Claim Management System

Claim management system is intended for non-life insurance companies. It gives clients a toolset for claim registration, case processing, orders for experts, repairs estimation (where car services apply their estimations), reports customization and integration with MIBL.


Claim for damages

  • Claims register allows users to register claims for damages on-premises, by telephone or over the Internet;
  • Organization of experts’ work before the claim case is created;
  • Faster completion of the claim for damages form by allowing the operator to access claims register data;
  • Simple claim case creation from the claim for damages data;
  • Correct insurance reserves tracking.

Claim case

  • Creation of claim cases either from the scratch or by converting an existing claim for damages entry or another insurance company’s request;
  • Entry of damaged and/or responsible object data;
  • Claim cases’ searching and processing;
  • Data exchange with LMIB (Latvian Motor Insurers’ Bureau);
  • Simplified attachment of dynamic documents, images and files;
  • Associated data and document collection (orders for experts, repairs estimates, incoming and outgoing invoices, operations);
  • History collection of claim case processing stages and statuses.

Order for experts

  • Order for experts registering and assigning (registering is easy, since the data is loaded from the LMIB database and the claims for damages or the claim cases);
  • Inspection record printing;
  • Correspondence with the expert;
  • Cooperation agreements with the expert;
  • Workflow organization and control;
  • Inspection-related expenses and work-related trip mileage entry;
  • Insured object inspection image, document and application attachment;
  • Damages entry;
  • Two-level expected indemnity adjustment.

Repairs estimate

  • Easy and fast data collection for the repairs estimate;
  • Simple repairs estimate conversion from the order for experts;
  • Repair offers mailing to the car service centers, both registered and unregistered in the system;
  • Workflow organization and control;
  • Insurance reserves adjustment.

Anti-fraud verification

  • Anti-fraud verification results entry and claim case data saving;
  • Anti-fraud department decision linking to the processing stages of the claim case;
  • Verification checklists are easily configurable for each insurance kind and product.

Requests

  • Requests are implemented as dynamically structured documents that allow to define multitude of various documents linked to the case;
  • Printouts can be created for the documents. These printouts can be sent out as emails.

Traffic police inquiries

  • Traffic police inquiry requesting from the Data Center of the Ministry of Home Affairs;
  • Traffic police inquiry storing and printing;
  • If the traffic police inquiry is not yet created in the Data Center, the system allows to save the request alone. Such requests are automatically parsed every night and the corresponding inquiry data is loaded from the Data Center;
  • The traffic inquiry request, as a dynamic document, can be saved into the claim case. After the automatic inquiry data loading, the traffic accident’s type in the claim case is automatically changed and the responsible specialists receive an email about the performed operations.

Claim decision

  • Determines the decision type (Insured Event, Refusal etc.) that has a substantial effect on the whole case settlement activity;
  • Contains information about the amount deductible, the recourse, the leasing and the retained premium;
  • Claim case may have multiple claim decisions.

Incoming invoices

  • Incoming invoices register collects all invoices from the car service centers and experts;
  • Incoming invoices are linked to the specific claim case when they are provided by the car service centers.


Indemnity decision

  • Contains information about the indemnity, the indemnity kind and the indemnity receiver;
  • Can be attached to the repairs estimate decision;
  • A letter can be created from it to be sent directly from the system to the client as an attachment;
  • Ensures reserve adjustment.

Payment order

  • Passed to the accounting department to effect a payment;
  • May contain multiple indemnity decisions or their parts.

Settlements

  • Contains expert’s invoice detailed specification. Each position should be linked to the specific order for experts;
  • After the settlement approval, it shows as a planned settlement in the claim case reserves. After the settlement payment, it turns to the settlement expenses.

Indemnity payment

  • Indemnity payment is, in fact, a fulfilled payment order;
  • Payment list contains information about the retained premium, the settlement payments, the received amount deductible;
  • Payment orders and settlement invoices are exported to the banks using the FiDAViSta standard.

Claim case reserves

  • Automatic average reserve calculation when the claim case is first registered;
  • Automatic reserve correction after the order for experts expected indemnity adjustment and repairs estimate approval;
  • Automatic reserve correction when the amount deductible is adjusted in the claim decision or when the deductible invoice or indemnity is paid or when the settlement expenses are registered and paid;
  • Manual reserve correction.

Insurance recourse

  • Recourse claim can be created inside the claim case;
  • Recourse claim is automatically created from the request to another insurance company via LMIB system;
  • Recourse claim consists of the following units: recourse registration, recourse request, debt collectors, court cases, closure, settlements (payment plan), received recourse payments.

Processing stages

  • Processing stages ensure convenient claim case handling and system structure compliance;
  • The system fulfills automatic stage opening and closing by relying on the input data;
  • The system structure provides the possibility of introducing flexible changes into the behavior of stages, as well as the ability to create new stages or remove existing ones.