CLMMEN

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CLMMEN main screen.PNG
Name Claims System Menu
Shortcut CLMMEN
Area Claims

See the NOVUS Walkthrough Guide for further information.


The claims system allows users to set up limits and excess points, and a probable maximum loss figure, for a particular policy number, year and section. Once the limits have been set up the maximum expected loss together with the latest known claimed amount can be recorded.

For further details on claims and associated documentation see the Claims page on this wiki.

These figures can be updated as more information becomes available. On completion of a claim entry, the amount payable is computed and any previously settled amounts deducted.

A new claim can be created by entering the policy number, year and section in the CLMMEN program, ensuring that the claim number and claim reference are both left blank. It is necessary to set up the limits before any loss amounts can be entered. It is also recommended that the limits are set up in all possible currencies before claimed amounts are entered in the claim entry field.

In RISKNEW a firm order date is required before a claim can be processed. If CLMMEN is accessed for a risk without a firm order date, an error will appear.

If a risk's policy basis is selected as 'claims made' using the additional information tab in RISKNEW and a retroactive date is added, the claim entry program displays the retroactive date, first advice date with the validation updated.

Limits cannot be changed once transactions have been made. When entering a new claim record, the next available claim number and claim reference are displayed automatically. The claim reference can be customised by the user but the claim number is system driven. Certain details such as original insured and policy period are automatically displayed.


Documents and Transactions relating to a claim are listed under every claim in the claims navigation panel.

Claims6.PNG


NOVUS

Each division can be configured to process claims in one of two ways, either on a from ground up basis (FGU), or on an incremental basis (Agg).

Once this setting has been selected it cannot subsequently be changed. Discuss with Morning Data if you are not sure which set up should be used.

In FGU processing any previous incurred/reserved entries are ignored in the new calculation of reserve and the new current paid claim value is entered which is used to deduct the previous claim value from to give the claim value for this transaction.

In Incremental (Agg) processing previous incurred/reserved/claim are incremented with the latest entry, which for the claim is the claim value for this transaction, these are then summarised to give the total value for the claim to date.

I.E. FGU is always the current figure inclusive of any policy deductible. AGG is the movement figure for the current transaction so the deductible is only applied to the first transaction that is in excess of the said deductible

The system supports the payment of fees to third parties, recoveries, VAT and other liability payments.

Full or part payments are supported.

Users can view the history of any claim in the history log and settlements in the settlement log. Under each claim reference, multiple claims, incurred (INC), reserves (RES), recoveries and fees can all be entered and modified until such items have been part of fully settled.

N.B. for FGU. The system uses the terms INC and RES interchangeably but both are the total incurred figure of the known outstanding and the settled claim. The system calculates the current outstanding figure shown on the claim entry history tab by deducting the paid claim amount (including any fees) that has been settled from the INC or RES amount.

The system supports limits in multiple currencies. This allows the calculation program to apportion losses and claims over the various currencies. Limits can be extended to cover peril codes, allowing different limits to be set up within a single section for various aspects of a risk, such as might be found in marine or liability insurance.

Claim acknowledgements, claims summary sheets, provisional claims advice and claim discharge sheets can be produced as well as LCCF (London claim collection form) forms and CP13’s for the London market.

To meet reinsurance London market requirements the user may opt to post to a ‘pending’ ledger which will allow LCCF’s and CP13’s to be produced on an FDO (for document only) basis. These records can be edited, before being posted to the IBA ledger.

In some circumstances, the claims system is required to record claims on an information-only basis whilst actual settlements take place directly between the insurance company and the claimant. A system flag has been provided to allow postings to go to a parallel ‘direct’ ledger (so-called because direct settlements apply) to enable claims to be monitored and documentation to be prepared.

(N.B. the navigation for this is activated after an initial save or commit is performed to prevent accidentally tabbing through by the user.) This allows full administration and document production during the processing of a claim, but the settlements will not appear in any ‘live accounting ledger in the system.

HELIX

There are two ways that the claims system can operate in HELIX, "from ground up" (FGU) or "incremental". The mode of operation is set at the division level, it can only be maintained by Morning Data.

FGU

The settlement is based on the difference between previous settlements and the latest CLM record entered. CLM records can be deleted or updated when in FGU mode. The latest entry should always be the 'current' state of the claim.

e.g.
first CLM entry 10,000
settlement of 10,000
claim amount was overpaid, it should have been 6,000
enter a new CLM record for 6,000
Helix interprets this as 10,000 already settled but the total claim amount now only 6,000 (the FGU amount) so HELIX will calculate and process a settlement of -4,000.

Incremental

The settlement is based on the sum of the CLM records visible on page 2 of the claim entry screen. CLM records cannot be updated or deleted. CLM records are entered as the change in the value of the claim.

e.g.
first CLM entry 10,000
settlement of 10,000
claim amount was overpaid, it should have been 6,000
enter a new CLM record for -4,000 (you will get a warning message that the -ve sign is unexpected, but you can continue).
HELIX looks at the sum of the CLM records (10,000 - 4,000), deducts the previous settlement of 10,000 and will calculate and process a settlement of -4,000.

The result is the same using both methods, but the screen entries are very different. It is possible for Morning Data to change the setting from FGU to incremental.


Field name Description
Status Status of the claim; this drop-down list field filters the results of the search if the list of values (LOV) is used to populate the pol. no: claim no: or claim reference: fields
Pol. No The policy number to which the claim refers. Double-click in this field or press F9 to see a list of policy numbers filtered according to the status field
Year Year of policy
Sec Section Types - double click for a list of values
Section Auto populated when the sec field is entered - the section of the policy that the claim refers to
MVN Market version that applies to the claim. If no consolidated market is found the user will be prompted by an error message: 'No consolidated market found for MVNxx, please use market entry (MART) to review and save'
Claim Reference A (unique) reference that can be entered manually or can be automatically generated; default generation gives the format policy-year-number of claim on this policy - leave blank for new claim
Claim No System generated claim number; the system assigns a new claim with a unique number from an internal sequence - leave blank for new claim
List of Options The claims system menu shows the list of options available to the system; some options may not be available on every system e.g. a non-Lloyd’s broker or an insurer would not require the LCCF or CP13 options
Required Option Scroll up/down or enter the number of option required; the previous field (or shift-tab) will return the cursor to the pol no. field to enter a different policy number
Work to do Diary Presents user of the list of outstanding claim reviews/acknowledgements with links to the claims involved.

Version History

v 6.1.0 – Updated to latest version

v 5.2.0 – Updated to latest version
v 5.0.0 – Updated to latest version
New version in NOVUS build 1.5
V77.1T
New version in NOVUS build 1.2
v73K - Resolve 999E porblem on MVN filed on LOV not returning bapolnum and bayear.
v72K - global.chain_flag='C' when LIBLOG (CLMFILE) is called.
v52K - Verification sheet allowed even if no premium against policy. Warning issued.
v50K - First version of this form to use the new style. No other updates except the restyle.