Create Claims

After having performed a search amongst the existing claims in the system, you might decide that you have to create a new claim record. Note that claims cannot be created on Pending or Declined Business. They must always be linked to a business that is either Informational or Definite. There are three different types of claims in SICS:

• Individual
• Interlocking
• Various

Claims can be created in numerous ways in SICS - either by creating an entirely new claim “from scratch” or by using an existing claim as a template, and copy this to another business or another section.

If the new claim is in fact a new link to another business/section the new claim will have the same ID as the old claim.

By using the Claim Program functionality the system creates several claim-to-section links simultaneously. Also when creating co-insurance claims or claims on Master Agreements, the system automatically creates all the required links.

The Create and Copy processes take you through a wizard with various pages where you can register the most important information. The system validates that the claim you create is valid for the selected business, and that you have recorded all mandatory information. For further details on any of the fields refer to the specific sections in this chapter.

Note! After you have completed a Claim Wizard you may see a Claim Worksheet. This depends on how your System Administrator has set up the system. Refer to section Claim Accounting for details on worksheet handling.

Create New Claim Business Validations #

When you select to create a new claim on a business, the system validates that the business is Informational or Accepted. In addition, the system returns warnings if no premium has been booked on the insured period, if Business is marked as To be Commuted, or if any of the section’s mandatory class of business classification values are inactive and only one value per classification type exists.

No other validations against business conditions take place in the creation process.

The system will validate that no bookings; being informational or actual, takes place unless the following conditions are recorded:

• Business has Share Condition recorded

• Non-Proportional Business has Limit recorded. For Non-Proportional Excess of Loss Treaty, a Cover and Excess Point is required. For Non-Proportional Stop Loss Treaty, either percentages for Cover and Excess in combination with SUPI, and/or Minimum and Maximum Amounts are required

• Business has Claim Basis recorded on Non-Proportional Treaties and Facultative and Direct Business if your System Administrator has defined this as mandatory. Note! The value NONE is not sufficient, an actual claim basis code, for example “Losses Occurring” must be defined.

• Business has 100% Proportional Protection Assignment (including allocation towards Own Retention) if this has been defined as mandatory by your System Administrator.

The three latter requirements are not relevant if you create a claim on an Assumed Business which has the “Supporting Business” indicator selected.

Create New Claim Wizard #

Use the Create New Claim wizard when you want to create an entirely new claim. You can open the Create New wizard from the following windows in SICS:

• Find Claim window- To open the wizard, click ‘Create New’or ‘New’from the pop-up menu.
• Business Properties window- To open the wizard, click the ‘Claims’button in the Navigation bar and select New from the pop-up menu.
• Claim Program Properties window/ Claim List tab - To open the wizard, select ‘Create New Claim’ from the pop-up menu. To create a new claim from the Find Claim window:

1. Open the wizard from Find Claim window by selecting the ‘Create New’button or New from the pop-up menu. You see the Business Properties New Claim window.

2. Specify the business properties. All fields are mandatory entries.
3. Specify the claim type (Mandatory entry).
4. Click Next.
5. Specify the claim properties.

• To edit the location, select Edit from the pop-up menu in this display list.
• To register Area of Jurisdiction, select Edit from the pop-up menu in this field.
• To link to a Risk Zone, click the Menu button next to this field and select Find.
• To access the Short description field, click the Menu button next to the Claim Security check box.
• For further information about Claim Security and Complex checkboxes, please refer to this chapter in the user guide.
• Modify the FGU check-box, to indicate that accounting should be made primarily using From Ground Up functionality, or manual accounting. The defaulted value depends on the Type of Participation, and access to modify it is controlled by a security use case.
• Note that the Claim Bdx (if this is activated by your System Administrator) is not editable at claim level.
• from the pop-up menu in the Claimants/Insured display list. Note that the Claimant may be mandatory, if your System Administrator has activated this
• If the claim should be associated with a risk name, enter the risk name. When you tab out of the field the system converts the entry to uppercase.
• If the claim should be included in recovery calculation as a single loss, or as a group of risk claims (not linked to a Headline Loss), set the “Include in Recovery” indicator. The system validates if there are any other claims which are included in recovery calculation with the same risk name registered.

6. Click ‘Next’.

If you are creating a claim on a business with a reporting unit which requires a link to Headline Loss (as defined by your System Administrator), the system opens a window of eligible Headline Losses, and allows you to create the link. Note that the list of Headline Losses do not filter on location, and the link to the Headline can be created even though the Headline Loss location is not matching. If no link is created, a warning is returned.

If your claim is a potential duplicate claim, the system opens a list of other claims with the same Claim Trigger Date or Date of Loss. You can open each of the claims from this list, to inspect further.

7. Specify the classifications.

8. Click ‘Next’.
9. Specify the section specific information. Note! If business section has more than one classification item per classification type, only active class of business classifications are shown as selected values.

10. Click ‘Next’.
11. Allocate to Protection Program or single OCC. If the business is protected by a US Quota Share the link to this outwards cedent’s contract is displayed.
12. Define the link to Claim Program. This page will only appear if Claim Program functionality is in use.
13. Specify the Claim Signature Notes. This page only appears if your System Administrator has defined Signature Notes to be mandatory as part of Claim Creation.
14. Click ‘Finish’. The system automatically opens the Claim Properties window for the claim you have created, or a claim worksheet if your System Administrator has defined this in the system setup.

Copy an Existing Claim #

When you want to use an existing claim as a template for the new claim, perhaps changing a few details, you can use the “Copy Existing Claim” option. This is available from the Business Claim List. Most information will in this case be copied from the existing claim (like name, dates, location etc) but will of course be validated against the new Scope of Cover.

1. Open the Business Claim List of the business from which you want to create the claim.
2. Select Copy Existing Claim from the pop-up menu.
3. Click the Find button to open Find Claim window.
4. Select the claim you want to use as a template and transfer back.
5. Select the Section to which you want to link the new claim.
6. Select the Claim Type.
7. Click Next.
8. Complete the wizard and change existing information where required.

The system will generate a new identifier for the new claim. Note that if Claim Bdx is in use, the value will be set as per claim condition of the new business.

Copy a Selected Claim #

Another copy option is Copy Selected Claim. Opposed to “Copy Existing Claim” which creates a claim on the business you are currently on, this option will copy a selected claim to another business. The option is available from the Business Claim List.

1. Open the Business Claim List of the Business where you want to create the claim
2. Select the claim you want to use as a template
3. Select Copy Selected Claim from the pop-up menu
4. If you know the Business ID, you can enter it directly.

Alternatively, you can use the ‘typeahead’ facility. Type in the business title or part of the title in the field, and you will receive possible matches for the text. If business ID or title is not known, click the magnifying glass to open Find Business. 5. Select the Business the claim shall be copied to and transfer it back. 6. Select the Insured Period and Section to which you want to copy the claim. 7. Click Next. 8. Complete the wizard, changing information where required.

The system generates a new identifier for the new claim.

Copy a Headline Loss #

You can also create a claim using a Headline Loss as a template. The entered information on individual and interlocking claims will be validated against the Headline Loss information in addition to the normal validations against business. If the new loss matches the Headline Loss, the link between the Headline and the claim is automatically created. If your business is a supporting business you can only create claims using this option.

Copy Headline Loss from Business Claim List #

1. Select Copy Headline Loss from the pop-up menu
2. Click the Find button to open Find Headline Loss window.
3. Select the Headline Loss you want to copy, or Create New Headline loss, and transfer it back.
4. Select the Section and Claim Type.
5. Complete the wizard.

Copy Headline Loss from Find Headline Loss #

1. Select the Headline Loss you want to use as a template.
2. Select Copy to Claim from the pop-up menu.
3. If you know the Business ID, you can enter it directly.

Alternatively, you can use the ‘typeahead’ facility. Type in the business title or part of the title in the field, and you will receive possible matches for the text. If business ID or title is not known, click the magnifying glass to open Find Business. 4. Enter the Insured Period and Section and the claim type. 5. Complete the wizard.

Copy Insurable Object Loss History #

If you have recorded an historical loss on an Insurable Object, you can use this as a template for a new claim.

1. Open the Loss History (LH) of the Insurable Object.
2. Select to view Historical Losses.
3. Select the Loss you want to use as a template.
4. Select Copy to Claim from the pop-up menu.
5. Complete the Claim wizard

No link to the Insurable Object is made unless the claim is linked to cession of the Insurable Object.

Create Claim Manually on Outwards Non-Proportional #

When you want to change the type of recovery claim (Refer chapter14) after recovery calculation has been performed, you must sometimes create the ‘new’ claim manually on the OCCs, unless it is already existing.

The claim creation process follows the same principles as for inwards claims as described above.

To create a new single claim directly on an OCC: #

Note that such claims cannot be used in any recovery calculations. The only reason for creating single claims on an OCC, is if you do not want to use the recovery functionality.

1. Open the claim list of the OCC on which you want to create the claim
2. Select New Individual
3. Define loss name, loss dates, loss location
4. Set the “Include in Recovery”, and leave the Risk Name empty
5. Confirm the warning
6. Complete the wizard

To create a new risk claim directly on an OCC: #

In order to ensure correct recovery calculations the same risk claim cannot occur more than once on the same OCC

1. Open the claim list of the OCC on which you want to create the claim
2. Select New Individual
3. Define loss name, loss dates, loss location
4. Define Risk Name and set the “Include in Recovery”
5. The system validates whether the Risk Claim is already existing on other businesses, and if so returns a warning.
6. The system validates if the Risk Claim is already existing for the OCC, and if so returns an error.
7. Complete the wizard

To create a new Claim linked to a Headline Loss on an OCC: #

1. Open the claim list of the OCC on which you want to create the claim

2a. Select Copy Existing Headline Loss from popup menu, and find the Headline Loss you want to copy, and transfer back to wizard OR

2b. Select New Individual from popup menu

3. Define loss name, loss dates, loss location
4. Complete the wizard
5. If you did not copy a Headline Loss, open Claim Properties, and select Assign to Headline Loss, and find the Headline Loss you want to link the claim to, and transfer back.

Assign to Existing Claim #

When a claim affects more than one layer, or businesses within the same program, you may want to be able to view the claim “as one”, and with only one identifier. SICS allows you to create claims with links to more than one section and/or business. When you have created the claim for the first time, you can then just add the required number of section-links. General information and From Ground Up information is maintained simultaneously for all the linked sections, still allowing you to record specific information for each of the linked sections.

1. Open the Business Claim List of the Business where you want to create the new claim.
2. Select Assign to Existing Claim from the pop-up menu
3. Click the Find button open Find Claim window.
4. Select the Claim.
5. Complete the wizard.

Some information is no longer editable, as it has already been defined.

Assign Claim Validations #

• Cedent must be the same for all linked Assumed Business
• Reinsurer on Assumed must be the same as Cedent of Outward Cedent’s Contract
• If claim is a “Claims Made” the claim trigger date must be equal or less than the Extended Reporting Period Date on the new Assumed Business.
• If Claim Bdx is in use, the value must be the same for all linked Businesses.

Create Claim from Claim Program #

Refer to Create New Claim from Claim Program.

Create Claim on Master Agreement #

If the claim is advised on an Assumed Business linked to a Master Agreement, the claim should be created on the Master Agreement level only. The system will automatically create the links to the linked Assumed Businesses.

Create Co-insurance Claims #

If the claim is advised on an Assumed Business or Policy Ceded linked to an Insured’s Contract, the claim should be created on the Insured’s Contract level only. The system will automatically create the links to the linked Assumed (or Policy Ceded) and Administrative Businesses.

Note: If your System Administrator has activated mandatory proportional protection assignment (for Assumed Business), the Assumed Business placements must be fully protected before you are allowed to create claims on the Insured’s Contract.

Create Claim on Layers - same Identifier #

Refer to Create Claim from Claim program, or Assign to Existing Claim.

Intra Group Claim Handling #

Refer to chapter 14 Non Proportional Retrocession Accounting.