Add a Claim

Add claims to enter the details of an insured’s covered loss. You can only add claims for Insured clients (not Prospects) and for contracted policies. If you only need to add the claim for tracking purposes, you can add it as a Summary Only claim. If you need to send a loss notice to the carrier, add a loss notice claim.

1. Locate the account in question and access the Claims area.
   1. To access Accounts from the Home screen, do one of the following:
   2. • Click Accounts on the navigation panel.
      • Click Areas > Accounts on the menubar.
      • Click the down arrow next to Home on the options bar and select Accounts.
      • Click the Locate button on the options bar.

   To access Accounts from another area of the program, do one of the following:

   • Click Home > Accounts on the menubar.
   • Click the down arrow next to Home on the options bar and select Accounts.
   • Click the Locate button on the options bar.

   2. In the Locate account dropdown menu, select Client.
   3. In the Locate by dropdown menu, select the appropriate option.
      
      Note: Location by phone number searches all phone numbers associated with client and contact accounts (e.g., residential, mobile, fax).

   4. Select the suitable checkbox or checkboxes to the right.

      • Insureds (available only if Clients is selected in the Locate Account field)
      • Prospects (available only if Clients is selected in the Locate Account field)
      • Active
      • Inactive
   5. Enter the first few letters of the name, policy number, lookup code, etc. (depending on the selection in the Locate by dropdown menu) and press [Enter] or click Locate.
   6. The Results list displays all of the accounts that match the criteria you entered. Click on a column heading to sort the list by that category. For example, click the Last Name column heading to sort by last name in ascending order. To sort in descending order, click the Last Name column heading again.
   7. Highlight the desired item in the Results list.
   8. Do one of the following:
      • Click Claims on the navigation panel.
      • Click Areas > Claims on the menubar.
2. Do one of the following:
• Click the Add button on the Claims screen.
• Click New on the options bar and select Claim.
• Click File > New > Claim on the menubar.
• Press [Insert] on your keyboard.
• Press [Ctrl]+N.
3. The current system date defaults in the Date of loss field, but you can change it if necessary. You can type a new date into the field, or click the down arrow to the right of the field to choose a date from the dropdown calendar.
4. Optionally enter a time of loss in the field to the right.
5. The Date reported defaults to the current system date, but you can change it if necessary. You can type a new date into the field, or click the down arrow to the right of the field top choose a date from the dropdown calendar.
6. The time the loss was reported defaults to the local time on your workstation when the Add a Claim screen opened. You can change it if necessary.
7. Enter a name in the Reported by field. To locate the Reported By contact, click the lookup button to display a list of contacts for the account and double click the appropriate contact or click once on the contact and click Finish or press [Enter].
8. Enter a name in the Reported to field. To locate the Reported To contact, click the lookup button to display a list of employees, enter all or part of the employee lookup code, click Locate, choose the appropriate employee, and click Finish.
9. Enter a Claim description.
10. Select the Record only checkbox if applicable.
11. Select the Previously reported checkbox if applicable.
12. Enter an Estimate amount if known.
13. Enter the Insurer Claim # if known.
14. If you add the claim from the Policies list or a Policy detail screen, the selected policy defaults as the Policy association for the claim. To change this association, select the policy under which the claim is covered in the Policy list. To display expired policies, select the Include history checkbox.
15. Select a Service summary.
16. Enter a Risk or click the lookup button to display a list of risks for the selected policy, double click the appropriate risk or click once on the risk, and click Finish or press [Enter].
17. Enter a Sub risk or click the lookup button to display a list of sub risks for the selected policy. Double click the appropriate item, or click once on the item and click Finish or press [Enter].
18. Select a Claim type if it does not default. The options available may be limited based on the associations set up in Policy Type Configuration. See Claim Type Configuration for instructions on adding, editing, and deleting claim types.
19. Select a Claim code if it does not default based on your Claim Type selection. See Claim Code Configuration for instructions on adding, editing, and deleting claim codes.
20. You can click Finish or press [Enter] to end the workflow at this point. However, it is advisable to click Detail and add the rest of the claim information at this time.
    
    Click Cancel or press [Esc] to exit the workflow without saving the information. You are prompted, "Do you wish to discard changes?" Click Yes.
    
    Click Detail to add more information. Continue to step 21.
21. The Claim Detail screen displays. The navigation panel expands to show the available categories for the selected claim. Click a category to show its specific sections on the claim. Click a section to view or fill in the information related to it.
22. All claims contain the following screens:
• Summary
  1. Change the Date of loss if necessary and enter a time of loss in the next field if known. If the date and time of loss cannot be established, select the Cannot be determined checkbox.
  2. Enter or revise the loss Description.
  3. Enter the Insurer claim # if known.
  4. Enter an Estimate amount if it is available.
  5. In the CAT code field, optionally enter the catastrophe code.
  6. Enter a name in the Reported by field or click the lookup button to display a list of contacts for the account. Double click the appropriate contact, or click once on the contact and click Finish or press [Enter].
  7. Change the Date reported and/or time reported if applicable.
  8. Enter a name in the Reported to field or click the lookup button to display a list of employees, enter all or part of the employee lookup code, click Locate, choose the appropriate employee, and click Finish.
  9. Enter or change the Date and time below the Reported to selection if necessary.

  10. Select any checkboxes that apply to the claim:

  • Record only

  • Previously reported

  • Chargeable

  • Suit pending

  • Subrogation

  11. This screen contains two tabs:

  • Policy

    The policy or line of business to which the claim applies displays in the list. To add a different policy or line, click the Add button to the left of the list.

    1. In the Add Policy/Line window that displays, choose the appropriate Claim type.
    2. Click to select the desired policy/line.
       
       Note: Select the Include history checkbox to display history policies in the list.
    3. Choose a Service summary.
    4. To select a Risk, click the lookup button to the right of the field. In the Available Risks window, choose a risk Type. Click to highlight the appropriate risk and click Finish.
    5. To select a Sub risk, click the lookup button to the right of the field. In the Available Risks window, choose a risk Type. Click to highlight the appropriate risk and click Finish.
    6. Select a Claim type if it does not default based on the associated line of business. See Claim Type Configuration for instructions on adding, editing, and deleting claim types.

    To remove a policy or line from the claim, click the item in the list and then click Delete . You are prompted, "Do you wish to delete this record?" Click Yes.

  • Reporting/History

    Claim codes associated with the claim display in the list. To add a claim code, click the Add button to the left of the list. In the Add Claim Code window that displays, choose a Claim Code. Click Add to add another code to this claim, or click Finish if there are no more codes to add.

    Note: The Claim Code options available in the dropdown menu are specific to your Claim Type selection for the associated policy/line. See Claim Code Configuration for instructions on adding, editing, and deleting claim codes.

    To remove a code from the claim, click to highlight the code in the list and then click Delete .

    Add additional information about the claim in the Comments field, such as notes about the claim’s progress (beyond its Open or Closed status). These comments will also display when you select this claim in the Claims list.

    History and Closed information cannot be revised.

• Servicing

  Enter servicing information for the claim on this screen. Select a specific Employee for each employee type, entering Descriptions to the right as necessary.

• Insured/Contact
  1. Enter an Insured loc code and Report purpose code if applicable.
  2. Select the Jurisdiction.
  3. Enter a Jurisdiction log number if known.
  4. Optionally enter an Insured report number.
  5. Enter an OSHA case number if applicable.
  6. The screen contains the following tabs:
  • Insured
    1. If the insured Name is incorrect, click the lookup button to the right of the field. Click on the appropriate contact in the window that displays and click Finish.
    2. To change the address, click in the large field in the Address/Phone Number section. Enter the Street, City, State/Province, and County (if applicable) in the highlighted fields that display.
    3. Enter the ZIP/Postal code, or click the lookup button to look up the code.
       1. Make a selection from the Search where dropdown to indicate your preferred search method.
       • If you selected ZIP Code/Postal Code or City:
       1. From the second dropdown, select Begins with or Contains.
       2. Enter at least one character of the desired zip code or city and click Locate or press [Enter]. If more than 500 results are found, you must enter more than one character.
       • If you selected State Code or Province Code, the second dropdown defaults to Equals and cannot be changed. Enter the two-character abbreviation for the state/province and click Find or press [Enter].
       2. Click to highlight the appropriate zip code in the list and click OK or press [Enter].
    4. Enter the Site ID if applicable.
    5. Enter or amend the Residence, Mobile, Business, and Fax numbers as necessary.
    6. Enter or amend the Primary email and/or Secondary email address.
    7. Enter or amend the Website associated with the insured.
    8. Enter the Date of birth.
    9. Select the Marital status.
    10. Enter the FEIN if applicable.
  • Contact

    1. Select the Contact insured checkbox if applicable. If you do not select this checkbox, fill in the fields on this tab.

    2. If the contact Name is incorrect, click the lookup button to the right of the field. Click on the appropriate contact in the window that displays and click Finish.

    3. To change the address, click in the large field in the Address/Phone Number section. Enter the Street, City, State/Province, and County (if applicable) in the highlighted fields that display.
    4. Enter the ZIP/Postal code, or click the lookup button to look up the code.
       1. Make a selection from the Search where dropdown to indicate your preferred search method.
       • If you selected ZIP Code/Postal Code or City:
       1. From the second dropdown, select Begins with or Contains.
       2. Enter at least one character of the desired zip code or city and click Locate or press [Enter]. If more than 500 results are found, you must enter more than one character.
       • If you selected State Code or Province Code, the second dropdown defaults to Equals and cannot be changed. Enter the two-character abbreviation for the state/province and click Find or press [Enter].
       2. Click to highlight the appropriate zip code in the list and click OK or press [Enter].
    5. Enter the Site ID if applicable.
    6. Enter or amend the Residence, Mobile, Business, and Fax numbers as necessary.
    7. Enter or amend the Primary email and/or Secondary email address.
    8. Enter the preferred contact time in the When field.
    9. Choose the Relationship to insured.
    10. Enter Comments as necessary.
  • Spouse
    1. If the spouse's Name is incorrect, click the lookup button to the right of the field. Click on the appropriate contact in the window that displays and click Finish.
    2. To change the address, click in the large field in the Address/Phone Number section. Enter the Street, City, State/Province, and County (if applicable) in the highlighted fields that display.
    3. Enter the ZIP/Postal code, or click the lookup button to look up the code.
    4. Enter or amend the Residence, Mobile, Business, and Fax numbers as necessary.
    5. Enter or amend the Primary email and/or Secondary email address.
    6. Enter the Date of birth.
    7. Select the Marital status.
    8. Enter the FEIN if applicable.
  • Authority Contacted
    1. Enter the Authority.
    2. Enter the Report #.
    3. List any Violations/Citations.
    4. Enter the Municipality and Division #.
    5. Enter the Office name, Badge # and Phone/email.
• Adjustor

  Adjustors are added to the system through Adjustor Configuration.

  1. To add an adjustor to the claim, click the Add button to the left of the Adjustors list.
  2. Click the lookup button to the right of the Name field.
  3. In the Adjustor Lookup window, enter at least one character in the Adjustor field and click Locate.
  4. Click the appropriate adjustor and then click Finish.
  5. Information for the selected adjustor defaults in the fields, but you can change it if necessary.
  6. Enter an Assigned date or select the date from the dropdown calendar.
  7. Enter Comments as needed.
• Litigation
  1. Enter the Case #, Court and Venue.
  2. Enter a Served date or choose the date from the dropdown calendar.
  3. Type an Answered date or choose the date from the dropdown calendar.
  4. Enter the Defense Name, Address, and Phone #, and enter Remarks if needed.
  5. Enter the Plaintiff Name, Address, and Phone #, and enter Remarks if needed.
• Additional Parties
  1. To add an additional party, click the Add button to the left of the list.
  2. The fields below the list are enabled. Enter the Name of the additional party, or click the lookup button to the right of the field to choose a contact associated with the account, click on the correct contact in the pop-up window that displays, and click Finish or press [Enter]. The Name field is required.
  3. Enter the Business name if applicable.
  4. Click in the Address field. Enter the Street, City, State/Province, and County (if applicable) in the highlighted fields that display.
  5. Enter the ZIP/Postal code, or click the lookup button to look up the code.
     
     Note: If you click the lookup to choose a contact in the Name field, the address defaults into the field.
     1. Make a selection from the Search where dropdown to indicate your preferred search method.
     • If you selected ZIP Code/Postal Code or City:
     1. From the second dropdown, select Begins with or Contains.
     2. Enter at least one character of the desired zip code or city and click Locate or press [Enter]. If more than 500 results are found, you must enter more than one character.
     • If you selected State Code or Province Code, the second dropdown defaults to Equals and cannot be changed. Enter the two-character abbreviation for the state/province and click Find or press [Enter].
     2. Click to highlight the appropriate ZIP/postal code in the list and click OK or press [Enter].
  6. Enter the Site ID if applicable.
  7. Enter the Residence and Mobile phone numbers.
  8. Enter the Business number and Ext.
  9. Enter the Fax number and Ext if applicable.
  10. Enter the additional party's Email address if known.
  11. In the Where to contact field, specify the party's preferred contact location.
  12. In the When to contact field, specify the party's preferred contact time.
  13. Select the party's claim Involvement.
  14. Enter any relevant Comments.
  15. To add another party, repeat the steps above.
      
      To remove a party, click on the additional party in the list and do one of the following:
  • Click the Delete button .
  • Press [Delete].

  You are prompted, "Do you wish to delete this record?" Click Yes.

• Payments/Expenses
  1. To add a claim payment, click the Add button to the left of the list.
     
     Note: If you are entering only a reserve amount, do not click the Add button. Instead, enter the Reserved values in the Totals section.
  2. The fields below the list are enabled. Enter a Date, or click the down arrow to the right of the field to select a date from the dropdown calendar.
  3. Enter a Check #.
  4. Enter the Amount of the claim payment. This field is required.
  5. Select a Payment type.
  6. Enter a Description of the payment.
  7. Choose a Loss type.
  8. Select the Payee type.
  9. Enter the payee Name or click the lookup button to the right of the field to choose a contact associated with the account, click on the correct contact in the pop-up window that displays, and click Finish or press [Enter]. The Name field is required.
  10. Click in the large Address field. Click in the large field in the Main or Mailing section of the Address frame. Enter the Street, City, State/Province, and County (if applicable) in the highlighted fields that display.
      
      Enter the ZIP/Postal code, or click the lookup button to look up the code.
      
      Note: If you click the lookup button to choose a contact in the Name field, the address defaults into the field.
      1. Make a selection from the Search where dropdown to indicate your preferred search method.
      • If you selected ZIP Code/Postal Code or City:
      1. From the second dropdown, select Begins with or Contains.
      2. Enter at least one character of the desired zip code or city and click Locate or press [Enter]. If more than 500 results are found, you must enter more than one character.
      • If you selected State Code or Province Code, the second dropdown defaults to Equals and cannot be changed. Enter the two-character abbreviation for the state/province and click Find or press [Enter].
      2. Click to highlight the appropriate ZIP/postal code in the list and click OK or press [Enter].
  11. Enter the Site ID if applicable.
  12. In the Totals section, click the Calculate link label to enter the payment amount in the correct field automatically. You can also enter the amounts manually if desired.
  13. In the Subrogation section, enter the Sent Amount and Date.
  14. Enter the Received Amount and Date.
  15. To add another payment, repeat the steps above.

  To delete a payment, click on the payment and click the Delete button . You are prompted, "Do you wish to delete this record?" Click Yes.

23. View, add to, or edit the fields on the remaining screens as necessary.
    
    Many of the screens have a list at the top. To expand the list, click the splitter at the bottom of the frame and drag it down the screen.

To view or revise information on these forms, select the correct line in the list. If there are no items in the list and the form is grayed out, click the Add button . The fields on the form are activated, allowing you to fill in the information.

Various tabs display below the list. Each tab contains different fields. To view or revise information in these fields, select the correct line in the list. If there are no items in the list and the fields are grayed out, click the Add button . The fields on the form are activated, allowing you to fill in the information.

To remove an item from a list, click on the item and do one of the following:

1. • Click the Delete button to the left of the list.
   • Press [Delete] on your keyboard.

Some form sections (e.g., the Contact tab of the Insured/Contact form) allow you to make changes to contact information. For example, you may notice that an address is wrong or a name is misspelled.

Note: Press [Alt]+[Shift] and the left arrow key to move from application detail to the selected line of business in the navigation panel. The selected item/application is outlined in orange.

Continue to press [Alt]+[Shift] and use the up and/or down arrow to move to another policy or section or to view a different area for the selected account.

Continue to hold [Alt]+[Shift] and use the right or left arrows to move the subsections under the primary section.

24. When you have made the desired changes, click the X next to the correct bulleted item in the navigation panel. Your changes are saved automatically.