Table of Contents

Introduction

Claim Rules Configurations is used to configure the rules that will automatically validate the information entered upon several claim/claim transaction events .

To access to this page, please see https://contemi.atlassian.net/wiki/pages/resumedraft.action?draftId=1762296043

Open

You can define the specific Rule to be triggered upon the corresponding claim/claim transaction events.

Supported Validation Rules

Currently, we support 5 validations:

1. Claim Validation

2. Reserve Validation

3. Payment Validation

4. Recovery Validation

5. Recovery Received Validation

Claim Validation

This is to define the validation rule upon claim registration (Claim created event).

You will need to define the rule in Rule Engine Setup first before selecting it for Claim Validation.

For ex: When creating a new claim, Date of Loss should be not in the future or outside the policy effective period. If Date of Loss is in the future or outside the policy effective period, it will return a validation message.

Reserve Validation

This is to define the validation rule upon claim reserve transaction created.

You will need to define the rule in Rule Engine Setup first before selecting it for Reserve Validation.

For ex: When creating a new claim reserve, the new total reserve amount of the cover in one claim should not exceed the policy’s cover limit. If the new total reserve amount of the cover in one claim exceeds the policy’s cover limit, it will return the validation message “Total reserve amount of cover is greater than cover limit.”

Payment Validation

This is to define the validation rule upon claim payment transaction created.

You will need to define the rule in Rule Engine Setup first before selecting it for Payment Validation.

For ex: When creating a new claim payment, the new total payment amount should not exceed total reserve amount of the same cover, damage/injury type, cause type, payment code in one claim. If new total payment amount exceeds total reserve amount of the same cover, damage/injury type, cause type, payment code in one claim, it will return the validation message “Total payment amount is greater than the corresponding total reserve amount.”

Recovery Validation

This is to define the validation rule upon claim recovery transaction created.

You will need to define the rule in Rule Engine Setup first before selecting it for Recovery Validation.

Recovery Received Validation

This is to define the validation rule upon claim recovery received transaction created.

You will need to define the rule in Rule Engine Setup first before selecting it for Recovery Received Validation.

For ex: When creating a new claim recovery received, the new total recovery received amount should not exceed total recovery amount of the same cover, damage/injury type, cause type, payment code in one claim. If new total recovery received amount exceeds total recovery amount of the same cover, damage/injury type, cause type, payment code in one claim, it will return the validation message “Total recovery received amount is greater than the corresponding total recovery amount.”

Claim Calculation

This is to define the calculation rule for claim transactions. See Auto Claim Calculation and Transaction Creation for details.

Auto Populate Standard Reserve

This is to define the rule to return the standard reserve amount based on the selected cover and damage/injury type.

How it’s working?

On Add Reserve transaction form, after providing the cover and damage/injury type, you will see the standard reserve amount automatically populated and displayed as a small hint below the Amount field.

Whenever you change the cover or damage/injury type, the standard reserve amount will be automatically re-populated.

How to define the rules to validate claim/claim transaction information

You will need to use Rule Engine Setup to define the rules to validate claim/claim transaction information.

Find how to setup Rule Spreadsheet here Configure rule engine file (rules spreadsheet)