Claims in Suspense

Any Claim transaction records received through download that do not match on all of the criteria listed in the Matching Downloaded Claims section are placed in the Suspense file.

Note: To access the Suspense file, you must have security granted through Security Manager under Utilities, Company Interface, Suspense File, Claims in Suspense.

To access the Suspense file, complete the following steps:

1. From the Home Base, click the Utilities button.
2. Expand the Company Interface folder in the treeview.
3. Expand the Suspense File folder.
4. Click Claims in Suspense, and then click the arrow to continue. The Claim Suspense File screen displays.
5. Suspended claim transactions are displayed in the list in the top section of the screen. Use the scroll bar to select and highlight the claim you wish to assign.
6. Additional information from the highlighted transaction displays in the middle section of the screen. The Claim Type Cd field on a new claim defaults to CLMD, but it may be revised at any time before Run Update is selected.
7. Existing Claim/Policy Information displays in the bottom section of the screen, based on the Locate By option selected:
   • Customer ID: Double click the Enter Customer ID field to display a list of TAM customers. Select the desired customer in the list and click OK. If a match is found, all policies and claims attached to that Customer ID display.
   • Policy Number: Enter the Policy Number and click Locate. If there is a match, then only that policy displays.
   • Company Claim #: Enter the Company Claim Number and click Locate. If there is a match, then only that claim displays.
   • Include Policy History Terms: Use this option to attach a claim to a history policy.
     
     Note: History records are not filed for claims.
8. To update an existing claim or create a new claim:
   • To update an existing claim, select the correct Claim/Policy in the Existing Claim/Policy Information list, click Update Claim, and click Yes on the Verification window.
   • To create a new claim (available only for CLI transactions), select the correct policy in the list, click Create New Claim, and click Yes on the Verification window.
9. Click Run Update to update the claims from suspense. The Print screen displays. Here you have the option to Preview or Print the Communication Log.
10. When the claim is processed out of suspense, an activity generates if the claim download transaction is configured to add an activity. In the Existing field of the activity, the following information displays for each claim transaction type:
    • ADJ: Claim Number, Adjuster Details (name, phone & email)
    • CLI: Loss Date, Claim Number
    • CLN: Loss Date, Claim Number
    • CLS: Loss Date, Claim Number, Claim Status
    • • Closed, Open, Reopened, Subrogration
    • PMT: Loss Date, Claim Number, Payment Amount
    • • Amount field: Amount of the payments reported in transaction
      • A cumulative total payment amount displays in the Existing field
    • RES: Loss Date, Claim Number, Reserve Amount
    • • Amount field: The value of the Reserve Amount