Note: The following authorities are needed to use this function.
Claim
Coverage Group:
Admin Clear Coverage: Allows an
administrator to clear a coverage.
Adjuster Clear Coverage: Allows
an adjuster to clear a coverage.
Claim
Detail Group:
Admin Clear Claim: Allows an
administrator to clear a claim.
Adjuster Clear Claim: Allows
an adjuster to clear a claim.
Optionally, two (2) new system settings have been added to the Claims folder. These include:
Notify Underwriting on Clearance: Determines if a task to Notify Underwriting is created when a coverage issue is cleared. Values = “True” and “False.” True = A task is created to Notify Underwriting when a coverage issue is cleared. True = A task is created. False = No task is created. Default = True.
Notify Underwriting on Denial: Determines if a task to Notify Underwriting is created when a claim or a feature / coverage is denied. Values = “True” and “False.” True = A task is created to Notify Underwriting when a task is created when a claim or feature / coverage is denied. False = No task is created. Default = True.
The Cov Issues Tab is located on the Claim Detail screen. This allows various issues (specific to a company's implementation) to be to be cleared in order for certain transaction types to be added to the claim.
Coverage issues are divided into two (2) levels:
Level 1: These types of coverage issues must be cleared by both the adjuster and supervisor before coverage can be afforded or any payments can be issued. Loss reserves or payments are not allowed until they are cleared. If the claim or coverage is denied, loss reserves / payments are not allowed. Some of these issues might be: Policy was inactive for the date of loss (Date of Loss / Time outside the policy term), an excluded driver was driving at the time of loss, vehicle involved in loss not listed on the policy, etc.
Level 2: These types of coverages can be cleared by the adjuster only. This level allows loss reserves to be entered but no payments are allowed until cleared. If the adjuster attempts to make a payment before clearing the issue, they will receive a validation: "Loss Payment invalid with pending coverage issues." If the claim or coverage is denied, then the loss reserve is zeroed and additional loss reserves / payments are not allowed. Some of these issues might include: Another loss already exists on the policy, a loss occurred within 30 days of a policy change (before / after the date& time of loss) or there was a delay in reporting the loss (e.g., 30 days or greater from the date of loss), etc.
On the Claim Detail screen, when the Cov Issues tab contains a number, this means there is a coverage issue. Selecting the tab opens a Grid View that shows what the issue or issues are. Remember, Level 1 requires both the supervisor and an adjuster. If the Level = 2, only the adjuster is needed to clear the issue.