here - Claims Portal

Report
The Claims Portal in
practice
June 2013
www.claimsportal.org.uk
Agenda
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Introduction to the Claims Portal
The Behaviour Committee
Registration
User profiles
Branches
Compensator example set up
www.claimsportal.org.uk
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Introduction to the Claims Portal
www.claimsportal.org.uk
Who is Claims Portal Ltd?
APIL
LAW SOCIETY
www.claimsportal.org.uk
ABI
INDEPENDENT
CHAIR PERSON
TUC
INSURERS
MASS
MOTOR
INSURERS’
BUREAU
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Protocols and the Portal
• It’s important to distinguish between the ‘what’ and the ‘how’.
• The Protocols have been written and are owned by the
Ministry of Justice.
• The Claims Portal itself is owned and managed by Claims
Portal Ltd.
• Any issues, questions or concerns about the ‘what’ – i.e. the
rules, requirements and expectations – should be directed to
the MoJ.
• Any problems with, or questions about, the ‘how’ – i.e. the
technology solution – can be directed to Claims Portal Ltd.
• It is essential that users understand the Protocols and do not
rely on the Claims Portal to comply.
www.claimsportal.org.uk
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Staying informed
• New Claims Portal website - www.claimsportal.org.uk
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The latest news and announcements.
• E-Newsletters:
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Sign up at http://www.claimsportal-mail.org.uk/
The latest news, updates and any actions required delivered to your
mailbox
www.claimsportal.org.uk
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What is the Claims Portal?
• Stakeholder solution for the
benefit of users:
– Secure electronic transmission of
information between claimant and
insurer/compensator parties.
– Provides forms to help capture and
submit the right information.
– Speedy communication of key
decisions.
MOJ PREACTION
PROTOCOLS
IMPLEMENTED
APRIL 2010
CLAIMS UP TO
£25K
RTA / EL / PL
POST BOX
• ‘Post box’:
– Not a compliance tool.
– Not a Case Management System.
– Not an MI repository.
www.claimsportal.org.uk
ELECTRONIC
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‘Web’ vs ‘A2A’
• There are 2 ways of accessing the Claims Portal:
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Directly via a web browser.
Through an Application to Application (A2A) interface.
• Using the web browser offers a simple and low-cost route into
the Claims Portal.
• An A2A interface enables you to link existing systems with
the Portal for an integrated experience.
www.claimsportal.org.uk
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Training and Support
• www.claimsportal.org.uk
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User guides for all users.
Walkthroughs of key elements.
Frequently Asked Questions.
Latest news and announcements
• ‘One Stop’ Claims Portal Helpdesk:
– Core Hours 7am – 7pm Mon-Fri; 8am – 2pm Sat.
– Supporting registrations, A2A credential requests, access to training and
integration sites, Portal queries and more.
www.claimsportal.org.uk
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‘Live’ and ‘Training’
• The Claims Portal has both a ‘Live’ and a ‘Training’ version.
• The Training version:
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Provides a safe environment for practice and familiarisation.
Allows access to both Claimant Representative and
Compensator/insurer elements.
Looks and behaves identically to the Live site.
• The Live and Training sites have different user credentials.
www.claimsportal.org.uk
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Management Information (MI)
EXECUTIVE DASHBOARD
PORTAL SERVICE
CLAIMS PROCESS
Availability
www.claimsportal.org.uk
Performance
Users
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Management Information (MI)
CLAIMS PROCESS MI: HIGH LEVEL ONLY
No OF CLAIMS SENT TO A COMPENSATOR
No OF CLAIMS THAT LEAVE THE PORTAL - STAGE 1
No OF CLAIMS THAT LEAVE THE PORTAL - STAGE 2
No OF CLAIMS THAT SETTLE - STAGE2
No OF CLAIMS THAT LEAVE THE PROCESS - EXIT FUNCTION
www.claimsportal.org.uk
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Management Information (MI)
• Things to remember / consider:
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The Claims Portal is not a case management system
Claims Process MI is High level only / Not at organisational level
Executive Dashboard is updated monthly, available to all and is
published at www.claimsportal.org.uk.
Portal User Agreements controls use of MI.
Ad hoc bespoke MI reports are not produced. Claims Portal do respond
to MoJ requests.
Ensure you consider your own claims management information
requirements and make appropriate provisions in your internal business
process/systems.
www.claimsportal.org.uk
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The Behaviour Committee
www.claimsportal.org.uk
The Behaviour Committee
• Formed to assist with the resolution of behaviour issues
arising from use of the Portal:
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A balance of claimant and insurer representation
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Meets on a bi-monthly basis and considers behaviour issues that
have been submitted
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Compulsory, non-binding, arbitration
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Provides general guidance on repeat behaviours (on the website)
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Regarding the use of the Portal, in the context of the Civil Procedure
Rules, including in particular the Pre-Action Protocol for Low Value
Personal Injury Claims and the spirit in which they was introduced.
www.claimsportal.org.uk
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The Behaviour Committee
• The reporting process:
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Address any issues in writing directly to the organisation concerned
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Where a satisfactory outcome has not been achieved, the issue is reported
to the Behaviour Committee using the Behaviour Report Form by a senior
representative of the complainant, with accompanying references to the
protocol and documents as appropriate
Common behaviour issues include multiple CNFs and
compensators contacting claimants directly
Consistent agreement within the Committee
www.claimsportal.org.uk
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Registration
www.claimsportal.org.uk
Registration
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Available online at www.claimsportal.org.uk
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Before you register you need to;
1. Decide whether you are using the Portal via Web or
Application 2 Application (A2A)
2. Decide what Claim Types you want to process (RTA
and/or EL/PL)
3. Nominate an Administrator
4. Understand your set up options
www.claimsportal.org.uk
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1. Registration - Web or A2A
Web
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Simply connect via the internet and log in using one of two standard
browsers, Internet Explorer (version 6 or above) or Mozilla Firefox.
Insert User ID and
Password to access the
Claims Portal.
www.claimsportal.org.uk
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1. Registration - Web or A2A
A2A
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You can choose to access the Claims Portal via A2A.
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This approach allows you to develop an interface to the Claims Portal
from your own internal claims system whereby you send and receive
XML messages to process claims.
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If you do develop internally you must have an appropriate level of IT
competence and availability.
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A2A also allows you to use products to connect to the Claims Portal
that have been developed by external software houses.
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If you choose to connect via A2A and are using a software house to
develop a bespoke A2A solution for you, point them to the Developers
section of www.claimsportal.org.uk
www.claimsportal.org.uk
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2. Registration – Claims Types
Claim Types
There are three options available when completing your registration;
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Road Traffic Accidents Only
(RTA Only)
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Employers’ Liability / Public Liability Only
(EL / PL Only)
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Road Traffic Accidents and Employers’ Liability / Public Liability
(RTA and EL / PL)
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Note: if you wish to add a claim type to your account at a later date
your nominated Administrator can do this via Manage Your Account
at www.claimsportal.org.uk
www.claimsportal.org.uk
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3. Registration - Administrator
Administrator
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The Administrator is responsible for your Claims Portal Account.
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They are responsible for;
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Accepting the Portal User Agreement on behalf of your
organisation
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Creating and maintaining Claims Handler access to your account
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Setting up user names and maintaining passwords
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Disabling users
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Maintaining your organisation’s account
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Change name and address
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Adding branches
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Adding Claim Types
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Dealing with transition to A2A
www.claimsportal.org.uk
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3. Registration – Second Administrator
Second Administrator
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As part of setting up your account, you should create a second Administrator
user.
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This will ensure you have cover for periods when your primary Administrator
is temporarily not available, or has left your organisation.
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It is also useful if your Administrator forgets their password as the second
Administrator can reset it immediately without having to contact the Helpdesk.
Administrator TIPs
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Administrators cannot access the Portal to process claims.
Ensure your claims handlers know who your Administrator is.
All users, including Administrators, are disabled if you have not logged in for
90 consecutive days. Set a reminder to log in.
www.claimsportal.org.uk
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4. Registration – Set Up Options
Self Insured Organisations / Large Deductible
• Set Up options largely depend on whether you handle claims in
house or via Third Party Administrators (TPAs) / legal advisors.
• Use the flow chart to help you understand the options available.
• The options set out are not mutually exclusive and it is entirely
possible that you will require a combination. This will be determined
by your requirements.
This information is contained within Section A of the Administrator User
Guide found on the Using the Portal page at www.claimsportal.org.uk.
www.claimsportal.org.uk
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www.claimsportal.org.uk
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Set up - Option 1
www.claimsportal.org.uk
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Notes about Set Up Option 1
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If your organisation handles and process all claims that fall within the Pre Action Protocol in Employers’ Liability
and Public Liability or you want to control access to your claims for a TPA you can register for an account on the
Claims Portal.
This compensator account will belong to your organisation and your nominated Administrator will be responsible
for controlling and maintaining access for all users in all branches.
This account will appear to claimant representatives when they look for a defendant/insurer when creating a Claim
Notification Form and you will receive claims straight into this account.
Within this account you can create branches and claim handler profiles to meet various requirements. For
example, you may allocate work to internal teams and wish to recreate this structure within your Claims Portal
account.
By using branches and relevant branch claim handler profiles you can allow access for a TPA or other claims
handling organisation. This allows you to maintain control over access to your claims.
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See Page 27 for an illustrated diagram of how the account could look.
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IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims handling
organisation you must not create an Administrator user for them as this will enable the TPA to control access to all
branches and all claims.
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For more information about branches and user profiles please see Section A2 and A3 of the Administrator user
guide contained on the Using the Portal page at www.claimsportal.org.uk.
www.claimsportal.org.uk
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Set up - Option 2
www.claimsportal.org.uk
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Notes about Set Up Option 2
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If your organisation wants all claims that fall within the Pre Action Protocol in Employers’ Liability and Public
Liability claims to go straight to a single TPA or other claims handling organisation you do not need a Claims
Portal account.
Providing your TPA or other claims handling organisation is already registered/or intends registering for a
compensator account that receives EL/PL claims, it is possible to list your organisation on the Claims Portal
so that when it is selected by a claimant representative the claim notification form is sent to your nominated
TPA or other claims handling organisation.
If you wish to pursue this set up you will need to speak with your TPA or other claims handling organisation
and agree this approach.
Once agreed your TPA Claims Portal Administrator will need to request this set up via the Helpdesk at
[email protected]
They will need to provide;
• Your organisation name and address and
• Written authority confirming that your organisation agrees to the TPA handling all EL/PL claims on your
behalf.
Once set up, your organisation name will appear to claimant representatives when they look for a
defendant/insurer when creating a Claim Notification Form. Once selected claims will be sent straight into the
TPA or other claims handling organisation’s account.
www.claimsportal.org.uk
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Set up - Option 3
www.claimsportal.org.uk
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Notes about Set Up Option 3
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If your organisation uses more than one TPA or other claims handling organisation to process claims that fall within
the Pre Action Protocol in Employers’ Liability and Public Liability claims you should register for an account on the
Claims Portal.
This compensator account will belong to your organisation and your nominated Administrator will be responsible
for controlling and maintains access for all users in all branches.
This account will appear to claimant representatives when they look for a defendant/insurer when creating a Claim
Notification Form and you will receive claims straight into this account.
In order to pass claims to the relevant TPA or other claims handling organisation according to your own business
rules, you can either set up branches and allow access for your various TPAs (as described in Set Up - Option 1)
or you can re-assign all or some claims from this account direct to the relevant TPA.
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IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims handling
organisation you must not create an Administrator user for them as this will enable the TPA to control access to all
branches and claims.
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If you intend re-assigning claims out of your account to a relevant TPAs, each TPA must already be registered/
intending to register as a compensator that receives EL/PL claims.
See Slide 31 for an illustrated diagram of how the account could look and work if you were to re-assign all your
EL/PL claims to the relevant TPAs with their own accounts.
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IMPORTANT: EL/PL claims can only be re-assigned at the outset of the claims process either before or after they
have been acknowledged. It is not possible to re-assign a claim that has been Accepted.
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For more information about re-assigning claims please see section B3 of the Compensator User Guide on the
Using the Portal page at www.claimsportal.org.uk.
www.claimsportal.org.uk
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User Profiles
www.claimsportal.org.uk
User Profiles
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The way that users process claims depends on the account set-up and the
Profile given to them by their Administrator.
A full list of profiles is available at www.claimsportal.org.uk
Compensator profiles
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The following profiles are available to compensators;
Profile TIP
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www.claimsportal.org.uk
It is recommended that you use the
profile associated to the claims type(s)
you process. i.e. if you only process
EL/PL claims only use the EL/PL user
profiles.
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User Profiles
Claimant Representative
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The following profiles are available to claimant representatives;
Profile TIP
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www.claimsportal.org.uk
It is recommended that you use the
profile associated to the claims type(s)
you process. i.e. if you only process
EL/PL claims only use the EL/PL user
profiles.
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User Profiles Summary
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Dispatchers (Compensators only)
Work with claims up to the point of acceptance, including
acknowledgement, reassignment and reallocation. These profiles can
also have their access restricted by claim type and branch.
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Claims Handlers
Work with claims according to their designation (EL/PL, RTA or all), or
branch.
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Team Leaders
Work with claims according to their designation (EL/PL, RTA or all).
Can ‘log in as’ to log in as any other user in the organisation.
www.claimsportal.org.uk
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Branches
www.claimsportal.org.uk
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Branches - Compensators
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Branches provide a way to place claims into different teams within the
Portal, to reflect different departments, geographies, responsibilities
and/or scope of work.
Branches can also be used to pass claims to third parties who have
delegated authority/large deductibles or are claims handling agents
All compensator organisations must have at least one branch, which is
nominated as the Central Point, and will always be named ‘001’ by
default.
The central point is the branch into which all CNFs are received.
There can only be one central point and it is possible to handle claims
in the branch nominated as the central point.
Additional branches may be created and are referred to as handling
points. It is possible to set-up a number of branches and you should
consider how to name your branches so that they remain appropriate
over the long term.
www.claimsportal.org.uk
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Compensator example set up
(EL/PL)
www.claimsportal.org.uk
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www.claimsportal.org.uk
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Notes about User Profiles (EL/PL Claims only)
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In this example set up, the Compensator organisation only receives EL/PL claims and has set up
a number of branches to allocate work internally across teams (001 – 005).
The compensator organisation has also created a branch (006) to allow access to claims for a
TPA or other claims handling organisation.
The appropriate user profiles in this set up are EL/PL specific i.e. COMP EL/PL Claims Handler
Team Leader.
The Comp Administrator user controls and maintains access for all users in all branches.
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IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims
handling organisation (as shown in Branch 006 above) you must not create an Administrator user
for them as this will enable the TPA to control access to all branches and claims.
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The Comp EL/PL Claim Dispatcher (Branch 001) can only see new EL/PL Claim Notification
Forms before they are accepted. They can re-allocate claims to branches.
The Comp EL/PL Claim Handler Team Leader (Branch 001) can see EL/PL claims in all
branches.
The Comp EL/PL Branch Claim Handlers (Branches 002-006) can only see EL/PL claims in
their associated branch.
It is possible to re-allocate claims between branches.
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www.claimsportal.org.uk
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Notes About Re-assignment
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The re-assignment function allows you to pass a claim either to a third party
administrator (TPA) that deals with your claims and has their own account or to
another brand within your own organisation.
If a claim has been sent to you in error you should not re-assign the claim to another
compensator organisation. These claims should be rejected, which will return them to
the Claimant Representative for resubmission to the correct Compensator/Insurer.
It is only possible to re-assign a Claim Notification Form at the outset before you
Accept the claim is one for your organisation.
It is possible to acknowledge an EL/PL Claim Notification Form and then re-assign
the claim to another compensator organisation such as a TPA.
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IMPORTANT: The re-assignment of a Claim Notification Form to another
compensator does not reset the timeframes.
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For more information please see Section B3 of the Compensator User Guide found
on the Using the Portal page at www.claimsportal.org.uk .
www.claimsportal.org.uk
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Next steps
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Visit www.claimsportal.org.uk for a wealth of Claims Portal information, including:
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Walkthroughs of the claim handling process,
User guides,
Frequently Asked Questions,
The latest news and announcements.
Once registered, access the training site at https://training.rapidclaimsettlement.org.uk
www.claimsportal.org.uk
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Thank you
www.claimsportal.org.uk
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