Siebel Insurance Guide > Managing Claims >

About Issuing a Settlement Payment (End User)

End users use the Financials, then the Payments view tab to issue a settlement payment. This task is a step in Process of Managing Claims.

A payment can be associated with a single or multiple reserves. For example, an adjuster can make a payment of $10,000, and this payment can be drawn from a collision reserve and a towing-and-labor reserve.

NOTE:  End users can associate a payment with reserves only if the payment type is indemnity. For other payment types, the Reserves list applet is a read-only applet.

Table 10 shows the fields in the Payment list applet.

Table 11 shows the fields in the Reserve list applet.

When the user clicks the Submit Payment button, the following checks are performed:

1. Check whether some of the fields are entered correctly. Siebel Insurance checks:
   1. That the Date From field is not null, and that it is before the date in the Date To field.
   2. That the Date To field is not null, and that it is later than the date in the Date From field.
   3. That the Payment Amount field is not 0.
   4. That the Payment Status field is pending. Only a payment with status Pending is evaluated when the user clicks the Submit Payment button.
   5. Whether the Mail To Flag is set for the Payee or Vendor Payee field. There must be only one payee among both the contact payees and the vendor payees that have the Mail Payment Flag checked.
2. Check whether the contact payee or account payee is in the OFAC database. Siebel Insurance checks whether the contact or account is in the OFAC database. If the payee or vendor payee is in the OFAC database, Siebel Insurance suspends the payment and changes the status of the payment to On Hold OFAC. For more information, see Checking a Claim Against the ISO Database (End User).
3. Check whether the per-coverage deductible has been applied to the payment amount. Siebel Insurance checks whether the deductible flag in the Reserve list applet is checked. This step is only applicable if the payment is associated with a reserve (that is, a payment of type Indemnity payment). If the deductible flag is not checked, Siebel Insurance displays a message prompting the adjuster to reduce the amount in the Reserve applied toward payment field by the deductible amount. When the flag is set to true, the deductible flag field becomes a read-only field and it applies to the reserve. So, the next time the adjuster associates the reserve to another payment, the deductible flag remains checked.
4. Check whether the payment amount is equal to the total of reserve applied to payment. Siebel Insurance checks whether the Total reserve applied toward payment field in the Reserve list applet is the same amount as in the Payment amount field in the Payment list applet. If the value is not the same, Siebel Insurance displays an error message prompting the user to adjust the amount to make it the same.
5. Check whether the reserve applied to payment is equal or less than outstanding reserve. Siebel Insurance checks whether there is enough outstanding reserve to make the payment. If there is not enough reserve left to make the payment, Siebel Insurance displays a message to adjust the Reserve Applied to Payment field in the Reserve list applet to be less or equal to the Outstanding Reserve field in the Reserve list applet.
6. Check if the payment authority limit is correct. Siebel Insurance checks whether the adjuster has enough payment limit to make this payment. The adjuster has a payment limit on the coverage level as well as on the total claim level (see Administering Adjusters' Financial Limits). For every payment made by this adjuster, Siebel Insurance keeps track of how much payment has been made on the coverage level and on the claim level. Siebel Insurance then compares this with the adjuster payment limit for each coverage and for the claim. For example: Adjuster A has a bodily injury payment limit of $10,000, collision payment limit of $5,000, and a total indemnity payment limit of $20,000. If the adjuster receives an invoice, say for $12,000, and he wants to draw from the collision and bodily injury reserves to make this payment, the most he can pay from the bodily injury reserve is $10,000, and the most he can draw from the collision reserve is $5000. If he tries to pay more than his payment limit, Siebel Insurance displays a message and sends notification to the supervisor for approval.

   Siebel Insurance keeps track of how much the user has paid from a particular limit. Suppose on this $12,000 payment, the user draws $10,000 from the bodily injury reserve and $2,000 from the collision reserve. The next time he wants to make a payment, he can not make a payment from bodily injury reserve without Siebel Insurance notifying his supervisor for approval, because he has already used up to his payment limit on bodily injury reserves.

   Siebel Insurance keeps track of the adjuster payment limit on the per reserve - per claim level. For example, adjuster A might have a bodily injury payment limit of $10,000. Suppose he wants to make a payment, and wants to draw $6,000 from the bodily injury reserve 1 for Mary and $6,000 from bodily injury reserve 2 for Todd. In this case, Siebel Insurance displays an error message since the total of bodily injury payments is more than the adjuster A's $10,000 limit. The per reserve - per claim basis will apply on the supervisor level as well.

   If the adjuster does not have enough payment limit, Siebel Insurance creates an Inbox item for the supervisor's approval. The supervisor can then go to the Inbox screen to approve the payment. The supervisor can drill down on the Inbox item to view the payment details. To see all of the payment records, the supervisor can use the query button. He can then return to the Inbox view and approve or reject the Inbox item. When the supervisor approves the payment, the payment status goes to Payment Generated. If the supervisor's limit is not enough, another Inbox item is created for the supervisor's supervisor. However, if the supervisor rejects the Inbox item, the payment status goes to Rejected. For more information about using the Inbox, see Siebel Applications Administration Guide.

7. Updating the reserve outstanding amount if all the above checks are passed. Siebel Insurance reduces the Outstanding Reserve field by the amount of payment made. For example, suppose an adjuster sets a $2,000 collision reserve for the claim, and the collision reserve has a $500 deductible. If the adjuster receives a bill from a glass vendor for $1,000, the adjuster applies the deductible for the collision reserve and pays the $500 from the $2,000 collision reserve. After he makes the payment, the outstanding reserve becomes $1,500. The adjuster can then use this $1,500 outstanding reserve to pay another bill related to collision coverage.

For more information about the financial limits for adjusters, see Administering Adjusters' Financial Limits.

If the adjuster makes a mistake, the adjuster can select the Void button to reverse the transaction. When the user select the Void button, Siebel Insurance adds the payment amount back into the outstanding reserve amount. Furthermore, the user can modify the payment and reserve record accordingly.