Overview of the FNOL process
FNOL (First Notice of Loss) is the event in which the insurer is informed of a potentially covered loss.
The following section provides an overview of FNOL behavior in ClaimCenter.
Draft claims and open claims
During the FNOL process, the claim is first created. The claim passes through two states: draft and open.
- A draft claim is a claim that has been saved to the ClaimCenter database, but there is not yet enough information for the claim to enter the adjudication process. Draft claims are not assigned to any user.
- An open claim is a claim that has been saved to the ClaimCenter database with enough information to enter the adjudication process. Once a claim becomes open, it is assigned to an adjuster. (Open claims are often referred to simply as "claims".)
During the FNOL process, a claim can have two different claim numbers: a draft claim number and an open claim number.
- Draft claim numbers are assigned when the draft is initially saved. In the base configuration, draft claim numbers typically start with "999".
- Open claim numbers are assigned when the claim moves from draft to open. In the base configuration, open claim numbers typically start with "000".
All open claims initially start as draft claims, regardless of how they are created. However, the New Claim Wizard hides most of the distinction between draft and open claims. For example, in the base configuration, draft claim numbers are not shown in the New Claim Wizard during claim creation.
Prior to finishing a draft claim in the New Claim Wizard, you can cancel the draft claim by clicking the Cancel button. This discards the claim information from the database. This action can be taken only on draft claims. Once the New Claim Wizard is finished, the claim cannot be canceled.
Verified and unverified policies
When a claim is created, ClaimCenter creates a policy and attaches it to the claim. This can be either a verified policy or an unverified policy.
A verified policy is a policy that is based on information retrieved from the PAS. In a production system, verified policies are the most common types of policies.
When a claim is created, if ClaimCenter can find the corresponding policy in the PAS, it creates a copy of the policy and attaches it to the claim. This is a snapshot of the policy at the point in time that the loss occurred.
Every claim has its own copy of the policy. If two claims are created from the same policy, they will each have their own copy.
Verified policies can be used in either a test or production system. However, they require a PAS (or test PAS) and an integration point to that PAS.
An unverified policy is a policy that is created during the FNOL process based on information supplied by an adjuster or by the caller application. This information may or may not correctly correspond to information in a PAS. Unverified policies let adjusters start the FNOL process without information from the PAS. This could be necessary if the reporter does not know or cannot recall enough information to find the policy.
Eventually, the unverified policy must be refreshed with data from the PAS, thereby converting it to a verified policy. You cannot complete the claim process and make payments on a claim while the policy is still unverified.
Unverified policies can be used in either a test or production system. In a test system, unverified policies may be a useful way to create policies without having an integration point to a PAS and without needing to enable the Test Util API.