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.
With this design, some information available on the claim file level is also available at the exposure file level. For example, claim file Injuries information related to an exposure is also available at the exposure file level.
You can add and manage injuries within the Injuries screen of a claim file. Injuries added during the first notice of loss (FNOL) automatically populate the Injuries screen. On the Injuries screen, you will see a list of all injuries currently listed on the claim. In the Injuries table, you will see the Injured Party, Injury Type, Injury Description Narrative, and Settlement Range. To add an additional injury, you can select +Add Injury.
Note: If you create an exposure for an injury related coverage, then an injury record will automatically be associated with the claimant and the exposure.
If you need to edit injury information, you can do so by accessing the Injury Details screen of a specific injured party. When you select the Injured Party link, you’re automatically directed to the party’s Injury Details screen.
The Injury Details screen of an injured party is separated into the following sections:
- Contact Information: This section contains basic contact information. For a first-party claimant, this section is populated from existing contact information in the system. For third-party claimant, this section is populated by information entered in the FNOL. You can edit this section by selecting the party link and then by selecting the Edit button in the <P## – Party name> dialog box.
- Injury & Severity: This section contains information related to the injury that occurred. Information is populated from the FNOL or from the Add Injury dialog box. Select Edit to edit this section.
Note: On an injury record, if you select that the injury was a fatality, add the Fatality tag to the claim. On an injury record, if you select the party is Medicare Eligible, add the Medicare tag to the claim.
- Treatment: This section contains diagnosis, prognosis, and treatment plan information. In this section, you can also add ICD-10 codes for the injury, which are used to gather healthcare statistics. In this section, you can also add a hospital or medical facility and a medical provider. Select Edit to edit this section.
- Settlement: In this section, you can add information about the settlement range and a summary of the decision made. Select Edit to edit this section.
Actions you can complete from the Injuries screen
- Add and remove parties from the Injuries screen
- Edit Contact Information
- Add and edit Injury & Severity Information
- Add and edit Treatment information
- Add and edit Settlement information