Presentation on theme: "Electronic Claims File Update"— Presentation transcript:
1Electronic Claims File Update The Old Library, Lloyd’s4th September 2006
2Agenda Introduction and Welcome Trevor Maddison A Broker’s View Trevor MaddisonECF and Market Reform Andy BrookesECF Underwriter View point Carl PhillipsElectronic Claims Files Steven MatthewsQuestions and Close Trevor Maddison
4Electronic Claims Trading is Simple Electronic transfer of data and documents, broker desktop to underwriter desktop.Claims workflow managed from the desktop electronically.Removal of the paper claim file.Simple claims – straight through processing, no broker involvement.Claims advocacy – broking where it matters.Delivery of a quality client and underwriter service.
5ECF – Key MessagesMarket reform is no longer a set of words. This project is real, ECF is real.In one weeks time the potential to trade new claims electronically with Lloyds syndicates (day 1 in-scope) will become a reality.The IUA are catching up fast, pilots have commenced and the commitment is there – we expect them to be live mid 2007.Reform of the claims process is happening, ECF is the catalyst to a modern market place.The London market is changing, market reform and electronic trading will work this time.Are you preparing for change?
6Key criteria for ECF success Full commitment of all syndicates to trade claims electronically.Full commitment of IUA carriers to trade claims electronically.Full commitment of brokers to move to electronic claims trading within a reasonable timeframe.All new claims received in the 4th Qtr 2007 traded electronically, all brokers, all underwriters.Underwriters are making a commitment, brokers need to respond.There will be issues, this is not Big Bang brokers need to work in partnership with Underwriters to make ECF a London market success.
8ECF: Key part of the London process reform programme Overall aim:A framework of standards for business processes that enables firms to deliver services efficiently to customers at a cost and level of risk comparable with other platformsNote:Any costs inherent in a subscription market must be offset to deliver this comparability.Any changes in business process must be managed in such a way as to avoid undermining the unique qualities/competitive advantages of the London Market.Page 8
9ECF is not happening in isolation Claims beyond ECFChange requests – no system stays putClaims infrastructure to include IUAProtocols (LMP2001); Lloyd’s Claims SchemeSupport Claims Strategy & Minimum StandardsIntegration with other reform workstreamsAccounting & SettlementRepository use; DRI standards; P2P strategy and claimsContract CertaintyRoles and responsibilities clearly definedRepositories……..againPage 9
10Implementation approach Lead implementersPrepare to followCommercialLloyd’s performance standardsRegulatorySponsors; project managersPage 10
11E.C.F. Underwriter Viewpoint Carl PhillipsAmlin & LMA Systems Delivery GroupPage 11
12Why Do Underwriters Need A Claim File? Good Business Practice Easy way of supporting / evidencing decisionsJustify Reserves and Payments to ShareholdersFSA RequirementsLloyd’s Claims Management Principles and Minimum StandardsClaims Agreement for Followers (CAF) - Consistency of informationGoshawk / TysersPage 12
13Why An Electronic Claim File (E.C.F.)? Concurrent/Contemporaneous AccessTransparent and Auditable ProcessImprove service levels to customersRemoval of dead time (transporting files)Worldwide access to the file 24/7Data Integrity and BackupCollaborative Agreement Lloyd’s Claims Scheme/ Claims Agreement for FollowersThe Technology Exists in everyday use by all London Market PractitionersStorage and filing requirementsPage 13
14To replicate today’s file electronically Based on existing products LMA ECF ObjectiveTo replicate today’s file electronicallyNot a Blue Sky Claims System developmentBased on existing productsNo changes to CLASS at this stageSeamless access to CLASS information and documents through an Integrated Repository using WindowsProvide a base product in September 06To be evolved once experience gainedPost implementation of base productStrategic review of on-going developmente.g. Third Party Access / Leader Reserves/Web Services etc.Page 14
15Broker submits claim electronically FeaturesBroker submits claim electronicallyEnables parallel presentation to insurersReduces data transcription errorsAllow brokers to concentrate on complex claimsFacilitates improvements in claims settlement timeImproves Customer ServiceImproved insurer access to informationIt’s the insurers’ fileConcurrent access to all subscribing insurers24/7 access, worldwidePage 15
17Status today Key Enhancements in 5 Phases Phase 1 - See all documents in one viewPhase 2 - Leader control of file/improved searchingPhase 3 - ACORD DRI (receipt of documents)Completed 2005Phases 4/5 – Merged into a single phase -Lloyd’s data through GUI, full DRI andSeamless link with documents in repositoryOn target for September Roll out Go/No Go Decision 7 SeptPage 17
18Systems Processes & Procedures Systems Processes and Procedures GuideBroker & Underwriter Collaborative ApproachHigh-level guideNOT a systems user manual or adjusting manualFocuses on processWorkshops have been convened to review generic process and class of business variationsConfirmed generic processConfirmed little variation by class of businessMany Issues identified and documented for resolution.Page 18
19Types of claimThe majority of all new claims can be processed via ECF. However there are certain circumstances that ECF has not been required to support and some other instances where system change or further definition of market processes is required to enable full support.Business or Claims types that ECF has never been required to supportClaims on unsigned risksGeneral AverageProportional treatiesScheme CanadaDirect LivestockClaims Payable AbroadLetters of credit, loss reserves and Outstanding Cash Advance (OCAs)Bulk SettlementsBusiness or Claims types excluded from the current implementation of ECFSolution is currently being developedDelegated Lead to XCS (other than 100% Delegation, which is in scope)Binding Authorities, Cover Collections and other Bordereaux ClaimsRequire further analysisPolitical RiskAviation verticalsCertain Multiple OSND claimsThird Party Access to ECFExisting paper claims filesPage 19
20Delivers first version Next StepsGO LIVE – September 2006Delivers first versionof an integrated electronic claims service for Lloyd’sreplicating existing file electronicallywith improvements where possiblecompanies and syndicates can see the same claimBUT a step-change for the London MarketThere will be more issues and enhancementsLegacy claimsIssues recorded and initial plan for resolutionThings change and we won’t have thought of everythingPage 20
21ECF is here and we’re ready MAT approaching completionStaff training underway16 Managing Agents participating from next monthRepresenting about 60% of Lloyd’s Market Capacity5 Brokers submitting ECFs next monthRepresenting about 40% of Lloyd’s Market CapacityThere won’t be a paper file!Increasing commitment every weekA Partnership Approach that Benefits all - But not least the Policy Holder.Page 21
22Amlin’s Approach Experience and extracting maximum benefit Have built experience in ECF through 7 pilots across 7 classes of business with 7 brokers over 2 yearsAll claims teams have been engaged in ECF, some since April 2004; claims handlers now looking forward to going live with Electronic Claims.Implemented new repository workflow system specifically to handle all claims electronicallyIt works!
23Amlin have begun internal training in preparation for live date. Amlin’s ApproachPreparednessAmlin have begun internal training in preparation for live date.Little change for those that have used CLASS beforeAmlin confident that 80% of their new claims can be handled through ECF now without impediment.There will be pain to get the gain!
24Electronic Claim Flies Stephen MatthewsTim LovickDate: 4 September 2006
25Agenda What is ECF? Process Overview Roles and Responsibilities Validation ChecksMandatory RulesRoll OutsLessons LearntSystem OverviewPractical Help
26…combination of new systems and procedures What is ECF?Market RepositoryConverged CLASSECFTrackerWorkflow…combination of new systems and procedures
27ECF Process Overview MARKET XCS ECF System XCS CLASS (XCS Internal System)Once all agreement Parties ‘Accept’ claimDocument storage systemSupplement claim details e.g. i. FIL ii. NAIC iii. TF codesBroker4. CLASSCLASS DatabaseAgreement PartySCM & BSM
28Roles & Responsibilities of ECF Parties BrokerLead Lloyd’s UnderwriterXCSAgent of the (Re)InsuredCollate and present claims data / information to Insurers - will include first and subsequent claim advicesCollection of claim monies on behalf of (Re)InsuredReview claims information provided by broker and other partiesRepresent the interest of Leading Lloyd’s Syndicate in any claims handling decisions, including coverage, recovery, litigation etcReview claims information provided by broker and other partiesRepresent the interest of Following Lloyd’s Syndicates (if CAF or Peer Review, will include claims handling decisions including coverage, recovery, litigation)Advise claim details to Lloyd’s Syndicates and process claims, recoveries and/or fees via Lloyd’s Market claims systemRoleCreate / update claims data in Lloyd’s in a timely fashion. Will include:-ClaimsRefundsFees, if included in indemnity amount (optional for brokers if not))Upload correct supporting claims documentation onto Market Repository. Will include (but not limited to):-Slip with OSND and policy, if available and all relevant endorsements (including AP/RP and Non Premium)Cover Note / Certificate / Declaration, where applicablePreliminary and subsequent loss detailsExpert reportsRelease Form / Proof of LossCorrespondence from (Re)InsuredSupporting claim documents (e.g. bordereau, shipping documents, invoices receipts, etc)Convey instructions to experts on behalf of InsurersCalculate claim adjustments, including application of any applicable deductibles, orders, reinstatements - where applicable etcArrange payment of claim funds to (Re)Insured on behalf of Lloyd’s syndicatesArrange payment of expert’s fees on behalf of Lloyd’s syndicates, if included in indemnity amount (or broker elects to collect fees if not)Confirm broker has uploaded correct claim documents and review same. Will include:-Slip with OSND and policy, if available and all relevant endorsements (including AP/RP and Non Premium)Cover Note / Certificate / Declaration, where applicableExpert reports, invoices, receipts, shipping documents etcCheck coverage details and confirm:-Certificate / Insured / interest / declaration attaches to policy and sum insuredDOL / DCM falls within policy / certificate periodClaim falls within available policy / certificate limitsApplicable coverage typeDeductible / excess / franchise correctly appliedLoss locationReview and assess claim documentation. Will include (but not limited to):-Identity of Insured / Coverholder / Cedant / ReinsuredPreliminary and subsequent loss detailsExpert reportsRelease Form / Proof of Loss Form etcReview broker loaded financialsUpdate Lead Underwriter comments on Lloyd’s entryRoute claim to other agreement parties, as necessaryInstruct and manage experts in conjunction with XCSManage disputes with insured in conjunction with XCS. Will include:-Arbitration hearings or court casesDepositions etcManage “Direct Report” claims files and agree any applicable “Direct Settlements”Determine and execute claims handling strategy in conjunction with XCSConfirm broker has uploaded correct claim documents and review same. Will include:-Slip with OSND and policy, if available and all relevant endorsements (including AP/RP and Non Premium)Cover Note / Certificate / Declaration, where applicableExpert reports, invoices, receipts, shipping documents etcCheck coverage details and confirm:-Certificate / Insured / interest / declaration attaches to policy and sum insuredDOL / DCM falls within policy / certificate periodClaim falls within available policy / certificate limitsApplicable coverage typeDeductible / excess / franchise correctly appliedLoss locationReview and assess claim documentation. Will include (but not limited to):-Identity of Insured / Coverholder / Cedant / ReinsuredPreliminary and subsequent loss detailsExpert reportsRelease Form / Proof of Loss Form etcReview broker loaded financialsUpdate XCS comments on Lloyd’s entryRoute claim to other agreement parties, as necessaryInstruct and manage expertsManage disputes with insured in conjunction with Leader. Will include:-Arbitration hearings or court casesDepositions etcManage “Direct Report” claims files and agree and process any applicable “Direct Settlements”Determine and execute claims handling strategy in conjunction with LeaderProvide Technical Processing or CAF service, as requiredProcess correctionsDetermine and create XCS CLASS entries in line with:-Regulatory requirementsCAT code splitsNAIC splitsTrust FundState Code requirementsCreate XCS CLASS entries and send SCM / USMs to SyndicatesOffer an Enhanced Claims Review servicePursue recoveries, where appropriateResponsibilities
29Lead Lloyd’s Underwriter Getting the data right first time System ValidationBrokerLead Lloyd’s UnderwriterXCSXCS release XCS CLASSand send SCM / USMto marketLloydsLloydsLloydsBroker loadsLead agreesXCS agreesClaimsDataXCS CLASSSCM & USMsMandatory Fields in - 25(Entered by Broker)UCR (includes Original Broker)TR (includes Payee Broker)BureauLMP IndicatorFirst Advice IndicatorAdvice to include Settlement- UMR- Broker Phone No.- Bureau Lead- Insured- Policy Period or Period Narrative- Slip Order 1 or Narrative- Loss Name- Loss Date From- Loss Details (Narrative)- Original CurrencyO/S amt or O/S QualifierOrder Settlement (if Settlement)- Settlement Currency (if Settlement)- Settlement Amount (if Settlement)- Original Signing No. & Date- Settlement Exchange RateEditable & Updateable Fields in - 5(Data originally entered by Broker)Risk CodeCAT CodePCS CodeFurther Agreement PartiesCause Codes (not used at the moment)Editable & Updateable Fields in - 5(Data originally entered by Broker)Risk CodeCAT CodePCS CodeFurther Agreement PartiesCause Codes (not used at the moment)Non-Editable Fields in XCS CLASS - 17(Data originally entered by Broker)- UCR- TR- Advice / Settlement- UMR- Syndicates on Risk (including Bureau Lead)- Slip Order- Original Currency- O/S Amount or O/S Qualifier- Settlement Currency- Settlement Amount- Original Broker (Calculated from UCR)- Payee Broker No. & Pseud (Calculated from TR)- Original Signing No. & Date- Settlement Exchange RateBroker Claim Reference 1 & 2InterestVAT amountEditable Fields in XCS CLASS – 16(Data originally entered by Broker)- Broker Phone No.- Insured- Pol / Cert Period From & To- Loss Name- Date of Loss From & To- Loss Details (Narrative)- Reinsured- Original InsuredPerilsSI LimitsSI CurrencyExcessLoss LocationVessel / AircraftLawyerAdjusterNB. Editing these fields will cause discrepanciesbetween and SCM/USMs sent to SyndicatesOptional Fields in - 42(Entered by Broker)Broker Claim Reference 1 & 2ReinsuredInterestPerilsLocation / VoyageSI LimitsExcessLoss LocationVessel / AircraftLawyerAdjusterPreviously PaidVAT amount etcAdditional Fields in XCS CLASS - 72(Entered by XCS on XCS CLASS)- Presentation Date- Charge Type- Peer Review Indicator- Market Code etcGetting the data right first time
30Contractual Framework – Mandatory Rules Licence to use and access to DocumentsUnintentional disclosure of Documents and PrivilegeTrue, fair and complete copiesUse of ECF and A&SResponse Buttons/Response Codes (for Lloyd’s only)Recording Transactions (ECF and A&S)Authentication of UsersGovernanceComplianceLaw and Jurisdiction
32Lessons LearntTo assist the efficient management of your ECF transactions and reduce rejections, the following points are important:Check the risk/class of business is applicable for ECFCheck the data listed in the ‘Validation Checks’ (see previous page) is included inthe presentationEnsure the correct signing number is presentedCheck a signed Slip is loaded on to the Repository (along with other relevantpolicy documentation such as schedules, breakdowns, APs, Endorsements etc.)Correct Slip order
33Lessons Learnt are completed or left blank) Ensure both the currency of limits and SI/limit amounts are entered (e.g. either both fieldsare completed or left blank)If a bordereau presentation includes a newly added US tax state or a Canadian provincewhich requires a payment, this needs to be loaded as an advice prior to the settlementCheck the Settlement currency is the same as the first and subsequent adviceWhen a first advice with settlement is presented, the advise must be loaded on the firsttransaction then the settlement on the second transaction
34Practical HelpXIS are running a number of familiarisationsessions across September 06.(Contact Graham Sheppard)XCS are planning a number of face-faceprocedural workshops and demonstrationswith Brokers commencing September 06.
35Tim Lovick Date: 4 September 2006 System OverviewTim LovickDate: 4 September 2006
46How Do I Get Involved – What Do I Need? To submit claims electronically you must have:Lloyds access either online or batchThe ability to load scanned claims documents to the Xchanging hosted market repository either via DRI auto load or direct loadBoth Class and the ability to put documents in the repository are pre requisites to eclaims trading with underwriters