Claims

Claims

Set and update claim status – step 11

The Claims module provides a number of statuses to choose from. When selecting a claim status, choose the status that best summarizes the claim.

Table 1:
Claim Status table.

StatusesDescription
Open, StandardDefault status when working a claim. This generates the Claim Acknowledgement Letter.
Open, SubrogationWorking a claim. Indicates that subrogation recovery is expected.
Open, SalvageWorking a claim. Indicates that salvage recovery is expected.
Open, Reinsurance Recovery Working a claim. Indicates that reinsurance recovery is expected.
Open, Reinsurer NotifiedWorking a claim. Indicates the reinsurer has been notified.
Open, LitigationWorking a claim. Indicates a lawsuit is in progress.
Reopened, StandardDefault status when reopening a claim.
Reopened, SubrogationReopened a claim. Indicates that subrogation recovery is expected.
Reopened, SalvageReopened a claim. Indicates that salvage recovery is expected.
Reopened, Reinsurance RecoveryReopened a claim. Indicates reinsurance recovery is expected.
Reopened, LitigationReopened a claim. Indicates reinsurance recovery is expected.
Closed, DeniedIndicates a claim was denied and all reserves were zeroed out.
Closed, PaidIndicates a claim was paid, and all reserves were zeroed out.
Closed, Without PayIndicates a claim was below the deductible, and all reserves were zeroed out.
Closed, Reinsurance RecoveryIndicates a claim was below the deductible, and all reserves were zeroed out.
Archive, Record onlyIndicates a claim was converted from the legacy system.
Pending, SubmittedIndicates a claim was submitted by an agent, and it awaits processing.
* The advanced setting submitted-claim-status indicates that the default status of a claim is Pending, Submitted when it is submitted.
Pending, UnsubmittedIndicates a claim has yet to be submitted by an agent. This status appears in the Agent portal by default and shows in the Provider Administrator portal via a setting.
* The advanced setting unsubmitted_claim_search determines if Pending, Unsubmitted will appear in the Claims filter list. If the setting is set to False, Pending, Unsubmitted won't appear. If the setting is set to True, Pending, Unsubmitted will appear.
Historical, Reporting OnlyIndicates a claim was converted from the legacy system but is still being processed.
* The advanced setting historical-claims determines if historical claims are allowed. When set to True, historical claims are allowed. When set to False, historical claims are not allowed.

To set or update the claim status, open the desired claim and:

  1. In the claim file header, navigate to Status and select Edit. The Claim Status dialog box will open.
    Figure 1: The claim file header and the StatusEdit button.
  2. From the Status dropdown list, select the status that accurately describes the claim, based on the descriptions in Table 1.
    Figure 2: View of the Claim Status dialog box.
  3. If you want to set the type of the claim manually, select the Set the type of this claim manually. checkbox. When you select the checkbox, a warning message appears below, stating: Warning: The claim type will no longer be set automatically on this claim. Choose the type of claim from the options provided.
  4. When you’re finished, select Done.

Usage consideration

The advanced setting claims-header-type can toggle whether the policy type or claim type is displayed in the claim’s header beneath Status.