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Scenario for Opening and Managing a Claim for Property Loss

This scenario features sample tasks performed by a claims representative. Your company might follow a different workflow according to its business requirements.

A claims representative for a property insurance company is on the phone with a policy holder whose home was burgled. The claims representative must first check that the policy holder has a valid policy and that there is appropriate coverage.

To report this first notice of loss, the representative opens a claims file in Siebel Insurance by navigating to the Claims screen and creating a new Claims record. The claims representative enters the loss date and selects a Policy effective at the time of loss. The representative then moves on to the Loss Description view to capture additional details about the burglary.

Next, he creates a detailed list of the lost insured items in the Insured Property view. Then, he uses the Police And Fire Reports view to initiate an order for a policy report on the burglary. Because heirloom jewelry was among the property that was stolen, he goes to the Appraisals view to document the value of the stolen property. Finally, he documents the coverages for the lost items.

During the next few weeks, he uses other views to track the adjustment process, including reserving and recoveries (subrogation or salvage). After the claim is settled, he adds payment details.

In this scenario, the end users are claims representatives. They enter information to:

• Create a loss claim and record details about it
• Associate the loss with a contact
• Create a list, record the worth, and the coverages for the lost insured items
• Record any police or fire reports, if applicable
• Track the adjustment process and record payment details