Submit a Loss Notice

Note: You must have the authority, "Create Claim Occurrence," (Claim Submission group) to add / submit a Loss Notice. You must also have authority to add, edit and delete either a vehicle or property (Claim Detail group) on the Loss Notice.

Once you have accessed the policy and recorded the Loss Date on the New Claim screen, Diamond returns the New Loss Notice screen. In this example, we are using the Property Loss Notice.

On the left side of the New Loss Notice screen, a Tree View is displayed in the My Navigator section. This allows you to advance logically through entering information for the Loss Notice. Nodes include:

• Main

  Used to record location, description, loss description, type of loss information, etc. on the claim. If a Loss Description is chosen, options listed here cab differ by version and claim fault.

   

  Once a claim has been submitted, users can set a Liability Decision with a corresponding amount. The Liability Decision combo box can be used to do this. Values include: blank, N/A and Yes.  If “Yes” is selected, an amount field displays and allows a user to set an amount for the Liability Decision and saved. The first time a Liability Decision is saved, the user and date it was added will be saved to the Claim Control and will not be changed if the decision is later changed.

• Reported / Insured

  If the claim was previously reported, place a check in the Previously Reported field.

   

  Enter or select:

   

  Reported By section:

   

  • Date: Select to produce a drop down calendar for date selection.

  • Reported By: Select from the combo box the individual reporting the claim.

  • Via: Select from the combo box the manner in which the claim was reported.

  • Reported By Link: If insured 1 was chosen as the "Reported By," the name and address automatically defaults in the Reported By field. If another selection is made, the field defaults blank; click the link to return the Edit Name / Address screen. Enter and select information as necessary; click OK.

   

  Contact section:

   

  • Contact Insured: Select to place a check mark in the field if this is the individual or entity that has been or will be contacting the insured about the loss.

  • Date / Time: Select to produce a drop down calendar for date selection.

  • Contact: Select to return the Edit Name / Address screen. Enter and select the contact person's information as necessary; click Save.

   

  Insured's Section

   

  • Insured 1: If "Insured 1" was the individual reporting the loss, the name and address automatically default

  • Insured 2: If an additional insured should also be included, click the Insured 2 link to return the Edit Name / Address Information  screen; enter / select all information as necessary and click Save.

   

  To exit and return to submitting the loss, click the Main tab or any of the other tabs to enter information.

  Information on who reported the occurrence. If information is entered here, the information automatically populates the Parties tab. Names (insured and contact) as well as the date and time information on the initial reporting of the claim.

• Vehicle / Property

  If the system setting, "Automatically Add Listed Units for LOB Ids," (Diamond System Editor / Claims / Submission folder) contains a value, the property (in this case) is automatically listed / added to the Loss Notice.

   

  If there are no values set, then you will have to manually add the property (or vehicle) by using the Listed button.

• Claimants

  If the system setting, "Insured as Claimant," (Diamond System Editor / Claims / Submission folder) is set to "True," the primary insured is automatically added as the first claimant on a new claim.

   

  Clicking the pencil icon, allows you to add / edit other information, such as: Narrative describing the property damage or carrier information.

   

  If the system setting is set to "False," or there are other claimants that need to be added, click the Add Claimant button to enter information.

   

  Users can also add a feature / coverage using the Claimant selection. This can only be done if the system setting, "Add Features / Coverages," (Claims / Submission folder) is set to "True" (Enabled.) To do this:

   

  • Click the Features / Coverages Tab.
  • Click Add Feature / Coverage.
  • 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.

  • 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.

   

  In the Coverage Limit section:

   

  • Coverage Limit: Displays the limit for the selected coverage.

  • Deductible: Protected field; shows the Deductible limit.

   

  When finished adding the feature / coverage, select Save; information is displayed in a Grid View.

   

  Click Save again to retain the claimant information. The feature / coverage is listed on the Tree View under the claimant.

• Witnesses

  Selecting the Witness node lets you enter / select information about any witnesses. Choose the Add Witness button.

   

  A free form field, Remarks, is provided to enter any additional information about the witness.

   

  Click Save to retain the information. If there is more than one (1) witness, repeat the procedure.

   

• Police / Fire

  Police Info Section

   

  • Police Department: Select from the combo box the Police Department responding to the site of the loss. If the name of the Police Department is not listed in the combo box, click the Add (Department) button. This returns the Edit Name screen. Make all entries as necessary and select Save.

  • Police Officer: Select from the combo box the Police Officer responding to the site of the loss. If the name of the officer is not listed in the combo box, click the Add Officer button. This returns the Edit Name screen. Make all entries as necessary and select OK.

  • Police Notified: Select the Police Notified field, placing a check mark in the field.

  • Badge Number: Enter the officer's badge number, if known.

  • Case No.: Enter the case number, if known.

  • Violations / Citations: Enter any violations or citations noted on the police report.

   

  Fire Department Section

   

  • Fire Department: Select from the combo box the Fire Department responding to the site of the occurrence. If the name of the Fire Department is not listed in the combo box, click the Add (Department) button. This returns the Edit Name screen. Make all entries as necessary and select Save.

  • Dept. Name: Once a selection or new entry has been made, the department's information is displayed in this field. If you need to edit the information, click the Fire Department button and make the changes.

   

  Click Save.

• Notes

  This is a free form field. You can enter any additional information you feel is appropriate to document the claim occurrence.

• Attachment

  This lets you attach other information, such as pictures or documents, to the Loss Notice.

   

  • Select the Browse button.
  • Locate the directory in which the document is stored.
  • Highlight the document to be attached by clicking it once.
  • Choose the Open button.
  • Before selecting Add, you can choose Private and assign it a Type by choosing one from the Type combo box. Also, if you want to create a Diary for the adjuster, click the Diary check box. When this is selected, a message is shown: "Diary created successfully for <Name of Adjuster." Click Ok.
  • Click Add.
  • The document displays in the spreadsheet.

   

  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.

• Personnel

  Your company may or may not require claim personnel to be assigned to the claim. This is controlled by system settings in Diamond System Editor: Claims / Submission folder. When these are set to "True," (for the different claim level personnel), they are required. When set to "False," they are not required,

   

  • Office: Select the office that is responsible for handling this claim from the drop down list.

  • Administrator: Select the assigned Administrator from the drop down list.

  • Administrative Assistant: Select an Administrative Assistant from the drop down list, if required.

  • Inside Adjuster: Assign an Inside Adjuster to the claim occurrence.

  • Outside Adjuster: If an Inside Adjuster is not assigned, designate an Outside Adjuster.

  • Subro Adjuster: If assigning a subro adjuster, select from those available in the combo box.

  • Restrict Access: If you have the authority, "Restrict User Access" in the Claim Detail group, selecting this button "locks" the Loss Notice from personnel you can choose and prevent them from seeing the claim.

   

  Note: If the system setting, "Email Adjuster, Email Admin, Email Admin Asst, Email Outside Adjuster, Email SIU Adjuster and Email Subro Adjuster," (Claims / Submission / Workflow folder in Diamond System Editor) an Email is sent with the Workflow Task notifying them Loss Notice has been submitted. Additionally, in order to use the functionality to send an Email along with the Workflow Task, you must set the "Notify XXX" to "1" (Enable) in the same group of settings. So, for example, if you wish the Admin of the claim to receive an Email upon submission, adding a feature or task re-assignment, you must set the "Notify Admin" setting to “1" (Enable) in all three of the folders. Additionally, you must enter the Admin's Email address in 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 "1" - Enable.

   

   

After all information is complete, select the Submit button at the top of the screen. Answer Yes to the question: "Submit the claim?" All information is added in the My Navigator pane on the left of the screen.

Special Note: Claims can be attached to the following policies:

• "Pending" Policies - When attaching a claim to a "Pending" policy, the “Pending” policy coverages are not pulled into the claim (i.e., users will not be able to set up any features on these claims.)  The status of the claim is "Record Only." Once the policy is issued and the status changes to “Active,” the system will pull the coverages in for that policy and features can be set up. When the policy is deleted from the “Pending” Workflow / Task List, the user deleting the policy will be notified that the policy will be “Denied” instead of “Deleted,” because there is an existing claim on that policy. If the system finds an Active / History or Future image (system setting driven) for the Date of Loss, it will use that instead of the "Pending” image. To use this functionality, the system setting, "Submit on Pending Policy," (Claims / Submission folder) must be set to "True."

• Cancelled Policies - Claims can be set up when the date of loss is after the cancel date of the policy but still within the original policy period. For example, a 12 month policy has a term of 01/01 - 12/31. It is cancelled on 07/15. This option allows users with authority to submit a claim from 07/15 - 12/31. The claim is "Record Only." Additionally, users (with authority) can change the status of the features and make loss payments. To use this functionality, the system setting, "Submit on Cancelled Policy," (Claims / Submission folder) must be set to "True."

• Future Policies - A claim can be submitted on a policy with a status of "Future." The user is warned that the claim is being added to a policy with a Future status and that the claim will be "Record Only." Only a user with the “Edit for Record Only” (Claim Detail group) authority will be able to change the claim type if the claim type is “Record Only” (on the Loss Notice or Claim Detail). To use this functionality, the system setting, "Submit on Future Policy," (Claims / Submission folder) must be set to "True."

One Other Special Note: Garage Address has been added to the Vehicle screen on the Loss Notice of a Claim. To enable this function, the system setting, "Garaging Information," (Claims / Claim Info folder) must be set to "True." This can be used to compare the information that insureds are telling the underwriters to what they are telling claims personnel. Coverage issues can easily occur if the address is not given or does not match.