Set Claim Product Rules
Learning Objectives
After completing this unit, you’ll be able to:
- Describe the process of evaluating a claim product rule.
- Check the components required for preparing rule expressions.
- Set rule conditions on a claim product.
Automate a Claim
So far, you’ve learned how to manage claims using the Claims Adjuster Workbench, which gives insurance companies simple, declarative tools for managing claims. As powerful as these tools are, Claims Management further automates the process to reduce repetitive work and make adjusters more accurate and efficient.
One important way to automate claims is with claim product rules. A claim product rule defines the conditions that, when met, automatically trigger an action within a claim process. They’re commonly used for automatically opening coverages on new claims. In this unit, you’ll learn to set up claim product rules to streamline the process of opening a claim coverage.
Here’s the basic process of rule evaluation.
When a product rule evaluates to true (1), the record moves to the TO STATE of the selected Transition Name and triggers the specified action. When a product rule evaluates to false, the record doesn’t move to the TO STATE of the selected Transition Name, and no action is triggered. If the transition has an alternate state (2), then the record moves to it. If not, the record stays in the From state.
Create a Claim Product Rule
Get ready to create claim product rules. Here are the basic steps.
- Describe the rule conditions.
- Review the required components.
- Configure the rule expression.
- Test the rule.
At Cumulus, Justus Pardo, a highly regarded solution architect and expert on the Digital Insurance Platform, is responsible for modeling claims and setting up all the rules and workflows.
Follow Justus as he sets up a product rule that automatically opens the Dwelling coverage on a property claim product. This coverage opens by default whenever a claimant reports the structure of the claimed property as damaged. Further, when this condition is met, the claim record transitions from a state of Draft to Open. This state transition can then trigger case assignment rules and other actions.
Describe the Rule Conditions
As a first step, turn the rule specifications into a set of declarative statements to determine which attributes, operants, values, actions, and transitions to include in the rule.
Based on the property claim specifications:
- The Dwelling coverage should automatically open on a property claim whenever the property’s structure is damaged.
- The claim should reflect the open coverage by transitioning from a draft state to an open state.
- When the property’s structure is not damaged, the dwelling coverage doesn't open, and the claim record only transitions to an open state if another product rule evaluates to true.
Based on these rule conditions, you identify the following components to include in the rule.
- An attribute on the Claim Damaged Property spec that reports whether the property structure is damaged.
- An action attached to the state model for the claim object that calls an Integration Procedure to open the Dwelling coverage.
- A state transition on the state model for a claim object that transitions a claim record from Draft to Open.
Review the Required Components
Nice work. You’ve identified the components needed for your rule expression. Now, determine whether these components are already present in your claim and state models. If so, note the relevant names, codes, and values because you’ll use them in your rule expression. If not, you’ll need to create them.
For the Dwelling coverage rule, Justus checks whether the Claim Damaged Property spec contains an attribute related to damage to the structure. He finds one that fits the bill perfectly: Primary Structure Damaged.
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He notes the Attribute Code (claimStructureDamaged) and the value to use in the rule expression. Justus wants the rule to trigger when the structure is damaged, so the value should be 'true'.
Next, review the state model components by visiting the state model for claims.
Already in the state model, a prebuilt action called ClaimsProductRulesOpenBuildingCoverage opens the Dwelling coverage. It calls an Integration Procedure called ClaimProductRules_OpenBuildingCoverage.
In the next unit, you learn how to configure Integration Procedures. For now, though, you can use the prebuilt one.
Check the enabled State Model Version for the claims state model. On the Related tab, observe a list of available transitions.
Currently, the default transition is set to Draft > Open. No alternate transition is specified, so the claim record transitions to open when it meets a specified condition and remains in Draft state when it doesn’t.
Create the Rule Expression
After you identify the required components for the rule, it’s time to create the rule expression.
To create a product rule for a claim, navigate to the Rules tab of the appropriate Claim product. Find the Underwriting section and build the specifications for your rule.
Let’s build a dwelling coverage rule based on the information collected in the previous step.
Justus is pleased with the new rule. It ensures consistency, saves adjusters time, and improves the customer experience. With this rule in place, he knows that property claims with structural damage will automatically open the necessary coverage, preventing delays and ensuring prompt attention for claimants. But there's still one more step! To complete the automation, he needs to configure an Integration Procedure and create a corresponding action.
In the next unit, learn how to set up these key components.
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