In some claims, the law may dictate that a barrier be created between adjusters who manage different coverages on the same claim for the same party. To address this need, depending on roles and permissions, the system is designed to allow an adjuster to manage a claim either at the claim file level or at the exposure file level. For example, an exposure-level adjuster can manage an exposure file on a claim without the need to navigate to the parent claim file or access other exposures.
Claims can be managed at the claim file and at the exposure level file. When a loss occurs, the exposure is the combination of the claimant, the coverage being claimed against, and the risk or injury that needs to be restored or healed for either the insured (the first-party claimant) or the third-party claimant.
- Risk: The reason for which insurance has been purchased.
- First-party risk: A person, place, or thing for which compensation will be received under one’s own insurance policy.
- Third-party risk: A person, place, or thing belonging to a party other than the insured for which compensation will be paid under the insured’s insurance policy.
- Coverage: The name of the specific type of insurance provided by the policy that protects a risk against loss.
- Exposure level adjuster: A claims adjuster assigned to a specific exposure within a claim.
- Exposure status: The state of an exposure on a claim. Exposures can have the following statuses: Open, Closed, Reopened.
Once a claim is submitted, the claim status is New. New claims are considered to be in an investigation stage when you can change information in the Parties, Vehicles, Damaged Properties, and the claim file’s Details screen. When you change the claim status from New to Open, you can add exposures to the claim. When you access an exposure, you can manage it and the claim by assigning claims adjusters to specific exposures and by accessing the Vehicle Details, Injury Details, Damaged Property Details, and Accounting screens at the exposure level. See Figure 2. When you’re ready to close a claim, you must make sure that all exposures are closed.
- Number 1 displays the exposure ID and coverage link. This link will direct you to exposure file’s Details screen.
- Number 2 displays the year/make/model of an involved vehicle in the Risk/Injury column. The year/make/model link will direct you to the Vehicle Details screen.
- Number 3 displays an injury type in the Risk/Injury column. The injury link will direct you to the Injury Details screen.
- Number 4 displays a property type other than a vehicle in the Risk/Injury column. The property link will direct you to the Damaged Property Details screen.
- Number 5 displays amount links in both the Reserve and Payment column. These links will direct you to the exposure file’s Accounting screen.
For Personal Auto, exposures are grouped by claimant/involved party. When you add an exposure and select the claimant or involved party associated with the exposure, the exposure you’re adding and any other exposure associated with that party will fall under the claimant or involved party in an exposure tree. This grouping will appear in three places throughout the claim file: the left menu, the Exposures screen, and the claim file’s Accounting screen. See the figures below.
Actions you can complete from the Exposures screen
- Add an exposure.
- Remove an exposure.
- Close exposure.
- Assign claims adjuster at the exposure level.
- View coverage from an exposure.
- View loss or injury from an exposure.
Note: Access additional screens by selecting the loss or injury links.
- View Accounting screen for an exposure.
Note: Access the Exposure Accounting screen on the Exposure file.
- Set reserves from exposure.
Note: View the summary of payments and reserves for an exposure, and provide a link to Exposure Accounting Summary screen on the Exposure file.
- Make a payment from exposures.
Note: This task can only be completed from the Exposure Accounting Summary screen on the Exposure file.
- Enter recoveries from exposures.
Note: This can only be done from the Exposure Accounting Summary screen on the Exposure file.