Workers' comp claims in ClaimCenter

The ClaimWorkComp entity

A large set of claim-level information is relevant only for workers' comp claims. For example, the activity the worker was performing when injured, and whether the worker required medical attention. This information is not stored on the Claim entity. Instead, it is stored on the ClaimWorkComp entity. This entity has a one-to-one relationship with Claim. A given claim has an instance of ClaimWorkComp only when the claim's policy is a workers' comp policy.

Possible exposures for a workers' comp claim

A workers' comp claim must always have one exposure and can have a maximum of three exposures.

  • There must always be an injury exposure used to track information related to the injury.

  • There can optionally be a lost wages exposure used to track information related to wages the employee has lost as a result of being injured.

There can optionally be an employer liability exposure used to track information related to legal proceedings initiated by the employee.

Creating exposures for a workers' comp claim

For most lines of business, exposures get created in one of two ways:

  • The exposure may be created automatically by business logic such as Claim presetup rules.

  • The exposure may be created manually by the adjuster, either during or after the New Claim wizard.

For workers' comp claims, exposures are always created automatically. Each type of exposure is triggered by the claim being in a certain state.

  • The injury exposure is created automatically at the end of the New Claim wizard. This is done for all workers' comp claims.

  • The lost wages exposure is created automatically at the end of the New Claim wizard if, on the Loss Details step, the Lost time from work field is set to Yes.

  • The employer liability exposure is created when the Employer Liability? field is set to Yes.

    • In the base configuration, this field is not exposed in the New Claim wizard. Thus, in the base configuration, this field can only be set after the claim has been created and assigned. The field is on the Loss Details: General screen in the Classification section.

Creating incidents for a workers' comp claim

Non-workers' comp claims have incidents. They often appear under some sort of "Incident" label. (For example, personal auto claims can have exposures with a Vehicle Incident label.)

Workers' comp claims also have incidents. However, the user interface does not call them out as incidents.

The injury exposure

Every workers' comp claim has a "main injury incident". This is an injury incident that stores most of the information about the injury.

There is also an "additional injury incident". In the base configuration, it is created by ClaimCenter presetup rules when the injury exposure is created. Note the following:

  • The injury exposure is associated with the additional injury incident, not the main injury incident.

  • In the base configuration, no information is stored on the additional injury incident. All of the injury information shown in the user interface and used in the claim process comes from the main injury incident.

Lost wages exposure

If a claim has a lost wages exposure, it also has an incident for lost wages.

  • This incident is created automatically by ClaimCenter presetup rules.

  • Like the main injury incident, this incident's subtype is injury incident.

Employer liability exposure

If a claim has an employer liability exposure, it also has an incident for employer liability.

  • This incident is created automatically by ClaimCenter presetup rules.

  • Its subtype is general incident.

Exposures in the user interface

For all claims, there is a list of exposures on the Overview screen.

For non-workers' comp claims, there is also a separate Exposures screen listed in the left-hand side bar. This screen lists all exposures for the claim. For workers' comp lines of business, there is no separate Exposures screen listed in the left-hand side bar. Instead, each exposure is given its own screen.

  • The injury exposure appears on the Medical Details screen.

  • The lost wages exposure appears on the Indemnity screen.

  • This screen is hidden if there is no lost wages exposure for the claim.

  • The employer liability exposure appears on the Employer Liability screen.

  • This screen is hidden if there is no employer liability exposure for the claim.

Each of these screens lists information from the associated incidents. However, the term "Incident" is not used in the user interface. The information is co-mingled with exposure-level information.