Issue Claim Payments

Learning Objectives

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

• Issue payments using the Claims Adjuster Workbench.
  
• Identify the records created and modified after a claim payment is issued.
  
• Describe how a service issues payments.
  

So far, our star adjuster, Phil, has found it remarkably easy to create claim coverages, set reserves, and add payment details using the Claims Adjuster Workbench. The clock is always ticking, though, and he knows Ernie, the claimant, is eager for a swift resolution and payment of his claim. Phil hopes the payment process, notoriously error-prone and tedious on the legacy system, will be far smoother with the Digital Insurance Platform. It’s time to test it out.

In this unit, you initiate the payment process and discover how the Digital Insurance Platform streamlines this critical step.

Issue Payments

Along with opening coverages and adding loss or expense items, use the Adjuster Workbench to issue payment on a single claim item.

On the Financials tab of the Claim record, select the desired loss or expense item and click Pay.

After issuing payment, review the updated Financial Summary chart for the property claim.

The chart automatically updates to show an accepted loss of $2,400, which equals the adjusted amount of the payment detail. The remaining reserve subtracts the accepted loss and adjusts to $92,600.

Next, review the Policy Terms Standing chart.

The Property Limit now displays a used amount of $2,400. The pending and remaining amounts both adjust for the used amount.

Navigate to the Related tab to survey the new records.

Notice a new Policy Terms Tracking Entry (1) and a new Claim Payment Summary record (2).

Let’s learn a little more about each record.

The new Policy Terms Tracking Entry record stores information about the property limit used on the newly paid loss item.

This new tracking record is associated with the appropriate Policy Term (1), Claim Coverage (2), and Claim Coverage Payment Detail (3). Most importantly, it contains the Posted Amount (4) and the Remaining Amount (5) for the property limit.

When you add a new payment detail to this claim coverage, the remaining amount will represent the amount available for the Property Limit policy term. Because this policy term has a claim coverage scope, the remaining amount is only active for this specific claim coverage. If there’s a new claim, the property limit resets to the initial amount of $100,000.

The Claim Payment Summary record contains a simple summary of the payment made on the loss item.

This summary includes the Name (1), Payment Amount (2), and Payment Status (3) of the claim payment.

Understand Issue Payment Services

The claim payment process works similarly to opening claims and creating payment details, but with a few extra steps.

The diagram shows the high-level flow.

Here’s what happens during the payment process:

• The adjuster creates the loss item (1), specifying key details about the loss.
  
• The adjuster selects Pay (2) for one or more line items.
  
• The payment triggers the service InsClaimItemService:InvokeInitatePaymentIP (3). This service calculates the sum of the items and then checks the total amount against any applicable limit power attributes. When the claimed amount is less than the available limit, it calls an Integration Procedure.
  
• This Integration Procedure procedure then calls the service InsClaimItemService:createPayments (4), which updates the Claim Coverage Payment Details (5) and creates the Claim Payment Summary records (6).
  
• Finally, the procedure creates Policy Term Tracking Entry (7) records for any power attributes involved in the payment details.
  

Following payment, Ernie checks his claim status online and breathes a sigh of relief. His payment has already been processed, demonstrating the efficiency of the Digital Insurance Platform. Phil, equally pleased, knows the quick resolution will earn him positive feedback.

Yet, there's always room for even greater efficiency through automation. In the next unit, learn how to set up rules that automatically open claim coverages, driving increased speed and accuracy for claims.