About Claims

The Diamond System includes comprehensive Claims Management. Claims are added to a policy using the New Claim screen. The New Claim screen records the policy number, loss date and, optionally, loss time. Detailed claim information is added on the Loss Notice screen.

Certain authorities are required when performing specific tasks in the Claims System. Currently, Claims has the following different groups of authorities listed in Administration: Users & Workflow Queues / User Setup. These groups include:

• Claim Appraisal

• Claim Catastrophe

• Claim Coverage

• Claim Detail

• Claim Financials

• Claim Forms

• Claim Payee

• Claim Submission

• Claim Transactions

• Claim Witness

If you receive a message you are not authorized to do a specific function, please discuss this with your IT Department or supervisor.

System Settings in the Diamond System Editor can affect certain claim layouts and default values. The settings in the Diamond System Editor / Claims folder and sub folders are used for establishing many different aspects of claim handling in Diamond.

Fields having an asterisk (*) next to them are required for entry or selection in processing a claim. These fields provide necessary information.

The New Claim and Loss Notice screens are used to record general claim information for claim submission purposes. The Claim Tree View can be used to manage all claim related tasks.

Claim information can be accessed a number of ways:

Home Page: The Claims menu option contains:

• New Claim: Allows the entry of a new claim.
• Load Pending Claim: Gives users access to a grid view containing all claims that have been "pended" (waiting for more information).
• Out of Office: This will allow a user with the proper authority to access claim personnel and set them up as “Out of Office.” (Note: Users must have the authority, "Access Out of Office" (Claims Detail group) to use this option.
• Claims Inquiry: Allows entry of a claim or policy number for lookup.
• Quick Claim Lookup: Allows entry of a claim number for quick access.
• My Claims List: This allows users to look for claims: Assigned to (Specific User), Role, Loss Type, Status (Open, Closed or Pending), By Age, Loss Date (From / TO) and Reported Date (From / To).
• Claim Import: This allows you to import legacy claims, or claims outside of Diamond, to be imported into Diamond through an XML file. Your company will create the XML file in a format specified by Insuresoft.

Claim information can also be accessed using the Claims selection on the Quick Links Tree View from a client's policy.

The Loss Notice screen records:

• Loss Location

• Claim Tracking Type

• Claim Personnel

• Fire / Police Department information

• Reported By

• Contacts

• Forms

The Claim Tree View displays all information such as:

• Claimant (Name, Address, Loss Location, Loss Type, Claim Personnel, Reported By, etc.)

• Feature / Coverage (Exposure, Sub-Exposure, Coverage, Reported By, Personnel, etc.)

• Claim Transactions (Expense, Loss / Indemnity, Reserve, Recovery and Subro).