the claimed amount. The first reserve is set to this amount.
4. Choose a claim handler if you already know who will deal with it, and the hospital, garage or surveyor involved.
5. Save. The claim gets its number, the customer receives an acknowledgement by email, and the handler is notified.

The automatic coverage check

As soon as a claim is saved, the system checks it against the policy and shows the result on the claim:

Check	What it looks at
Policy in force on the loss date	The loss falls inside the cover period and before any cancellation
Premium paid up to date	No overdue invoice on the policy
Claimed amount within the remaining sum insured	The sum insured, less what other claims on the policy have used
Deductible on the policy	The highest deductible, as a reminder

The check informs your decision. It does not approve or reject anything by itself.

Handle the claim

The buttons at the top of a claim follow its status.

Action	What it does
Assign handler	Gives the claim to a person, who is notified. The claim becomes Under review
Change the reserve	Updates your estimate of what the claim will cost
Approve settlement	Sets the amount you agree to pay. The claim becomes Approved and the customer is told
Pay	Records a payment to the customer, the provider or someone else. Several part payments are possible
Reject claim	Ends the claim with the reason given to the customer
Close without further payment	Closes the file
Reopen claim	Brings a settled, closed or rejected claim back

When the approved amount has been paid in full, the claim becomes Settled.

Upload reports, photos and invoices under Files. Use More > Download settlement letter for the customer, or Write a letter to create a documents request or a rejection letter from your templates.

Who must approve

Setting a reserve, approving a settlement, paying and reopening can each have an approval chain, usually from a chosen amount. A typical set-up: a claims officer approves settlements up to a limit, a claims manager approves above it, and a finance officer approves the payment. See Approval chains.

Tabs on the list

Open, Assigned to me, Approved, to pay and Settled, closed or rejected. The dashboard shows the claims you have to handle.

Pre-approvals

For health cover, a hospital often asks whether a treatment is covered before it happens. Record these under Claims > Pre-approvals.

1. Choose New pre-approval. Choose the policy, the member, the hospital or clinic, the treatment requested and the estimated cost.
2. Choose Approve and enter the approved amount and how long the approval is valid. A lower amount than the estimate is a partial approval. Or choose Reject with a reason.
3. When the provider's invoice arrives, choose Create claim. A claim is registered for the approved amount, linked to the pre-approval, and the pre-approval is marked Used.