Denying a Claim or a Feature

Note: In order to edit or deny a claim or feature coverage, users will need the following authorities:

• Claim Coverage Group:
  Deny Coverage: Allows a user to deny a feature or coverage.
  Edit Feature Deny Status: Allows a user to edit the status of a feature / coverage.

• Claim Detail Group:
  Deny Claim:  Allows a user to deny a claim.
  Edit Claim Deny Status: Allows a user to edit the claim type of a denied claim.

Deny a Claim

Claims can be denied for many different reasons, some of which may be: Statute of Limitations Exhausted, Loss Date Not within the Policy Period, Claim not Filed on Time or a Hold Harmless Agreement Exists, etc.

• Access the claim.
• Highlight the claim number in My Navigator (left side of screen).
• Select the Administer button on the toolbar; click Deny.
• Answer OK to the message: "Deny feature / coverage?"
• On the Deny Reason screen, choose the reason for denial from the list to place it in the Deny Reason combo box.
• Enter any additional remarks (Optional); click Save.
• The Close Claim Summary screen displays; click OK.
• On the Close Reason screen, select from the list why the claim is being closed; click Save.

Once you have denied the claim, a red dot is placed opposite the claim number in My Navigator. The status of the Claim is closed and any features / coverages that have been added are also closed.

A system generated Note is added, which you can view by either selecting the Notes Tab or the Cov Issues Tab on the toolbar. In either case, you can then view the details of why the claim was denied and the person who denied it.

Once a claim has been denied, the Claim Type combo box (Miscellaneous Section of screen) is updated to "Denied."

Note: Users can also deny a claim using the Cov Issues Tab. From the Claim Detail screen, select the Cov Issues Tab; click Deny opposite the issue. Follow the steps listed above to close the claim.

Deny a Feature

• Access the Features / Coverages folder.
• Highlight the feature / coverage in the Grid View.
• Select the Administer button form the toolbar; click Deny.
• Answer OK to the message: Deny feature / coverage?"
• On the Deny Reason screen, choose the reason for denial from the list to place it in the Deny Reason combo box.
• Enter any additional remarks (Optional); click Save.
• If reserves have been set up, you will see the Close Financials screen; click OK. If no reserve has been set up and Save was chosen, the Feature Grid View is returned. A red dot is placed opposite the feature / coverage which means it is closed.

In looking at the feature's detail, a check mark is placed in the Denied field. A system generated Note is added. It can be viewed on the Notes Tab of the feature. The Note shows the details of why the feature was denied and the person who denied it.  

Edit a Denied Claim

When editing a claim that has been denied, you are editing the "Claim Type."

• Highlight the claim number from My Navigator.
• Select Edit.
• Claim Type: Change the type from "Denied" to one listed in the combo box.
• Answer Continue to the warning: "You are updating the status of this feature / coverage from denied. Do you wish to continue?"
• Click OK to "Save changes?"

A Note is automatically generated which you can see from the Notes Tab on the Main toolbar. It displays the date / time and the user who changed the Claim Type.

When a claim is "undenied," it and any or all of the features still remain closed.

Edit a Denied Feature

• Select the denied feature from My Navigator.
• Click Edit  on the main toolbar.
• Remove the check mark from the Denied field.
• Answer Continue to the message: "You are updating the status of this feature / coverage from denied. Do you wish to continue?"
• The check mark is removed from the Denied field.
• Click Save.

A Note is automatically generated which you can see from the Notes Tab of the feature. It displays the date / time and the user who "undenied" the feature.

When a feature's type is "undenied," it still remains closed.