Note: Users must have authority to add and edit a claim feature. Additionally, each claim feature is required to have a coverage associated with it or it cannot be saved.
Feature information cannot be added to a claim until claimant information has been entered and saved. Feature information contains exposure and coverage information for a claimant.
When you are adding a new feature / coverage for the first time, the following options are available:
Add Feature / Coverage: Selection begins the process of adding a new claim feature.
Add Multiple Features: Click to add multiple features to a claimant. (Note: This button can be disabled if the system setting, "Allow Multiple Feature Setup," in the Claims / Feature folder is set to "0" - Disable.)
To add a feature / coverage:
In the left pane of the Claim Tree View, select the claimant for which the feature will be opened.
Click the Features / Coverages folder.
Select Add.
The New Features screen has three (3) tabs:
Main: Allows you to select information about the feature.
Reported By: You can chose information about the person reporting the feature.
Personnel: Lets you view or change claim personnel assigned to the feature.
In the Exposure Section, enter or select the following:
Exposure: Select the appropriate coverage exposure from the combo box.
Sub-Exposure: Select the claim sub-exposure related to the vehicle (s) / property covered by the policy from the combo box.
Coverage: Select the policy coverage from the combo box.
Sub-Coverage: Select the corresponding claim sub-coverage from the combo box, if applicable.
Attorney Represented Date: If litigation is involved, enter a date here.
Attorney: Select to indicate if the status of the claim is in litigation.
In Suit: Select to indicate if the status of the claim is in suit.
In Salvage: Select to indicate that the claim is in salvage.
In Subro: Select to indicate that the claim is in subrogation.
Record Only: This check box is active only if no policy coverage is available for the selected coverage record (state specific). For example, collision or comprehensive is selected but neither exists on the policy.
Zero Tort: Indicates whether Zero Tort is applicable to the current line of coverage.
Waive ISO: ISO is waived.
Exclude from Medical Bill Review: For third party interfaces, a check mark here means the feature / coverage information will be omitted from being exported to the third party vendor.
In the Coverage Limit section:
Coverage Limit: Displays the limit for the selected coverage.
Deductible: Protected field; shows the Deductible limit.
Applied: When entering a new feature, this field is protected. When a Deductible amount has been applied against a Loss Payment, the system will automatically check this field to confirm the deductible has been applied.
Waive (Deductible): For exception processing where a deductible may be waived, the claim adjuster would use this field to indicate that the deductible should be waived by placing a check mark in this field.
Coverage Limitations (Display Only): This displays specific limitations for coverages or sub coverages. This information is saved with the Claim Coverage or Claim Sub Coverage and is populated during submission. The new field is displayed on the Claim Feature screen and saved with a Claim Feature.
Corvel Approved Amount: Used with the Corvel (3rd Party) interface.
You have the option to establish an indemnity reserve amount for this feature at this time. Otherwise, setting the indemnity reserve is a separate transaction once the feature has been added.
At the bottom of the screen, click in the Indemnity (Initial Reserve / Anticipated) field of the financial spreadsheet and enter the reserve amount.
Both the Reported By and Personnel tabs are populated with the data entered on the Loss Notice screen. If information for these areas was not completed on the Loss Notice screen, or if changes need to be made, you may change the information by selecting the appropriate tab and entering the information here.
The Restrict Access button on the Personnel tab is used to "lock" a feature / coverage. You can identify the personnel you want to prevent from viewing a specific coverage. (Note: You must have the authority, "Restrict User Access" in the Claim Detail group to use this function.)
This is used to look at all of the activity associated at the feature / coverage level. Columns (Added, Description, User and Remarks) can be sorted by clicking on the column heading.
The Forms screen displays all forms that have been selected for the feature currently in view.
Note: Forms added on the Feature screen are added at the Feature level. These forms are not viewable at the Claim, Claimant or Policy level.
To add a form:
To delete a form from the list, click the X next to the form. Answer OK to the question: "Delete this form?" The form is removed from the Grid View.
If you wish to notify underwriting about the feature / coverage:
When adding a feature / coverage, you have the ability of sending an email to claims personnel assigned letting them know a new feature has been added. The system settings, "Email Adjuster, Email Admin, Email Admin Asst, Email Outside Adjuster, Email SIU Adjuster and Email Subro Adjuster," (Claims / Feature / Workflow folder in Diamond System Editor) must be set to "True" (Enable.) In order to use this functionality to send an email along with the Workflow Task, you must set the "Notify XXX" to "True" (Enable) in the same group of settings. So, for example, if you wish the administrator of the claim to receive an email, you must set the "Notify Admin" setting to “True" (Enable). Additionally, you must enter the administrator's email address for the user specified as the "Administrator" in Diamond Administration: User Setup. If no email address is entered, an email will not be sent even though both settings are set to "True" - Enable.
Note: In order to use this function as well as the Negotiation Tracker and PIP Negotiation Tracker, pre-implementation work is required. You will need to define what coverages (e.g., Medical Payments) your company will track.
This your company the ability to track explanations of benefits, maintain the history of them and make payments on the logs. The tab is only displayed when the coverage associated with the feature is eligible.
When the EOB Tab is selected, a summary screen is shown. It includes a grid of each added service as well as totals for all dollar amount columns. Users can add, edit or delete the service records if they have the authority to do so. Please Note: The Edit and Delete options are only allowed when a check has not been printed.
Once services have been added to the Grid View, users have the option to make a payment. Users may select a single or multiple rows to include in the payment. If multiple rows are selected, the benefit applied amount for those rows feeds to the Payment screen. The transaction that is created is associated with the EOB log rows. The check date / check number feeds from the transaction.
Prior to implementing this function, new system settings must be enabled in the Claims / Feature / Explanation of Benefits folder as they are used to determine what fields on the EOB tab can be shown or hidden.
In the Claim Detail group of authorities, user must have the Add, Edit and / or Delete Explanation of Benefits to access and use this function.
This allows your company to track by feature any type of negotiation proceedings. Once a BI feature is added and Saved, users can add information. Fields on this screen are configurable by your company.
This allows your company to track by feature any type of PIP negotiation proceedings. Like the Negotiation Tracker once a feature is added and Saved, users can add information. Fields on this screen are configurable by your company.
Attachments can be added at the feature level.
Special Note! Multiple Attachments can be added at the same time. After clicking the Browse button, users can select multiple files in the Open File Dialogue. After selecting the files, clicking the Add button adds them as Attachments.
If any coverage issues exist, a number will be displayed opposite the Cov Issues tab. Additionally, an icon (Caution Sign) is shown on the Claim Tree View for easy identification. Prior to adding a claim feature, users must either Clear or Deny the issues. Issues are identified by your company. Examples of these could be: A Loss has occurred within 30 days of a policy change or the garage address is different than the policy address.
When completed with the entry of all necessary feature information, select the Save button on the Feature screen toolbar. Answer Yes to the question: "Save changes?"
Once a claim feature has been opened, it may be necessary to edit some of the information.
Select the desired feature / coverage from the Claim Tree View (left pane).
Choose the Edit button on the Features screen toolbar.
Make the necessary changes and select the Save button and answer OK to the question: "Save changes?"
Note: Once Exposure, Sub-Exposure, Coverage and Sub-Coverage data has been saved on a feature, it may not be changed.
When adding features / coverages, other options include:
Add Split Transaction: Selection allows claim adjusters to select a claimant and have all features and coverages with their current reserves display on one (1) screen for selection to issue a payment or transaction.
Administer: The Administer button displays activity functions, which are available only to users with proper authority established. These options on the Features screen affect only the selected feature.
Open File: This allows you to open a closed feature record. The status on the Features spreadsheet is changed to "Open."
Close File: Closes or zeroes the selected feature record. Status on the Features spreadsheet is changed to Closed.
Zero Financials: Selection opens the Close Financials screen. All financial categories currently open are available for selection. Choose OK after category selection to zero and close the financials for the selected items.
Refresh Financials: Select to recalculate claim totals to reflect any new data or transactions processed.
The Grid View displays information for each feature associated with the claim.
Diamond has the ability to allow a user to submit a feature with the default initial reserve without having the current reserve change authority. Users will need, however, the Loss / Indemnity Open Initial Reserves authority (Claim Transaction group) to do this. This allows your company to better control reserve changes which may have compliance / audit criteria. The Feature screen has been modified to lock the reserve entry if the user has the authority. Additionally, the Loss Reserve validation has been skipped since it cannot be changed from the default value.