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Say Hello to Insurance Claims

Learning Objectives 

After completing this unit, you’ll be able to:

  • Identify the parts of an insurance claim.
  • Describe how casual policy participants, such as a witness to a road accident, can be included in a claim.
  • Relate cases to claims.

Bump, Dent, Scratch

Remember Rachel from Unit 2? She was recently involved in a road accident, along with her husband, Nigel, that broke the car’s windshield, and the car needed to be towed. Esperanza Fulton was biking to work when she saw the accident happen. Bookmark this detail: We revisit it shortly.

Scene of  a car accident.

Rachel calls up Cumulus Insurance and is directed to Zaw, who you’ll remember from Unit 1, is Cumulus’s go-getter customer service agent. Zaw is happy to assist Rachel with raising a claim.

Zaw checks Rachel’s policy and finds that roadside assistance is covered. Zaw also notices that Nigel is a policy participant in Rachel’s insurance policy. 

A picture showing the information contained in the Insurance Policy, Insurance Policy Asset, Customer Property, Insurance Policy Coverage, and Insurance Policy Participant objects and how they relate to each other.

Staking a Claim

Digital insurance claim form.

Zaw initiates a new claim request. He enters all relevant details of the incident, and adds Rachel’s car to the Insurance Claim Asset related to the claim. The data model for this is represented in the following diagram.

A picture showing the information contained in the Insurance Policy, Claim, Insurance Claim Asset, and Insurance Policy Asset objects and how they relate to each other.

An Eyewitness Account

Zaw enters the claim’s participants into the system. Remember Esperanza, the incidental witness to the accident from earlier in this unit? She’s a claim participant too. Zaw records her details too as a claim participant. Let’s see what the data model for this looks like.

A picture showing the information contained in the Insurance Policy, Claim, and Claim Participants objects and how they relate to each other.

Case-by-Case Basis

Cumulus Insurance takes great pride in delighting its customers and it mandates strict service level agreements (SLAs) for the turnaround of claims. Cumulus uses Salesforce Service Cloud to manage SLAs and milestones. 

So, when Zaw answers Rachel’s distress call to customer support after the road accident, he uses the Initiate First Notice of Loss (FNOL) flow to record the accident details. The FNOL flow is one of many out-of-the-box flows available in Insurance for Financial Services Cloud. A new case is automatically created as a result and Zaw gives the case number to Rachel for future tracking purposes.

Rachel was given an initial damage coverage estimate of $1000, but at the time of claim settlement, that was reduced to $700. So, when Rachel challenges this decision, another case (this is a special type of case called the claim case—more about that in a minute) is automatically created, but this time against her original claim. This new case is associated with the claim via the Claim Case object. The data model visualization for this relationship is as follows.

A picture showing the information contained in the Insurance Policy, Claim, Claim Case, and Case objects and how they relate to each other.

Resources