Claim Manager

This module handles claims made due to accidents covered by policies of any Line of Business. The handling of a claim in the system includes its opening and reserve allocation, the registration of any variation which may occur, as well as the issuance of checks in payment and registration of salvages and recoveries made against it.

At the time of opening, the computer verifies whether or not the policy was in force at the time of the loss, showing the units covered (buildings, automobiles, etc) as well as the risks and amounts insured for each coverage, thus allowing us to create an estimated reserve coverage, which is taken as a base for checking when making payment to the claimant. The computer permits the creation of the reserve under a fictitious coverage which is setup for cases of ex-gratia payments.

Both the information on the accident as well as the estimated reserves can be varied at any time, thus changing automatically the terms of the claims, as well as the report on pending claims used for the registration of the reserves. The checks are issued automatically, against the reserves established.

When the policy contains mortgagee clause/loss payable clause or the claim has creditors, the system includes the ability to make payments directly to the mortgagee (mentioned at the time of issuance of the policy) or to the creditors (mentioned at the time of opening the claim).

Letters both to the facultative reinsurers and to the coinsurers are produced automatically indicating the proportion in which they will be affected by the loss. At the time of opening the claim, when the reserve is set up, a first letter is produced advising the creation thereof. And at the time of payment another letter giving notice of reimbursement ins produced for the facultative reinsurers as well as for the co-insurers, in case the company has made the payment in case the company has made the payment in full, and not only in the proportions of its participation in the co-insurance, as it happens sometimes.

The SIS indentifies clients with outstanding balance to the company at the time of payment of a claim, for the purpose of advising the Collection Department to take the necessary steps. The reports of control of claims as well as the reports for registration in the books of the reserves and the payments made are generated by SIS.

This module also includes some statistical reports, one of which is required by the Government.

The reports of registration in the books include the distribution of co-insurance and reinsurance, giving backup for the preparation of the statements of account of the co-insuring and reinsuring companies.