Computer system and method for work management5182705Abstract A computerized system and method for managing work in process is provided. An initial transaction records case specific information. The case specific information is automatically linked with a work source index which includes basic client information. An electronic file is created for each case arising out of the initial transaction record. As work is performed on the case, the system tracks its progress and providces a variety of support functions. An electronic activity log function maintains a record of key activities involved in the processing of work items. An electronic diary function provides a means for prioritizing work and for scheduling various tasks. A staff table function provides a facility for storing information relevant to office personnel. Most of the system functions are integrated with the staff table function which provides a number of security and function parameters. A text processing function is provided which integrates stored database information into preformatted and customized documents. A "local data" function provides a facility for customization of data recordation and output at the local level. Various other systems functions provide the ability to modify, update, search and record additional case information. Claims What is claimed is: Description TABLE OF CONTENTS
TABLE I
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* * * Wang VS Logon * * *
Workstation 38 9:31 AM Monday April 19, 1989
Hello new user
Welcome to CAS
Please identify yourself by supplying the following information
Your userid =
Your password =
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system. (An alert is also simultaneously generated to a supervisor.) If the password entered has expired (most passwords remain active for 30 days) a Password Expiration screen (not shown) is displayed. This screen permits an operator to select a new password and then access the system. It is not necessary to wait until a password expires. Rather, passwords can be changed at any time through a Password Change screen (not shown). 2. System Controller The System Controller is a program module that manages and controls every CAS session. It does this by controlling the timing and execution of all CAS functions. The Controller is based on a CAS model transaction which is the blueprint for every CAS online transaction. FIG. 7 is an Action Diagram of an overview of a successful CAS session. (As shown in FIG. 6, an Action Diagram is analogous to a sideways flow chart. The nested brackets depict various functional steps occurring under the umbrella of other functional steps. Double lines indicate a loop, while single lines with multiple bracket ends indicate a choice of functions. Wording between two pairs of asterisks is merely explanatory in nature.) As indicated at 102, entry into the CAS system must be achieved prior to the takeover of all operations by the System Controller 100. After the System Controller has assumed control it first verifies that the requested transaction is available for use within CAS 104 (Primary and default menus are not subject to this verification since, if the system is available these menus must be available as well. The code to invoke the Default Primary Menu is given automatically after successful logon and just prior to takeover by the System Controller 106). Once the System Controller 100 verifies the availability of the requested function it must insure that the operator has the proper authority to invoke the requested function 108. This is done by comparing the function' s required authority level with the System Security (Menutech) authority level. If the operator has the appropriate authority, the function is "run". Two types of functions may be invoked, either a menu 100 function or an application function 112. If a menu function is selected, the System Controller 100 first checks for messages and then displays any appropriate screen indicators 114. Next, the selected menu is displayed 116. A number of options are available from within a menu including: Help, Local Copy, Logoff and a variety of application functions 118. Help and Local Copy do not cause any change in the system location, Logoff 120 exits the system entirely, while the selection of an application returns the System Controller to the Function control position 104. If an application function is initially selected 112 the record to be acted upon must be selected 122. This involves either the entry of a new claim number or the selection of "Data Carry" when leaving a previous function. (The selection of Data Carry carries the same claim with its corresponding information to the next function.) If Data Carry is not used, the System Controller first checks for any messages and displays appropriate screen indicators 124. It then provides a screen or screens which permit the selection of a claim number 126. Once a claim number has been chosen the System Controller again checks for messages 128 before undertaking any business transaction 130. (A business transaction is the part of a function which changes or creates a specific record or set of records.) Any business transaction can be interrupted 132 to "window" to another function of a different type. The original transaction is restored 132 when the operator windows back out of the other function. Just prior to completing the business transaction the operator can place a four letter code in a `Next Trans` field to specify the next function to be undertaken 134. When the business transaction is then ended, the function is exited and the System Controller returns to the Function Control position 104 to evaluate the next requested function. (The following is a partial list of available functions: Loss Processing Transaction, Activity Log, Diary, Directory Tables, Info Search, Payments, Reassignments, CAS Secondary Menu and TEXT Processing. All the available functions are shown in block form in FIG. 8). 3. Menu Screens The CAS menu screens serve as a table of contents enabling an operator to select a desired system function or transaction. Following a successful logon, the system displays a Default Primary Menu tailored to the operator's specific needs and security level. (See, e.g., Tables II and III, for screens designed for a claim handler and a supervisor). The appropriate Primary Menu screen for a particular operator is determined by a Default Menu Number which is entered in the operator's Staff Table.
TABLE II
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SUPERVISOR MENU
Press a PFKey below or RETURN to do Next Trans:
1) Activity Log 10) Mailbox Menu
2) Claim Status Changes
11) Nature of Payments
3) Diary Function 12) Payments
4) Diary Listing 13) Reassignments
5) Directory Tables
14) Wang OFFICE
6) Info Search 15) CAS Secondary Menu
7) Investigative Instructions
8) LP Control Change
9) LP Element Change
32) Logoff
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A Secondary Menu, shown in Table IV is also available. This Secondary Menu displays less frequently used functions and transactions. Using the Primary Menu or the Secondary Menu, an operator can access virtually any available system function.
TABLE III
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CLAIM HANDLER MENU
Press a PFKey below or RETURN to do Next Trans:
1) Activity Log 9) LP Element Change
2) Claim Status Changes
10) Mailbox Menu
3) Diary Function
11) Nature of Payments
4) Diary Listing 12) Payments
5) Directory Tables
13) TEXT forms
6) Info Search Selection/Completion
7) LPT Inquiry 14) Wang OFFICE
8) LP Control Change
15) CAS Secondary Menu
32) Logoff
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System functions are accessed from the Primary or Secondary Menus by actuating the "PF" or "Function " key corresponding to the desired function (e.g. a PF1 or F1 key is pressed to access the Claim Status Change function from the Secondary Menu, the PF5 or F5 key is pressed from a Main Menu to access the Directory Tables function, etc.). 4. The Loss Processing Transaction The processing of a claim begins upon receipt of a notice of loss. These "loss notices" are received from agents, insureds, customers or claimants, either through the mail, in person, electronically or over the telephone.
TABLE IV
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CAS SECONDARY MENU
Press a PFKey below or RETURN to do Next Trans:
1) Claim Status Changes
12) Payment Corrections
2) Diary Function
13) Reassignments
3) Diary Listing
14) Staff Table
4) HTC Sent 15) Subsequent Print Trans
5) Investigate Instrs.
17) Text Forms
Selection/Completion
6) Local OHC 18) TEXT Print Queue
7) Loss Processing Trans
19) Word Processing
8) LP Control Change
21) 3270 Emulation
9) LP Element Change
22) DPSA Security Functions
10) LPT Inquiry 23) Forms Maintenance
11) LPT Subsequents
24) Text Processing
16) Return to Previous Menu
32) Logoff
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In a typical claims office, a person called a Claim Assistant is primarily responsible for the input of loss notices into the CAS System. The loss notice information is input through a Loss Processing Transaction ("LPT") function which may be accessed from a Primary Menu (see, e.g., Tables II and III) or by placing the four letter code `LPTX` in the `Next Trans` field of any transaction. The first screen displayed when the LPT function is accessed is shown in Table V. This is the Loss Processing Transaction Interface screen. This screen is used to input skeletal policy information which, in turn, is used to extract policy information from a Policy File which may reside in one of the Host Computer's databases or in a local database. (Even if some of the policy information is maintained in one of the Host's databases, most claim's offices have a Policy Index Table which tracks the name, address, policy number, etc. of its large accounts. This Policy Index is available for display through the CAS system to assist in the proper extraction of policy information.) The main element required to extract policy information from the Policy File or Policy Index Table is the policy number. If no policy record is found in a Policy File or Policy Index Table, an explanatory error message is displayed and the information must be input manually. (Even if no policy number is found, the loss report must still be maintained. Therefore, a "non-claim" "record report" is maintained on the system.) When information is successfully extracted from the Policy File or Policy Index Table, the initial input fields (i.e. the Interface Screen fields) are protected to preserve the credibility of the extracted data. Upon completion of the LPT Interface screen, the `Enter` key is pressed and a series of loss screens particular to a single "line of business" are displayed. The loss screens are formatted according to a policy symbol (indicating the type of policy) and the line of business specified on the Interface screen. These screens contain policy/insured and loss/claim description data. The number of screens and their sequence is relative to the number of claims arising from the loss occurrence and the manner in which the loss was reported. The initial screens accessed contain fields for inputting required information that applies to the entire loss occurrence. Reporting screens are used to record information which is specific to an individual claim arising out of the loss occurrence. Screens are also available for entering Witness, Contact/Comment information and Special Procedures, if applicable. Where the notice of loss is received electronically from agents, insureds, customers or a central reporting center, the information is in a form which is used to prefill fields in the LPT. The electronically reported information must be reviewed for accuracy but this type of reporting substantially reduces input time. The following is a list of screens specific to the automobile line of insurance business (which will be used as an example for purposes of this description) in their logical order of appearance (screens marked with asterisks will (potentially) become new claims): Policy Information Screen (required) Special Procedures (optional unless extracted from Policy Index Table) Description of Accident (required) *Claimant Screen (required) *Physical Damage screen (required for certain types of policies--identified by claim symbol) *Property Damage screen (required for certain types of policies) *Injured Party Information screen (required for certain types of policies) Witness/Passengers screen (optional) Contact/Comment screen (optional)
TABLE V
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LOSS PROCESSING TRANSACTION LPTX
POLICY NUMBER: .sub.-- ---- ------ LARS IND: SERV EXPEDTR CODE:
AGENT CODE:
LOSS DATE:
REPT DATE:
INDICATE LINE OF BUSINESS: .sub.--
1 AUTOMOBILE
2 PROPERTY/LIABILITY
3 WORKERS' COMPENSATION
4 FIDELITY/SURETY
TELEPHONE FIRST REPORT: *
LOCAL PREFILL: X
ENTER) POLICY INFO 6) POLICY INDEX 18) HELP 23) LC 32)
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CANCEL
Table VI shows an Auto Policy Information Screen. Much of the information necessary to complete the input called for by this screen is prefilled or input through the LPT Interface screen and the information extracted from the Policy File (e.g. Policy Status, Policy Number, Agt Code, Loss Date, Insured Name
TABLE VI
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POLICY INFORMATION
POL NUM:
.sub.-- ---- ------
AGT CODE: AGCY NAME: SALESMAN CODE:
INSURED: P/C: .sub.-- TITLE:
STREET:
CITY: ST: .sub.--
ZIP:
BUS PH: RES PH: TIN:
POL EFF: POL EXP: LOSS DATE: REPT DATE:
FORMS/ENDT:
SPECIFY FORMS/ENDT AFF COV:
EXCESS IND: CERT NUM: LARS IND: LARS LOC CODE:
SERV EXPEDITER CODE:
ENTER)
VEH-DRIVER
3) SPECIAL PROCEDURES
18) HELP
27) ERASE LPT
1) CLAIM SET-UP
19) SELF REFER
23) LC 30) LOCAL DATA
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and Address, etc.) Any additional information that is needed to complete this screen is input manually through the keyboard. The Special Procedures screen, shown in Table VII, is accessed from the Policy Information screen and is used to note any special handling procedures, specific to the policy involved, that are required in the processing of the claim. Multiple screens are available for input and information can be added, modified or deleted as needed. If special procedures are enumerated in the Policy Index Table this screen will be prefilled.
TABLE VII
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SPECIAL PROCEDURES
PERRY, FREDERICK 02 PH 123123
ENTER) ADD 4) PREVIOUS PAGE 18) HELP 23) LC 16) RETURN
3) NEXT PAGE
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The Vehicle-Driver Coverage Information screen, shown in Table VIII, is used to enter information pertaining to the insured driver's coverage limits as well as vehicle information such as the make and model of the car. Any information which is prefilled to this screen can be modified. This screen is generally accesssed after information has been entered to the Policy Information screen. It may, however, be accessed from a number of screens within the LPT. The Description of Accident screen, shown in Table IX, is used to enter information that applies to all claims in the Loss Processing Transaction. The information includes the accident
TABLE VIII
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VEHICLE - DRIVER COVERAGE INFORMATION
CUSTOMER TESTER 02 PH 123123
VEH NUM: YR: MAKE: MODEL:
VIN: PLATE: ST:
COV/DED BI: PD: MED PAY: NON COLL:
COLL: UM: NO FAULT:
T/L: RR: FULL GLASS:
LIAB DED AMT: DED COV:
SPECIFY IF OTHER COV/LIMITS:
MI: LOSS PAYEE:
SPECIFY IF OTHER INSUR ON VEHICLE:
ENTER `X' IF DRIVER SAME AS INSD:
DRIVER: TITLE:
STREET:
CITY: ST: ZIP: PHONE:
LIC NUM: ST:
AGE: DOB: SEX: MS: REL TO INSD:
ENTER)
DESC OF ACC
19) SELF REFER
18) HELP
16) RETURN
1) CLAIM SET-UP
23) LC 27) ERASE LPT
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description, location of accident, impact area, time of loss etc. This screen is generally accessed following input of the Vehicle-Driver Coverage Information screen, it also may be accessed from a number of screens within the LPT. The Witness Information Screen (not shown) is accessed from the Description of Accident screen and is used to input basic witness information when necessary (e.g. name, address, telephone number, etc.). If information about more than one witness needs
TABLE IX
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DESCRIPTION OF ACCIDENT LPTX
CUSTOMER TEST 02 PH 123123
DESCRIBE ACCIDENT:
LOC OF ACCIDENT:
CITY: ST: ZIP:
TIME OF LOSS:
IMPCT AREA: NUM CARS: CAT CODE: CAT LOB:
ENTER "X" IF SUBROGATION POSSIBILITIES:
INVEST AUTHORITY:
VIOLATIONS/CITATIONS: VIOLATION CODE:
REPT TO: REPT BY:
COVERAGE REQ:
RSK ALRT:
QUESTNBLE COV IND:
SVRTY IND:
6) ADD CLMT 14) WITNESS
19) SELF REFER
18) HELP
16) RETURN
15) COMMENTS-CONTACT
28) RESP PARTY
23) LC 27) ERASE LPT
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to be recorded, a Witness List screen (not shown) is available. This screen permits the viewing, addition, modification or deletion of witness information. A Comments/Contact Information screen (not shown) can be accessed from the Description of Accident screen and from other screens within the LPT to enter any relevant comments about the claim. This screen can also be used, for example, to indicate who should be contacted for further information if the insured is unavailable. A Responsible Party screen (not shown) may be accessed from the Description of Accident screen to enter any relevant information indicating responsibility for the loss. When all available information is entered through this screen, pressing `Enter` automatically returns the Description of Accident screen to the display. A Claimant Information screen, shown in Table X, is used to add claimant information (e.g. name, address, telephone number etc.) to the system. The information requested in the Claimant Information screen must be input before a claim can be added for that claimant. Once this information is input, multiple claims can be added for the same claimant as necessary.
TABLE X
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CLAIMANT INFORMATION
CUSTOMER TEST 02 PH 123123
CLAIMANT - ENTER X IF SAME AS INSURED:
(IF NOT ENTER DATA BELOW)
NAME: P/C: TITLE:
STREET:
CITY: ST: ZIP:
BUS PH: RES PH:
AGE: SEX: MS: NUM DEP:
OCC CODE: STATUS: INCOME RANGE: TIN:
11) PHYS DAMAGE
13) INJURY 18) HELP
16) RETURN
12) PROP DAMAGE
30) LOCAL DATA 23) LC
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The Auto-Physical Damage Information screen, shown in Table XI, is used, when necessary, to enter information pertaining to any damage to an insured vehicle. The operator is also prompted to enter a variety of additional information including: incurred loss information, the estimated incurred allocated expense, a repair estimate, etc.
TABLE XI
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PHYSICAL DAMAGE INFORMATION
CUSTOMER TEST 02 PH 123123
OWNER NAME: CUSTOMER TEST
DESCRIBE DAMAGE TO INSD VEH:
USED W/PERM? (Y/N): PURPOSE OF USE:
REPAIR EST: ENTER "X" IF SALVAGE POSSIBILITIES:
WHERE/WHEN VEH CAN BE SEEN:
ATTY (N/R): NAME:
CLM DESC CODE: CLM DESC:
LOSS TYPE: CLM SYM:
COV ID: TOTAL LOSS IND:
EST INC LOSS:
EST INC ALLOC EXP: VERIFIER:
PTA: JIA: CLAIMS MADE DATE:
1) CLAIM SET-UP
13) INJURY 18) HELP
6) ADD CLMT
31) STAT CODING
23) LC
16) RETURN 11) PHYS DAMAGE
30) LOCAL DATA
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The Auto Third Party Property Damage screen, shown in Table XII, is used to enter information relating to any property damaged in the accident. A description of the property, the damage, as well as the estimated incurred loss and other additional information is entered through this screen.
TABLE XII
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AUTO THIRD PARTY PROPERTY DAMAGE
CUSTOMER TEST 02 PH 123123
OWNER: CUSTOMER TEST
PROPERTY DAMAGE
DESC OF PROP:
DESC OF DAMAGE:
REPAIR EST: ENTER "X" IF SALVAGE POSSIBILITIES:
WHERE DAMAGE CAN BE SEEN:
ATTY (N/R): NAME:
IF DRIVER OTHER THAN OWNER - DRIVER NAME:
OTHER PROP INSD BY:
ENTER "X" IF DED AMT APPLIES:
CLM DESC CODE: CLM DESC:
LOSS TYPE: CLM SYM: COV ID:
TOTAL LOSS IND:
EST INC LOSS: EST INC ALLOC EXP:
VERIFIER:
PTA: JIA: CLAIMS MADE DATE:
1) CLAIM SET-UP
18) HELP
30) LOCAL DATA
16) RETURN
6) ADD CLMT
13) INJURY
31) STAT CODING
23) LC
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An Injured Party screen is provided to enter information about any party injured in the accident (i.e., description of the injury, disability dates, claim descriptions, etc.). This screen is shown in Table XIII.
TABLE XIII
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INJURED PARTY INFORMATION
CUSTOMER TEST 02 PH 123123
NAME: CUSTOMER TEST
DESC OF INJURY:
TYPE INJURY CODE: DIS BEG DATE:
DIS END DATE:
ENTER "X" IF DED AMT APPLIES:
SEAT BELT USE:
ATTY (N/R): NAME:
CLM DESC CODE:
CLM DESC:
LOSS TYPE: CLM SYM:
COV ID:
COLL SOURCE IND:
EST INC LOSS: EST INC ALLOC EXP:
VERIFIER:
PTA: JIA: CLAIMS MADE DATE:
1) CLAIM SET-UP
12) PROP DAMAGE
23) LC 18) HELP
11) PHYS DAMAGE
31) STAT CODING
22) SERVICE PROVIDER
6) ADD CLMT
16) RETURN 13) INJURY
30) LOCAL DATA
PACKAGE: DUPLICATE PAYMENT PROBLEM
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A Service Provider screen, (not shown) which may be accessed from the Injured Party Information screen is used to record the names and addresses of the individual(s) or institute(s) that provides medical services to the claimant. A Claim Set-Up screen, shown in Table XIV, is the final screen of the LPT. Each claim (at least one for each of the asterisked screens on the earlier list) is displayed in summary form, showing the loss type, the claim symbol (an internal processing code), the claimant's name as well as the estimated incurred loss. If more claims are involved than space permits, additional screens will be generated for those remaining. From the Claim Set up screen, the LPT can be completed, routed to another staff member for additional input or review, or edited further. In order to complete the LPT all required fields must be validly filled. If all the required fields are not properly filled, the operator is prompted to correct and/or input the appropriate information. If the operator is unable to complete the required field(s) the LPT will not be completed and the claim number(s) will not be assigned. In such situations, however, pre-determined dummy codes are used to maintain the notice of loss. Alternatively, if other staff members may be able to provide the necessary information, the incomplete "claim" may be routed to them. Routing the incomplete claim is accomplished by pressing a function key and appropriately completing the Route/Process screen shown in Table XV. (This procedure is discussed in more detail below). Routing the incomplete LPT generates a message to the receiving staff member's mailbox to let him know that he should review the incomplete "claim". He, in turn, can then route the unfinished LPT to any other staff member. There is no limit to the number of times this routing can occur. Editing of the unfinished LPT can be done by actuating certain function keys corresponding to the small "secondary" menu on the bottom of the Claim Set-Up screen. By using the function keys all of the LPT screens can be redisplayed (except the interface screen). When a screen is redisplayed it can be edited in accordance with regular system editing procedures.
TABLE XIV
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CLAIM SET-UP SCREEN
SMITH, JOHN 02 PH 123123
TELEPHONE FIRST REPORT:
LOSS CLM EST INC
TYPE SYM CLMT NAME LOSS
CR AF CLAIMANT #1
300
CR AP CLAIMANT #2
450
CP AC CUSTOMER TEST
150
1) ROUTE-PROCESS 10) POLICY INFO
2) SELECT KEY CLM
6) ADD CLAIM
19) SELF REFER
18) HELP
7) DESC OF ACC
25) MODIFY LOSS
23) LC
17) MORE FUNCTIONS
9) MODIFY CLMT
29) VEH-DRIVER
27) ERASE LPT
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When the Claim Set-Up screen is completed, pressing the appropriate function key activates an Automated Claim Numbering facility. This facility automatically assigns a number, from a pre-determined range, to each claim or record report of the LPT (record reports are given numbers from a separate range from the range of claim numbers.). These numbers are the primary method of accessing individual claims for processing and review. 5. Routing and Assigning Claims Typically, when all the information available from the notice of loss has been input through the Loss Processing Transaction, the as yet incomplete LPT is routed to a supervisor for review and assignment This routing is done through the Route/Process screen, shown in Table XV. When the initials of a staff member are placed in the "Route To:" field and `Enter` is pressed, the unfinished LPT is routed to the indicated individual.
TABLE XV
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ROUTE-PROCESS SCREEN LPTX
INSURED, INC. 02 WEC 123123
ROUTE TO: ASSIGN TO: SUPERVISOR:
KEY OFFICE CODE:
PT: NEXT TRANS: DATA CARRY:
ENTER) ROUTE 2) PROCESS 18) HELP 23) LC 16) RETURN
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When the LPT is routed to a staff member he receives a message in his electronic "mailbox". The message comprises a very brief summary of certain information already input into the LPT and indicates who routed the LPT, the reason for the routing (a referral, usually for review in supervisor's case). When the staff member next works on the CAS system, he will be prompted that he has a message waiting (See FIG. 7 steps 114, 124 and 128). When a supervisor retrieves an unfinished LPT from the database which has been routed to him for review, he typically fills in certain information in the various LPT screens including the estimated incurred loss, the estimated incurred allocated expense, special procedures, etc. The supervisor's input generally completes the LPT. Upon this completion, the supervisor electronically assigns the claim to a particular handler for processing by using a Route/Process screen (see Table XV). When the LPT is complete (complete, meaning all initial information available has been input) and the supervisor assigns the claim, a sequential claim number (or record report number) is automatically generated and assigned by the system to every claim resulting from the loss. (A supervisor in the claims office specifies various ranges of claim numbers to be used by the system through a Number Assignment Transaction screen (not shown)). A claim that has not yet been assigned and given a claim number (or record report number) is considered to be "in-process." When the claim has been assigned and has been given a claim number (or record report number) it is considered to be "processed". 6. Modifying or Augmenting the Loss Processing Transaction Information Once an LPT has been completed it cannot be altered by merely returning to the original LPT. Thus, to add a companion claim arising out of a previously entered loss a separate function called the Add Companion Claim transaction is provided. All information previously input through the LPT (e.g. description of the accident, etc.) may be viewed in the Add Companion Claim transaction. The Add Companion Claim Select screen, shown in Table XVI, is used to select the claim to which the subsequent companion claim(s) will be added. This screen may be accessed via a Main Menu or by entering `CCLM` in any `Next Trans` field.
TABLE XVI
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CCLM
ADD COMPANION CLAIM TRANSACTION
ENTER CLAIM NUMBER:
ENTER) CLAIM LIST 18) HELP 32) CANCEL
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The Claimant Information screen, the Physical Damage Information screen, the Injured Party Information screen, the Service Provider screen and the Claim Set-Up screen are all available in the Add Companion Claim transaction for the companion claim, just as they were for the original LPT. A set of LP-Element Change screens are used to add, modify or delete information previously input via the LPT. An LP-Element Changes screen (not shown) is accessed via a Main Menu selection or by entering `ECHG` in any `Next Trans` field. Each LP-Element Change transaction is comprised of prefilled screens containing essentially the same fields as the corresponding original LPT screens. Changes are made on a per-screen basis. In other words, information entered via an LPT is redisplayed screen-by-screen for correction of any item on that screen. (See, e.g. Table XVII.)
TABLE XVII
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CLAIMANT INFORMATION
BUMSTEAD, DAGWOOD 02 PH 000999
CLAIMANT - ENTER X IF SAME AS INSURED: (IF NOT ENTER DATA BELOW)
NAME: P/C: TITLE:
STREET:
CITY: ST: ZIP:
BUS PH: RES. PH:
AGE: SEX: MS: NUM DEP:
OCC CODE: STATUS:
INCOME RANGE:
TIN:
11) PHYS DAMAGE
13) INJURY 18) HELP
16) RETURN
12) PROP DAMAGE
30) LOCAL DATA
23) LC
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p There are two ways to change element information previously input via
the LPT.
1. Overlay The cursor is moved to the desired field location on the display and the original information in that field is typed over. This continues through each succeeding field requiring modification. If the modified information has fewer characters than before, any extra characters may be deleted by erasing to the end of the field. 2. Deletions This method is used to remove all the information in a field. The cursor is placed in the first character space of the field and the "Erase Key" is pressed. This deletes all the information in the field. "Control Changes" are changes to any of the following: a claim number, a claimant name, or a policy number. These are essentially fundamental changes which impact the accessibility of the entire loss transaction. An LP-Control Changes Menu is used to designate the desired control change and claim number (See Table XVIII). First, the entire claim number is entered. Then, the appropriate function key is selected for the Control Change function desired. By way of example, an LP-Control Changes Claim Number screen is shown in Table XIX. This screen is displayed following the selection of the Claim Number/Record Report Change function on the LP-Control Changes Menu screen. The majority of the information on LP-Control Changes Claim Number screen is prefilled with the existing control information. However, a field is provided for entry of a new claim number. When the new claim number is entered, this transaction is processed and a comment providing both the old and new claim number is automatically generated to the Activity Log (discussed in detail below).
TABLE XVIII
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LP - CONTROL CHANGES
MENU
CLAIM NUMBER: .sub.---- -- ------
1) CLAIM NUMBER/RECORD REPORT CHANGE
2) POLICY NUMBER CHANGE
3) DELETE LINKAGE
4) CHANGE LINKAGE
5) CLAIMANT NAME CHANGE
18) HELP 23) LC 32)
CANCEL
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7. Review of Claim Files An LPT Inquiry function is used to view claims after they have been processed (through the LPT). The LPT Inquiry transaction, available for viewing purposes only, consists of a series of screens which are essentially the filled screens of the current LPT. To review any claim using the LPT Inquiry function the claim number must be entered through an LPT Loss Inquiry screen shown in Table XX. The LPT Loss Inquiry screen is accessed via the Main Menu or by inputting `LPTI` in the `Next Trans` field of any transaction.
TABLE XIX
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LP - CONTROL CHANGES
CLAIM NUMBER
INSURED:
JOHNSON, RICHARD
P/C: P TITLE: MR
CLAIMANT: JONES, PETER
P/C: P TITLE: MR
POLICY NUMBER:
02 PH 120000
CLAIM NUMBER:
023 AP 00103
NEW CLAIM NUMBER:
.sub.---- -- ------
LOCAL ONLY UPDATE: .sub.---- PT: .sub.---- PTA: .sub.----
NEXT TRANS: .sub.----
DATA CARRY: .sub.----
ENTER) CHANGE CLAIM 23) LC 18) HELP 32) CANCEL
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A loss Assignment/Inquiry--Claim Summary screen, shown in Table XXI, is displayed in response to the entry of the claim number in the LPT Loss Inquiry screen. This screen lists all
TABLE XX
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LOSS INQUIRY
CLAIM NUMBER: 023 AC 13131
ENTER) VIEW INFORMATION
16) RETURN
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claims associated with the claim number entered (i.e. the claim requested and all companion claims). Positioning the cursor next to the desired claim and pressing `Enter` displays a filled Claim Information screen. From the Claim Information screen it is then possible to review filled screens from the current LPT.
TABLE XXI
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AUTO LOSS ASSIGNMENT/INQUIRY SUMMARY SCREEN
INSURED: DARBY ENTERPRISES
300 COMPOSER AVENUE BUS PH: (203) 528-8888
WEST HARTFORD CT 06102 RES PH:
POL NUM: 37 DP 100111 AGENCY:
CLM DESC: WITNESS: N
LOSS DATE: 08/01/88 TIME OF LOSS: 06P
REPORTED DATE:
TELEPHONE FIRST REPORT:
CLAIM NUMBER
CLAIMANT EST INC LOSS HAND/SUPV
023 AC 13131
DARBY ENTERPRISES 2,000 RRD/CGM
300 COMPOSER AVENUE
WEST HARTFORD CT 06102
BUS PH: (203) 528-8888
RES PH:
023 Ac 13132
JOHN DALEO BUS PH:
258 CONCORD DR. RES PH:
POTTSTOWN, PA 19464
ENTER)
SELECT CLAIM
7) SELECT CLAIMANT
12) ADD DIARY ENTRY
16) RETURN 4) PREV CLAIM
10) POLICY INFO
14) ACTIVITY 17) NT 5) NEXT CLAIM
11) DESC OF ACC
29) VEH-DRIVER
23) LC
__________________________________________________________________________
8. Transfer of Claims Between Claims Offices Claims initially received, set-up, and numbered in one office may need to be transferred to another office to Handle to Conclusion (HTC) due to a change in the claimant's or insured's address (or other change in location). To do this, the originating office completes an HTC Sent transaction, through CAS, and electronically transfers the claim file to the new claims office. The HTC Received Transaction screens are almost identical to the LPT screens and follow the same screen flows and completion procedures. The difference between the HTC Received screens and the LPT screens is the addition of a claim number field, a sending office field and the removal of the claim symbol field as a separate field. For example, for the automobile line of business LPT, the additional fields appears on the Physical Damage Information screen, the Auto Third Party Property Damage screen and the Injured Party Information screen. When the HTC Received transaction is accessed, an Interface screen returns which is identical to the LPT Interface screen and follows the same completion procedures and subsequent screen flows. Shown below in Table XXII, is an example of one of the HTC Received screens with the addition of the claim number field and the sending office field (marked with asterisks). A "Service Item" is a request by one claims office to another claims office for a partial investigation of a claim that is being handled by the first claim office. Such requests can include obtaining a police report, a signed statement, etc. A Service Item request may be mailed or electronically transferred to a receiving office. If the request is mailed it must be manually input into the CAS System via a Service Item
TABLE XXII
__________________________________________________________________________
PHYSICAL DAMAGE INFORMATION
BURMINGHAM, TED 12 MKZ 030889
OWNER NAME: BURMINGHAM, TED
NUMBER: * OFFICE: *
DESCRIBE DAMAGE TO INSD VEH:
USED W/PERM? (Y/N): PURPOSE OF USE:
REPAIR EST: ENTER "X" IF SALVAGE POSSIBILITIES:
WHERE/WHEN VEH CAN BE SEEN:
ATTY (N/R): NAME:
CLM DESC CODE:
CLM DESC:
LOSS TYPE: COV ID: TOTAL LOSS IND:
EST INC LOSS:
EST INC ALLOC ESP:
VERIFIER:
CLAIMS MADE DATE:
1) CLAIM SET-UP
11) PHYS DAMAGE
18) HELP
16) RETURN
6) ADD CLMT
13) INJURY 23) LC
30) LOCAL DATA
__________________________________________________________________________
transaction. If the request is transferred electronically, the Service Item transaction screens prefill. In such cases, when the Service Item request is received it goes to a predesignated supervisor's mailbox for review and assignment. The Service Item transaction screens (not shown) are similar to the LPT screens and follow the same screen flows and completion procedures. The difference between the Service Item screens and the LPT screens is that not as much information is required for processing a Service Item and the Service Item screens contain fields for recording Requesting Office information (e.g. name, code, etc). 9. Staff Tables The Staff Tables function maintains information relevant to the claim office personnel. This information includes authority level, case load maximum, job title, etc. for each staff member. Supervisors determine the proper reserve authority level, payment authority level, diary limit, case load amount, etc. for each staff member. Only claim office personnel having the proper authority are able to view, update, and or delete information on the Staff Tables. When the Staff Table function is accessed, the operator can: view a particular staff member's table; add staff members to the staff directory; search for a particular staff member; or modify information on the Staff Table. The ability to perform any or all of these functions is entirely dependent on the operator's Staff Table authority. To view all the members of the staff a Staff Directory screen (shown in Table XXIII) is available. This directory will display on multiple screens, if necessary, depending on the number of staff members.
TABLE XXIII
__________________________________________________________________________
STAFF DIRECTORY
LAST NAME FIRST NAME INITIALS
JDC
ANDERSON SUSAN SAA GA
ANDREWS ANNE AOA ASR
ASHTON PAULA PXA SA
BALD LISA LLS ICR
BARNES DWAYNE DJB SA
BARR DAVID DKB OCR
BARR ROBIN RSB CA
BARR 2ND ROBIN RB1 OCR
BEARSE ELIZABETH EJB OSU
BECKER-JONES PAM PBJ OCR
BECKLES-MITCHELL
BRENDA BAM IND
BELISLE JOANNE JAB CP
BELL ANNE ALB CA
BENSON RON RAB 999
ENTER)
INQUIRE 6) ADD
9) MODIFY
16) RETURN
8) DELETE
5) NEXT/LAST
7) FIND
18) HELP
23) LC
__________________________________________________________________________
When a new staff member needs to be added to the staff tables a screen entitled Valid JDC-AMC Combinations, show in Table XXIV, is typically accessed first. This screen is a prefilled table of job descriptions applicable to a claim office. By positioning the cursor on the appropriate job description and pressing "Enter" the selected job description pre-fills into an Add Staff Member screen. This Add Staff Member screen is used to input the various authority levels, system IDs and other information regarding the new staff member. (See Table XXV).
TABLE XXIV
__________________________________________________________________________
VALID JDC - AMC COMBINATIONS
JOB ADJUSTMENT
JOB
DESCRIPTION CODE
METHOD CODE
DESCRIPTION
BA.sup. 1 GENERAL ADJUSTER
HSR 1 HEALTH SERVICES REP
OCR 1 OUTSIDE CLAIM REP
OCS 1 OUTSIDE CLAIM SPECIALIST
OSR 1 OUTSIDE SENIOR CLAIM DEP
RCR 1 RESIDENT CLAIM REP
CP.sup. 2 CLAIM PROCESSOR
ICR 3 INSIDE CLAIM REP
ICS 3 INSIDE CLAIM SPECIALIST
ISR 3 INSIDE SENIOR CLAIM REP
TCR 3 TELEPHONE CLAIM REP
CA.sup. 4 CLAIM ASSISTANT
OSU 4 OFFICE SERVICES UNIT
SA.sup. 4 SYSTEM ADMINISTRATOR
6) ADD STAFF MEMBER
18) HELP 23) LC
5) NEXT/LAST 32) CANCEL
__________________________________________________________________________
In order to view, modify or delete a particular staff member's table, the cursor is placed next to the name of that staff member and `Enter` is pressed. Alternatively, a Find Staff Member screen (not shown) is available for directly accessing a particular staff member's screen. All that is necessary is to input that individual's initials or last name. When a supervisor wishes to check on authority levels and/or other parameters for a staff member, a Staff Member Inquiry screen can be accessed to view the current settings. This screen
TABLE XXV
__________________________________________________________________________
ADD STAFF MEMBER
STAFF TABLE FOR:
LAST NAME:
FIRST NAME:
LOGON ID:
JOB TITLE:
UNIT: UNIT NUMBER:
AMC: DEFAULT MENU NUMBER:
JOB DESCRIPTION CODE: STATE LICENSE NUMBER:
SUPERVISOR: ALERT MSG REC:
PAYMENT AUTHORITY: TRANS REVIEW:
RESERVE AUTHORITY:
OUT OF OFFICE: TO ABSENCE TYPE: (S-T-V)
CASELOAD/NEW ASSIGNMENTS:
CASELOAD OUTSTANDING:
DIARY LIMIT PER DAY:
GENERATE SUPV DIARY - COMPENSATION:
"ALL OTHERS":
DIARY ROLLOVER LIMIT - PER CLAIM:
STAFF TABLE AUTHORITY: (A-B-C-D-E)
TERMINATION/TRANSFER DATE:
OTHER TABLE AUTHORITY: (Y-N)
PRIMARY OFFICE CODE:
AUTHORIZER: UPDATER:
NEXT TRANS:
ENTER) ADD 13) VALID ADMINISTRATIVE UNITS
23) LC
32) CANCEL 18) HELP
__________________________________________________________________________
is shown in Table XXVI. Additional screens are available within the Staff Tables function to modify staff member information and to delete staff members from the file. The Staff Table function and the Staff Tables created through that function are an extremely important piece of the CAS system. The Staff Tables are integrated with virtually every other function in CAS. For instance, before an operator can even access CAS functions, the User ID which has been input is
TABLE XXVI
__________________________________________________________________________
STAFF MEMBER INQUIRY
STAFF TABLE FOR: AOA
LAST NAME: ANDREWS
FIRST NAME: ANNE
LOGON ID: AA 6646 C
JOB TITLE: SYSTEM ADMINISTRATOR
UNIT: AU/CHU
UNIT NUMBER: 03
AMC: 8 DEFAULT MENU NUMBER:
01
JOB DESCRIPTION CODE:
ASR STATE LICENSE NUMBER:
SUPERVISOR: JFM ALERT MSG REC: EWW
PAYMENT AUTHORITY: TRANS REVIEW: N (Y/S/N)
RESERVE AUTHORITY:
OUT OF OFFICE: TO ABSENCE TYPE:
(S-T-V)
CASELOAD/NEW ASSIGNMENTS:
CASELOAD OUTSTANDING:
DIARY LIMIT PER DAY:
GENERATE SUPV DIARY -
COMPENSATION:
"ALL OTHERS":
DIARY ROLLOVER LIMIT -
DAILY:
PER CLAIM:
STAFF TABLE AUTHORITY:
A (A-B-C-D-E)
TERMINATION/TRANSFER DATE:
OTHER TABLE AUTHORITY:
Y (Y-N) PRIMARY OFFICE CODE: 515
AUTHORIZER: RAB UPDATER: DML
NEXT TRANS:
ENTER) NT 18) HELP 16) RETURN 23) LC
__________________________________________________________________________
compared to the staff initials specified in the Staff Tables. If no match is found, the operator will not be able to access any CAS functions. Once the operator has successfully logged on, the System Controller must look to the Staff Tables to display the proper Primary Default menu which is indicated in the Default Menu Number field of the user's Staff Table. Still further, the Staff Tables are referenced to properly route alert messages, to limit function access, to limit payment and reserve activities, to prefill operator information for Activity Log entries and to specify when diary and authority level alert messages will automatically be generated. In each of these cases, the Staff Tables are referenced to insure the proper operation of other system functions which are user specific. Another available function, which is a derivative of the Staff Tables, is the Caseload Monitoring function. This function can produce a series of reports which permit supervisors and other claim office managers to monitor the case loads of individual staff members, claim units and the office as a whole. This series of reports can include information such as monthly claim openings and closings, the number of claims handled by line of business, and total caseload counts. The Caseload Monitoring function can also provide a Current Claim Distribution report. This report, which can be done by individual staff member, claim unit or the entire office, shows the number of claims of a specific monetary range which are being handled. This is an important management tool since higher valued claims generally require substantially more time and effort to complete. 10. Directory Tables The Directory Tables function is used to store and display names, addresses and other pertinent information about currently used services and individuals. These include attorneys, doctors/hospitals, investigating authorities, etc. Each listing in the directory tables is automatically assigned a unique directory code upon initial input. (The code includes a category designation so that, for example, a list of defense attorneys can be readily displayed.) The Directory Tables function then interacts with various other functions including the LPT, Payment and TEXT Processing functions to pre-fill the name and/or address information when the directory code is input into one or more fields on these screens. When the Directory Tables function is accessed the first screen which is displayed is the Directory Tables List screen, shown in Table XXVII. This screen is a listing of entries in the Directory Tables. (The Directory Tables List screen will automatically display the appropriate category of entries for filling in certain empty text fields during Text Processing. In such cases placing the cursor on the correct listing and actuating the correct function key will fill in the blank field.) In order to access all the information associated with the entry, the cursor can be placed next to the entry and `Enter` pressed. A Directory Table Display screen, shown in Table XXVIII, then appears displaying the information applicable to the particular entry. Alternatively, a Directory Tables Inquiry screen, shown in Table XXIX, can be used to search for the particular entry.
TABLE XXVII
__________________________________________________________________________
DIRECTORY TABLES LIST SCREEN
CODE NAME P/C
TITLE
A 00001
LASSERMAN, TAMMY E. P MS.
A 00002
D'ANGELO & D'ANGELO, LAW OFFICES OF
P
A 00003
KARSH, DIANNE P MS.
A 00004
STEVENSON, JACOBS & ROSE PC C
A 00005
JOHNSON, DAVID LEE P MR.
A 00006
JOHNSON, DAVID LEE P MR.
A 00008
GILLEY, HINKEL & BROWNE, ATTYS AT LAW, PC
C
A 00008
JAMESON, HENRY P MR.
A 00009
FOY, MICHAEL P ATTY
A 00010
LINCOLN, WASHINGTON, ROOSEVELT & KENNEDY, PC
C
A 00013
ROGERS & ROGERS PC C
A 00015
HURLEY, MARY P MS.
A 00016
WALBACK AND WALBACK PC C
ENTER) DISPLAY
4) PREV/FIRST
6) ADD
8) DELETE
16) RETURN
5) NEXT/LAST
7) FIND
9) MODIFY
17) NT
23) LC 18) HELP
__________________________________________________________________________
To add an entry to the Directory Tables, a Directory Tables Add screen, shown in Table XXX, is available. When the input fields have been filled and the `Enter` key is pressed, the new entry becomes part of the Directory Tables list.
TABLE XXX
__________________________________________________________________________
DIRECTORY TABLES ADD SCREEN
CODE: P/C:
NAME:
TITLE:
STREET:
(OPTIONAL):
CITY:
STATE:
ZIP CODE:
TELEPHONE:
TIN:
TR CODE:
NEXT TRANS:
ENTER) ADD
18) HELP 23) LC 32) CANCEL 3) ACCEPT DUPLICATE
__________________________________________________________________________
Additional screens (not shown) are also provided to delete and modify individual entries. The screen structure and format is very similar to that used for the Staff Tables function. 11. Info Search The Info Search Facility provides the ability to search for information resident on the local data base (on-line) as well as data that has been purged to an off-line database. Info Search will access both "in process" and "processed" claims. The Info Search Facility screen, shown in Table XXXI is accessed via a Main Menu selection or by entering `SRCH` in the Next Trans` field of any transaction. The Info Search Facility performs searches by using any of the following criteria: (1) claim number; (2) claimant name; (3) insured name; and (4) policy number. One or more of these pieces of information may be input through the Info Search Facility screen. If exact spellings of names are not known, phonetic translation, a technique that puts a similar sounding or spelled name/text to a numeric equivalent or phonetic key, is used by the System to assist in the location of the records. If the entire name is not known, the system will also search on a partial name. To further restrict the search and limit the number of records returned, additional information about the claim(s) can be input through the Info Search Facility screen (such as loss date, insured address, claimant address, etc.) A Select Applicable Insured Information screen (not shown) is displayed when the insured name is searched through the Info Search Facility screen and multiple records are found. Similar screens are available when claimant information is used as the search basis.
TABLE XXXI
__________________________________________________________________________
INFO SEARCH FACILITY
INSURED:
CLAIMANT:
CLM NUMBER: POL NUMBER:
IF KNOWN, ENTER THE FOLLOWING INFORMATION:
LOST DATE: SEEK TERM: THRU
INSURED ADDRESS: ST: ZIP:
CLAIMANT ADDRESS: ST: ZIP:
ENTER "X" IF OFFLINE SEARCH:
ENTER) SEARCH 10) NAME EXACT MATCH 18) HELP 23) LC 16)
__________________________________________________________________________
RETURN
Once the desired claim is found, the operator may acquire further detailed information by accessing the Activity Log or the LPT Inquiry function (to determine the nature of the claim) screens from the Claim Information screen or by pressing a `Next Trans/Data Carry` function key and placing the appropriate code in the `Next Trans` field to access any other function. Off-line Information is displayed in the same manner through separate Off-Line Claim Information screens (not shown). 11. Activity Log The Activity Log is a record of the key activities involved in the processing and adjustment of a claim. The Activity Log is created in one of two ways. A claim handler, supervisor or other staff member can create an Activity Log via input of a claim number to an Activity Log Select screen shown in Table XXXII (This screen is also used to access an existing Activity Log). Alternatively, the system will create an Activity Log automatically, if one does not already exist, when an operator moves directly to the Activity Log function for a specific claim. If another CAS transaction generates a comment to the Activity Log and the Log does not already exist, it will likewise be automatically created. An Activity Log Comments screen, shown in Table XXXIII, is pre-filled and displays all comments presently in the Activity Log. There is no limit to the number of Comments screens in an Activity Log. The screens within the Activity Log are displayed in reverse chronological order allowing the operator to view the most recent entries to the Log first.
TABLE XXXII
__________________________________________________________________________
ACTIVITY LOG SELECT
CLAIM NUMBER:
ENTER) ACTIVITY LOG 18) HELP 16) RETURN 23) LOCAL COPY
__________________________________________________________________________
The Activity Log Add screen shown in Table XXXIV is used to add a comment to an Activity Log. Any time an entry is made to the Activity Log, the claim number, insured name, claimant name, loss date, claim description and estimated incurred loss fields are pre-filled. All these fields are protected and cannot be
TABLE XXXIII
__________________________________________________________________________
ACTIVITY LOG COMMENTS
CLM NUM:
023 C 00002
CLMT: BAILEY, BILL
INSD: STRADLIN, IZZY
LOSS DATE: 03/03/89
CLM DSC:
EST INC LOSS: 250
HAND: LLB SUPV: RJM
INITIAL RESERVE:
250
03/03/89 JACKET INDEX NON SCAN - DLSA:
03/03/89 JACKET INDEX NON SCAN - DLSC:
6) ADD COM
10) INDEX 14) POL LIMITS
17) NT 16) RETURN
7) SELECT
12) DIARY FUNCTN
15) DIARY LIST
18) HELP 23) LC 19) PAYMENT COM
__________________________________________________________________________
modified by the operator. When a comment is automatically generated to the Activity Log, these fields are likewise prefilled and protected. In fact, every field in the Activity Log is protected once an entry has been made. This provides an audit trail for any necessary claim review. An Activity Log Index screen, shown in Table XXXV, is provided to show the general status of a claim and serves as an index to multiple claims of a particular loss occurrence. The Activity Lot Index screen, which is prefilled, can be used to select the desired claim by positioning the cursor next to the claim number and pressing the appropriate function key.
TABLE XXXIV
__________________________________________________________________________
ACTIVITY LOG ADD
CLM NUM:
023 C 00002
POL NUM: 00 GNR 010101
INSD: STRADLIN, IZZY
CLMT: BAILEY, BILL LOSS DATE:
03/03/89
CLM DSC: EST INC LOSS:
250
03/07/89
LAE
6) ADD COMMENT 18) HELP 23) LC 32) CANCEL
__________________________________________________________________________
Within the Activity Log function, a Modify screen (not shown) is available to modify or input the Destroy Date, the Coverage Requested Date, the Coverage Received Date and the Comment field of the Activity Lot Index. This information may appear pre-filled if these dates or comments were previously entered or generated. If the fields are pre-filled, they can be modified by overlaying the information. If there are no pre-filled dates or comments, the correct date or comment can simply be added in the blank field.
TABLE XXXV
__________________________________________________________________________
ACTIVITY LOG INDEX
INSURED: STRADLIN, IZZY
POL NUM: 00 GNR 010101
LOSS DATE: 03/03/89
DESTROY DATE:
COV REQ: COV. REC:
OCC RESERVE: 250
POLICY STATUS: LAPSE STATUS:
COMMENTS:
CLAIM NUMBER
CLAIMANT EST INC LOSS
STATUS
023 C 00002
BAILEY, BILL
250 0
ENTER) ACTIVITY LOG
9) ADD/MODIFY
18) HELP
16) RETURN 14) POL LIMITS
23) LC
__________________________________________________________________________
An Activity Log Payment Comments (not shown) is available for viewing. This screen is pre-filled and displays all payment comments which have been automatically generated to the Activity Log. This provides a quick, efficient way to evaluate a claim's payment record. 13. Claim Reassignment There are three types of reassignment transactions: claim; family; and global. A Claim Reassignment transaction is available through a Claim Reassignment screen (not shown) to reassign a single new claim to a different claim handler and/or supervisor. A Family Reassignment transaction is available through a Family Reassignment screen (not shown) which is used to reassign a family of claims to a new/different claim handler and/or supervisor. Lastly, a Global Reassignment transaction is available to reassign all open claims from one claim handler and/or supervisor to another claim handler and/or supervisor. The latter is accomplished through a Global Reassignment screen (not shown). This transaction requires a high security level and can only be undertaken by certain staff members. 14. Claim Status Changes A Claim Status Change function is used when one of the following activities is required on a claim file: (1) close a claim when no closing check is being issued at the time of the closing; (2) reopen a closed claim that is to remain open; or (3) change the reserves on an open claim. A Claim Status Change Menu, shown in Table XXXVI, lists each of the Claim Status Change transactions available for selection. A Claim Status Changes Claims Select screen (not shown) is used to enter the claim number for which a change is required. This screen is displayed after selection of an type of Claim Status Change through the Claim Status Change menu screen.
TABLE XXXVI
__________________________________________________________________________
CLAIM STATUS CHANGES
PRESS A PF KEY BELOW OR RETURN TO DO NEXT TRANS:
1) CLAIM STATUS CHANGE - CLOSE
2) CLAIM STATUS CHANGE - REOPEN
3) CLAIM STATUS CHANGE - RESERVE
16) RETURN TO PREVIOUS MENU
32) LOGOFF
__________________________________________________________________________
Either a Claim Status Change-Close Transaction or a Final/Close Payment transaction is required to close a claim. If a Final/Closed Payment check is issued, the Closing Payment transaction will close the file. If the claim is being closed without a payment, the Claim Status Change-Close transaction must be used to close the claim. A Claim Status Change-Close screen, shown in Table XXXVII, is accessed from the Claim Select screen after the selection of "Claim Status Change-Close" n the Claim Status Changes Secondary Menu. There are two types of claim reopenings. They are: (1) reopen/close to issue a payment and to close the claim again in one transaction using a Payment Reopen/Close transaction; and (2) a
TABLE XXXVII
__________________________________________________________________________
CLAIM STATUS CHANGES - CLOSE
CLAIM NUMBER:
023 L 00003 POLICY NUMBER:
02 SCC777777
INSURED: THE DUPONT CORPORATION
CLAIMANT: JERKINS, HARRY CLAIMANT STATUS:
LOSS PAID:
0.00
ALLOCATED EXPENSE PAID: 0.00
SUBROGATION EXPENSE: 0.00
SALVAGE EXPENSE:
REFUND EXPENSE:
CLAIM ACTION CODE: 0 SUIT RESULT CODE:
COLLATERAL SOURCE/TOTAL LOSS IND:
DISABILITY BEGINNING DATE:
DISABILITY ENDING DATE:
LOCAL ONLY:
DESTROY DATE:
PTA: NEXT TRANS: DATA CARRY:
2) PROCESS 18) HELP 23) LC 30) LD 32) CANCEL
__________________________________________________________________________
reopen that is to leave the claim open using a Claim Status Change-Reopen transaction. A regular Payment transaction is used to reopen and close a claim if an additional payment is made and the claim does not need to remain open. A Claim Status Changes-Reopen transaction is required to reopen a claim which will remain open. The loss type will remain the same as it is when the claim was closed. A Claim Status Change-Reopen screen, shown in Table XXXVIII, is used to perform this transaction. If the closed claim is not found using the On-Line Info Search Facility the Off-Line Info Search Facility is used.
TABLE XXXVIII
__________________________________________________________________________
CLAIM STATUS CHANGES - REOPEN
CLAIM NUMBER:
023 L 00003
POLICY NUMBER: 02 SCC 777777
INSURED: THE DUPONT CORPORATION
CLAIMANT: JERKINS, HARRY
EST INC PAID
LOSS: 0 .00
ALLOCATED EXPENSE:
0 0.00
LOSS VERIFIER:
0
DISABILITY BEGINNING DATE:
DISABILITY ENDING DATE:
LOCAL ONLY: ASSIGN TO: SUPERVISOR:
PTA: NEXT TRANS: DATA CARRY:
2) PROCESS 18) HELP 23) LC 30) HOLD 32) CANCEL
__________________________________________________________________________
A Claim Status Changes-Reserve Change transaction is required to change the estimated incurred loss and/or estimated incurred allocated expense on open claims (The estimated incurred allocated expense is the amount of money that is expected to be spent by claims office for investigation of a claim). When a Reserve Change is processed, a comment is automatically generated to the Activity Log. A Claim Status Changes-Reserve Change screen, shown in Table XXXIX below, is used to complete this transaction. The claim number, policy number, insured and claimant name fields will pre-fill with the previously entered information. The Initial Reserve field will pre-fill with the original that was entered in the LPT and the Estimated Incurred and Paid fields will prefill with the most current totals.
TABLE XXXIX
__________________________________________________________________________
RESERVE CHANGE
CLAIM NUMBER:
023 L 00003
POLICY NUMBER: 02 SCC 777777
INSURED: THE DUPONT CORPORATION
CLAIMANT: JERKINS, HARRY
INITIAL RESERVE:
1,200
EST INC PAID
LOSS: 0 .00
ALLOCATED EXPENSE:
0 .00
LOSS VERIFIER:
0
LOCAL ONLY: ASSIGN TO:
MKZ SUPERVISOR: CGM
PTA: NEXT TRANS: DATA CARRY:
2) PROCESS 18) HELP 23) LC 30) LD 32) CANCEL
__________________________________________________________________________
15. Text Processing The Text Processing function provides the ability to perform various types of text processing without leaving the CAS system. Text Processing can generate preformatted documents and pre-fill blank fields in the documents' bodies by extracting information input through other system functions. Upon operator request, all applicable information, previously input into CAS via other transactions (e.g. LPT) is pre-filled into the requested document. In the event that all the information necessary for form completion cannot be extracted from the system, the Text Processing function prompts the operator to manually input the additional information. A core group of generic forms are preformatted for use in all claims offices. However, each claims office can customize its own forms. This customization requires the creation of a form in "Word Processing" (A Word Processing function is provided with Wang.RTM. brand equipment, however, this function is available with virtually every other available system. The Word Processing function is generally accessed through a "Wang.RTM. Office" menu selection.) After the form is created it is brought within the Text Processing function where it is coded so that all blank fields will prefill. Thus, a local claims office is not constrained by the preformatted forms. A Document Claim Selection screen (not shown) is used to select the claim(s) for which documents are needed. A Document Claim Request screen, (not shown) is used to select the particular claim for which correspondence is desired. A Document Request screen, shown in Table LX, displays a list of preformatted documents applicable to the selected claim. From this screen an operator may select the specific form(s) to be printed. Only those documents appropriate for the type of claim which has been input are listed. If multiple claims are selected for correspondence generation, form lists are displayed one at a time for each claim. Text Processing pulls applicable information from within the system and pre-fills as many fields requiring completion as possible. If all the required fields are completed and if a particular designation is made (i.e. placing an `X` in the `X OR V` field), the system automatically sends the document to the appropriate print queue. If the system is unable to pre-fill all of the fields, the requester is prompted to input the necessary information via a Directory Completion screen (if the information is contained in a directory table) or with a Document Completion screen (if the information is not contained anywhere in the system). The Directory Completion Screen, shown in Table XLI, is associated with the Directory Tables function. It lists the
TABLE XL
__________________________________________________________________________
DOCUMENT REQUEST SCREEN
CLAIM NUMBER:
023 AC 00001
LOSS DATE 04/19/89
INSURED: SMITH, JOHN
CLAIMANT: SMITH, JOHN
(X OR V) DOCUMENT NAME HANDLING INSTR
* CP-16 CLAIM RECOVERY ESTIMATE
*
* ACKNOWLEDGE AND REQUEST FOR INFO
*
* FILE TRANSFER *
* ACKNOWLEDGE OF CLM -NO INFO ML-10
*
* ASR ASSIGNMENT SHEET INSD AUDTX
*
* ADR-ML 11 *
* APP BENEFITS AUTO/PROP LC-5069-1
*
* ACKNOWLEDGEMENT LETTER TO AGENT WTCHR
*
* ASR ASSMT SHT INSD NON-AUDA - DLSA
*
* ATTORNEY ACKNOWLEDGEMENT *
* ASR ASMT SHT-CLMT - AUDA LC 5344
*
* CLAIM FOR DAMAGES LC-2474 *
* ASR ASMT SHT-INSD - AUDA LC 5344
*
* CLAIM FOR DAMAGES PROPERTY LC4556
*
ENTER) SELECT 4) PREV SCREEN 16) RETURN
5) NEXT SCREEN 18) HELP
__________________________________________________________________________
appropriate type of Directory entries (e.g. all Doctors, or all investigators, etc.) for the particular empty field. If a designation is made (i.e. placing a `V` in the `X OR V` field) the system will display the Document Completion screen (even if the document is 100% completed) so that the requestor may view, modify and/or complete the document prior to sending it to the print queue. Each Document Completion screen is unique for each specific document. Any blank fields displayed on the Document Completion screen are those which the system was unable to complete with the available system information. Fields which are necessary in order to generate the document, are highlighted and underlined. A document cannot be sent to the print queue if a required field is blank. Ultimately, if a required field cannot be filled, the document request must be cancelled. Some forms are generated automatically without any operator intervention. This may occur, for example, when an LPT is processed, or when certain LPT screens are completed and a form is generated to provide system or legal backup for the loss notice. If the system reaches an automatic form generation point, and the necessary information to send the form to the Text Processing Print queue is unavailable, an alert message is generated. The CAS system also supports the preparation of free form documents through the Word Processing function, as indicated previously. This permits an operator to type any letter or form that is needed. The usual edits are available to permit the revision of any errors.
TABLE XLI
__________________________________________________________________________
DIRECTORY TABLE
POSITION CURSOR AND PRESS ENTER FOR DESIRED SELECTION:
- EASTON, ELIZABETH
MIDDLESEX MEMORIAL HOSPITAL
HARTFORD HOSPITAL
PATTERSON, IRVING
IRVINGTON, JAMES
DAVIDS, JOHN
BROWN, ALFRED
BANKS, SUSAN
BRIGHAMS, SAMUEL
JACKSON, CARMEN
PALMER, DOROTHY
ST. FRANCIS HOSPITAL
RIVERVIEW HOSPITAL
SMITH, FRANKLIN
ENTER) SELECT RECORD 16) RETURN 5) NEXT/LAST 18) HELP
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16. Print Queues There are two main output facilities available through CAS. They are the LOHC (Local Output Hold Control) facility and the Text Processing Print Queue. (Local Copy is available to print out single screen transactions or to print out one screen of a multi-screen transaction. Local copy is sent to the designated printer (without LOHC intervention)). As indicated above, the Text Processing function provides the means for the selection and completion of the majority of the claim office forms and letters. All documents are complete coming off the printer. Some documents are ready for mailing immediately after printing. However, multipart forms need to be torn apart and distributed. Depending upon office structure, an output operator generally pulls all text processing output and mails or completes the "processing" of the output. Depending on the form, a document request is also sent to a mail print queue or a file print queue or both. After documents are sent to one or both of these print queues, the request for document printout is initiated, as described above, via the print queue facility. A Document Summary Mail Print Queue screen, shown in Table XLII, provides an overview of the documents to be printed and mailed. Documents are listed by group (paper type) with the number of documents requested and any special handling instructions. A Document Summary File Print Queue screen (not shown) is also provided to give an overview of the documents to be printed and filed. Again, documents are listed by group and number of documents requested along with any special handling instructions. A number of Detail Queue screens (not shown) reformat the summary information of the Document Summary Mail and File Print Queues into detailed columns that list: 1) claim number; 2) document name; 3) group;
TABLE XLII
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DOCUMENT SUMMARY MAIL PRINT QUEUE
TOTAL HANDLING
GROUP NAME DOCUMENTS
INSTRUCTIONS
.sub.-- BLANK STOCK (SHEET FEED)
4
.sub.-- BLANK STOCK (SHEET FEED)
2 A
.sub.-- BLANK STOCK (SHEET FEED)
2 R
.sub.-- LETTERHEAD 2
.sub.-- LETTERHEAD 6 A
.sub.-- LETTERHEAD 6 R
1) PRINTED DOCUMENTS
6) FILE QUEUE
16) RETURN
8) DELETE
17) DETAIL QUEUE
15) PRINT
18) HELP
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4) request date; and 5) user ID. For example, the Detail Queue by Claim Family screen shown in Table XLIII, displays all requested documents for the applicable claim family. The documents displayed are listed in claim number order. The Local Output Hold Control facility (LOHC) is an electronic storage facility designed to hold information which is waiting to be printed as a result of a transaction input to the local database. There are a number of types of output printed from LOHC including Print Transactions, Transaction Logging and a
TABLE XLIII
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DETAIL QUEUE BY CLAIM FAMILY
CLM NUMBER
DOCUMENT GROUP REQ DATE
UID
.sub.-- 033 00110
MEDICAL REQUEST TO DOCTOR
LTRHED
07/08/87
RAB
.sub.-- 033 00110
MEDICAL REQUEST TO DOCTOR
LTRHED
07/08/87
RAB
.sub.-- 033 00112
REQUEST FOR POLICE REPORT
LTRHED
07/08/87
RAB
.sub.-- 033 01112
DEDUCTIBLE RECEIVED LTR PRATE
LTRHED
07/08/87
MGR
.sub.-- 033 00112
DEDUCTIBLE RECEIVED LTR PRATE
LTRHED
07/08/87
MGR
8) DELETE 10) DATE REQ SORT
15) PRINT
16) RETURN 9) REQ SORT 11) GROUP SORT 18) HELP
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variety of system reports. The Print Transaction, when requested, generates a hard copy of selected processed (completed), multi-screen CAS transaction screens. This may be used, for instance, when a claim is to be transferred to another office for completion or partial investigation. Transaction Logging captures and sends every screen of most CAS transactions to LOHC to p | ||||||