CC AppGuide

Guidewire
ClaimCenter ™
Application Guide
Release 9.0.5
©2001-2018 Guidewire Software, Inc.
For information about Guidewire trademarks, visit http://guidewire.com/legal-notices.
Guidewire Proprietary & Confidential — DO NOT DISTRIBUTE
Product Name: Guidewire ClaimCenter

Product Release: 9.0.5
Document Name: Application Guide
Document Revision: 27-April-2018
Application Guide 9.0.5
Contents
About ClaimCenter documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Conventions in this document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Part 1
Introduction
1 Introduction to ClaimCenter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Claim Management Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
ClaimCenter Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
2 Claims Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Claim Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Other Aspects of Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Claim Summary Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Viewing Details of Summary Screen Sections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Claim Headline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Workplan Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Loss Details Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Claim Associations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Fraud—Special Investigation Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Incident Tracking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Exposures Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Reinsurance Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Parties Involved Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Contacts Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Users Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Working with Contacts and Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Policy Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
Financials Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Summary Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Transactions Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Checks Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Working with the New Claim Wizard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Notes Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Documents Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Plan of Action Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Evaluations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Negotiations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Services Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Litigation Menu Link . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
History Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
FNOL Snapshot Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Calendar Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Contents 3
Part 2
ClaimCenter User Interface
3 Navigating ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Logging in to ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
ClaimCenter Login Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Log in to ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Setting ClaimCenter Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Change Your ClaimCenter Password . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Change Your ClaimCenter Startup View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Change the ClaimCenter Regional Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Change the ClaimCenter Default Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Change the ClaimCenter Default Phone Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Viewing ClaimCenter Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Selecting language and regional formats in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
Options for setting the display language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
Options for setting regional formats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
Common Areas in the ClaimCenter User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
ClaimCenter Tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
ClaimCenter Desktop Tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
ClaimCenter Claim Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
ClaimCenter Search Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62
ClaimCenter Address Book Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
ClaimCenter Dashboard Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
ClaimCenter Team Tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
ClaimCenter Administration Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
ClaimCenter Vacation Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Saving Your Work in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
4 Changing the Screen Layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Adjusting List Views. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Change List View Column Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Change List View Column Widths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Sort List Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Hide and Show Columns in a List View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Grouping Rows in a List View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Change the Sidebar Width . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Managing Layout Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Storage of Layout Preferences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Clear Layout Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
5 Claim Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Perform a Simple Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Advanced Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Search by Contact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
How Free-text Search Works. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Query and Filter Search Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Search Types and Ranking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Archived Claims Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Search by Contact User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Working with Free-Text Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Search Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
Search Index Updates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
6 QuickJump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
QuickJump Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
4
Using QuickJump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Chaining QuickJump Destinations Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
QuickJump Behavior in Wizards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
Configuring QuickJump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
QuickJump Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Static Commands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Commands Available with a Claim Open . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Part 3
Working with Claims
7 Claim Creation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Overview of the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
Save Your Work, and, Retrieve Unsaved Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Delaying Creation of a Draft Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Working with Multiple Claims in Draft Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Flows of the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Capturing Incidents in the New Claim Wizard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
New Claim Wizard Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Selecting or Creating a Policy in the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Basic Information Step of the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Add Claim Information Step of the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Services Step of the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93
Save and Assign the Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Complete the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
Optional New Claim Wizard Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96
New Claim Wizard and the Lines of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
New Claim Wizard and Commercial Auto LOB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
New Claim Wizard and Commercial Property LOB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
New Claim Wizard and Homeowners LOB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98
Configurable Risk Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
8 Working with Policies in Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Verified and Unverified Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Validating Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Working with Policies in ClaimCenter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Searching for Candidate Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Search for a Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
List of Vehicles or Properties on the Policy Details Screen . . . . . . . . . . . . . . . . . . . . . . . . . 103
Select a Verified Policy for a New Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Search for a Claim by Its Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Create an Unverified Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Retrieve the Correct Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Edit a Policy Copy in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Refreshing the Policy Snapshot on a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Policy Refresh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Policy Refresh Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Resolving Issues with Policy Refresh. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Configuring a Policy Comparison . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Selecting a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Replacing a Policy on a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Replace a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Adding Coverages to a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Add a Policy-level Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Adding Coverage Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Contents 5
Add a Coverage Term to a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Configuring Policy Menu Links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Verifying Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Loss Party and Coverages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Loss Causes and Coverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
View and Edit Invalid Loss Causes and Coverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Incompatible Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
View and Edit Incompatible Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Liabilities and Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
View and Edit Liabilities Incompatible with Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Coverage Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Aggregate Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Policy Periods and Aggregate Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Add Aggregate Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Adding Coverages to an Aggregate Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Archiving Claims with Aggregate Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
View Aggregate Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Policies and the Data Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Policies in ClaimCenter and PolicyCenter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Claim Policies and the Policy Administration System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
9 Accounts and Service Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Account Entity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Accounts and Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Account Manager Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Account-related Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Working with Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Service Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Adding Service Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Deleting Service Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
10 Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

Overview of Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Automated Notifications for Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Automated Activities for Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Other Instructions for Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Examples of Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Adding Special Handling Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Working with Automated Notifications for Special Handling . . . . . . . . . . . . . . . . . . . . . . . 126
Working with Automated Activities for Special Handling. . . . . . . . . . . . . . . . . . . . . . . . . . 128
Working with Other Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Import Special Handling Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Export Special Handling Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
11 Claim History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Content of a Claim History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Claim Viewing History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Financial Transaction History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Claim History of a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Adding History Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
12 Validation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Field-level Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Validation on Data Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Validation on Field Validators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
6
Validation Expressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

Validation Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Validatable Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Validation Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Preupdate and Validation Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Validation Errors and Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Run Validation Rules Manually in the User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
13 Claim Fraud. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Overview of Fraud Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Special Investigation Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Special Investigation Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
When to Run Special Investigation Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Evaluating Risk Potential . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Using Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Answer Special Investigation Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Evaluating the Special Investigation Score. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Set the SI Review Score Threshold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Review Claim for SI and Escalate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Using the Special Investigation Details Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Updating Rules and Answers for Special Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Manually Refer a Claim for SI Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Special Investigation Permissions and Restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
14 Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Assessment Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Working with Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Access Assessments Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Assessment Tab. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Documents and Notes Used in Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Data Model for Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
15 Catastrophes and Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Overview of Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Working with Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Catastrophe List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Working with Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Using Catastrophes Defined by ISO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Catastrophe Bulk Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Associating a Claim with a Catastrophe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Associate a Claim with a Catastrophe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Associating Claims with Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Catastrophe History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Catastrophe Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Catastrophe Dashboard Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Preparing to Access the Catastrophe Search Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Accessing the Catastrophe Search Screen and Heat Map . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Working with the Catastrophe Heat Map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
16 Service Provider Performance Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Part 4
ClaimCenter Lines of Business
Contents 7
17 Homeowners Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Homeowners Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Homeowners Loss Details Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Policy Screens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Homeowners Coverage Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
View the Homeowners Line of Business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Homeowners Coverage Types, Subtypes, Exposures, and Incidents . . . . . . . . . . . . . . . . . . . 177
18 Personal Travel Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

Personal Travel Insurance Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Personal Travel Coverage Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Personal Travel Non-covered Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Work with the Personal Travel Line of Business. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Personal Travel Screens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Personal Travel Summary Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Personal Travel Loss Details Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Personal Travel Coverage Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
View the Personal Travel Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Personal Travel Coverage Types, Subtypes, Exposures, and Incidents . . . . . . . . . . . . . . . . . 185
19 Workers Compensation Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Overview of Workers' Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Workers' Compensation Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Working with Workers' Compensation Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Status of a Workers’ Compensation Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Initiating 3-Point Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Loss Details for Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Working with Medical Details for Workers’ Compensations Claims . . . . . . . . . . . . . . . . . . 191
Indemnity Screen for Workers’ Compensation Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Employer Liability Exposure for Workers’ Compensation Claims . . . . . . . . . . . . . . . . . . . . 194
Compensability Decision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
How Jurisdiction Affects the Compensability Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Working with Jurisdictional Compensability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
How the Activity Due Date is Calculated for a Compensability Decision . . . . . . . . . . . . . . . 195
Managing Denial of Compensation for Workers’ Compensation Claims. . . . . . . . . . . . . . . . 195
Finding Injured Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Change a User’s Sort Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Jurisdictional Benefit Calculation Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Temporary Disability (TD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Permanent Disability (PD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Jurisdictional Waiting Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Workers’ Compensation Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Workers' Compensation Coverage Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
View Workers' Compensation Coverage Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Workers' Compensation Coverage Types, Subtypes, Exposures, Incidents . . . . . . . . . . . . . . 198
Part 5
Additional Features of ClaimCenter
20 Work Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
How Assignment Models the Way an Insurer Distributes Work . . . . . . . . . . . . . . . . . . . . . . . . . 203
Assignable Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Viewing Your Assignments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
How ClaimCenter Assigns Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Global and Default Rule Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
8
Manual Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

Automated Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Reassignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Assignment Without Using the Assignment Engine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Dynamic Assignment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Assigning Other Entities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Assignment Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Using Group Types and Load Factors in Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Using Regions in Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Using Security Zones Indirectly in Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Assigning to Roles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
User Assignment by Proximity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
User Assignment by Activity Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
User Assignment to the Current Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Queues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
How to Use a Queue to Assign Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Using the Pending Assignment Queue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
21 Weighted Workload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Overview of Weighted Workload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Round Robin Versus Weighted Workload Assignment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Weighted Workload Classifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Add Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Edit Existing Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Types of Weights Used in Workload Balancing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Weighted Workload Assignment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Assigning Objects to Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Resolving a Tie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
View Weights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
22 Claim Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

Automated Claim Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Claim Segmentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Assignment of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Workplan Generation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Segmentation Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Segmentation Rule Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Comparing Strategy to Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Uses of Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
23 Working with Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Activities as Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Elements of an Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Creating Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Assigning Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Completing or Skipping Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Activity Escalation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Activity Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Viewing Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
Workplans and Activity Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
The Desktop and Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Searching for Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Team Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Activity Detail Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Understanding Activity Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Contents 9
Activity Pattern Types and Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Creating and Editing Activity Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Generating an Activity from an Activity Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Activity Calendars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Activities and the Data Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
24 Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Working with Email in Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Opening the Email Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Using the Email Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
Sending an Email from a Rule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
How Emails are Sent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Handling Incoming Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
25 Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Overview of Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Incidents, Exposures, and Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Incident Data Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248
Incident Entity and Its Subtypes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Mapping Between Exposures and Incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Creating Incidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Creating an Incident by Manually Entering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Creating an Incident by Using Policy Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Incident-Only Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
26 Legal Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Overview of Legal Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Matters Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Matter Details Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
Matter Type Sections in the Matters Detail Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Budget Lines Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Payments and Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Working with Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Open a Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Create a Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Close a Matter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Reopen a Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Setting a Matter Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
Organizing Financial Legal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Display the Budget Lines Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Edit the Budget Lines Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Making Payments Connected to a Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
27 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Differences Between Notes and Documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Working with Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Searching for Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Viewing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Viewing Notes Related to an Activity or Matter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Edit a Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Delete a Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
How to Print a Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Create a Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Create a Note from a Note Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Creating a Note in an Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Linking Documents to Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
10
Note Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Permissions Related to Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Confidential Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Configuring Notes and Note Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Note Plugin Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Note Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
Creating a Note Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
28 Holidays and Business Weeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

Specifying Holiday Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Holiday Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Holiday Zones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Working with Holidays, Weekends, and Business Weeks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Add a Holiday. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Edit a Holiday . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Delete a Holiday . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Create a New Zone or Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Using Gosu Methods to Work with Holidays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Gosu Holiday Methods that Use Zones and Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Business Weeks and Business Hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Business Week Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
Business Day Demarcation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Work with business weeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Business Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Gosu Methods for Business Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Holiday Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Business Week Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
29 Vacation Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Set Your Vacation Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Access the Vacation Tab as a Backup User. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Backup Users and Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Backup Users and Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
30 Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Service Provider Question Sets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Fraud Question Sets and Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Working with Question Sets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Import Question Sets and Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
Export Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Creating a Question Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Creating a QuestionChoice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Creating a Conditional Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Question Set Entities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
31 Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Working with Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Start a Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Recording a Subrogation Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
Refer a Claim to Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Viewing Responsible Parties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Assigning a Subrogation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Pursuing a Subrogation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Working with Subrogation Recoveries and Recovery Reserves . . . . . . . . . . . . . . . . . . . . . . 297
Schedule Delayed Recovery Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Requirements for Closing a Subrogated Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Contents 11
Working with Salvage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

Assign an Exposure to Salvage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Salvage Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Enabling Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Permissions for Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Roles Used in Subrogation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Subrogation Rules and Scenarios. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Subrogation Data Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
32 Archiving in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

Archiving Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Archiving Claims versus Purging Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Archiving Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Whether to Enable Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
More Information on Archiving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
ClaimCenter Preparations for Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Defining the Boundary of an Archived Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Defining Claim Summary Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Archiving Item Writer Batch Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Archive Item Writer Batch Process Execution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Claims and Claim Entities not Possible to Archive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Entities That Cannot Be Archived . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Non-Configurable Exclusions from Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Configurable Exclusions from Archiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Searching for Archived Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Info Entities and their Part in Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Simple Search for Archived Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Advanced Search for Archived Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Finding Archived Claims without Searching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
About Retrieved Archived Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Retrieve an Archived Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Permissions Needed to Retrieve a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Archived Claim Retrieval Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Reassigning Retrieved Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
New Activity Generation in Retrieved Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
New Note Generation in Retrieved Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
Purging Archived Claims. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
33 Personal Data Destruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317

Encapsulation of Business Logic for Retention and Destruction . . . . . . . . . . . . . . . . . . . . . . . . . 317
Notification of Data Protection Officer on Errors or Conflicts . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Wide-swath Data Destruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Individual-entity Data Destruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Integration with Other Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
Notification of Downstream Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Part 6
ClaimCenter Financials
34 Claim Financials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Overview of ClaimCenter Financials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Transactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Transaction Approval. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Checks and Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Transactions and Transaction Line Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
12
Transaction Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Estimating Reserve Amounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Uses of Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Effect on Reserves of Closing a Claim or Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Payments and Available Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Definitions of Reserve Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Definitions of Total Incurred Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Set Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
How ClaimCenter Displays Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Configuring the Set Reserves Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
Reserves in Multiple Currencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Set Reserves in Multiple Currencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Effect of Single Currency Setting on Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Reserve Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Eroding and Non-eroding Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Partial, Final, and Supplemental Payment Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Modifying Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Payments and Zeroing Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Payments and Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Types of Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Manual Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Working with Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Electronic Funds Transfer (EFT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Add EFT Information in the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Add EFT Information in the New Check Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Add EFT Information by Creating a New Person. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
EFT Data Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Recoveries and Recovery Reserves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
Recoveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Recovery Reserves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Modifying Recovery Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Working With Transactions and Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
View a Claim’s Existing Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
View a Summary of a Claim’s Existing Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
View Existing Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Create a New Transaction or Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Create Checks Against a Reserve You Have Selected. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Create Recoveries Against a Particular Payment or Recovery Reserve . . . . . . . . . . . . . . . . . 354
Modify a Transaction or Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
How Transactions Affect Financial Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
The Lifecycle of Financial Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Approval Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Transaction and Check Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Standard Lifecycle Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
Unusual Lifecycle Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Voiding Versus Stopping a Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Lifecycles of Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Lifecycles of Checks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Downstream Denials of Recoveries and Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Denying a Check or Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Closing a Claim or Exposure with a Denied Payment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Financial Holds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Contents 13
Applying Financial Holds to a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364

ClaimCenter Handling of Financial Holds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Integration with External Financial Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Financials Escalation Batch Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
T-Account Escalation Batch Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Using Financials Batch Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Bulk Invoice Escalation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
ClaimCenter Financial Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Financial Transactions Outside the User Interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Financials Data Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Transaction Line Items and Their Line Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Reversing Transactions: Offsets and Onsets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
T-account Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Transaction Business Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
Transaction Business Rule Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
Transaction Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370
Transaction Authority Approvals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Setting Initial Reserves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Financial Permissions and Authority Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
User Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Authority (Transaction Amount) Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
Access Control Levels for Financial Objects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
35 Multiple Currencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

Overview of Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Currency Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
Currency Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
Claim Currency and Policy Currency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Configuring Multiple Currencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Preferred Currency on Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Checks, Payments, and Recoveries and Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Reserves and Recovery Reserves and Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
Multicurrency Display and the ClaimCenter User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376
The New Check Wizard and Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Multicurrency Searches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Using Multiple Currencies in Bulk Invoices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Multicurrency Reserving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Multicurrency Financial Summaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378
Examples of Using Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Example: Canadian Insurer that Also Covers Losses in Other Currencies . . . . . . . . . . . . . . . 379
Example: British Insurer with Satellite Office in Paris . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Example: Operating in a Marine Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Exchange Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Market and Custom Exchange Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Obtaining Market Exchange Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Multicurrency and Active Market Rate Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
Importing Multiple Currency Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Foreign Exchange Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Making Foreign Exchange Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Methods That Make Foreign Exchange Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Foreign Exchange Adjustments and Financials Calculations . . . . . . . . . . . . . . . . . . . . . . . . 384
Foreign Exchange Adjustments in Custom Financials Calculations . . . . . . . . . . . . . . . . . . . 384
Methods That Use Foreign Exchange Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
Example: Base Configuration of Foreign Exchange Adjustments . . . . . . . . . . . . . . . . . . . . 385
14
36 Deductible Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

Overview of Deductible Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Working with Deductibles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Viewing Deductibles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Applying Deductibles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Edit a Deductible. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Waive a Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Setting Up Deductibles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
37 Bulk Invoices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391

Bulk Invoice Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Bulk Invoice Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Additional Information on Bulk Invoices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Using the Bulk Invoice Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Bulk Invoice Details Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393
Working with Bulk Invoice Line Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Create a New Bulk Invoice Line Item . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Stopping or Voiding a Bulk Invoice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
Bulk Invoice Validation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
How ClaimCenter Validates a Bulk Invoice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
Bulk Invoice Approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
Invoice Line Item Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Placeholder Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Transfer and Recode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Repeated Line Item Validations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Orphan Line Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Bulk Invoice Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Bulk Invoice Escalation Batch Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Lifecycle of a Bulk Invoice and its Line Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Lifecycle of a Bulk Invoice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
Lifecycle of Bulk Invoice Line Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
Bulk Invoice Events and Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Bulk Invoices and Multicurrency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Bulk Invoice Financial Permissions and Authority Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Bulk Invoice Web Service API . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Bulk Invoice Data Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Part 7
ClaimCenter Services
38 Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Overview of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Setting Up Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Service Request Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Creating a Service Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Create a New Service Request in the Actions Menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Creating Services Requests in the New Claim Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Viewing Service Requests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Services List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Detail View of a Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
History Card for a Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Activities Card for a Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Documents Card for a Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Notes Card for a Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Invoices Card for a Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Contents 15
Messages Card for a Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

Promote Service Requests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Canceling or Declining Service Requests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Cancel a Service Request in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Record a Service Request as Declined in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Assign a Service Request. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Service Request Documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Add a Quote Document to a Service Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420
Editing a Quote Document for a Service Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Add an Invoice to a Service Request Quote . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Approve a Service Request Quote Invoice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
Make Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
Straight-through Invoice Processing (STIP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Invoice Auto-Approval Criteria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Invoice Auto-Payment Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Selecting Reserve Lines for STIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
Lifecycle of a Service Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424
Example: Request Quotes for a Carpentry Service (Quote) . . . . . . . . . . . . . . . . . . . . . . . . . 424
Service Request Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Service Metrics Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Service Metrics Calculations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426
Configuring Service Requests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Part 8
ClaimCenter Management
39 Claim Performance Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Claim Health Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Uses of Claim Health Metrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Claim Health Metrics Fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Claim Health Metrics Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Claim and Exposure Tiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Aggregated Metric Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Claim Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
Claim Status Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
General Status Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
High-Risk Indicators Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
Flags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 438
Administering Metrics and Thresholds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Use the Claim Metric Limits Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Use the Exposure Metric Limits Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
Use the Large Loss Threshold Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
Claim Duration Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
Defining Claim Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Health Metrics Permissions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
40 Team Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443

Overview of Team Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
My Groups on the Team Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 444
Groups on the Team Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Group Members on the Team Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Remove Claim Flags for a Team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448
Administering the Team Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Team Tab Configuration Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Calculating Team Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
16
41 Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Part 9
Reinsurance Management
42 Reinsurance Management Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Overview of Reinsurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Reinsurance Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456
Reinsurance Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Treaties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Facultative Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Proportional Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
Non-proportional Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Summary of Agreement Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
43 Reinsurance Management in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467

Reinsurance in ClaimCenter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Reinsurance Agreements Retrieval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Reinsurance Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468
Setting up Reinsurance Users and Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Reinsurance Manager Role . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Reinsurance Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Reinsurance Unit Group Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
Working with Reinsurance Agreements and Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
Viewing Reinsurance Financials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Manually Edit Reinsurance Transactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Managing Reinsurance Agreements and Agreement Groups . . . . . . . . . . . . . . . . . . . . . . . . 471
Manually Retrieve Reinsurance Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
Mark a Claim as Reinsurance Reportable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Associate Claims for Reinsurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Part 10
PolicyCenter Administration
44 Users, Groups, and Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Understanding Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
Understanding Users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478
Understanding Roles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Custom User Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Create User Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
User Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Related Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
Understanding Assignment Queues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Using a Queue to Assign Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484
Using the Pending Assignment Queue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484
Understanding Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484
How Regions Compare to Security Zones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484
Working with Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485
45 Security: Roles, Permissions, and Access Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487

Role-Based Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Working with Permissions and Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488
Contents 17
Data-based Security and Claim Access Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491

How Access Control Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
Configuration Parameters That Affect Access Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
Elements of Access Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
Configuring Access Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Access Control for Documents and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496
Working with Access Control for Documents and Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . 497
Access Control for Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500
Exposure Level Security. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500
Static and Claim-based Exposure Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Working with Exposure Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Create Exposure Security Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Assign a Security Type to an Exposure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Create and Grant New Permissions for Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502
System Permissions for Access to Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502
Create Exposure Access Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Static Exposure Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Implement Claim-based Exposure Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
Security Zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504
User Login and Passwords. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Log in to ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
Change your Password . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
Administrator Change a User’s Password . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
Administrator Unlock or Lock Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Administrator Create New User, Password, and User Name . . . . . . . . . . . . . . . . . . . . . . . . 507
.......................................... . . . . . . . . . . . . . . . . . . . . . . . . 507
Configuration Parameters for Password Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
Security Dictionary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Configuration Files for Access Control Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
Security for Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
46 Administration Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511

Personal Administration Settings and Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Vacation Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Administration Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512
Managing Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514
Managing Users and Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514
Find Users and Groups in the Organization Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 514
Search for a User or Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Create New Users and Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Manage Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Deleting Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Manage Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Managing Activity Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Manage Attributes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Managing Catastrophes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Add a new catastrophe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Activate or deactivate a catastrophe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Associate a catastrophe with a claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
Managing Authority Limit Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Authority Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Configuration Parameters that Affect Authority Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Authority Limit Profiles in Another Currency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
18
Working with Authority Limit Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521

Managing Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522
Assign Roles to Users . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Changing Roles and Their Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
Managing Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524
Search for Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524
Creating, Editing, and Deleting Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
Managing Holidays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Managing Messages Queues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526
Monitoring Message Queues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
Suspending and Resuming Messaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 527
Retrying Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528
Synchronizing Contacts with ContactManager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Managing Script Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Modify Existing Script Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Create, Edit, and Delete Script Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Managing Workflows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Find Workflows. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530
Start and Stop Workflows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530
View Workflow Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530
Managing Importing and Exporting Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531
Importing Administrative and Other Data in the Administration Tab . . . . . . . . . . . . . . . . . . 531
Export Data in the Administration Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532
Importing and Exporting with APIs and from the Command Line . . . . . . . . . . . . . . . . . . . . 536
Managing Security Zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 536
Add and Edit Security Zones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Choose or Change a Group’s Security Zone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Creating and Managing Reference Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Coverage Verification Reference Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538
Configuring Reference Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538
Managing Coverage Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 538
Managing WC Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Using the Benefit Parameters Detail Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 540
Enter Information in the PPD Min/Max Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Enter Information in the PPD Weeks Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Entering Denial Period Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542
Deciding Compensability and the Denial Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542
Creating Benefits Calculations in Gosu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542
Workers’ Compensation Reference Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 544
Workers’ Compensation Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Managing Reinsurance Thresholds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Administer Reinsurance Thresholds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Managing ICD Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
Working with ICD Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 546
ICD Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Managing Metrics and Thresholds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Editing Metric Limits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547
Using Tiers to Add Granularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 548
Claim Metric Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549
Claim Metric Limits and Currency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Exposure Metric Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Set a Large Loss Threshold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Claim Metrics Batch Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Managing Business Weeks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Contents 19
47 Business Rules Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553

Business Rules for Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553
Accessing Business Rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553
Managing Business Rule Export and Import . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 554
Configuring Business Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 554
Business Rule States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 554
Working with Business Rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Create a New Activity Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Promote Business Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556
Clone Business Rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Specifying Business Rule Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Specifying Rule Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 561
View Rule History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Deleting a Business Rule Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Business Rule Execution Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564
Business Rule Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 564
Part 11
External System Integration
48 ClaimCenter Integration Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571
49 Policy Administration System Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573

Policy Administration System Integration Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
Retrieving a Policy in ClaimCenter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574
Viewing Policies in a Policy Administration System (PAS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574
Viewing a Policy in PolicyCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574
Large Loss Notifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Policy System Notification Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Administering Large Loss Notifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Permissions for Working with Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
Coverage Term Mapping Between ClaimCenter and PolicyCenter . . . . . . . . . . . . . . . . . . . . . . . 577
Coverage Term Typelist Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578
50 ClaimCenter Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579

Types of Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
ContactManager Integration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Working with Contacts in ClaimCenter and ContactManager . . . . . . . . . . . . . . . . . . . . . . . . . . . 582
Pending Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582
Contact Permissions and Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Changing the Subtype of a Contact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586
51 Document Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587

Claim Document Storage Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
Document Metadata Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
Working with Claim Documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589
Viewing Claim Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589
Searching for Claim Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 592
Create a New Claim Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 593
Edit Content for a Claim Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 596
Edit Metadata Properties of a Claim Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
Linking Documents to Claim-related Entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
Hiding a Claim Document . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600
Delete a Claim Document. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601
Removing a Claim Document Link . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601
20
Configuring and Integrating Claim Document Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . 601

Document Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 602
Configuration Parameters for Claim Document Management . . . . . . . . . . . . . . . . . . . . . . . 602
Claim Document Management Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603
Creating a Claim Document Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604
52 Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605

Overview of Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605
Working with Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606
Viewing a Metropolitan Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606
Metropolitan Reports Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607
Ordering a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608
Configuring Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608
Metropolitan Reports Configuration Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608
Configuring Display Keys for Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608
Preupdate Rules and Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609
Activity Patterns and Metropolitan Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609
Metropolitan Report Templates and Report Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609
Metropolitan Report Data Types, Typelists, and Properties . . . . . . . . . . . . . . . . . . . . . . . . . 609
Metropolitan Report Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610
53 ISO and Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611

How ISO Interacts with Claims and Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
How ISO Works with ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
ISO Lifecycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
Viewing ISO Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
ISO Permissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615
Contents 21
22
About ClaimCenter documentation
The following table lists the documents in ClaimCenter documentation:
Document Purpose
InsuranceSuite Guide If you are new to Guidewire InsuranceSuite applications, read the InsuranceSuite Guide for
information on the architecture of Guidewire InsuranceSuite and application integrations. The
intended readers are everyone who works with Guidewire applications.
Application Guide If you are new to ClaimCenter or want to understand a feature, read the Application Guide. This guide
describes features from a business perspective and provides links to other books as needed. The
intended readers are everyone who works with ClaimCenter.
Database Upgrade Guide Describes the overall ClaimCenter upgrade process, and describes how to upgrade your ClaimCenter
database from a previous major version. The intended readers are system administrators and
implementation engineers who must merge base application changes into existing ClaimCenter
application extensions and integrations.
Configuration Upgrade Guide Describes the overall ClaimCenter upgrade process, and describes how to upgrade your ClaimCenter
configuration from a previous major version. The intended readers are system administrators and
implementation engineers who must merge base application changes into existing ClaimCenter
application extensions and integrations. The Configuration Upgrade Guide is published with the
Upgrade Tools and is available from the Guidewire Community.
New and Changed Guide Describes new features and changes from prior ClaimCenter versions. Intended readers are business
users and system administrators who want an overview of new features and changes to features.
Consult the “Release Notes Archive” part of this document for changes in prior maintenance releases.
Installation Guide Describes how to install ClaimCenter. The intended readers are everyone who installs the application
for development or for production.
System Administration Guide Describes how to manage a ClaimCenter system. The intended readers are system administrators
responsible for managing security, backups, logging, importing user data, or application monitoring.
Configuration Guide The primary reference for configuring initial implementation, data model extensions, and user
interface (PCF) files. The intended readers are all IT staff and configuration engineers.
PCF Reference Guide Describes ClaimCenter PCF widgets and attributes. The intended readers are configuration engineers.
Data Dictionary Describes the ClaimCenter data model, including configuration extensions. The dictionary can be
generated at any time to reflect the current ClaimCenter configuration. The intended readers are
configuration engineers.
Security Dictionary Describes all security permissions, roles, and the relationships among them. The dictionary can be
generated at any time to reflect the current ClaimCenter configuration. The intended readers are
configuration engineers.
Globalization Guide Describes how to configure ClaimCenter for a global environment. Covers globalization topics such as
global regions, languages, date and number formats, names, currencies, addresses, and phone
numbers. The intended readers are configuration engineers who localize ClaimCenter.
About ClaimCenter documentation 23

Document Purpose
Rules Guide Describes business rule methodology and the rule sets in ClaimCenter Studio. The intended readers
are business analysts who define business processes, as well as programmers who write business
rules in Gosu.
Contact Management Guide Describes how to configure Guidewire InsuranceSuite applications to integrate with ContactManager
and how to manage client and vendor contacts in a single system of record. The intended readers are
ClaimCenter implementation engineers and ContactManager administrators.
Best Practices Guide A reference of recommended design patterns for data model extensions, user interface, business
rules, and Gosu programming. The intended readers are configuration engineers.
Integration Guide Describes the integration architecture, concepts, and procedures for integrating ClaimCenter with
external systems and extending application behavior with custom programming code. The intended
readers are system architects and the integration programmers who write web services code or
plugin code in Gosu or Java.
Java API Reference Javadoc-style reference of ClaimCenter Java plugin interfaces, entity fields, and other utility classes.
The intended readers are system architects and integration programmers.
Gosu Reference Guide Describes the Gosu programming language. The intended readers are anyone who uses the Gosu
language, including for rules and PCF configuration.
Gosu API Reference Javadoc-style reference of ClaimCenter Gosu classes and properties. The reference can be generated
at any time to reflect the current ClaimCenter configuration. The intended readers are configuration
engineers, system architects, and integration programmers.
Glossary Defines industry terminology and technical terms in Guidewire documentation. The intended readers
are everyone who works with Guidewire applications.
Conventions in this document

Text style Meaning Examples
italic Indicates a term that is being defined, A destination sends messages to an external system.
added emphasis, and book titles. In Navigate to the ClaimCenter installation directory by running the
monospace text, italics indicate a variable to following command:
be replaced.
cd installDir
bold Highlights important sections of code in for (i=0, i<someArray.length(), i++) {

examples. newArray[i] = someArray[i].getName()
}
narrow bold The name of a user interface element, such Click Submit.
as a button name, a menu item name, or a
tab name.
monospace Code examples, computer output, class and The getName method of the IDoStuff API returns the name of the
method names, URLs, parameter names, object.
string literals, and other objects that might
appear in programming code.
monospace italic Variable placeholder text within code Run the startServer server_name command.
examples, command examples, file paths, Navigate to http://server_name/index.html.
and URLs.
Support
For assistance, visit the Guidewire Community.
24 About ClaimCenter documentation
Guidewire Customers
https://community.guidewire.com
Guidewire Partners
https://partner.guidewire.com
About ClaimCenter documentation 25

26 About ClaimCenter documentation

part 1
Introduction
chapter 1
Introduction to ClaimCenter
ClaimCenter is a web-based enterprise software application designed to manage the process of reporting, verifying,
and making payments on claims against a policy. It manages the claims process from first notice of loss through
execution of financial transactions, including the payment and setting of reserves. This insurance claims
management system also manages claims information and coordinates the claims process to ensure compliance with
corporate policies and claims best practices. ClaimCenter functionality includes:
• Group-based ownership of claims and claim subobjects – Enables assignment of objects to users based on the
group they are in, as well as user access to an object based on who owns the object.
• Claim maturity – A set of rules that automatically manage the claim's maturity level. Particular attention is paid
to whether the claim can be paid out or not and whether activities are prevented if the claim is not yet payable.
• Claim financials – Enables management of the finances involved in a claim. Financials include setting aside
money for expected payments (reserves), issuing payments (checks), tracking recovery opportunities, and
requiring approval for financial activity in excess of a given user's authority.
• Address book integration – Enables sharing of vendor contact information across claims. If PolicyCenter is
installed and integrated, you can also manage client contact information in a central address book database.
Guidewire provides an address book application called ContactManager that can be integrated with ClaimCenter.
For more information, see the Guidewire Contact Management Guide.
• Workspace to manage claims process – Adjusters and supervisors use a workspace to manage the claims
process, whether they are connected to or disconnected from the corporate network. Many routine tasks are
automated.
• Distributed collaboration – ClaimCenter manages distributed participants such as fraud investigation units, auto
repair shops, and claimants.
• Activity coordination – Adjusters and supervisors manage activities on open claims being managed by a group
of adjusters at any given time. ClaimCenter tracks critical activities and coordinates the distribution of work on a
claim across people inside and outside the organization.
• Worker and claim management – ClaimCenter ensures that supervisors are aware of claims and activities in
their groups in real time.
Introduction to ClaimCenter 29
Claim Management Process

ClaimCenter guides you through these types of activities:
• First Notice of Loss (FNOL) – You can enter initial claim information directly into ClaimCenter through the
New Claim wizard or enter it into an external system and import that information into ClaimCenter. External
systems include call centers or a third-party, outsourced system.
• Claim Setup – After you enter claim information into ClaimCenter, the system runs business rules to segment
and assign the claim. The business rules also assign initial activities for handling the claim. This initial workplan
of activities establishes initial priorities in conformity with best practices and provides adjusters with a starting
point for their work.
• Claim Management - Investigation and Evaluation – You can plan, investigate, and evaluate steps in the claim
management process. Adjusters can record their investigative notes, collaborate with other adjusters and internal
experts, and view high priority or overdue claims.
• Payment and Recovery – Use ClaimCenter to track claim reserves, payments, and any salvage or subrogation
activities.
• User Management – Administrators can create groups and teams of users, and provide them and other users
with passwords, permissions, and authority limits.
• Catastrophe Management – You can assign catastrophes to claims as well as search and assign those claims to
catastrophes after claim creation.
• Fraud – ClaimCenter contains several mechanisms that help identify potential fraud.
• Litigation and Negotiation – The Plan of Action section of a claim is useful for identifying strategies in
negotiating a claim.
• Property and Vehicle Assessment – ClaimCenter contains an assessment section that stores and evaluates
assessment information in one location.
• Subrogation – ClaimCenter handles subrogation in auto and property claims.
ClaimCenter Users
ClaimCenter has several types of users who address the claim’s process. The following table lists typical
ClaimCenter users and their roles in the base configuration.
Users Typical activities

Customer Service • Create and work on claims, bulk invoices, and new exposures.
Representatives • Typically collect basic information prior to establishing that coverage exists.
(CSRs) or FNOL
technicians
Adjusters There can be several adjusters and types of adjusters that work on a claim, each with various roles and
responsibilities. For example, one can be the claim owner, another can own several exposures or
activities, and another adjuster can have the role of subrogation owner. Adjuster activities can include:
• Creating, editing, and closing claims
• Working on exposures, activities, and matters
• Editing policies
• Working on bulk invoices
• Transferring checks
• Creating evaluations
• Generating manual payments
• Working on payments, recoveries, and recovery reserves
30 chapter 1 Introduction to ClaimCenter

Users Typical activities

Managers • Members of a group who are responsible for occasionally knowing about or doing work that is
assigned to another member of the group.
• Can access any object that any member of the group can access.
• View summary information on the Team tab about objects assigned to users in a group.
• A group can have zero, one, or many managers.
Supervisors • Assigned to one or more groups, supervisors are responsible for ensuring that the group's work is
completed as efficiently as possible. They must have the supervisor role, which contains the
permissions appropriate to doing the work of a supervisor.
• Listed as the supervisor for one or more groups.
• Access any object that any member of the group can access.
• View summary information about objects assigned to users in a group.
• Assign Pending Assignment claims. The Pending Assignment link on the left pane in the user interface is
visible only to group supervisors.
• Attend to escalated activities or transactions that are pending approval.
• Can remove flags from a claim.
• A group must have one and only one supervisor.
Reinsurance Manage the reinsurance reportable thresholds and reinsurance processes.
Managers
Litigation specialists Typically, the in-house legal staff that works on legal matters.
Subrogation • Review and evaluate complex collision liability claims to identify subrogation potential.
specialists • Recover monies paid for damages from responsible parties such as uninsured or underinsured
motorists and other carriers.
Salvage specialists • Assist insureds in processing their total loss claim, including mailing or collecting all necessary
paperwork and issuing any necessary payments.
• Issue settlements to lien holders and insureds.
• Monitor the sale of salvage, and post proceeds to the claim file.
• Coordinate the sale of all property assigned to the carrier as a result of settlement of a physical
damage and a total loss claim.
• Review all incoming salvage paperwork for accuracy
ClaimCenter Users 31
32 chapter 1 Introduction to ClaimCenter

chapter 2
Claims Overview
To insurance carriers, a claim is a collection of all the information related to an accident or loss of some kind. A
ClaimCenter claim is analogous to a physical claim file that collects and records in one place all the information
relating to the claim. Unlike a physical file, a ClaimCenter claim also records and tracks the progress of all work
involved in handling the claim.
This topic briefly introduces you to the features of ClaimCenter.
Claim Contents
Every claim is a collection of the following screens and sections of screens:
• Summary – Lists the most salient information about the claim. See “Claim Summary Screens” on page 35.
• Workplan – Shows initial activities and grows to include all activities created for the claim. See “Workplan
Screen” on page 36.
• LossDetails – A description of the types of losses, including vehicles, properties, injuries, and the causes of the
losses. These screens also include claim associations, damage assessments, subrogation, catastrophes, and fraud
detection information. See “Loss Details Screens” on page 36.
• Exposures – Screens correlating policy coverages with claimants. In a workers’ compensation claim, the exposure
screens are specific to this type of claim, like Medical Details, Time Loss, and so on. See “Exposures Screen” on
page 39.
• Reinsurance – If there is reinsurance for the policy, these screens show a summary of financial records for
reinsurance. See “Reinsurance Screen” on page 40.
• PartiesInvolved – All people, companies, users, vendors, legal venues and so on involved with the claim.
• All information related to the Policy associated with the claim. This includes general information such as the
policy number, policy type, and insured parties as well as information on associated endorsements and aggregate
limits. See “Parties Involved Screens” on page 40.
• Financials – An auditable record that includes checks, transactions, reserves, payments, recoveries, and recovery
reserves. See “Financials Screens” on page 47.
• Notes – All notes entered for the claim. See “Notes Screen” on page 48.
Claims Overview 33
• Documents – All documents that have been added to the claim. See “Documents Screen” on page 49.
• PlanofAction – Plans for evaluations and negotiations, useful for settling complex claims without resorting to legal
action. See “Plan of Action Screens” on page 49.
• Services – Includes information on all service requests associated with the claim and communicated to vendors.
See “Services Screen” on page 50.
• Litigation – A list of legal matters and pending litigation related to the claim. See “Litigation Menu Link” on page
50.
• History – A record of all claim events. See “History Screen” on page 51.
• FNOLSnapshot – Saved First Notice of Loss (FNOL) data that encapsulates the initial data entered for the claim.
See “FNOL Snapshot Screens” on page 51.
• Calendar – Current and upcoming events and activities. See “Calendar Screens” on page 52
Clicking the Claim tab takes you to the Summary screen, accessible from the sidebar by navigating to
Summary→Overview.
Other Aspects of Claims

ClaimCenter uses the following associated features to enable you to create and use claims:
• ClaimCenter tracks its users, how they work together in groups and queues, and how they receive work. This
tracking is useful because a claim is seldom handled by only one person. See “Users, Groups, and Regions” on
page 477.
• ClaimCenter assigns work by creating owners for claims, exposures, and other parts of a claim. It can use
attributes, such a location, proximity information, and user characteristics, to make these assignments. See “Work
Assignment” on page 203.
• The New Claim wizard facilitates the collection of all information when a claim is first reported. See “Claim
Creation” on page 85.
• ClaimCenter creates descriptions of each event concerned with the claim, and keeps them in separate Incidents.
An incident can be a general description of the loss, or center around each individual auto, piece of property, or
injured individual.
• Claims make use of complex financial features, such as multiple currencies and bulk invoices. See “Overview of
Multicurrency” on page 373 and “Bulk Invoices” on page 391.
• Create, track, and manage requests for claim services to be provided by vendors. See “Services” on page 413.
• Rate and select vendors based on their ratings by using service provider performance reviews. See “Service
Provider Performance Reviews” on page 169.
• Use the archiving feature to reduce the size of the active claims database and make it more manageable. See
“Archiving in ClaimCenter” on page 305.
• Work with the security features for contacts and many aspects of claim information. See in “Security: Roles,
Permissions, and Access Controls” on page 487.
• Use business rules and workflows to define your own business model. See the Rules Guide.
• View statistics for each user, including how many claims and activities have been recently opened and closed.
Supervisors can see these statistics for their teams as well. See “Dashboard” on page 451.
• With administrative permissions, find users, edit permissions, set claim metrics, manage catastrophes, and
perform other administrative functions. See “Administration Tasks” on page 511.
• Work with users, parties involved in claims, companies and vendors, and legal venues. ClaimCenter can integrate
with ContactManager to provide full, centralized contact management for vendors and claim contacts. See the
“Administration Tasks” on page 511.
•
34 chapter 2 Claims Overview

Claim Summary Screens

In the base configuration, the default view of a claim is the Summary screen, which you see when you open a claim.
You can also navigate in the sidebar to Summary→Overview to open this screen.
In addition to the Summary overview screen, there are Claim Status and Claim Health Metrics screens that enable you to
quickly surmise the condition of the claim. Navigate to Summary→Status or to Summary→Health Metrics to open these
screens. See “Claim Status Screen” on page 436 and “Claim Health Metrics” on page 432.
The Summary overview screen provides common information that applies to all exposures in the claim. Initially, all
work to verify policy coverage and the basic facts of the incident is centralized with a single adjuster. Eventually, the
work for investigating separate exposures is often divided among specialists, making the information provided on
the Summary screen useful for seeing who is responsible for which areas. The Summary screen shows the facts of the
incident and related policy information, including limits that apply across all payments for a single incident.
The claim Summary screen has the following sections:
• Claim Headline – Basics, Financials, and High-Risk Indicators that apply to the claim. See “Claim Headline” on page
36.
• Loss Details – A summary of information about the losses reported for the claim, including the loss date, when the
loss was reported, the location, and a description of the loss.
• Services – A list of current vendor service requests associated with the claim.
• Exposures – The type, coverage, claimant, adjuster, status, and financial summary information for each exposure.
• Parties Involved – A list of contacts related to the claim and the roles those contacts have for the claim.
• Planned Activities – A list of the most urgent claim activities that need to be completed by users working on the
claim.
• Litigation – A list of all legal matters related to the claim.
• Associated Claims – Other claims that have the same insured, claimant, or damaged property or vehicle.
• Latest Notes – The notes most recently entered about the claim.
Viewing Details of Summary Screen Sections

In general, to view details of each Summary screen section, click the menu link with a similar name in the sidebar
menu, on the left side of the screen. The screens for some sections are listed under other menu links. To see Planned
Activities, use the Workplan menu link. To see Associated Claims, navigate to Loss Details→Associations.
For example, the Workplan screen shows more detail about each activity than Planned Activities, including:
• External – Whether the activity is completed by someone employed by the carrier or not.
• Ext Owner – The name of the outside, external owner of the activity.
• Assigned By – The ClaimCenter user who assigned the work.
• Assigned To – The ClaimCenter user who must complete the work.
Claim Summary Screens 35

See also
• “Workplans and Activity Lists” on page 233
Claim Headline
The claim Summary screen provides a picture of the most important aspects of a claim’s overall condition. Using a
combination of summary text and icons, it provides details that answers questions such as:
• Basics – How long has the claim been open? Is this within an acceptable range? What happened?
• Financials – What is the total incurred amount of this claim? How much has the carrier paid? Has the deductible
for the claim been paid, if applicable?
• Risk Indicators – What are the risks associated with this claim? Answers can include if the claim is in litigation or
has been flagged.
Additional claim details are also visible such as loss details, exposure statuses, and recent notes entered by claim
handlers. The claim headline is one way to monitor the status of the claim and is part of the ClaimCenter Claim
Performance Monitoring strategy. See “Claim Performance Monitoring” on page 431.
Activities
Activities are the tasks to be performed in handling a claim. Examples include inspecting a vehicle, reviewing
medical information, negotiating with the claimant, and making payments. ClaimCenter tracks all activities.
Supervisors use activities to identify problem claims and to assign workloads based on the number of activities of
each team member. For example, an adjuster with many overdue or escalated activities might be overworked and
need to have activities reassigned to another adjuster.
You can generate and assign an activity either manually or automatically. Automatic generation and assignment uses
business rules and activity patterns to assign work to users based on their workloads, special skills, or locations.
See also:
• “Activities as Tasks” on page 226
• “Elements of an Activity” on page 226
• “Creating Activities” on page 227
• “Assigning Activities” on page 228
• “Completing or Skipping Activities” on page 229
• “Activity Escalation” on page 232
• “Activity Statistics” on page 232
Workplan Screen
The Workplan includes all activities. It does not matter whether they are completed or assigned to a specific user.
The Workplan screen provides a view of what remains to be done and a history of what has been done with a date.
The entries on this screen are activities identical to those on the adjuster’s activities list, except that they are
collected to show all activities specific to a given claim.
Click Workplan in the sidebar to view and manage activities. To view or edit the details of an activity, exposure or
involved party, select the corresponding subject, which is underlined.
See “Workplans and Activity Lists” on page 233.
Loss Details Screens

The Loss Details screen of ClaimCenter displays the information typically gathered during the first call from a
claimant. It also contains various sections of standard claim information. To modify the information listed, click Edit.
Note: In the workers’ compensation line of business, the Medical Details pages contain medical information that is
relevant to the claim.
On the Loss Details screen, you can work with some of the following features:
• Assessments – Select a vehicle or property incident listed on the Loss Details screen and then click the Assessments
card for the item you clicked. See “Assessments” on page 151.
• Catastrophes – When you edit the Loss Details screen, Catastrophe is a field in the Loss Details section. To associate
the claim with a catastrophe, select one from the Catastrophe drop-down menu. See “Catastrophes and Disasters”
on page 157.
• Subrogation – The Loss Details screen is often where you start a subrogation. Click Edit and then set the Fault Rating
field either to Other party at fault or to Insured at fault. If you set it to the latter, set the Insured’s Liability %, which then
displays just below, to less than 100%. See “Subrogation” on page 289.
You can also open the following screens under the Loss Details menu link in the sidebar:
• Claim Associations – Navigate to Loss Details→Associations to open this screen. See “Claim Associations” on page
37.
• Special Investigation Details – Navigate to Loss Details→Special Investigation Details to open this screen. See “Fraud—
Special Investigation Details” on page 38.
Claim Associations
Claims are not always completely independent. One claim can be related to others, and it is often useful to associate
such claims with one another. For example:
• Many claims can result from the same root cause – For example, after a catastrophe or damage to a roadway
occurs, a carrier might receive multiple claims due to the same underlying event.
• Claims can have the same person as the insured and the claimant – The same auto incident can affect the
insured’s auto and another vehicle or property that is covered by the same insurance company. Both drivers can
file first person or third person damage claims, or both.
• Multiple claims from the same claimant could represent fraud – An SIU team might want to associate all
claims made by the same person as part of their investigation.
• The same incident can result in multiple claims – For example, if the carrier insures both a hotel and a
restaurant in the hotel, a fire can cause two related claims.
• The same incident can result in parent and child claims – For example, an insured can have both an auto and
umbrella policy with the same carrier, and can file claims under both policies for the same incident.
• Litigation can involve related claims – Associating claims based on the same incident can assist lawyers in
looking for different sets of facts.
Open a claim and navigate to Loss Details→Associations to associate one claim with others. The screen shows a table
of claims that are associated with each other. For each claim, it shows:
• Title – A unique name that you give to a group of associated claims. For example, if your association is for all
claims involving one particular vehicle, you might use the vehicle name.
• Type – The kind of association, from the ClaimAssocType.ttx typelist. You can edit this typelist in Guidewire
Studio to add your own associations. In the base configuration, the typelist provides association typecodes like
the following:
◦ General – A placeholder for your own category of association.
◦ Event-related – One event, such as catastrophe or multi-car accident, associates all the claims.
◦ Parent/child – A group of policies associate the claims. The master policy might be an umbrella, and there can
be child claims from related auto and injury policies.
◦ Prior claims – An association of all claims by the same claimant, or concerning the same vehicle.
◦ Reinsurance-related – Claims related by reinsurance.
• Description – A free-form text entry box associated with the association of this claim.
Loss Details Screens 37
• Claims – The list of all claims having the name of that association.
◦ Primary – Select one claim in each association as the main one. ClaimCenter does not further use this
information.
The Associations section provides a button bar with the following buttons:
• New Association – Create a new association between claims.
• Delete – Remove the checked claims for the association.
• Find Association – Search for existing claims by claimant, number, or loss date, or search for an association by
name.
Create a New Association with the Current Claim
Procedure
1. With the claim open, navigate to Loss Details→Associations.
2. Click New Association, and then click Add to add a claim.
3. Use the search icon in the Claim field to locate each claim, and click Select in the search results for the claim.
4. Enter a new or existing Title, Type, and Description, optionally check Primary for one of the claims.
5. Click Update.
Delete a Claim from an Association
Procedure
1. Navigate to Claim→Loss Details→Associations.
2. Select an association, and then click Edit.
3. In the list of claims, select the check box for the claim you want to remove from the association.
4. Click Remove, and then click Update.
Next steps
When an association contains just two claims, you cannot delete one because an association must contain at least
two claims. If you delete the Primary claim, you must mark another claim Primary to enable the delete.
Delete an Entire Association
Procedure
1. Navigate to Claim→Loss Details→Associations.
2. Select the check box for the association you want to remove, and then click Delete.
Find an Association
Procedure
1. Navigate to Claim→Loss Details→Associations→Find Association.
2. On the Association Search screen, search by association title, claim number, loss date, insured name, or
organization name.
Fraud—Special Investigation Details

Fraudulent claims are a continuing problem for all who handle them, and identifying suspicious claims can be
difficult. Too often, flagging a suspicious claim is left to ad hoc processes that might be different for each adjuster.
ClaimCenter provides a mechanism to help you determine when to further investigate a claim.
With the claim open, navigate to Loss Details→Special Investigation Details and fill out the questionnaire. See “Claim
Fraud” on page 143.
Incident Tracking
ClaimCenter tracks incidents, such as issues or accidents, that can result in claims. Some examples include:
• You are in an automobile accident and have filed a claim with your insurance company.
• Your customer slips and falls at your store but has not yet filed a claim. You contact your insurance carrier
anyway so that the incident is recorded with them.
For more information, see “Incidents” on page 247.
Exposures Screen
An exposure, one of the liability items of a claim, associates a claimant with a particular policy coverage. Each
exposure on a claim relates one claimant to one coverage and one coverage subtype. Different exposures on a claim
always have a different combination of a claimant, coverage, and coverage subtype. For example, in an auto
accident claim, you could have multiple exposures for a damaged vehicle with the same coverage and claimant, but
with different coverage subtypes.
In the base configuration, one exception to this constraint would be in claims involving third-party damages, where
it is possible to have multiple liability exposures with the same parameters. For example, consider a collision
involving multiple vehicles, where two cars are owned by the same third party. In such cases, ClaimCenter extends
the uniqueness constraint to include incidents as well. In other words, no two liability exposures on a claim can have
the same claimant, coverage, coverage subtype, and incident combination.
The following table summarizes the two types of constraints:
Exposure Type Constraint

Liability Claimant
(third-party claims) Coverage
Coverage Subtype
Incident
All other exposures Claimant
Coverage
Coverage Subtype
ClaimCenter uses exposures as the basic unit to capture potential loss and tracks financial details by exposure. This
uniqueness constraint on exposures is imposed to prevent duplicating exposures. It can, however, be configured
using the ExposureDuplicateChecker class file.
The Exposures screen enables you to Assign, Edit, and Close exposures and create reserves for them.
The following columns can be enabled in the Exposures screen:
• # – A unique number identifying the exposure in the claim.
• Type – The type of exposure, such as Vehicle or Bodily Injury
• Coverage – The related coverage type for the exposure, such as Collision, Medical payments, or Liability - Bodily
Injury and Property Damage.
• Claimant – The name of the claimant for the exposure, not necessarily the same as the claimant for the overall
claim.
• Adjuster – The adjuster in charge of processing the exposure, not necessarily the same as the adjuster for the
overall claim. Individual exposures in a claim can be assigned to different people. While there is always one
Incident Tracking 39
main adjuster in charge of the whole claim, there can be different people managing individual exposures of the
claim.
• Status – The status of the exposure, such as Draft, Open or Closed.
• Remaining Reserves – The related reserve liability amount allocated for the exposure.
• Future Payments – The amount planned to be paid out for the exposure.
• Paid – The amount already paid out for the exposure.
The Exposures screen also has a button bar that provides the following buttons for processing exposures:
• Filter – Show the exposure list by all claimants or by individual claimant.
• Assign – Assign ownership of the exposure to someone else.
• Refresh – Show the latest list of exposures.
• Close Exposure – Mark the selected exposure as closed.
• Create Reserve – Create a new reserve for the selected exposure.
Reinsurance Screen
The Reinsurance menu link is available if there is reinsurance for the policy associated with the claim. ClaimCenter
provides visibility into reinsurance agreements and financials to users in the Reinsurance Manager role or with
riview permissions. To access the Reinsurance Financials Summary screen, open a claim and click Reinsurance in the
sidebar.
The Reinsurance Financials Summary screen helps identify agreements applied to a claim, their ceded reserves, and their
reinsurance recoverables. For more information on this screen, see “Working with Reinsurance Agreements and
Transactions” on page 470.
Parties Involved Screens

Parties involved are all the people and organizations associated with the claim. Involved parties are divided into two
categories, contacts and users. The Parties Involved menu link, available in the sidebar when a claim is open, by
default opens the Contacts screen. You can work with users by clicking the User menu link. The two screens are:
• Contacts – People, companies, vendors, or legal venues associated with the claim. Contacts do not directly use
ClaimCenter. Use this screen to add contacts to the claim, remove them from the claim, and update contact
information.
• User – Anyone interacting with ClaimCenter is a user. Claim users either have work assignments on the claim or
have user roles on the claim. Use this screen to manage the users who work with the claim.
Contacts Screen
The Contacts screen lists all the contacts associated with the claim and shows the role each contact has on the claim.
With the claim open, you get to this screen by clicking PartiesInvolved in the sidebar. For example, the contacts can
include the insured, the claimant, the people involved in an accident, experts, witnesses, and vendors associated with
the accident, like an auto repair shop. To associate a contact with a claim, each contact must have at least one role on
the claim.
• The upper part of this screen is a filtered list of contacts and a set of buttons for adding and removing contacts.
• The lower part of the screen provides a detailed view of one selected contact.
Contacts Screen: Contact List and Adding and Removing Claim Contacts
The upper part of the Contacts screen provides both a list of contacts and a filter and a set of buttons you can use to
add and remove contacts.

The upper part of the screen provides the following field and buttons:
• Filter – Use this drop-down list to limit contacts shown. Choices include:
◦ Claim – Covered parties on the claim
◦ Contacts related to an exposure of the claim
◦ Primary roles – Contacts in primary roles like Claimant, Covered Party, Insured, and Main Contact
◦ Secondary roles – Contacts in secondary roles like Driver
◦ Litigation roles – Contacts in litigation roles
◦ Vendors – Contacts providing services for the claim, like auto body repair or doctor
◦ “Former” roles – Contacts in roles that no longer exist.
• New Contact – Create a new contact. Submenus enable creation of a person, vendor, company, or legal venue.
• Add Existing Contact – If ContactManager or another contact management system is integrated with ClaimCenter,
you can search the Address Book for a contact to add to the claim. See the Guidewire Contact Management
Guide.
• Delete – Remove a contact from the claim, including all its contact roles. You must first select the contact’s check
box. This action does not remove a linked contact from ContactManager.
The list of contacts has the following columns:
• Name – The name of the contact related to the claim.
• Roles – The relationship of the person to the claim, such as claimant or witness, from the ContactRole.ttx
typelist.
• Contact Prohibited? – A Boolean field indicating whether you can communicate with the contact.
• Phone – Telephone number of the contact.
• Address, City, State, ZIP Code – Address information for the contact.
Contacts Screen: Contact Details

The lower part of the Contacts screen shows the details of the currently selected contact in the following cards:
• Basic – A summary of the most important details.
• Addresses – The contact can have multiple ways to be contacted. This card shows them.
• Documents – This card is visible only if the contact has its Vendor tag set and the contact is stored in
ContactManager. It shows documents that have been attached to a vendor contact in ContactManager. These
documents are independent of claim documents and are maintained separately for the vendor contact in
ContactManager. You can view document contents and metadata properties for any document in the list. You
cannot edit vendor documents in ClaimCenter.
Note: If there are documents that you know are attached to a vendor, but they are not showing up in the list in
ClaimCenter, the documents might be hidden in ContactManager. Additionally, a document might have a
security type that limits who can see it, like Sensitive Document. In that case, the ClaimCenter user must be in a
role that can view these kinds of documents, such as a role with the docviewall permission.
• Related Contacts – You can add any other contacts and describe the relationship in any way you like. Common
uses are the spouse of a witness, the guardian of a minor, and the company representative of a contact that is a
company.
Note: You can also see this detail view when selecting a contact in the Address Book or the New Claim wizard.
The Basics card provides the following buttons for managing contacts, the first two of which are also on the
Addresses and Related Contacts cards:
• Edit – Edit the contact’s information. This button is also on the Addresses and Related Contacts cards.
• Link/Unlink – Either link the contact to an external contact management system, such as ContactManager, or unlink
it—disconnect the contact from that system. This button is also on the Addresses and Related Contacts cards.
Parties Involved Screens 41

When a contact is not linked, you see the Link button and a text message indicating that the contact is not linked.
When a contact is linked, you see the Unlink button and a text message indicating the status of the contact in the
external contact management system.
◦ Clicking the Link button stores the contact in the external system and changes the button to Unlink. Linking a
contact enables ContactManager to manage the contact data. ContactManager sends updates to ClaimCenter if
the data or status of the contact changes. ClaimCenter sends contact changes made in ClaimCenter to
ContactManager.
◦ Clicking the Unlink button removes the link, making the contact locally stored, and changes the button to Link.
◦ Transfer roles from other contacts – Opens a screen for the current contact in which you can transfer claim roles
from other parties on the claim and then remove those contacts from the claim.
See also
• “Merging Contact Roles” on page 46
• Guidewire Contact Management Guide
Users Screen
Users are people who have access to ClaimCenter, such as an employee of your company. A user has access to a
specific claim if either of the following is true:
• Some work on the claim has been assigned to the user.
• A user role has been given to the user for this claim.
The Claim→Parties Involved→Users screen lists the ClaimCenter users that are related to the claim. For example, one
person can be the primary adjuster, and another can be the subrogation owner.
The Users screen provides the following information for each user:
• Name – The name of the ClaimCenter user related to the claim.
• Group – The ClaimCenter business group to which the person belongs.
• Assignments – The exposures to which the relationship applies if the relationship does not apply to the entire
claim.
• Roles – The relationship of the person to the claim, such as adjuster.
• Phone, Email – Phone number and email address of the user.
This screen also has a button bar with the following buttons for managing users:
• Add User – Add a new user to the claim.
• Remove User Roles – Remove the roles from the selected user. You can add new roles for the user in the User Details
view.
Working with Contacts and Users

Users are people who have access to ClaimCenter. Typically they are employees of your company. In the base
configuration, information about users is managed and stored in ClaimCenter and not in a contact management
system. It is possible to extend ClaimCenter to integrate with your human resources database, where centralized data
about users can be stored.
• You add users to and remove them from claims in a claim’s Parties Involved→Users screen. See “Adding a User to
a Claim” on page 45.
• You create, edit, and manage users in Administration tab screens. See “Manage Users” on page 515.
You can work with contact information in a claim. If ContactManager or another contact management system is
integrated with ClaimCenter, you can search for existing contacts from a claim screen or in the Address Book.

You can create, edit, and delete contacts only in claim screens, such as the Parties Involved→Contacts screen or the
New Claim wizard
• If you create a new vendor contact or edit a contact that is stored in ContactManager, the changes are
automatically sent to ContactManager, and the contact becomes linked. The contact information might be put in
pending state in ContactManager, depending on your permissions, as described later.
• If you create a new contact that is not a vendor, such as a person who is a witness, the contact is not
automatically linked. You can click the Link button after creating the contact to send the contact data to
ContactManager.
ClaimCenter generates messages informing you of the contact’s link status.
Note: Some messages use the term Address Book, which means an external contact management system, like
ContactManager, that is integrated with ClaimCenter.
The status of the contact information in ContactManager depends on your contact and tag permissions, and on the
type of contact, as follows:
• Changes made to linked, non-vendor contacts are sent to ContactManager and take effect when ContactManager
receives them. These changes are never made pending. Non-vendor contacts can include clients and claim
contacts that are not vendors, such as witnesses.
• You are logged in as a user with contact and tag permissions, such as abedit and anytagedit. Vendor contact
changes for which you have permission are sent to ContactManager. These changes are applied immediately.
• You are logged in as a user who does not have contact and tag permissions for an operation on a vendor contact.
Your contact changes are sent to ContactManager, which puts the changes in Pending state. Pending contact
changes must be reviewed in ContactManager by a user who has the appropriate permissions.
Note: Searching from the Address Book works only if you have integrated ClaimCenter with ContactManager or
another contact management system. See the Guidewire Contact Management Guide.
Select a Contact or User
About this task

To select a contact from or a user assigned to an open claim:
Procedure
1. Navigate to Parties Involved, and select Contacts or Users.
2. Click the contact or user’s name.
Add an Existing Contact to a Claim
Before you begin

Ensure that ContactManager or another integrated contact management system is running.
About this task

You can add contacts in the New Claim wizard during the claim intake process, or you can add them after the claim
has been created. To add contacts to an existing claim, use the Parties Involved→Contacts screen.
Note: If you want to add an existing contact, ClaimCenter must be integrated with ContactManager or another
contact management system, and that contact management system must be running. See the Guidewire Contact
Management Guide.
To add an existing contact to an open claim:
Procedure
1. Navigate to Parties Involved→Contacts.
Working with Contacts and Users 43

2. Click Add Existing Contact.

The Search Address Book screen opens.
3. Search for the contact.
You can limit your search to include contacts that are pending creation or vendors offering specific services. If
you select Limittovendorsprovidingservices, the Services table is shown. Click Add to select specific services to
filter by.
4. In the search results, click Select for the contact you want to add.
An edit screen opens for the contact.
5. On the edit screen, add a claim role for the contact.
a. Under Roles, click Add.
b. Click the new Role field and choose a role from the drop-down list.
6. Click Update.
The contact is added to the list of contacts on the Contacts screen.
Create a New Contact for a Claim
About this task

To create a new contact, you can define a contact in the claim. Alternatively, if you have a ContactManager login,
you can open ContactManager from ClaimCenter, define the contact, and then add it to the claim.
To define a new contact in the claim:
Procedure
1. With the claim open, navigate to Parties Involved→Contacts.
2. Click New Contact and select the type in drop-down menu.
3. Enter your contact’s information.
4. Under Roles, click Add, and then click the new Role field and choose a role in the claim.
5. Click Update.
Define a New Contact in ContactManager
Procedure
1. Click the Address Book tab to open the Search Address Book screen.
2. Click Open Contact Manager.
ContactManager opens. You might have to log in to ContactManager. You might have to turn off or bypass
your browser’s popup blocker for this action to succeed.
3. In ContactManager, click the Actions button and choose the type of contact you want to create.
4. After you create the contact, return to the claim, and then add the contact on the Parties Involved→Contacts
screen. See “Add an Existing Contact to a Claim” on page 43.
Modifying a Contact in a Claim
About this task

You can change the information for a contact directly in the claim.
Procedure

2. Select a contact and click Edit.

3. Make your changes and click Update.
Where the changes are saved, either only in ClaimCenter or in both ClaimCenter and your contact
management system, depends on whether the contact is synchronized with the contact management system.
• If the contact is linked to the Address Book, at first you see a message saying that the contact is out of sync.
However, the changes are saved in ContactManager or your contact management system. You might have to
refresh your screen to see that the contact is linked with the new information.
• If the contact is not linked to the Address Book, you see a message to that effect. The contact information is
saved with the claim in ClaimCenter. If you want to save it in the contact management system, you can click
the Link button.
Adding a User to a Claim
About this task

You do not have the option of creating new users in a claim. You must add existing users from the claim screens.
To add a new user to a claim:
Procedure
1. With a claim open, navigate to Parties Involved→Users, and then click Add User.
2. Enter a name or partial name and click Search.
3. Click Select for the user you want to add.
4. Under Roles, click Add and then click the Role field and choose a role for the user in the claim.
5. Click Update.
Remove a Contact from a Claim
About this task

If a contact is no longer connected with a claim, you can remove the contact from the claim. For example, a contact
with the role of nursing supervisor has completed work on medical treatment for a claimant and no longer needs to
be contacted.
Removing a contact from a claim deletes only the record that ClaimCenter stores for that contact with this claim.
This action does not affect information in the Address Book or in other claims that might use the same contact.
To remove a contact from a claim:
Procedure
2. Select the check box for the contact and click Delete.
Remove a User from a Claim
About this task

If a user is no longer connected with a claim, you can remove the user from the claim. Removing a user from a claim
affects only the claim roles that user had on the current claim. It does not change any other information stored for the
user, like the user’s roles in the company or the groups the user belongs to.
To remove a user from a claim:
Before removing a user from a claim, if necessary, reassign all the user’s work on the claim to another user.
Working with Contacts and Users 45

Procedure
1. With the claim open, navigate to Parties Involved→Users.
2. Select the check box for the user and click Remove User Roles.
Merging Contact Roles
About this task

The data on a claim regarding the contacts who are involved and how they are involved can come from different
sources at different times, or from different systems. For example, the claim might show two contacts named Mike
Smith. The first contact is listed as the insured and driver, and the second contact has the role of lienholder. At first,
you might not know if these names are the same person. The lienholder's full name might be Mike Smith, Senior,
and the insured and driver might be Mike Smith, Junior, and they are different people.
If you find that two or more contacts are the same, you can consolidate the claim contact roles into a single contact.
This contact will have all the roles of the previous contacts.
Note: Merging contact roles affects the claim roles for contacts in the current claim. Merging roles does not change
any other contact data, although it does result in removing one or more contacts from the claim. See “Remove a
Contact from a Claim” on page 45. Additionally, merging contact roles is not the same as merging contacts. For
information on merging contacts, see the Guidewire Contact Management Guide.
To transfer roles to a contact:
Procedure
1. With a claim open, navigate to Parties Involved→Contacts.
2. In the list of contacts, click the contact to which you want to transfer claim roles, the target contact.
This contact is highlighted after you click it and you see the contact’s data in the Basics card.
3. Click Transfer roles from other contacts.
The Transfer Roles screen opens. On this screen, you see the target contact, and you can select the contacts who
will have their roles transferred.
4. Select the contacts whose roles are to be transferred and click Select.
The contacts you selected appear below the Remove button.
5. To exclude a contact that you previously selected, click the check box for the contact in this list and click
Remove.
When you have selected all the contacts whose roles you want to transfer, you can click Transfer Roles to
continue the operation or Cancel to cancel it.
6. Click Transfer Roles to transfer the roles to the target contact and delete the contacts whose roles are to be
transferred.
ClaimCenter opens a confirmation dialog telling you the roles that will be transferred, the contact that will
receive them, and the contacts that will be deleted if you continue.
7. Click OK to continue or click Cancel to return to the Transfer Roles screen.
Policy Screen
ClaimCenter retrieves policy information from an external policy administration system, such as Guidewire
PolicyCenter. The exact policy information that you see depends on the type of claim and the application’s
configuration. Policy data that is imported is considered a verified policy. You cannot edit a verified policy itself. If
there is additional information in the Policy section that is not part of the verified policy, that information is editable.
If you enter policy information manually into ClaimCenter, the policy is unverified. Until you import the policy
from the policy system, making the policy verified, there are limitations on what you can do with the claim.

See also
• For a description of how ClaimCenter works with policies, see “Working with Policies in Claims” on page 101.
• For a discussion on how ClaimCenter can integrate with PolicyCenter, see “Policy Administration System
Integration” on page 573.
Financials Screens
Financials screens show information on the financial transactions that are related to the claim. The screen can be a
read-only view of transactional information imported from an external financial system, or it can be editable
information managed in ClaimCenter. To access these screens, with a claim open, click Financials in the sidebar.
See also
• For an overview of how ClaimCenter uses financials, see “Claim Financials” on page 323.
• For information on how ClaimCenter handles multiple currencies, “Multiple Currencies” on page 373.
• For information on how to use bulk invoices in ClaimCenter, see “Bulk Invoices” on page 391.
• For information on how ClaimCenter handles deductibles, “Deductible Handling” on page 387.
Summary Screen
The Financials→Summary screen shows an overview of reserves, payments, recoveries, and total amount incurred for
the claim. You can use the View filter to see subtotals grouped by exposure, claimant, coverage, and other criteria.
This screen provides the following data for each summarized item:
• Open Recovery Reserves – Recovery reserves are estimates of how much money might be recovered from others in
settling the claim. Open recovery reserves are calculated by subtracting total recoveries from the total recovery
reserves. See “Recovery Reserves” on page 349.
• Remaining Reserves – The estimate of the remaining amount that the carrier still has to pay out for the claim. See
“Definitions of Reserve Calculations” on page 327.
• Future Payments – Amount that is scheduled to be paid at a future date. See “Payments” on page 332.
• Total Paid – Amount already paid out for the claim. See “Definitions of Total Incurred Calculations” on page 327.
• Recoveries – Amount of money collected to offset the claim payments, such as from salvage or subrogation. See
“Recoveries and Recovery Reserves” on page 348.
• Net Total Incurred – Amount of money the company currently expects to pay for the claim. See “Definitions of
Total Incurred Calculations” on page 327.
Clicking specific values on this screen drills down into more financial details. When multicurrency reserving is
enabled, you can view values on this screen using fixed or market exchange rates.
Transactions Screen
The Financials→Transactions screen lists all the individual financial transactions for the claim and provides the
following data for each transaction:
• Type – A filter that controls the type of transactions shown, such as reserves, payments, recoveries, or recovery
reserves.
• Amount – The amount of money involved in the transaction.
• Exposure – The exposure that is associated with the payment.
• Coverage – The policy coverage related to the transaction.
• Cost Type – The cost type associated with the transaction, such as claim cost, which applies across the entire
claim.
Financials Screens 47
• Cost Category – The cost category associated with the transaction, such as medical, auto body, baggage, property
repair, indemnity, and so on.
• Status – The status of the transaction, such as Submitted or Pending Approval.
See also
• “Transactions” on page 324
Checks Screen
This Financials→Checks screen lists the checks that have been generated for the claim and includes the following data
for each check:
• Check Number – The number that identifies the check.
• Pay To – The payee, the person or company to whom the check is payable.
• Gross Amount – The amount of the check.
• Issue Date – The date on which the check was issued.
• Scheduled Send Date – The date on which the check was sent or is scheduled to be sent to the payee.
• Status – The status of the check, such as Issued or Pending Approval.
• Bulk Invoice – The bulk invoice, if any, that the check is part of. See “Bulk Invoice Checks” on page 400.
See also
• “Checks” on page 338
New Claim Wizard

To open new claims, use the New Claim wizard. The screens of the wizard model the manner in which a caller
describes the loss, by dividing the claim into incidents. The wizard’s normal workflow conforms to the type of
claim, but allows for free navigation through its many pages.
Working with the New Claim Wizard

To access the New Claim wizard, navigate to Claim→New Claim.
The topic “Claim Creation” on page 85 describes in detail what information the wizard requests and requires. In
brief, the wizard:
• Models the natural flow of collecting First Notice of Loss (FNOL) information.
• Uses logically ordered steps, or pages.
• Has peripherally useful screens, like Parties Involved and Documents, that are not in the main wizard flow.
• Enables you to can jump between steps and non-step pages.
• In its default mode, is optimized for both personal auto and workers’ compensation, but can be configured for
any line of business.
• Uses incidents to organize Loss Details data by vehicle, property and injury.
• Enables you to pick subflows, such as first-and-final or auto glass, to further optimize the wizard’s flow.
• Provides quick navigation and data entry.
• Can be used by all levels of users.
Notes Screen
The Notes screen finds and displays notes entered by users as they perform work on the claim. The screen has a
search area at the top and shows search results—notes—at the bottom.

See also
• “Notes” on page 263
Documents Screen
ClaimCenter manages claim-associated documents. These documents can be either online documents, created within
ClaimCenter, or hard copies. For example, you can write and send the insured a letter to acknowledge the claim. Or
the claimant can email you a map of the loss location. You manage all these varieties of documents in ClaimCenter.
Use the Documents feature to:
• Create new documents, involving templates and optional approval activities.
• Store documents, both those you create and those received from other sources.
• Search for documents associated with a claim, and categorize them to simplify the searches.
• Link to external documents.
• Indicate the existence of documents that exist only in hardcopy.
• Remove documents.
• Associate a document with a single claim, exposure, or matter.
• Associate the creation of a document with an activity.
• Create and send a document while performing an activity.
• Create and send a document with rules or in workflows.
For details, see “Document Management” on page 587.
Plan of Action Screens

The Plan of Action screens of a claim, Evaluations and Negotiations, enable you to settle complex claims without
resorting to legal action. When you click Plan of Action in the sidebar, the Evaluations screen opens by default.
• Evaluations – Tracks the expected claim liabilities and helps you evaluate a claim’s possible, expected, and worst-
case cost scenarios. It helps you track both actual claim costs and possible punitive damage costs. Knowing the
potential financial exposure helps you to both negotiate a settlement and plan your response to any litigation.
• Negotiations – Helps you plan how you will discuss the claim when negotiating a settlement with the claimant or
representatives of the claimant.
Evaluations
Open an Evaluation
Procedure
1. With a claim open, navigate to Plan Of Action→Evaluations.
2. Select an Evaluation from the list.
Start a New Evaluation
Procedure
1. Open a claim.
2. Choose the path to access the Evaluations screen.
• Navigate to Plan Of Action→Evaluations and click New Evaluation.
• Select Action→New→Evaluation.
Documents Screen 49
Negotiations
View a Negotiation
Procedure
1. With a claim open, navigate to Plan Of Action→Negotiation.
2. Select a Negotiation from the list.
Start a New Negotiation
Procedure
1. Open a claim.
2. Choose the path to access the Negotiations screen.
• Navigate to Plan Of Action→Negotiations and click New Negotiation.
• Select Action→New→Negotiation.
Services Screen
The Services screen lists all service requests associated with the claim that have been sent to vendors. To open this
screen, with a claim open, click Services in the sidebar. You can select a service in the list to open its detail view.
The screen displays the following data summary for each service:
• Type – The service request type, such as Perform Service or Quote. Represented by an icon as described at
“Services List” on page 416.
• Status – The status of the service, such as Requested, Quoted, or Completed. Represented by an icon as
described at “Services List” on page 416.
• Service # – Unique number generated by ClaimCenter and assigned to the service request.
• Ref # – Number assigned by the vendor.
• Next Action – The next step to be taken to complete the service request.
• Action Owner – The party responsible for taking the next step, usually the adjuster or the vendor.
• Relates To – Specifies if the service request is associated with the entire claim or with a specific incident.
• Services – The kind of service requested, such as appraisal or plumbing repair.
• Vendor – The contact that will perform the service.
• Target– The estimated date for the next action to be completed.
• Quote – Price quoted to perform the service.
• Assigned To – The user responsible for monitoring the work of the service provider. Typically, this user is an
adjuster on the claim.
See also
• “Detail View of a Service” on page 417
• “Services” on page 413
Litigation Menu Link

For claims that involve legal action, the Legal Matters screen shows the legal matters that are pertinent to the claim. A
matter is the set of data organized around a single lawsuit or potential lawsuit. A matter includes information on the
attorneys involved, the trial details, and the lawsuit details.

See “Legal Matters” on page 253.
History Screen
The History screen provides an audit trail of actions taken on the claim. It records all the events associated with a
claim, including the viewing actions, tracking whenever a claim is viewed. See “Claim History” on page 133 for a
complete description of this feature.
History tracks the following for each event:
• Type – Indicates what happened to the claim, such as being viewed, an exposure being closed, an exposure being
reopened, a flagged indicator being set, and so on. Viewing events record every user that opens a particular claim.
These events are helpful in tracking whether an adjuster has been working on a claim enough or whether non-
authorized users have been viewing claims. For a full list of what can be recorded in the history, review the
HistoryType typelist in the ClaimCenter data dictionary.
• Related To – Whether the event occurred on the entire claim or a part of the claim such as an exposure.
• User – The user who triggered the event.
• Time Stamp – The date and time the event occurred.
• Description – A brief description of the event.
The History screen also has a button bar, containing the following buttons for managing history events:
• Filter – Show the history list by the type of event.
• Refresh – Show the latest list of history events.
See also
• “Claim History” on page 133
FNOL Snapshot Screens

After a claim is created in the New Claim wizard or imported as an FNOL into ClaimCenter from an external system,
ClaimCenter preserves a snapshot of the initial claim data. Subsequent changes to the claim in ClaimCenter do not
affect this snapshot, which always shows the claim data at the time it was first obtained by ClaimCenter.
Note: The EnableClaimSnapshot parameter in the Snapshot Parameters section of the config.xml file
determines whether these snapshots are visible in ClaimCenter.
The FNOL Snapshot menu link opens screens showing specific parts of a claim, Loss Details, Parties Involved, Policy,
Notes, Documents and Additional Fields. In the base configuration, when you have a claim open and click FNOL
Snapshot, the Loss Details screen for the snapshot opens.
The screens for the snapshot are:
• FNOL Snapshot→Loss Details
• FNOL Snapshot→Parties Involved
• FNOL Snapshot→Policy
• FNOL Snapshot→Notes
• FNOL Snapshot→Documents
See also
• “Loss Details Screens” on page 36
• “Parties Involved Screens” on page 40
• “Policy Screen” on page 46
• “Notes Screen” on page 48
• “Documents Screen” on page 49
History Screen 51
Calendar Screens
ClaimCenter provides a variety of calendars to help organize activities. The calendars show activities in monthly and
weekly views. You can navigate to the Calendar menu link from either the Desktop tab or the Claim tab. Additionally,
you can filter the activities and view activities from multiple users if you have supervisor permissions. See “Activity
Calendars” on page 237.

part 2
ClaimCenter User Interface

chapter 3
Navigating ClaimCenter
This topic describes how to access ClaimCenter and provides instructions on how to navigate the user interface.
Logging in to ClaimCenter
About this task
You log in to ClaimCenter by running the application and logging in with your user name and password.
ClaimCenter Login Requirements

Logging in to ClaimCenter requires the following:
• A web browser – For example, Firefox, Chrome, or Internet Explorer.
• The URL (web address) for connecting to ClaimCenter – You can set up a Favorite link to the URL or create a
shortcut on your computer desktop that starts a web browser with that URL.
• A user name and password – You must have one or more roles assigned to your user name by a system
administrator. Roles determine the pages you can access and what you can do in ClaimCenter.
Because ClaimCenter generates pages dynamically:
• You cannot create Favorites to pages other than the login page.
• The Back button of the browser is not supported. If you use the Back button, you will exit ClaimCenter. If you are
in Edit mode, the application displays a warning that you might be exiting ClaimCenter.
Log in to ClaimCenter
Procedure
1. Launch ClaimCenter by running a web browser and using the appropriate web address, such as:
http://localhost:8080/cc/ClaimCenter.do
2. Enter your User Name and Password on the login page.
Navigating ClaimCenter 55
Result
If your login is successful, ClaimCenter displays your startup view or landing page. In the default configuration,
ClaimCenter initially opens the Activities page on the Desktop tab. This page lists all open activities that have been
assigned to you.
Setting ClaimCenter Preferences

You can change your preferences, which include your password, startup view, regional formats, default country and
phone region and entries in the recent claims list.
Change Your ClaimCenter Password

Procedure
1. Click the Desktop tab.
2. Select the Actions menu on the left and click Preferences.
The Preferences worksheet appears below the main work area.
3. Enter your OldPassword.
4. Enter the NewPassword.
5. Enter the new password again in the Confirm New Password field.
6. Click Update.
Change Your ClaimCenter Startup View

About this task
In the base configuration, ClaimCenter opens with the Activities page on the Desktop tab. This page lists all open
activities that have been assigned to you. You can optionally change your default view and the number of recent
entries in the claims list. For example, if you are a supervisor, you might prefer to see the Team page first.
Procedure
1. If necessary, click the Desktop tab.
2. Select the Actions menu in the left pane and click Preferences.
3. In the Preferences worksheet, select a different Startup View.
4. In the base configuration, Entries in recent claims list is empty, but you can optionally enter a number. If you
leave this field empty, the number of claims shown in the list of recent claims is 10.
5. Click Update.
Change the ClaimCenter Regional Format

Procedure
The Preferences worksheet opens below the main work area.
3. Select a format from the Regional Formats drop-down list.
4. Click Update.
56 chapter 3 Navigating ClaimCenter

Change the ClaimCenter Default Country

Procedure
3. Select a Default Country.
4. Click Update.
Change the ClaimCenter Default Phone Region

Procedure
3. Select a Default Phone Region.
4. Click Update.
Next steps
See also
• “Preferences” on page 512
Viewing ClaimCenter Statistics

It is possible to see the status of your activities and claims by clicking the Desktop tab and navigating to
Actions→Statistics. The information that you see in the Statistics screen varies by role. If you log into ClaimCenter as
a supervisor, the screen provides additional information related to team statistics.
The Statistics batch process updates the data shown on the Statistics screen. In the base configuration, Guidewire
schedules this process to run every hour at 3 minutes after the hour.
Setting ClaimCenter Preferences 57

See also
• System Administration Guide
Selecting language and regional formats in ClaimCenter

In Guidewire ClaimCenter, each user can set the following:
• The language that ClaimCenter uses to display labels and drop-down menu choices.
• The regional formats that ClaimCenter uses to enter and display dates, times, numbers, monetary amounts, and
names.
You set your personal preferences for display language and for regional formats by using the Options menu at
the top, right-hand side of the ClaimCenter screen. On that menu, click International, and then select one of the
following:
• Language
• Regional Formats
To take advantage of international settings in the application, you must configure ClaimCenter with more than one
region.
• ClaimCenter hides the Language submenu if only one language is installed.
• ClaimCenter hides the Regional Formats submenu if only one region is configured.
• ClaimCenter hides the International menu option entirely if a single language is installed and ClaimCenter is
configured for a single region.
ClaimCenter indicates the current selections for Language and Regional Formats by putting a check mark to the left of
each selected option.
Options for setting the display language

In the base configuration, Guidewire has a single display language, English. To view another language in
ClaimCenter, you must install a language pack and configure ClaimCenter for that language. If your installation has
more than one language, you can select among them from the Language submenu. The LanguageType typelist
defines the set of language choices that the menu displays.
If you do not select a display language from the Language menu and your user administrator has not set your
language, ClaimCenter uses the language specified by your web browser. The configuration parameter
DefaultApplicationLanguage specifies the default language for ClaimCenter screens, but it does not specify the
default browser language. In the base configuration, the default language is en_US, U.S. English.
Options for setting regional formats

If your installation contains more than one configured region, you can select a regional format for that locale from
the Regional Formats submenu. At the time you configure a region, you define regional formats for it.
Regional formats specify the visual layout of the following kinds of data:
• Date
• Time
• Number
• Monetary amounts
• Names of people and companies
The LocaleType typelist defines the names of regional formats that users can select from the Regional Formats menu.
The base configuration defines the following locale types:

• Australia (English) • Germany (German)

• Canada (English) • Great Britain (English)
• Canada (French) • Japan (Japanese)
• France (French) • United States (English)
Unless you select a regional format from the Regional Formats menu, ClaimCenter uses the regional formats of the
default region. The configuration parameter DefaultApplicationLocale specifies the default region. In the base
configuration, the default region is en_US, United States (English). If you select your preference for region from the
Regional Formats menu, you can later use the default region again only by selecting it from the Regional Formats menu.
See also
•
•
Common Areas in the ClaimCenter User Interface

This topic describes some of the common areas in the ClaimCenter user interface.
The ClaimCenter main user interface contains the following areas:
Area Description
1 The Tab Bar contains:
• Tabs – The number of tabs depends on the user’s permissions. For example, a supervisor sees the Team tab. If you are
a colleague’s backup, you see the Vacation tab. If ClaimCenter is integrated with reporting, you see Reports.
• QuickJump box – The QuickJump text box that displays Go to (Alt-/) is a fast way for you to navigate in ClaimCenter or
search for information in specific categories. This feature checks permissions and blocks unpermitted jumps. Type
Common Areas in the ClaimCenter User Interface 59

Area Description
the name of a command and press Enter to jump to that location in the application. Guidewire provides you with a
number of predefined commands. See “QuickJump” on page 79.
•
Unsaved Work menu – You can access your unsaved work from the Unsaved Work menu in the Tab Bar. This menu is
activated when you have work in a ClaimCenter screen that you have not saved. See “Saving Your Work in
ClaimCenter” on page 65.
• Options menu – This menu contains global links including International, Help, About, Preferences, and Log Out.
2 The Info Bar contains relevant information that pertains to your immediate task as seen in the main screen. Using a
combination of icons and text, you can quickly see where you are and what you are looking at in the screen below.
In this example, the following items are included in the Info Bar:
• The blue circular button means the claim is open and/or has exposures that are open.
• The hammer indicates that the claim has a matter.
• The red flag indicates that there is a condition associated with it. For information about flags, see “Flags” on page
438.
• The car icon indicates that this is a personal auto claim.
• Ray Newton is the name of the insured party.
• 8/17/2013 is the date of the loss.
• The status of the claim is Open.
• The adjuster is Andy Applegate, and he belongs to the Auto1-Team A group.
3 The Actions menu displays choices based on the page you are on. For example, if you click the Desktop tab and then click
Actions, you can select only Statistics, Preferences, and VacationStatus. However, if you are on the Summary page of a claim,
the Actions menu offers many more options that relate to the claim.
4 The Sidebar provides menu links. Use it to navigate to different pages. The items in the Sidebar are contextual and can
change depending on the claim object.
5 This section shows the title of the current page, in this case, the claim Summary. The Claim Headline below shows basic
and financial information that provides a quick view of the state of the claim. If there are any issues pertaining to the
claim, ClaimCenter shows the high-risk indicator icons. See “Claim Summary” on page 436 for details.
6 The Screen Area displays most of the business information. This is where you interact with ClaimCenter.
7 The Workspace can display additional information while keeping the Screen Area visible, such as menus for entering a
note or adding a new document.
ClaimCenter Tabs
In ClaimCenter, tabs in the Tab Bar at the top of the screen group logical functions.
To work with a tab:
• Click the tab to see its default page. You can then choose one of the pages grouped by the tab from the Sidebar
menu on the left.
For example, in the base configuration, clicking the Desktop tab opens the Activities page.
• Tabs can also contain menus with shortcuts to pages on that tab. To see a menu, click the down arrow next to the
tab name and select a menu item from the drop-down menu.
For example, click the down arrow on the Desktop tab and then click Calendar→My Calender to open your Calendar
page.
This topic describes each ClaimCenter tab in the following topics:
• “ClaimCenter Desktop Tab” on page 61
• “ClaimCenter Claim Tab” on page 61
• “ClaimCenter Search Tab” on page 62

• “ClaimCenter Address Book Tab” on page 64

• “ClaimCenter Dashboard Tab” on page 64
• “ClaimCenter Team Tab” on page 65
• “ClaimCenter Administration Tab” on page 65
• “ClaimCenter Vacation Tab” on page 65
Note: The visibility of tabs is based on user permissions. For example, only a user who is a manager or supervisor
can see the Team tab.
ClaimCenter Desktop Tab

The Desktop tab organizes your activities, claims, exposures, pending assignments, and other items. The Desktop tab
provides links to the following pages:
• Activities – Shows all activities assigned to you. For more information, see “Viewing Activities” on page 232.
• Claims – Shows the claims that you have been assigned. By default, the list shows all your open claims. You can
use a drop-down menu to filter the list and show subsets, like claims assigned to you this week, flagged claims,
or open related claims. See also “Viewing Your Assignments” on page 204.
• Exposures – Shows a list of exposures that you own. By default, the list shows all your open exposures. You can
use a drop-down menu to filter the list and show subsets, like exposures assigned to you this week or exposures
closed in the last 90 days.
• Pending Assignment – Visible only to supervisors, this page lists assignments that the supervisor needs to assign
manually. For more information, see:
◦
◦ “Manual Assignment” on page 206
◦ “Global and Default Rule Sets” on page 205
• Queues – Shows activities that have been queued for selection by members of your group. Use this page to select
an assignment or assign it to someone else if you have permission to do that. For more information, see:
◦ “Assigning Activities” on page 228
◦ “Queues” on page 210
• Calendar – You can see the activities in a calendar format for either yourself or your supervisor. For more
information, see “Activity Calendars” on page 237.
• Bulk Invoices – Shows bulk invoices that you can view and edit and enables you to create new ones or further
process a existing bulk invoice. For more information, see:
◦ “Bulk Invoices” on page 391
◦ “Using the Bulk Invoice Screens” on page 393
ClaimCenter Claim Tab

Use this tab to open a new claim, to search for existing claims by claim number, or to see a claim you already have
open. Clicking to open a claim shows the claim’s Summary page. When you click the tab, it opens the last claim you
were working with. If you were not working with a claim, clicking the tab opens a page that lets you choose whether
to start a new claim or search for an existing claim.
Clicking the arrow for the Claim tab shows a drop-down menu with the selections New Claim, Claim # (search by
number), and any claims you have open for edit.
ClaimCenter Tabs 61
See also
• “Claim Summary Screens” on page 35
ClaimCenter Search Tab

You can use the Search tab to search for claims, activities, checks, recoveries, and bulk invoices.
Some fields on search pages are text fields. When you enter text into one of these fields, ClaimCenter searches for a
match that starts with that text. For example, if you enter Ray in the First Name field, the search returns all first names
that start with Ray. These names would include Ray and Raymond. However, you must enter an exact match in the
Claim Number and Policy Number fields.
During a search, ClaimCenter uses only the fields in the form that have data. For example, if you search for a Claim
and enter a Last Name but not a Claim Number, ClaimCenter omits Claim Number from the search.
If ClaimCenter shows a search page divided into two columns, you are required to enter at least one search criterion
from the left side. The secondary search criteria, in the Optional parameters section, are optional.
Note: You can configure the optional parameters section, but not the primary search criteria, the fields on the left
side. This limitation on configuration is for performance reasons.
Claim Search
You can search for claims by using simple or advanced search parameters. You can also find claims using claim
contacts.
Simple Search
Simple searches include searching by claim or policy number, type of person, by name, or tax ID. Type of person
can include claimant, insured, any party involved, or additional insured.
Advanced Search
The advanced search has additional parameters that might be useful in finding your claim. For example, you can
search by jurisdiction state, assigned group, loss dates, or flagged or high-risk indicators.
Search by Contact
The SearchbyContact option provides free-text search for claim contacts, which can make searching large databases
quicker. Free-text search provides exact and inexact matching and is configurable.
See “Search by Contact” on page 72.
Activity Search
Your search for activities can include the following criteria:
• Claim number
• Assigned group or user
• Creator of the activity
• External owner of the activity
• Status
• Priority
• Overdue or late
• Pending assignment
• Description
• Dates
• By subject, derived from activity patterns
Check Search
Your search for checks can include the following criteria:
• Claim number
• Group or user that approved the check
• Creator of the check
• Check number
• Invoice number
• Payee information
• Check total
• Status
• Payee
• Dates
If multicurrency is enabled, you can search for check totals that are based only on transaction currency. This
criterion limits the search to checks in the selected currency. If you specify a currency but no amount range, the
search returns results with that selected currency, regardless of amount.
Recovery Search
Your search for specific recoveries can include the following criteria:
• Claim number
• Created by
• Amount
• Status
• Cost type, such as claim cost or expense - A&O
• Recovery category, such as salvage or deductible
• Dates
If multicurrency is enabled, you can search for recovery amounts in a transaction currency. The currency field refers
to the transaction currency. If you specify a currency but no amount range, the search returns results with that
selected currency, regardless of amount.
Bulk Invoice Search

The Search Bulk Invoices page available from the ClaimCenter Search tab includes the following criteria:
• Claim number
• Invoice number
• Check number
• Invoice approved total range
• Pay to
• Dates
If your ClaimCenter installation includes multicurrency, you can search for bulk invoices in the invoice approved
total currency. The currency field refers to the transaction currency. If you specify a currency but no amount range,
the search looks for bulk invoices with that selected currency but does not search on amount.
ClaimCenter Search Tab 63

The Desktop view also provides a Bulk Invoice link. However, ClaimCenter uses the Desktop view for bulk invoices on
which you are currently working or that ClaimCenter is processing.
ClaimCenter Address Book Tab

You can use the Address Book tab to search for contacts, such as vendors, to help you with a claim. Searching for
contacts works only if you have integrated ClaimCenter with a contact management system, like ContactManager.
ClaimCenter Dashboard Tab

You see the Dashboard tab if you are a manager or supervisor. This tab provides a high-level summary of
ClaimCenter data. You can use it to gain an overview of claims and related financial information during a standard
time period. This time period is specified using the DashboardWindowPeriod field in the config.xml file.
The information shown on the Dashboard includes the number of open claims, recent claim activity, current
financial data, and summary financial data. You can view Dashboard data for your team as a whole, or you can drill
down to view individual groups. When you view Dashboard statistics at the organization level, data is summarized
by business group, line of business, loss type, and coverage.
In particular, the Dashboard shows you the following reports:
• Open Claim Counts – Information on open claims, organized by group. There is data on the number of exposures
open, number of handlers, average pending, number of claims flagged and litigated, and the number in excess of
the total incurred limit. You can see this limit at the bottom of the report.
• Period Activity – Number of claims and exposures that are new, closed, or new incident only, and matters that are
new in the current period. Additionally, there is data on the average number of days taken to close a claim and the
number of claims that have been reopened.
• Open Claim Financials – A financial summary of all currently open claims, organized by group.
• Period Financials – A financial summary of payments and recoveries in the specified time period, as well as
payments made on claims that were closed in the same period. Payments on closed claims can date back to
before the specified time period when the associated claims are recently closed.
These reports are generated by the Dashboard Statistics batch process. You can configure ClaimCenter to provide
additional Dashboard reports.
Dashboard Permissions
A user in the role of manager or supervisor has the permissions needed to view the contents of Dashboard tab.
Permissions that affect viewing the Dashboard are:
• View Dashboard claim activity – Permission to view the Dashboard claim activity page, code edbclaimact.
• View Dashboard claim counts – Permission to view the Dashboard claim counts page, code edbclaimcounts
• View Dashboard current financials – Permission to view the Dashboard current financials page, code edbcurrfin.
• View Dashboard period financials – Permission to view the Dashboard period financials page, code edbpdfin.
Calculating Dashboard Statistics

The Dashboard Statistics batch process updates the data on the Dashboard tab. In the base configuration, Guidewire
schedules this process to run once a day at 1:00 a.m.
See also
• Configuration Guide

ClaimCenter Team Tab

The Team tab, available if you are a manager or supervisor, opens a visual management tool that helps you manage
your groups. This tool displays the number of claims, exposures, matters, activities, and subrogations grouped by
whether items are open, closed, flagged, new, or completed.
For more information, see “Team Management” on page 443.
ClaimCenter Administration Tab

With administrator privileges, you have access to the Administration tab. You can also see this tab if you are a
Catastrophe Administrator or a Reinsurance Manager, but for those roles your choices are limited to those two
functions. With full administrator privileges, you can view and maintain many business elements that define how
ClaimCenter is used. You can define your organization’s group structure and manage the users that belong to those
groups. You can also specify permissions and roles, such as adjuster, manager, supervisor, and so on, to manage user
access to certain ClaimCenter actions.
For more information, see “Administration Tab” on page 512.
ClaimCenter Vacation Tab

This tab enables you to view work assigned to you as a backup by another user currently on vacation. It is not
available if there is no vacation work assigned to you. If work is assigned to you, you can select any activities,
claims, or exposures to work on.
For more information, see “Vacation Status” on page 277.
Saving Your Work in ClaimCenter

ClaimCenter includes some safeguards to protect updates that have not been saved. It automatically saves your work
in wizards to the database.
ClaimCenter also saves your work when you are in the Claim or Administration tabs, but not to the database. If you
leave a page in one of those tabs with unsaved changes and navigate to another section of ClaimCenter, the server
keeps your information in memory.
You can retrieve your work from memory by using the Unsaved Work menu, which returns you to the page that has
your unsaved data. You can then finish your work and save it. This feature is useful if you must navigate away from
a page but need to return to it later. After you complete and save your work, ClaimCenter removes that item from the
Unsaved Work menu.
If you attempt to log out without saving, ClaimCenter alerts you that your unsaved work will be lost if you continue.
Autosaving is the mechanism that ClaimCenter uses to save work that you can retrieve by using the Unsaved Work
menu.
ClaimCenter Tabs 65

chapter 4
Changing the Screen Layout
You can adjust several aspects of the screen layout according to your own preferences.
Adjusting List Views

You can change the default appearance of individual list views.
Change List View Column Order

About this task
You can change the order in which columns appear in a particular list view. This change remains in effect until you
clear the layout preferences.
Procedure
1. Click and hold the left mouse button on the heading of the column that you want to move.
2. Drag the mouse pointer across the other column headings until it is between the two columns where you want
to place the moved column.
If it is valid to move the column there, two arrows point to the line between the columns:
3. Release the mouse button.
Changing the Screen Layout 67

Next steps
See also
• “Clear Layout Preferences” on page 70
Change List View Column Widths

About this task
You can resize a list view column to make it wider or narrower than it currently is. This change remains in effect
until you clear the layout preferences.
Procedure
1. Position the mouse pointer over the left or right border of the column heading. The pointer turns into a double
arrowhead .
2. Drag the column border to the new width.
Next steps
See also
Sort List Views

About this task
You can change the column on which a list view is sorted, and also the sorting direction. Note that you can sort on
only one column at a time.
Procedure
Click the heading of a column to sort the list view on that column.
• To sort a list view on a particular column, click the column heading.
• To change the sort direction of a list view column, click the heading of the column on which the list is currently
sorted.
Icon Sort direction

Ascending
Descending
Result
Each time you click the column heading, the sort changes direction. An icon on the column heading indicates the
direction in which the list is sorted.
Hide and Show Columns in a List View

About this task
You can change which columns appear in a list view. This change remains in effect until you clear the layout
preferences.
68 chapter 4 Changing the Screen Layout

Procedure
1. Position the mouse pointer over any column heading, and then click the drop-down menu icon that appears
at the right side of the heading.
2. In the drop-down list, click Columns, and then click the columns that you want to change:
• To hide a column, clear the check box for the column.
• To show a column, select the check box for the column.
Next steps
See also
Grouping Rows in a List View

When multiple rows in a list view have the same value for a particular column, you can arrange them to be listed
together in a group. Each group appears in the list view under a new heading row for the common value. For
example, if you have a list of contacts, you can group them by their values in the Type column: Person, Company,
Doctor, and so on. The related contacts are then listed together under a heading for each type.
The following figure shows rows grouped by Type.
You can group a list view only by one column at a time.
Arrange List View Rows into Groups
Procedure
2. In the drop-down menu, click Group By This Field.
Ungroup List Views
Procedure
2. In the drop-down menu, clear the Show in Groups check box.
To collapse or expand a group, click Collapse or Expand next to the group name.
Adjusting List Views 69

Change the Sidebar Width

About this task
You can resize the sidebar to made it wider or narrower than it currently is. This change remains in effect until you
clear the layout preferences.
Procedure
1. Position the mouse pointer over the right border of the sidebar. The pointer turns into a double arrowhead .
2. Drag the sidebar border to the new width.
Next steps
See also
Managing Layout Preferences

ClaimCenter records many changes that you make to the screen layout and automatically saves them as layout
preferences. For example, changes to the size, ordering, and visibility of list view columns are stored in the layout
preferences. Once set, these preferences remain in effect, even if you log out and log back in.
Storage of Layout Preferences

Layout preferences are stored in your web browser’s local storage. Using the local storage has several implications:
• If you log in using a different browser, then ClaimCenter uses the preferences stored with that browser, if any,
rather than your preferences set in the first browser.
• If another user logs in to ClaimCenter from your browser, their layout will reflect the preferences that are stored
with your browser.
• Clearing the browser's cookies also clears the saved layout preferences.
• Clearing the browser cache does not clear the saved layout preferences, and clearing the layout preferences has
no effect on the browser’s cache.
Clear Layout Preferences

About this task
To reset your layout changes back to their defaults, you must clear the layout preferences. This action does not affect
the web browser’s cache.
Procedure
In the Options menu, click Clear Layout Preferences.
70 chapter 4 Changing the Screen Layout

chapter 5
Claim Search
ClaimCenter provides three types of searches for claims:

• Simple Search
• Advanced Search
• Search by Contact
Simple and advanced searches access the ClaimCenter database to find claims. Search by contact uses a searchable
index and is a free-text search that includes both exact and inexact matching. Inexact matching returns results that
partially match, are synonyms, and sound like the terms in the search criteria.
Additionally, you can also search for activities, checks, recoveries, and bulk invoices. See “ClaimCenter Search
Tab” on page 62.
Perform a Simple Search

About this task
In ClaimCenter, SimpleSearch enables you to search for a claim by using a group of text field entries.
Note: You must enter an exact match in the Claim# and Policy# fields. During a search, ClaimCenter uses only those
fields in the form in which data exists. For example, if you enter a Last Name but not a Claim #, ClaimCenter omits
Claim # from the search.
Procedure
1. Access the simple search from Search→Claims.
2. Enter one of the following to search for a claim:
• Claim Number
• Policy Number
• First Name
• Last Name
• Organization Name
Claim Search 71
• Tax ID
Result
The search results return claims with links to view details.
Advanced Search
The advanced search screen in Guidewire ClaimCenter is similar to the simple search with additional parameters
that might be useful in finding your claim. For example, you can search by jurisdiction, assigned group, loss dates,
and flagged or high-risk indicators.
Some fields on the simple and advanced search screens are text fields. If you enter text into one of these fields,
ClaimCenter searches for a match that starts with that text. For example, if you enter Jones into the last name field,
the search returns all last names that start with Jones. The search results include: Jones, Jonesburg, or Jones-Smith.
It does not find McJones.
If multicurrency is enabled, you can use advanced search to search for the currency, type, and amounts. The search
returns claims in that currency. Note that ClaimCenter searches for claim currencies.
See also
• “Perform a Simple Search” on page 71
• “Multiple Currencies” on page 373
Search by Contact
In ClaimCenter, the SearchbyContact option provides faster, free-text search for claims than database search,
especially against very large databases. The search is faster, because it searches through text-based representations
of selected data. ClaimCenter uses a custom integration with the Apache Solr search engine, the Guidewire Solr
Extension, to generate a full-text search index. You can choose to enable or disable this type of search. For more
information on enabling and configuring free-text search, see the Configuration Guide.
In the base configuration, Guidewire disables the SearchbyContact functionality.s. If you choose to enable
SearchbyContact, Guidewire recommends that you remove SimpleSearch as a menu option, because SearchbyContact
effectively replaces it. Free-text search is best suited for approximate searches, where it is possible to enter inexact,
phonetic, or synonym search terms and recover accurate results. When you are searching for very specific objects in
ClaimCenter, such as a check or an activity, SearchbyContact is not recommended. Use other available search options
such as Search→Checks instead.
The Search by Contact screen has fields to enter data by name, address, role, and other criteria. Search fields are not
case-sensitive. For each field, there is a corresponding search index to optimize retrieval of that data. One search
field can map to more than one object or property in the database. For example, entering a value in the Name field
compares the search string against an index field that consists of concatenated First Name and Last Name or Company
Name.
Note: Free-text search using SearchbyContact is not integrated with a contact management or address book system,
such as Guidewire Contact Manager. You search for claims using claim contacts within ClaimCenter.
How Free-text Search Works

The free-text search process consists of four steps:
1. Setup and enabling of free-text search for ClaimCenter.
2. Initial loading of the Guidewire Solr Extension index.
3. Continuous index updates in production using messaging.
4. Sending a search query to the Guidewire Solr Extension and receiving results.
As users make and save changes, ClaimCenter updates the Guidewire Solr Extension index dynamically.
72 chapter 5 Claim Search

Query and Filter Search Fields

On the Searchby Contact screen, the fields for entering search criteria are of two types:
• Query fields – These are grouped under the SearchBy heading. ClaimCenter sends the query fields to the search
engine. You need to enter at least one query field for the search to function accurately.
• Filter fields – These are grouped under the FilterBy heading and help narrow down the results returned by the
query.
Search Types and Ranking

Search fields are configured to match exactly or inexactly. An exact match of a field returns a result that matches the
search string exactly. An inexact match of a field returns a result that starts with, contains, or sounds like the search
string.
For example, exact and inexact matching returns the following names if you search for Rob:
• Rob – Exact.
• Robertson – Starts with.
ClaimCenter ranks the search results with a score that reflects the degree to which the result matches the search
criteria. In the base configuration, only exact, prefix, and phonetic searches are enabled. Synonym matching for the
full name is not enabled.
A configuration file defines for each search field how to rank exact matches and the various types of inexact
matches. For more information, see the Configuration Guide.
A search field may return matches from two or more pieces of information on the search object. The search ranks
the matching information. When searching for claims, for example, a name search attempts to match the names of
all the contacts associated with a claim.
Search Type Selection Shortcuts

Search type selection shortcuts allow the user to enter a one-character or two-character string that directs the free-
text search function to return only matches of a particular type. Search types with a corresponding shortcut string
include exact match, prefix match, synonym match, and phonetic match. Adding the corresponding shortcut string to
the end of a free-text search field entry activates the corresponding search type in the search algorithm.
The next example will contrast the results that the user obtains when not using a search type selection shortcut
versus when using one. The user not inputting a search type selection shortcut enters a name such as "john" in the
name field. The user then searches on the specified name. The results of this search can include matches of all types.
The search type selection shortcut feature allows the user to add a short string such as "-n" directly to the end of the
search string, "john." The search string as modified is "john-n." Adding the shortcut restricts the results of the
search. The results only contain matches of the type corresponding to the shortcut. In this case, the results would
include only synonyms for "john." They would not include matches of any other type.
The following is a list of the search type selection shortcuts that Guidewire supports:
• -e : exact match only
• * : prefix match only
• -n : synonym (nickname) match only
• -p : phonetic match only
Archived Claims Search

Free-text search using the SearchbyContact menu option targets claims in the active database. In the base
configuration, you cannot use free-text search to access archived claims.
Search by Contact 73
Additional configuration would be required to create a separate index for claims in the archive database. If you do
choose to add this configuration, you need to ensure that both databases are current when changes such as archiving
or restoring a claim are made.
Search by Contact User Interface

In the base configuration, SearchbyContact searches for claim contacts in the active database and retrieves the
corresponding claims.
SearchbyContact has the following features:
• The Name search field matches a concatenated first and last name or company name.
• The Phone search field matches a home, mobile, or work phone number.
Note: When entering a phone number as a free-text search criterion, enter a phone number appropriate for your
default phone region and do not use an extension. If free text search finds a match, it returns the phone number
formatted according to your default phone region.
• The Address field matches the address associated with the claim.
Note: ClaimCenter also includes advanced search for additional object types. For more information, see
“Advanced Search” on page 72.
Navigate to Search→Search by Contact, enter search criteria in the top of the screen, and ClaimCenter displays results
in the bottom pane, as shown in the following figure.

Search Criteria
On the Search Claims screen, the following search fields appear at the top of the screen.
Field Description Matching Type

Search By
Role Search for the role of the claim contact. Select Additional Insured, Any Party Involved, Exact Query
Claimant, or Insured. The default selection is AnyPartyInvolved.
Name Search for first and last name of a person or company name. Starting with the best match, Inexact Query
the search ranks the matching names as follows:
• Exact
• Starts with (prefix)
• Sounds like (phonetic)
• Contains
Phone Search for a matching work, home, or mobile phone number. You must enter the whole Exact Query
phone number. For example, valid telephone number formats for the US phone region are:
• 650-555-1234
• 650 555 1234
• 6505551234
• (650)555-1234
• (650) 555-1234
• 650.555.1234
Country codes must be prefixed with +. See the note about phone regions and full text search
at “Search by Contact User Interface” on page 74.
Address Search for the street address. The search ranks the results from highest to lowest as follows: Inexact Query
• Exact
• Contains
City Search for the city. The search ranks the results from highest to lowest as follows: Inexact Query
• Exact
• Contains
Filter By
State Search for the state. Select from a preconfigured drop-down list. Exact Filter
Postal Code Search for the postal code. Exact Filter
Date Search for claims in one of the following date ranges: Exact Filter
• Loss date
• Reported date
• Closed date
• Creation date
The Matching column indicates whether the field matches exactly or inexactly. The Filter column indicates whether
the field is a query or filter field.
You must specify at least one query field other than Role, such as Name or Phone. For more information, see “Query
and Filter Search Fields” on page 73.
Search by Contact User Interface 75

Search Results of Searching by Contact

On the Search by Contact screen, the following Search Results fields appear at the bottom of the screen.
Field Description
Rank The rank indicates the relevance of the result to the search criteria. The lowest rank corresponds to the most
relevant match.
Relevance The relevance is a percentage value that indicates the closeness of the match. The higher the relevance
percentage, the better the match. A relevance of 100% represents the highest score of all the search results.
Claim The claim number.
Policy The policy number.
Status The status of the claim.
Date The date, typically the loss date, listed on the claim.
Name The first and last name of the person or the company name returned by the search results.
Address The street address on the policy.
City The city on the address of the policy.
State The state on the address of the policy.
Postal Code The postal code on the address of the policy.
Phone The primary phone number listed on the policy.

Roles The roles held by the contact on this claim.
Name Search
The Name field finds matches in the contacts associated with claims, including company names. This is an inexact
search field.
If you enter more than one word in the name field, the search gives a better rank to results containing both words. A
match has a better ranking if the words exist in the same order. If only part of the words match, the match has an
inferior ranking.
Note: The middle name is not indexed in the base configuration.
Address Search
The address search finds matches in addresses associated with claim contacts. Query fields for an address search
include Address and City, and filter fields include State and Postal Code.
Working with Free-Text Search

This topic provides instructions for working with the SearchbyContact functionality.
Prerequisites
These examples assume that you have set up and enabled free-text search for ClaimCenter. For more information
about setting up free-text search, see the Installation Guide. The examples also use sample data included with the
base ClaimCenter installation. See the Installation Guide.
Search Examples
The following examples illustrate some simple claim searches using the ClaimCenter Search→Search by Contact
functionality.

Example Comments
In the Name field, enter robert, The Search Results area displays information on claims with a contact name that contains
then click Search. ‘robert’ as the first name or last name. For example, the results contain rows for Robert
Farley and Robert Peterson. The search results can also return claims in which the entered
text is part of the contact name, such as Allen Robertson or George Roberts. A name such as
Allen Robertson has the highest relevance and rank.
In the Name field, enter nuton, The Search Results area displays claim contacts with ‘Newton’ in the name, which is a
then click Search. phonetic match to the entry, ‘nuton’. Example results include Ray Newton and Brian
Newton.
Free-text search finds claims based on matching search criteria to contacts from the index. Thus, it is possible for a
claim to appear more than once in the results for each matching claim contact. In the base configuration, Guidewire
does not index contact middle names.
Search Index Updates

About this task
In ClaimCenter, if you commit a change that is part of the search index, ClaimCenter automatically updates the
change in the free-text search index. The following example illustrates this concept.
Procedure
1. In ClaimCenter, select Search→Search by Contact.
2. Enter a name in the Name field and click Search.
For example, enter Ray Newton in the Name field.
3. In the SearchResults pane, click one of the search results associated with the name that you entered in the
previous step.
For example, click claim # 235-53-365870 to navigate to the Ray Newton claim.
4. Select the PartiesInvolved menu link, then click on a contact name.
For example, click on BrianNewton.
5. Edit the contact information and click Update.
For example, change the contact role from ExcludedParty to Other.
6. .Return to the Search by Contact screen and enter the name for the contact that you updated in the previous step,.
For example, enter newton in the Name field.
7. Click Search.
Result
The search results now display the updated role for that contact in the Roles column. It is possible for the index
update to take a short period of time before ClaimCenter updates the screen.
Working with Free-Text Search 77


chapter 6
QuickJump
Use the QuickJump text box in the ClaimCenter user interface to perform fast navigation to a screen in the
application.
QuickJump Overview
The QuickJump box provides a fast way to navigate to a particular screen in the application.
In ClaimCenter, the screens you can jump directly to are:

• Desktop→Activities
• Search→Claims→Advanced Search
• AddressBook→Search
• Administration→Users
• New Claim wizard
• Claim Summary
• Team→Summary
You can also configure QuickJump to go to any other destination, any screen that does not require an argument to
specify it, such as the Quick Check wizard.
The QuickJump box can also retrieve and show information about a particular entity. In the base configuration,
ClaimCenter provides support for the Claim entity. You can add additional entities.
Using QuickJump
The QuickJump box appears at the upper right corner of most ClaimCenter screens. The box is not available in pop-
ups.
QuickJump 79
To use the box, position the cursor in it or use the shortcut key Alt /, and then enter a QuickJump command. To
view a list of available commands, press the Down Arrow key.
For example, to retrieve a claim, type claim followed by the claim number, as in claim 312_36_300870, to open
that claim’s Summary page.
The QuickJump box provides automatic command and parameter completion. Type the first few letters of a
command, and the QuickJump box automatically provides a list of the possible commands. For example, type the
letter A to list all commands or parameters that begin with the letter A.
Chaining QuickJump Destinations Together

It is possible to chain multiple QuickJump destinations together to jump to a specific screen.
For example, Claim claimNumber Workplan jumps you to the Workplan of claim claimNumber. Chaining works only
if the final destination is unique. Therefore, Claim claimNumber Workplan and Claim claimNumber Litigation are
allowed, but Claim claimNumber NewExposure is not. The last one does not work because there are multiple
exposure types.
After entering the claim number, press the Spacebar, and then type the first letter of the command you want to
chain. You see a list of available commands that start with that letter.
QuickJump Behavior in Wizards

Wizards are typically used to advance sequentially through a series of steps. QuickJump can be used to skip steps
and jump to a screen listed in the Sidebar.
QuickJump actions available in a wizard are active only when operating in the wizard. For example, it is not
possible to jump from an account screen to a specific wizard screen.
When operating in a wizard, if you want to jump to another part of ClaimCenter, save your work before jumping.
After the jump, if you did not save your work, your wizard work will be lost.
Configuring QuickJump
The QuickJump box can be configured in various way.
• You can add new commands that jump to newly-created screens.
• You can change existing QuickJump commands. For example, you can provide commands that users were
accustomed to using on another system.
• You can remove the QuickJump box from the user interface.
You can use the XML Editor in Studio to configure the QuickJump box. In the Project window, navigate to
configuration→config→Page Configuration and open quickjump-config.xml to edit QuickJump resources. Labels for a
particular language are defined in the display_languageCode.properties file.
You can also configure QuickJump to go to another entity besides a claim, such as a bulk invoice. The entity must
require either no argument or one argument to be specified. It is not possible to jump to an entity requiring more
than one argument.
See also
• Globalization Guide
80 chapter 6 QuickJump
QuickJump Reference
The tables in the following topics list the QuickJump commands that ClaimCenter provides. Some commands can be
chained—appended with other information, such as another entity name or a claim number.
This topic includes:
• “Static Commands” on page 81
• “Commands Available with a Claim Open” on page 81
Static Commands
The following table lists the QuickJump commands that open screens or run commands directly.
Screen or Command Command
AddressBook→Search AddressBook
Administration→Users Admin
Claim Summary for claimNumber Claim claimNumber
Desktop→Activities Desktop
New Claim Wizard NewClaim
Runs the specified batch process RunBatchProcess batchProcess
Search→Claims→Advanced Search Search
Team→Summary Team
Commands Available with a Claim Open

After QuickJump recognizes the name of a claim, it has a context and can jump directly to a screen related to that
claim. The following table lists the QuickJump commands that are accessible when a claim is open.
Screen Command
Calendar→Claim Calendar Calendar
Financials→Checks Checks
Email worksheet Email
Exposures Exposures
Financials→Summary Financials
History History
Litigation Litigation
Loss Details→General LossDetails
Check wizard NewCheck
New Document worksheet NewDocumentTemplate
Create Recovery NewRecovery
Note worksheet NewNote
Set Reserves NewReserve
PartiesInvolved→Contacts PartiesInvolved
PlanOfAction→General PlanOfAction
QuickJump Reference 81
Screen Command
Policy→General Policy
Summary→Overview Summary
Workplan Workplan
These context-specific jumps are a useful part of QuickJump. They allow rapid switching among the claim-related
screens.
82 chapter 6 QuickJump
part 3
Working with Claims

chapter 7
Claim Creation
The New Claim wizard is a flexible and configurable wizard that simplifies the intake of First Notice of Loss
(FNOL) information to create a new claim.
The New Claim wizard:
• Models the natural flow of collecting FNOL information.
• Uses a small number of logically ordered steps.
• Captures high-level details, such as the reporter, relevant parties, and loss details in an organized way.
• Provides peripherally useful screens, like Parties Involved and Documents, that are accessible at any time, outside
the main wizard workflow.
• Enables you to jump between step and non-step screens.
• Is optimized, in the base configuration, for personal auto and workers’ compensation, but can be configured for
any line of business.
• Uses incidents to organize Loss Details data by vehicle, property, and injury.
• Enables you to pick subflows, such as first-and-final or auto glass, to further optimize the wizard’s workflow.
There are also other wizards, such as Auto First and Final or the Quick Claim Auto used in Personal auto, that you
can use, depending on your business requirements. For example, the Auto First and Final wizard would typically be
used when a claimant calls to report that the car’s windshield is cracked.
Overview of the New Claim Wizard

The New Claim wizard provides two navigation panels on the left and a main screen to collect data.
Access the wizard by selecting New Claim from the Claim tab.
Claim Creation 85
Wizard Step Navigation Panel

The New Claim wizard provides different flows depending on the policy type that the policy search returns. For
example, if the selected policy is of type Auto, the flow consists of four steps as seen in the previous graphic. The
Wizard Steps navigation panel displays these steps, and you can navigate among any enabled steps. To access all the
steps, including those that are not enabled, you must go through the wizard.
For personal auto and workers’ compensation policy types, you can further specify a subflow, such as Quick Claim
Auto, as a Type of Claim when selecting a policy. Additionally, there are subflows for homeowners and personal travel
policy types, such as Quick Claim Baggage or Quick Trip Cancel. These selections also affect the flow and change the
steps shown in the Wizard Steps navigation panel.
Claim Action Navigation Panel

Besides the main wizard steps, you can add additional information as you create the claim. You enter this optional,
claim-related information into screens that you reach from the Claim Action navigation panel. These screens include
Parties Involved, policy-related information, Documents, and Notes. You can use this panel and the Wizard Step
navigation panel together to jump quickly through the claim, but you cannot navigate to greyed-out choices. For
example, you can always enter a new note, but you can attach Documents only after completing Step One – Search or
Create Policy. See “Optional New Claim Wizard Screens” on page 96 for more details.
Claim Info Bar

The Claim Info bar contains information about the claim. It shows whether the claim is open or closed, the selected
policy, the insured, date of loss, and the claim status. After you select a policy, an icon describing the type, auto,
property or workers’ compensation, appears by the policy number.
86 chapter 7 Claim Creation

See also
• “New Claim Wizard Steps” on page 88
Save Your Work, and, Retrieve Unsaved Work

About this task
The New Claim wizard stores the state of your work and returns you to work that you started but have not yet saved.
The Unsaved Work menu shows a drop-down list of all step and claim action panels for which you have entered data
but not saved.
Following are the high level steps used to create a draft claim using the wizard. The first step of the wizard is always
to select a policy.
Note: The system saves only when you click Next. The system does not save when you click Back.
Procedure
1. In ClaimCenter, select a policy and click Next.
For you to be able pay the claim, the claim must have a verified policy.
2. Create a new claim and save it with draft status.
The New Claim wizard does not save a claim in a more advanced status. However, each time you exit a step or
claim action screen by using Next, you save the information on that screen in the draft.
3. Use the navigation panels to add information in any other wizard steps or claim screens.
4. Use the Unsaved Work menu to return to any screen you have begun but not saved by clicking Next.
5. Click Finish to exit the wizard.
Claim validation rules run and the claim is saved in the highest status allowed by these rules.
Delaying Creation of a Draft Claim

To delay creating a draft claim until a later wizard step, change the autosaveable attribute at the end of page one of
fnolwizard.pcf to false. Change this attribute to true in the step where you want to create the draft claim.
Working with Multiple Claims in Draft Mode

After you have created a draft claim by completing the first screen of the New Claim wizard, you cannot exit the
wizard and enter it again to create another claim. After you enter the wizard again, it displays your current draft.
However, this feature is configurable.
To enable multiple draft claims, change the autosaveable attribute to false in all screens of the fnolwizard PCF
file.
After you enable multiple draft claims, you can exit the wizard at any time after creating a draft claim. When you
open the wizard again, you can begin entering a new claim, instead of being required to return to your previous draft
claim.
To enter the wizard again with a particular draft claim, use the Desktop tab to see the list of your claims. The list
includes all drafts. Select any draft to return to the wizard with that draft open.
See also
• “Overview of the New Claim Wizard” on page 85
Flows of the New Claim Wizard

If you create an unverified policy, you must enter a Policy #, Policy Type, and Type of Claim before you exit Step One –
Search or Create Policy. Requiring these entries enables the New Claim wizard to decide which flow to use. Then,
after you select a flow, you can exit the step.
Overview of the New Claim Wizard 87

Capturing Incidents in the New Claim Wizard

You can use the New Claim wizard to capture incidents. A claim that contains incidents with no exposures is a claim
that is recorded but not processed any further. No payments are made against it. This kind of claim can result from
reported losses that are not covered by the policy or from a decision by the insured not to process the claim. Reasons
not to process the claim might be that the loss amount is just slightly over the deductible or the insured does not
want a rate increase. Incident only is an accepted industry term that implies that there is no expectation of financial
liability by the carrier.
Another reason to capture incidents on a claim is that a customer service representative (CSR) might not have the
permissions to create an exposure. The CSR might not know enough about the type of claim to create an exposure
and, therefore, just gathers available information during the first notice of loss.
You can create incidents after a claim is created. Navigate to the claim’s Loss Details screen, and then click Edit and
make your selection. Available incidents are located on the right side of the screen.
Note: In the base configuration, there is an Incident Only radio button in Step Three of the wizard. This radio button
is actually a Boolean field, IncidentReport, on the Claim entity. ClaimCenter provides this radio button for
optional configuration purposes. For example, you might decide to generate a report that contains a list of all
claims that are incident-only. This button does not create an incident.
To learn more about incidents, see “Incidents” on page 247.
New Claim Wizard Steps

This topic describes the workflow of the creation of a claim by using the example of an auto claim. The flows for
personal auto and commercial auto are similar, as are the flows for personal and property claims. Differences are
noted, where applicable.
You access the New Claim wizard by selecting New Claim from the Claim tab.
Follow these steps to create a claim:
1. “Selecting or Creating a Policy in the New Claim Wizard” on page 88
2. “Basic Information Step of the New Claim Wizard” on page 90
3. “Add Claim Information Step of the New Claim Wizard” on page 91
4. “Services Step of the New Claim Wizard” on page 93
5. “Save and Assign the Claim” on page 95
The following two topics provide additional information.
• “Complete the New Claim Wizard” on page 96
• “Optional New Claim Wizard Screens” on page 96
Selecting or Creating a Policy in the New Claim Wizard

The first step of opening a new claim is ensuring that a policy exists for the claim. You must either search for an
existing policy or create an unverified policy as a placeholder. If you create an unverified placeholder policy, you
then update the claim with the actual policy later.
ClaimCenter searches an external system for a policy for the new claim or creates a new one, based on the current
policy description. If the policy description matches the claim's current policy, the wizard's setPolicy method does
nothing.
The wizard determines whether two policies are the same based on fields in the policy summaries. For example, you
might return to the wizard’s first step and select a new policy. If you click Next again, ClaimCenter relies on
configurable logic to compare two policy summaries and determine if they are the same policy. You can configure
the logic of how ClaimCenter compares the policy summaries, for example, to use additional fields such as the loss
date.

See also
• For information on the reasons for and consequences of using each type of policy, especially as they affect claim
validation, see “Verified and Unverified Policies” on page 101.
Select an Existing Policy for a Claim
Before you begin

Before proceeding, review “New Claim Wizard Steps” on page 88.
Procedure
1. In ClaimCenter, in the New Claim wizard, select the Find Policy radio button.
2. Enter the search criteria in the claim search panel to retrieve the correct policy from a policy administration
system, such as Guidewire PolicyCenter.
Policy search criterion Additional criteria for a name search

Policy #
First and/or Last Name of policy holder SSN or Tax ID, City, State, ZIP, and/or Country
Organization Name (of policy holder) SSN or Tax ID, City, State, ZIP, and/or Country
Policy Type
Loss Date
Auto VIN (vehicle ID #)
3. Click Search.
ClaimCenter displays the results in a table at the bottom of the screen.
4. Use Select to display the correct policy.
• If the search finds just one result, the New Claim wizard selects it for you. You can use the Unselect button to
override this choice and try again.
• Selecting a policy shows additional details. For example, if the policy type is Personal Auto or Property, you
see a history of all other claims filed against the policy, both open and closed, but not archived. Workers’
compensation and commercial policies do not show a claim history because there are often many claims
against these kinds of policies. After the claimant’s name becomes known, ClaimCenter displays a claim
history for the current claimant. You must enter additional information to complete this step.
5. Enter information for date of loss and type of claim.
• Date of Loss – Required so the New Claim wizard can evaluate if the policy is valid for the claim. You can
optionally enter the Loss Time. The value defaults to midnight.
• Type of Claim – If the policy type can have more than one flow, you must select the targeted flow. See “Flows
of the New Claim Wizard” on page 87.
6. Click Next.
The New Claim Wizard saves the claim as a draft and advances to the next step.
Next steps
After completing this procedure, continue to “Basic Information Step of the New Claim Wizard” on page 90.
Create an Unverified Policy for a Claim
Before you begin

Before proceeding, review “New Claim Wizard Steps” on page 88.
Selecting or Creating a Policy in the New Claim Wizard 89

Procedure
1. In ClaimCenter, in the New Claim wizard, select the Create Unverified Policy radio button.
2. Enter a Loss date, a Policy Number, Policy Type, and Type of Claim.
The New Claim wizard uses the last three values to determine which flow to use. This topic describes the main
Auto flow, and assumes you have chosen one of the Auto claim types.
3. Choose the none selected option from the Select Property or Select Vehicle drop-down list.
This option is for claims, such as Property - Quick Claim Property or Auto First and Final, that can complete even if
the policy is unverified. However, you cannot specify the property or vehicle.
4. Continue through the wizard steps.
Next steps
After completing this procedure, continue to “Basic Information Step of the New Claim Wizard” on page 90.
Basic Information Step of the New Claim Wizard

The Basic Info screen in Step Two captures information about the main contact for the claim. This screen is designed
to capture information about the people involved in the claim.
You can capture information about other relevant contacts—people, organizations, and companies—by navigating to
the Parties Involved claim action screen at any time while in the New Claim wizard.
After you complete this step and go to the next step, ClaimCenter has enough information to perform a search for
duplicate claims.
Enter Basic Information
Before you begin

Complete the step “Selecting or Creating a Policy in the New Claim Wizard” on page 88 before you perform this
step.
Procedure
1. Enter the Reported By information for the claim.
This information captures the person who called in the claim. See “Reported By Pane of the Basic Info Step”
on page 91.
2. Enter the Insured information for the claim.
This information captures the person or people who are insured on the policy. See “Insured Pane of the Basic
Info Step” on page 91.
3. Enter the Main Contact information for the claim.
This information captures the person serving as the principal point of contact for the claim. See “Main Contact
Pane of the Basic Info Step” on page 91.
4. Enter the Involved Vehicles information for the claim.
This information captures the vehicles that were reported as involved in the claim. See “Involved Vehicles
Pane of the Basic Info Step” on page 91.
Next steps
The next step of the wizard is “Add Claim Information Step of the New Claim Wizard” on page 91.

Reported By Pane of the Basic Info Step

In the Reported By pane, enter how the claim was reported. Enter information about:
• How reported – Choices are Phone, Fax, Mail, Internet, Walk-in, and None.
• Name – If you click the picker icon next to this field, it tries to find the contact name you need. To add the contact
yourself, choose the New Person option on the picker. If you choose a contact from the list shown by the picker,
the screen shows contact information. Some of this information, like phone numbers, but not addresses, is
directly editable. An Edit button enables you to edit all contact information in a popup window. The picker icon
restricts itself to contacts already on the claim. If you are unsure of the picker’s selection, you can click the View
Contact Details option of the picker.
• Relation to the insured – Choose a relationship from the drop-down list.
• Date of Notice – The date the claim was opened—the current date by default.
Insured Pane of the Basic Info Step

This section contains the name, address, and primary phone number of the insured. This data derives from the
information in the policy associated with the claim. You cannot edit this information directly. However if you click
the name, the Contacts screen opens and you can create a new contact or make any edits.
Main Contact Pane of the Basic Info Step

The main contact is, more often than not, the person reporting the claim. This contact is set to the person reporting
the claim by default. To choose another main contact, select Different Person, which opens the Name and Relation to
Insured text boxes. Next to the Name box is a picker that behaves identically to the Reported By picker. The Relation to
the insured field uses the same typelist for its options as described previously in “Reported By Pane of the Basic Info
Step” on page 91.
Involved Vehicles Pane of the Basic Info Step

This section shows the names of all vehicles listed on the policy and comes from information in the policy. Clicking
the check box by any vehicle displays coverages and coverage limits of the policy. If the claim is a property claim,
Involved Properties replace this section, and the check boxes show policy details for each property. By clicking a check
box, you choose that vehicle to be the first party (insured’s) vehicle.
For commercial policies, this section does not appear, since the number of covered vehicles and properties is likely
to be too large to be useful.
Add Claim Information Step of the New Claim Wizard

Step Three, Add Claim Information, is the center of the New Claim wizard.
Incidents are collections of information about a loss involving an injury or a loss to a vehicle or some property. The
information is about what happened and is something that an observer could relate.
To make it usable by call center operators with no insurance background, the New Claim wizard collects incident
information rather than exposure information.
See also
• “Incidents” on page 247
Add Claim Information in the New Claim Wizard
Before you begin

Complete the step “Basic Information Step of the New Claim Wizard” on page 90 before you perform this step.
Procedure
1. Enter basic claim information for the loss.
Basic Information Step of the New Claim Wizard 91
See “Basic Claim Information in the Add Claim Information Step” on page 92.
2. Enter information for vehicles, people, and property involved in the claim.
See “Vehicles, People, and Property in the Add Claim Information Step” on page 92.
3. Enter information for witnesses, officials, and police present at the scene of the incident.
See “At the Scene in the Add Claim Information Step” on page 93.
4. Enter categorization information such as fault rating, weather condition, and catastrophe name.
See “Categorization in the Add Claim Information Step” on page 93.
Next steps
The next step in the New Claim Wizard is “Services Step of the New Claim Wizard” on page 93.
Basic Claim Information in the Add Claim Information Step

This section contains only the most basic claim details:
• What Happened – A text box for your description.
• Date of Loss – Not editable, from “Selecting or Creating a Policy in the New Claim Wizard” on page 88.
• Loss Cause – ClaimCenter does not take any action based on this field. The choices come from the Losscause
typelist.
• Incident Only – ClaimCenter does not take any action on this field. You can configure a rule to decide what to do
with the draft claim already opened by the New Claim wizard.
• Location – A number of text boxes for address, city, and so on. The fields default to a new address. The Location
drop-down list shows all the addresses obtained from the policy. Selecting one fills in the other address fields.
Vehicles, People, and Property in the Add Claim Information Step

For an auto claim, this section initially contains only the vehicles selected by the previous step. For a property claim,
this section contains selected properties. It provides additional buttons to add other incidents, based on another
vehicle, a property loss, or a pedestrian injuries. If there is an injury to a person in a vehicle, you capture that
information as part of a vehicle incident.
The buttons are:
• Add Vehicle
• Add Pedestrian
• Add Property Damage
Add Vehicle Button

Each time you add a vehicle, you create another vehicle incident for the claim. Add vehicles in this step by selecting
vehicles listed on the policy. These are usually first party incidents. Select these vehicles to delete them or edit the
details of the incident that concerns them. You can also add any other vehicle and add its details.
The Vehicle Basics section displays the vehicle information, if known, from the policy. If this information is not
known, or if the Third Party button is selected, fields appear to help you describe the vehicle. If you click Stolen or
Parked in this section, the Other Details and Damage sections disappear from the screen.
Besides the expected Basic, Damage, and accident (Other Details) sections, the Occupants and Injuries section displays a
Passenger Details or Driver Details screen. Enter contact details, including injury details, for anyone in the auto.
Use the damage section to describe the vehicle damage. This section includes a Total Loss Calculator, which is a series
of scored questions that help you decide whether to write off the damage to the vehicle. Rules can use its score to
help you decide whether the vehicle is a total loss.
Services check boxes—Rental, Towing, Appraisal and Repair—appear in each Vehicle Incident screen. They are identical to
the Services described in “Services Step of the New Claim Wizard” on page 93.

Add Pedestrian Button

Use this button to add a person to the claim, someone not inside a vehicle. This pedestrian must be part of a vehicle
incident as previously described. After clicking this button, you see the Pedestrian Details screen.
The Injuries fields appear only when you select the Injured (Yes) button. After you save this screen, a new entry
appears in the Vehicles, People & Properties table of the main Step Three screen. If no name or address is given for the
pedestrian, the listing in this table is for an Unknown Pedestrian. If the pedestrian is injured or dead, appropriate icons
precede the name. You can add a pedestrian incident only to an auto claim, not a property damage claim.
Add Property Damage Button

This button displays a Property Incident screen each time you click it. Each time you save this screen, a new row
appears in the Vehicles, People & Properties table of the main Step Three screen. You cannot add a property incident
(loss) to an auto claim.
At the Scene in the Add Claim Information Step

This section of Step Three of the New Claim wizard contains the following sections. Each time you select the Add
button, you create a new entry in that section.
Witnesses
After you click NewWitnessesAdd, enter the witness’ Name, whether there was a Statement Obtained, the location (Where
was the witness), and the witness’s Perspective.
Officials?
To make a new entry under Officials?, click its Add button and enter the official’s Type and Name, and the Report# of
any report made by that official.
Police Report?
Selecting Police Report?Add, opens the Metropolitan Report Details screen. Enter details of the report.
Note: If ClaimCenter is integrated with Metropolitan Police Reports, this screen shows data when ClaimCenter
receives its accident report.
Categorization in the Add Claim Information Step

This section of Step Three of the New Claim wizard contains:
• Fault rating – Used by the subrogation feature. See “Working with Subrogation” on page 289.
• Weather – The weather at the accident, from the Weather typelist.
• Catastrophe – Entering a name associates the claim with that catastrophe. See “Catastrophes and Disasters” on
page 157.
• Special Claim Permission – Entering a name puts the claim on that ACL. See “Data-based Security and Claim
Access Control” on page 491.
Services Step of the New Claim Wizard

An important part of receiving the first notice of a loss is providing help to those who have suffered the loss. The
New Claim wizard’s Step Four enables you to select services. These services might be needed to start the claim
resolution process for the insured, the claimant, or another party reporting the claim. Services are filtered based on
the choices you made in previous steps of the New Claim wizard.
Add Claim Information Step of the New Claim Wizard 93

Note: In the New Claim wizard, you can select services from a menu of predefined, commonly used services for
your type of claim. The request type for these services is also preselected to simplify this process. Alternately, you
can also choose to manually add services using the OtherServices menu option, in which case, you can make more
granular selections, including the request type.
For each service, ClaimCenter shows the related coverage and limit. For example, the Auto Body Repair Shop service
section shows whether the vehicle has collision coverage and its deductible, obtained from the policy.
Other types of claims involve other types of providers. For example, a workers’ compensation claim might offer a
doctor, medical clinic, and physical therapy facility to visit. A property loss might involve an appraiser or a
company involved in insurance replacements.
See also:
• “Service Provider Performance Reviews” on page 169.
Services Screen of the New Claim Wizard

The following example shows Step Four of the New Claim wizard. Details of each service appear only when its check
box is selected.
The picker can be configured to search based on proximity to the loss, which is already part of the claim. You can
use the picker to select only Preferred Vendors, or vendors meeting a certain minimum standard, as determined by a
ranking score.
Complete the Services Step of the New Claim Wizard
Before you begin

Complete the step “Add Claim Information Step of the New Claim Wizard” on page 91 before you perform this
step.

Procedure
1. Select auto claims services from the choices presented.
• Rental Car
• Towing Services
• Appraiser
• Auto Body Repair Shop
2. Select the details for each service.
3. Add services in the OtherServices section as needed.
4. Continue with the wizard steps.
Next steps
The next step is “Save and Assign the Claim” on page 95.
Save and Assign the Claim

Before you begin
Complete “Services Step of the New Claim Wizard” on page 93 before you perform this step.
About this task

The New Claim wizard attempts to ensure that data that has just been entered is not lost. It saves the claim as a draft
claim after you exit Step One. The draft is saved again every time you move to another step in the wizard.
Procedure
1. Add a new Note on the claim with the First Notice of Loss section.
2. Assign the claim, either to the logged-in user filling out the wizard, by using automatic assignment, or by using
a picker.
The picker helps you find a user by name, group name, or proximity to a location. You also have the option of
assigning the claim and exposures individually using the same methods.
3. Create Exposures. The wizard uses the incidents entered into Step Three of the New Claim wizard to help you
select:
• Vehicle Exposures – Generated for each vehicle incident already entered.
• Property Exposures – Generated for each property incident already entered.
• Injury Exposures – Generated for each injury incident, whether entered separately, such as a pedestrian, or
as part of a vehicle incident, such as a driver or passenger.
• Exposures based on the coverage type – Choices reflect the coverages on the policy.
4. After you create individual exposures, you can assign them.
This feature is more appropriate for a claim adjuster than a call center, and is optional during the New Claim
wizard.
The following example shows the exposure types generated for a vehicle on the policy:
New Claim Wizard Steps 95

Next steps
The next step is “Complete the New Claim Wizard” on page 96.
Complete the New Claim Wizard

Complete the step “Save and Assign the Claim” on page 95 before you review the claim information.
After you click Save, ClaimCenter runs its automatic assignment rules if you selected this method of assignment.
ClaimCenter then saves the claim.
Note: If you have integrated ClaimCenter with ContactManager, after you complete the New Claim wizard, you
might notice that contacts brought over from ContactManager or PolicyCenter are marked as not synchronized. It
can take some time for ClaimCenter to synchronize these contacts with ContactManager. When this process is
complete, the contacts will be marked as being in sync.
You have completed the steps of the New Claim wizard and created a claim. You have the option to access
additional screens as described in the topic “Optional New Claim Wizard Screens” on page 96.
See also
Optional New Claim Wizard Screens

The topic “Overview of the New Claim Wizard” on page 85 describes other screens that are part of the New Claim
wizard. For auto claims, these screens are always available after you have chosen a policy and finished Step One.
• Parties Involved – A screen for entering all contacts that you did not enter elsewhere. Enter other types of contacts,
as well as contacts normally entered on a step screen. For example, if the caller suddenly thinks of a witness
name, you can enter it on this screen rather than navigating back to the previous step.
• Policy General – This screen and the one that follows provide editable information on the selected policy. Editing
policy information makes the policy no longer verified. See “Working with Policies in Claims” on page 101.
• Policy Details – The General screen is the policy overview. The Details screen shows the vehicles or property that are
covered, what coverages they have, and the coverage limits. Workers’ compensation claims do not show the
Policy Details option, since these policies never list vehicles or properties, only coverages that apply to the insured.
• Documents – Use this screen to review existing documents and add, link, or indicate the existence of a new
document to the claim. It is the same screen you reach in ContactManager when you select Documents. It is
available after you complete Step One.

• Notes – Use this screen to add a new note.
New Claim Wizard and the Lines of Business

This topic describes the differences in the New Claim wizard based on lines of business in the base configuration.
Policy Type Loss Type Flows (steps) defined in default wizard

Businessowners (BOP) General liability, Property main (9), quick claim property (2)
Commercial auto Auto only main (6), quick claim auto (2), first and final (2)
Commercial property Property main (9), quick claim (2)
Farmowners General liability main (5)
General liability General liability main (5)
Homeowners Property main (5)
Inland marine Property main (8), quick claim (2)
Personal auto Auto only main (5), quick claim (2), first and final (2)
Personal travel Travel main (4),quick claim baggage (2), quick trip cancel (2)
Professional Liability General liability main (5)
Workers’ compensation Workers’ compensation main (4)
New Claim Wizard and Commercial Auto LOB

In commercial lines of business, it is common for there to be a significant number of risk units on a policy. In a
Commercial auto policy, for example, a full fleet of trucks might be listed on the policy. In ClaimCenter, all the
vehicles are retrieved, and you can select the ones that pertain to the claim.
Specific Features in the Commercial Auto New Claim Wizard

The following table lists specifics in the wizard steps:
Wizard Step Description

Find Policy, step 1 Select your policy or create an unverified policy.
Affected Properties, step 2 Select the vehicle that is affected from this list of vehicles from the policy.
Basic Info, step 3 Provide the contact information.
Loss Details, step 4 Provide loss information. Add incidents, such as those affecting vehicles, pedestrians, or property
damage. You can add any existing witnesses, officials, or police reports.
Services, step 5 Assign additional services, such as rental, towing, appraisal or auto body repair.
Save and Assign Claim, step 6 Assign the claim specifically to an adjuster or through automated assignment.
New Claim Wizard and Commercial Property LOB

The claims intake process for commercial property claims works as follows:

Find Policy, step 1 Select your policy, or create an unverified policy.
Affected Properties, step 2 Select the property that is affected from the list of policy properties.
New Claim Wizard and the Lines of Business 97


Basic Info, step 3 Provide contact information.
Loss Details, step 4 Provide loss information. Add incidents, such as those affecting properties or people. You can assign
a catastrophe to the claim in this step as well as add any existing Metropolitan Reports.
Exposures, step 5 Optionally, create exposures in this step from the Actions, New Exposure menu.
Parties Involved, step 6 Provide contact details of the people involved in the claim.
Documents, step 7 If there are no documents, then this step is skipped.
Save & Assign Claim, step 8 Assign the claim to specifically to an adjuster or through automated assignment.
Save Claim, step 9 Review the claim before saving.
New Claim Wizard and Homeowners LOB

The claim intake process for homeowners claims is usually faster than intake for auto claims. For example, a
Customer Service Representative (CSR) might take 10 minutes to gather data for a homeowners claim, while
gathering auto claim information might take up to 45 minutes. As a result, the New Claim wizard uses only four
steps.
The wizard provides:
• Damage mitigation by using Services early in the process. Dispatching services early in the claim process can
prevent issues from escalating. An example is a pipe leak, which can escalate to damaged contents and mold
issues.
• Questions for capturing detailed damage information on the claim.
• Automatic incident creation upon selection.
Specific Features in the Homeowners New Claim Wizard

The following table lists specifics in the wizard steps:
Wizard Step Specific Feature

Find Policy, step 1 Claims History – You can see immediately if there are other related claims, their status and loss dates, and
who was assigned to them. Finding information at this level could alert an adjuster or CSR of potential
fraud.
Basic Info, step 2 ClaimCenter pulls the coverage limits on the policy into the claim for you.
Loss Details, step 3 This step captures claim loss details, property incidents, and liability incidents, besides additional
information. There is only one Property incident per claim, but for Liability incidents, there can be
multiple incidents. Property incidents include Dwelling, Personal Property, Other Structures, and Living
Expenses. Selecting a damage type of Fire or Water expands the screen so that you can capture
additional details and ask the right questions about the damage.
This step also captures any witnesses, officials, or reports.
Services, step 4 This screen is where you assign services. If done early in the claim process, assigning services can help
keep damages to a minimum.
Save and Assign You can create new exposures during this step by clicking the New Exposure button. When you are
Claim, step 5 finished, save the claim and assign to an adjuster or use automated assignment.

See also
• “Homeowners Line of Business” on page 173 for additional information.
Configurable Risk Units

Step Two – Basic Information of the New Claim wizard for commercial auto and commercial property displays the
list of either vehicles (RiskUnit objects) or properties contained in the policy. From this list, you make your
selection of the property or vehicle to be included in the claim.
This process is configurable, enabling you to configure other loss types and display different types of RiskUnit
objects. Examples can include configuring locations for a workers’ compensation claim or changing the RiskUnit
objects to show coverages in a homeowners claim.
New Claim Wizard and the Lines of Business 99


chapter 8
Working with Policies in Claims
Every claim is a claim against a single insurance policy. The policy associated with a claim determines what the
claim covers. The coverages on the claim map to the exposures on a claim. It is the coverage limits that bind or limit
the payments on a claim.This topic explains the relationship between policies and claims.
Verified and Unverified Policies

ClaimCenter depends on an external system to provide and verify—vouch for the authenticity of—the claim’s
policy. Usually, ClaimCenter is integrated with a policy administration system, which provides policies that are
guaranteed to be real and accurate, or verified. If that system does not provide ClaimCenter with a verified policy,
you can enter policy information to open the claim.
You can also edit a verified policy. However, the policy you create or edit in this way is always unverified. To make
payments and complete a claim, ClaimCenter requires that the claim have a verified policy.
Validating Policies
Every claim must be associated with a policy when it is first created. ClaimCenter validation rules verify that when a
claim is first created, it is associated with a policy, which can be an unverified policy. Allowing unverified policies
enables a novice call center employee to start the claim process. As claim processing progresses to making
payments, the policy validation rules provided in the base configuration do not look for a verified policy, although
you can create rules that do.
Working with Policies in ClaimCenter

You can perform the following actions on policies with Guidewire ClaimCenter:
Task or action Description

Search for a policy You can search for policies by entering information that helps ClaimCenter search for a policy in a
policy administration system. This system can be either Guidewire PolicyCenter or an external policy
Working with Policies in Claims 101

Task or action Description

administration system. The search, if successful, returns a list of possible policies from which you can
make a selection.
See “Searching for Candidate Policies” on page 102.
Retrieve a policy You can retrieve a snapshot of an existing policy. Selecting one of the candidate policies returned by a
snapshot policy search associates that policy with the claim. This operation retrieves full policy information,
correct as of the -claim loss date.
See “Retrieve the Correct Policy” on page 104.
Create an unverified You can create a new, unverified, policy. If you want to open a claim without knowing about the policy,
policy enter possible policy information. It is not necessary to know the correct policy number.
See “Create an Unverified Policy” on page 103.
Edit an existing policy You can change actual policy information or add extra policy information that is local to ClaimCenter. If
you edit an existing policy, ClaimCenter no longer considers the policy to be verified.
See “Edit a Policy Copy in ClaimCenter” on page 104.
Refresh policy You can replace the policy information on a claim with a new copy of the policy information pulled
information from a policy administration system.
See “Refreshing the Policy Snapshot on a Claim” on page 105.
Replace a policy on You can replace the policy associated with a claim with a different policy.
the claim See “Replacing a Policy on a Claim” on page 108.
Add coverages to a You can add coverages to a policy.
policy See “Adding Coverages to a Policy” on page 109.
Searching for Candidate Policies

The initial step of the ClaimCenter New Claim wizard requires that you provide a policy number. You can either
search for an existing policy or create a new, unverified, policy.
Additionally, you can select a verified policy for a new claim, and you can search for a claim by its policy.
See also
• “Create an Unverified Policy” on page 103
Search for a Policy

Procedure
1. Select Find Policy in the Search or Create Policy screen of the New Claim wizard.
2. Enter search information, such as the insured’s name and address, the VIN number of the vehicle, or the policy
number.
If successful, the integrated policy administration system returns a list of all policies that match your search
criteria. The summary for each policy contains information about the policy along with information about any
claims against this policy.
3. Click a policy number in the list.
You see a Policy Details screen that shows a list of all vehicles or properties insured under the policy.
ClaimCenter truncates the list of vehicles or properties if the policy contains a large number of them.
102 chapter 8 Working with Policies in Claims

Next steps
See also
• “List of Vehicles or Properties on the Policy Details Screen” on page 103
List of Vehicles or Properties on the Policy Details Screen

If you search for policies and select one, you see the Policy Details screen. ClaimCenter truncates the list of vehicles
or properties if the policy has a large number of them.
If ClaimCenter truncates the list:
• ClaimCenter attempts to retain the correct vehicle or property in the returned list by using the search criteria.
• ClaimCenter generates a warning message to indicate that truncation occurred.
ClaimCenter stores the totals for these lists in the Policy.TotalVehicles and Policy.TotalProperties
properties.
Note: To suppress these warning messages, in Guidewire Studio you can open config.xml and set the
configuration parameters IgnorePolicyTotalPropertiesValue and IgnorePolicyTotalVehiclesValue.
See also
• “Search for a Policy” on page 102
Select a Verified Policy for a New Claim

Procedure
1. Navigate to the New Claim wizard in the Claim tab.
2. Click Find policy.
3. Enter the policy number.
4. Click Next to continue with the New Claim wizard.
Search for a Claim by Its Policy

Procedure
1. Navigate to Claims in the Search tab.
2. Enter the policy number.
3. Click Search.
Create an Unverified Policy

About this task
If you do not have sufficient information to retrieve a snapshot of an existing policy, you can create a new,
unverified policy. Later, you can associate the claim with an actual verified policy.
Procedure
1. Navigate to New Claim in the Claim tab.
2. Click Create Unverified Policy and enter the requested information and a policy number. The policy number does
not have to be valid at this point. It is possible to change the policy number at a later date.
3. Click Next.
Searching for Candidate Policies 103

Retrieve the Correct Policy

About this task
ClaimCenter returns one or more policies that match your search criteria. The external policy administration system
retrieves and transfers a snapshot of the entire policy, valid on the date of loss to ClaimCenter. Retrieval occurs
automatically as you select a verified policy.
Procedure
1. Review the policies returned by the search.
2. Select the appropriate policy from the list.
Edit a Policy Copy in ClaimCenter

About this task
Because any edit to a verified policy changes it to unverified in ClaimCenter, you have an incentive not to make
changes to the policy. You must have a role that has the Make Policies Editable permission to be able to enter an
unverified policy or to edit a verified policy.
Procedure
1. Select a Claim.
2. Select the Policy menu item and click Edit.
ClaimCenter displays a warning indicating that editing the policy will mark it as unverified.
3. Click OK to continue.
4. Make your edits.
5. Click Update to save your work.
Note: Clicking Edit immediately makes the policy unverified, even if you make no edits. You can click
Refresh Policy to verify the policy again.

Refreshing the Policy Snapshot on a Claim

Each claim contains a snapshot of the policy associated with that claim. In working with policies, you can perform a
number of tasks, including:
• Updating the snapshot of the policy directly from the integrated policy administration system.
• Choosing an entirely different policy to associate with a claim.
Note: Refreshing a policy from the policy administration system always gives you a verified policy.
Policy Refresh
Refreshing a policy replaces the policy snapshot with the latest version of the policy from the policy administration
system, effective on the date of loss. In this process, ClaimCenter does the following:
• Retrieves a new snapshot of the policy from the policy administration system.
• Replaces the policy snapshot with the new policy and rewires the connections between the policy and the claim.
This process is called relinking
There are several reasons that you might want to refresh the policy attached to the claim:
• The loss date was wrong when the claim was created, and the wrong policy was retrieved and used in the
snapshot.
• There was a mistake on the policy in the policy administration system when the claim was created. For example,
there was an incorrect contact. This mistake has been fixed and the policy needs to be updated.
• There was a risk unit or coverage missing on the policy. It is possible that the wrong risk unit was chosen during
claim creation or that the policy lacked a risk unit that needed to be covered. The error has now been corrected in
the policy administration system.
• A policy change has been made that is effective for the date of loss, and this changed has rendered the policy
snapshot obsolete.
What ClaimCenter Replaces During a Refresh

When a policy is refreshed, only information from the policy administration system is updated. For example:
What ClaimCenter updates What ClaimCenter does not update

• Coverages • Aggregate limits
• Coverage limits • Reinsurance agreements
• Policy contacts • Claim contacts, which are not updated if they have claim
• Claim contacts, which are updated if they have policy roles only, like reporter, witness, and similar roles.
roles like insured, covered party, and similar roles.
Refreshing a policy replaces the current policy information. In a refresh, ClaimCenter preserves only the policy
fields marked as internal. ClaimCenter also preserves information related to claim contacts and the parties involved.
For example, in the base configuration, refreshing a policy does not update witness or claimant information because
this claim information is not present in the policy administration system.
Policy refresh checks to see if any of the aggregate financial values have changed. If this is the case, ClaimCenter
recalculates those values.
Additionally, if an existing policy contact has changed roles, such as no longer being the agent, ClaimCenter
attempts to assign a former role, such as formeragent, to the contact. If there is no former role defined, such as for a
new policy contact role that you have added, ClaimCenter displays an error message.
Refreshing the Policy Snapshot on a Claim 105

See also
• For information on defining former roles for policy contacts, see the Configuration Guide.
Policy Refresh Wizard

You initiate a policy refresh by clicking the Refresh Policy button in the Policy: General screen of a claim. Depending
on your line of business, the wizard takes a path enabling you to:
• Select the policy.
• Make the risk unit selection for commercial auto and commercial property only.
• Compare policy information on the Policy Comparison screen.
The comparison screen shows the differences and any errors or warnings. Errors prevent refresh from completing. If
there are warnings only, then you can still complete the refresh.
Policy Comparison Screen

After you click Policy Refresh, ClaimCenter displays a side-by-side comparison of the current policy and the new
policy in the Policy Comparison screen.
• The current policy version is the snapshot of the policy that is already on the claim.
• The new policy version is the snapshot of the policy returned by the policy administration system upon
requesting a policy refresh. This version is the latest version of the policy from the policy administration system
effective for the date of loss.
The Policy Refresh screen provides:
• An area at the top for errors and warnings that can occur during a refresh. An error blocks a refresh. A warning
draws attention to a potential problem.
• A tree representing differences between the policy snapshot and the latest policy retrieved from the policy
administration system. The tree shows policy entities and properties.
• Two columns on the right, one labeled Current Policy, the other labeled New Policy. The policy snapshot on the
claim is the current policy version. The copy of the policy that the policy administration system returns is the
new policy version.
• A button bar that provides Cancel and Finish buttons.
Resolving Issues with Policy Refresh

If ClaimCenter encounters an error condition, such as an incompatible change, during policy refresh, the error
prevents the refresh.
The following list describes the policy refresh behavior in the ClaimCenter base configuration:
Retrieved policy changes Policy refresh changes in ClaimCenter

Contact no longer present on the The insured becomes the former insured. ClaimCenter adds the contact as an excluded
policy as insured, and is added as party.
an excluded party
Coverage added ClaimCenter shows the refreshed policy with the coverage.
Coverage incident or exposure ClaimCenter updates the coverage limits on the policy. ClaimCenter provides a warning if
limits changed or the limit the limit decreases.
currency changed
Effective date or the expiration ClaimCenter shows a warning.
date changed on the coverage
PIP aggregate limits lowered ClaimCenter shows a warning.

Retrieved policy changes Policy refresh changes in ClaimCenter

Policy currency changed • If the currency is editable, ClaimCenter provides a warning.
• If the currency is read-only, ClaimCenter blocks the refresh with an error.
Policy period changed ClaimCenter shows a warning.
Risk unit added to policy, such as a ClaimCenter adds the risk unit to the claim. It is possible to modify an incident to use the
vehicle new risk unit, such as a vehicle.
Risk unit coverage removed that is • If the exposure is still open, ClaimCenter blocks the refresh. The user must close the
used by an exposure exposure first to continue.
• If there are non-reserving transactions on the exposure, or the net incurred is greater
than 0, ClaimCenter blocks the refresh.
• If the exposure is closed, meaning that there are no transactions except reserves, and
the net incurred is zero, ClaimCenter allows the refresh.
Spelling of an insured’s name The action is dependent on the matching logic:
changed • If the contact is uniquely identified, ClaimCenter treats the change as a name change.
• If no unique identification is present, the default behavior in the base configuration is
to use the name as an identifier by using fallback matching criteria. ClaimCenter
considers this change to be the addition of a new contact.
You can configure this behavior.
Workers’ comp class code ClaimCenter blocks the refresh with an error.
removed
Configuring a Policy Comparison

In the Policy Comparison screen, it is possible to configure the following:
• The objects and properties that ClaimCenter lists in the policy comparison tree.
• The order and labels of objects and properties listed in the policy comparison screen.
• The messages that ClaimCenter generates if it detects an issue during policy refresh.
Configuration of the Policy Comparison Screen

It is possible to configure the following items in the policy comparison tree shown in the Policy Comparison screen:
• Entity and property labels
• Entity and property display order
See the Integration Guide for details.
Configuration of Policy Refresh Messages

ClaimCenter can show messages during policy refresh as it encounters certain conditions. These messages can be
any of the following:
Error An error identifies a problem severe enough that ClaimCenter does not allow the policy refresh. If ClaimCenter
identifies an error condition, it disables the Finish button in the Policy Comparison screen.
Warning A warning identifies a possible problem, but ClaimCenter still allows the policy refresh.
ClaimCenter lists all messages in order of severity, errors first followed by warnings.
Refreshing the Policy Snapshot on a Claim 107

In the base configuration, ClaimCenter provides error or warning messages for the following:
• Missing class code
• Changed currency value
• Changed policy period
• Missing property item to which the claim refers
It is possible to configure all message types, which means that you can do the following:
• Modify the text of a message.
• Modify the conditions under which ClaimCenter generates a message in the base configuration.
• Remove a base configuration message.
• Add additional messages to those in the base configuration.
See also
• For details on the IPolicyRefreshPlugin plugin interface, see the Integration Guide. ClaimCenter provides this
plugin interface in the base configuration to define the interactions between ClaimCenter and policy refresh code.
Selecting a Policy
In the Policy: General screen, clicking Select Policy opens a policy search screen. Use policy select to replace a claim's
policy snapshot with a different policy from the policy administration system. For example, you can use policy
select to:
• Search for and select a different policy to associate with the claim. It is possible, due to various factors, that the
wrong policy was chosen initially.
• Replace an unverified policy that was entered manually with a verified policy. You might have created an
unverified policy, for example, if you did not know the number of the specific policy to associate with the claim.
When you know the policy number or other policy information, you could search for the correct verified policy
to associate with the claim. For information on unverified policies, see “Verified and Unverified Policies” on
page 101.
If you select a new policy to associate with the claim, ClaimCenter can relink the information on the claim to the
new policy.
Replacing a Policy on a Claim

You can replace a policy on a claim instead of refreshing the current policy. Contacts, claim contact, and interested
party information are treated as if the policy was refreshed. The claim similarly undergoes a new validation. In
addition, policy replacement nulls most other policy-related claim information. For example, vehicle information
from a former policy listed in one of the claim’s exposures is no longer be present in the claim after replacing the
policy.
Policy replacement can cause exposures to become invalid. If the replacement policy does not have the coverage
needed for an exposure, that exposure cannot remain a part of the claim. ClaimCenter does not remove such
exposures, but they fail validation.
Replace a Policy
About this task
Use these steps to replace the policy on an existing claim. As an alternative to these steps, you can return to the first
screen of the New Claim wizard and select a new policy.
Procedure
1. Select a Claim.

2. Select the Policy menu action and click Select Policy.

3. Click OK to re-select in the popup.
You do not need to click Update.
Adding Coverages to a Policy

It is possible to add a coverage to a policy that you select in ClaimCenter. A coverage provides protection from a
specific risk. Coverages always attach to a coverable, which is an exposure to risk that a policy can protect against.
You typically divide coverables into property coverables and liability coverables:
• Property coverables – Things with physical attributes, such as height, weight, value, construction type, age, and
similar attributes.
• Liability coverables – Operations represented typically by class codes, such as coal mining or personal
automobile operation.
You can divide coverages into the same two types as well, property and liability. For example, on an auto policy:
• A collision property coverage protects the vehicle owned by the insured.
• A liability coverage protects the driver for damage done to a vehicle owned by someone else. Liability coverage
provides insurance for the operation of the vehicle. It does not provide insurance for the car, bus, or snowmobile.
Under what circumstances do you need to add a coverage to a policy in ClaimCenter? Suppose, for example, that the
ClaimCenter version of the policy does not contain the correct endorsements and coverages that were in effect on the
policy before an incident took place. In many cases, you must add these coverages before you can continue with
claim processing.
IMPORTANT ClaimCenter does not push any changes in coverages that you make in ClaimCenter back to the
policy administration system. The policy administration system is the system of record for policies, not
ClaimCenter.
Add a Policy-level Coverage

About this task
As described in “Adding Coverages to a Policy” on page 109, you can add coverages to the policy on a claim.
Procedure
1. Open a claim.
2. Navigate to the Policy link on the left-hand side of the screen.
3. Click Edit.
4. At the bottom of the screen, click Add in the area labeled Policy-level Coverages.
5. Choose the coverage type from the drop-down list.
6. Enter the other values as needed.
7. Click Update.
Adding Coverage Terms

A coverage term is a value that specifies the extent, degree, or attribute of a coverage. Using a coverage term, you
can:
• Specify the limits or deductibles of a coverage.
• Specify the scope of a coverage.
• Specify a selection or an exclusion that is specific to a particular coverage.
Adding Coverages to a Policy 109

A coverage can have zero, one, or many coverage terms.

If you select Policy→Coverage Terms→Add, ClaimCenter opens a screen in which you can define a coverage term.
ClaimCenter divides coverage terms into the following types:
• Classification
• Financial
• Numeric
ClaimCenter provides an entry screen for each coverage term type. Each screen contains common fields and
additional type-specific fields. The following table lists the fields that are common to all coverage term types:
Field Description
Subject Drop-down list of coverage terms that are available for the chosen coverage type.
For example, if you select a coverage type of Comprehensive for a Personal Auto claim, ClaimCenter provides
you with the following choices for the Subject field:
• Comprehensive deductible
• No deductible for glass
ClaimCenter defines the available choices in typelist CovTermPattern.
Applicable To Drop-down list of coverage terms that restrict what the chosen coverage type actually covers. The kinds of
restrictions available for selection depend on the coverage type.
For example, if you select a coverage type of Collision for a Personal Auto claim, ClaimCenter provides the
following choices for the Applicable To field:
• Accident
• Bodily injury
• Bodily injury/property damage
ClaimCenter defines the available choices in typelist CovTermModelRest.
Per Drop-down list of coverage terms that indicate that this coverage term applies to a subset or a subtype of the
coverage. For example, if you select a coverage type of Collision for a Personal Auto claim, ClaimCenter
provides the following choices for the Per field:
• Annual aggregate
• Each accident
• Each common cause
• Per claim
• Per item
• Per occurrence
• Per person
ClaimCenter defines the available choices in typelist CovTermModelAgg.
Type Read-only label that identifies the coverage term type. ClaimCenter generates this label from typelist CovTerm.
The following table lists the fields that are specific to each coverage term type:
Type Type-specific fields

Classification • Code – Policy administration systems often use classification codes to segment or categorize a large set of
items. For example, there are jurisdictional class codes that divide a geographical region into smaller areas,
each with a specific code. There are also medical class codes that assign every conceivable medical
condition a specific code. The code that you enter must match a valid class code used in the policy
administration system.
• Description – Optional text field for additional information.
Financial • Amount – A non-negative currency amount.

Type Type-specific fields

Numeric • Value – A numeric value.
• Units – The associated units for that value. Available choices include days, hours, money, or percent, for
example.
ClaimCenter defines the available choices in typelist CovTermModelVal.
See also
• “Add a Coverage Term to a Policy” on page 111
Add a Coverage Term to a Policy

Procedure
1. Open a claim.
2. Navigate to the Policy link on the left-hand side of the screen.
3. Click Edit.
4. Select a coverage at the bottom of the screen in the area labeled Policy-level Coverages.
5. Click Add in the area labeled Coverage Terms.
6. Select the coverage term type:
• Classification
• Financial
• Numeric
7. Fill in the fields on the Coverage Term definition screen appropriately for that coverage term type.
Configuring Policy Menu Links

It is possible to configure how ClaimCenter displays policy information. Specifically, you can configure the Policy
screen of a claim to display aggregate limits, lists of insured properties, endorsements, and vehicles.
ClaimCenter defines the possible options within the Policy screen in the PolicyTab typelist.
See also
Verifying Coverage
ClaimCenter leverages your organization’s best practices in reviewing the claim’s characteristics. ClaimCenter helps
you create exposures that make sense and warns or prevents you from creating exposures that do not. After you
create a new exposure, ClaimCenter looks for inconsistencies between a policy’s coverages and the loss party, the
loss cause, other existing exposures, and the claimant’s liability.
For example, the following exposure examples do not have sensible relationships between an exposure’s coverage
and its loss party, loss cause, other existing exposure, or liability:
• Comprehensive coverage for the auto of a third party – An incompatible loss party.
• Collision coverage for a stolen auto – The wrong loss cause for the coverage.
• Collision coverage for an auto damaged by a windstorm – A collision exposure cannot be created if an
exposure based on comprehensive coverage for that auto already exists.
• Coverage for a third party’s auto when the first party is not at fault – The insured has no liability, so there is
no need to create an exposure.
Adding Coverages to a Policy 111

In the base configuration, the Coverage Verification feature checks for all these types of incompatibilities. You can
define the incompatibilities to check for, except for an incompatible loss party. In that case, you cannot create an
exposure. In the other cases of incompatibility, you can create new exposures, but ClaimCenter displays a warning
message.
Loss Party and Coverages

Every exposure in ClaimCenter must be either a first party or a third party exposure. Some exposures, like injuries
covered by an auto liability coverage, must always be third party. Other coverages, such as Medical Payments, can
cover only a first party.
The LossPartyType typelist categorizes exposures by loss party. If you have selected the loss type to be first party,
ClaimCenter displays only the coverages categorized for first party loss types. If you have selected third party,
ClaimCenter displays only the third party exposure types in this typelist. The categories in this typelist are based on
the CoverageSubtype, rather than the ExposureType typelist.
Because ClaimCenter restricts you to certain combinations of loss party and coverage subtype, you cannot create an
incorrect combination, and ClaimCenter never warns you that you have. You cannot edit the table of prohibited
combinations, and there are no rules that affect the application’s behavior.
Your typelist can contain exposures categorized as both first and third party, and you must manually edit this file.
Loss Causes and Coverages

A LossCause typically applies to some, but not all, CoverageTypes. Examples include:
• Theft, Fire, and Vandalism – Appropriate loss causes for comprehensive, but not collision coverages.
• Collision with Motor Vehicle or with an Animal – An appropriate loss cause for a collision coverage, but not a
comprehensive coverage.
Some coverages, such as Medical Payments, do not have a strong relationship to loss cause. If your business rules
specify that certain combinations are prohibited, you can modify your configuration to include them. See “View and
Edit Invalid Loss Causes and Coverages” on page 112.
ClaimCenter maintains a table of loss cause and coverage pairs that administrators can edit. After creating a new
exposure with a pair of values in the table, ClaimCenter displays the following warning:
Warning: This exposure’s coverage is not expected due to the claim’s Loss Cause: [Loss Cause name]
Note: You can also use LossCause to create rules that govern conditional questions in question sets, to open a
subrogation review, or take other ClaimCenter actions.
See also
• “View and Edit Invalid Loss Causes and Coverages” on page 112
View and Edit Invalid Loss Causes and Coverages

About this task
You can view and edit invalid pairings of loss causes and coverages.
Procedure
1. Click the Administration tab and navigate to Coverage Verification→Invalid Coverage for Cause.
2. If you click Edit in this table, you can add or delete inappropriate loss cause and coverage pairs to conform
with your business rules.

Next steps
See also
• “Loss Causes and Coverages” on page 112
• “Coverage Verification Reference Tables” on page 538
Incompatible Exposures
Some exposures might not exist when other exposures already exist on the claim. For example:
• If a collision exposure exists on a claim, there is no comprehensive exposure.
• If a medical payments exposure exists on a claim, there is no extraordinary medical payments exposure.
ClaimCenter maintains a table of incompatible exposure pairs that users with administrator privileges can edit. After
creating a new exposure with a pair of values in the table, ClaimCenter displays the following warning, but you can
still create the exposure:
Warning: This exposure’s coverage conflicts with at least one existing exposure: [exposure name]
See also
• “View and Edit Incompatible Exposures” on page 113
View and Edit Incompatible Exposures

About this task
You can view and edit the table of incompatible exposure pairs.
Procedure
1. Click the Administration tab and navigate to Coverage Verification→Incompatible New Exposure.
2. Click Edit to add or delete inappropriate exposure pairs to conform with your business rules.
3. Use the drop-down menu to select exposure names.
4. To remove a table entry, select its check box and click Remove.
5. Click Update to save your changes.
Next steps
See also
• “Incompatible Exposures” on page 113
Liabilities and Exposures

Some exposures require the insured to be at fault and are not needed otherwise. For example, if the insured is
entirely at fault, an uninsured motorist exposure is probably incorrect.
ClaimCenter maintains a table of pairs of incompatible exposure and the insured’s liability pairs. Administrators can
view and edit this table. After creating a new exposure with an incompatible liability as defined in this table,
ClaimCenter shows the following warning, but you can still create the exposure:
Warning: This exposure’s coverage is not expected due to the claimant’s fault rating: [rating value]
Verifying Coverage 113

See also
• “View and Edit Liabilities Incompatible with Exposures” on page 114
View and Edit Liabilities Incompatible with Exposures

About this task
You can view and edit the table of inappropriate pairings of fault rating and exposure.
Procedure
1. Click the Administration tab and navigate to Coverage Verification→Possible Invalid Coverage due to Fault Rating.
2. Click Edit to you can add or delete inappropriate pairs to conform with your business rules.
3. Choose exposure names or fault ratings in the drop-down menu.
4. To remove a table entry, select its check box and click Remove.
Next steps
See also
• “Liabilities and Exposures” on page 113
Coverage Verification
The Coverage Verification feature contains tables of incompatible pairs. Methods scan them and determine if the end
user is to receive a a warning if a potentially invalid exposure has been selected.
Coverage verification Table of incompatibilities Method to read table

Loss Party incompatible with exposure none none
Loss cause InvalidCoverageForCause invalidCoverageForCause
Incompatible exposures IncompatibleNewExposure incompatibleNewExposure
Liability incompatible with exposure InvalidCoverageForFaultRating invalidCoverageForLiability
Note: The Reference Table framework is at the configuration layer. The same techniques described can be used to
administer any reference tables added by an implementation.
Aggregate Limits
An aggregate limit is the maximum financial amount that an insurer is required to pay on a policy or coverage
during a given policy period. An aggregate limit can apply to a policy, a specific coverage, a coverage subtype, a
group of coverages, or an account. The purpose of using aggregate limits is to enable ClaimCenter to track the
financial transactions made on a claim, and warn you if a preset limit is exceeded.
An aggregate limit effectively caps the insurer’s total liability for a specified time. The cap applies regardless of the
number of claims made against the relevant policies or the number and variety of exposures represented in the
claims. At the highest level, an aggregate limit can apply to a policy or an account. A limit that applies to a single
policy establishes a maximum total liability for all of the claims made against that policy. A limit that applies to an
account establishes a maximum liability for all claims made against all the policies belonging to that account.

In the base configuration, ClaimCenter displays a warning if the aggregate limit is exceeded by the creation of a
reserve or payment. This message is simply a warning, and you can still continue to create the reserve or make the
payment. You can change this configuration in rule TXV08000 in the Transaction Validation rule set.
See also
Policy Periods and Aggregate Limits

Policy periods play an important role in aggregate limits. ClaimCenter uses policy periods to do the following:
• To connect aggregate limits to either accounts or individual policies – ClaimCenter associates aggregate
limits with policy periods, and policy periods identify the policy or policies to which the aggregate limit applies.
• To distinguish between policy versions – Policies are typically in effect for a single year or portion thereof.
Each year the policy in effect is a different version of the policy, with different effective dates.
See also
Add Aggregate Limits

About this task
You can add an aggregate limit to an account or an individual policy.
• If the policy is part of an account, any aggregate limit you define on that screen applies to the account as a whole,
rather than to the individual policy.
• If the policy is not a member of an account, aggregate limits defined on that policy’s Aggregate Limits screen apply
only to that policy.
When you add a new aggregate limit, the default selection is Policy.
Procedure
1. In a ClaimCenter claim, navigate to Policy→Aggregate Limits to create and view aggregate limits.
2. Define a new aggregate limit by specifying the following:
• Applies To – Applicable account or policy.
• Aggregate Type – Aggregate limit or deductible.
• Amount – Aggregate limit amount.
• Count Towards Limit – Financial transactions to include in the aggregate limit, based on their cost types and
cost categories. These options can be configured in the aggregate limits configuration file,
aggregatelimitused-config.xml.
• Coverages – Optionally, one or more coverage types, coverage subtypes, and covered items. You can add
coverages with coverage type only or coverage type and subtype or a combination of coverage type,
subtype, and covered item.
Aggregate Limits 115

Next steps
See also
• “Adding Coverages to an Aggregate Limit” on page 116.
Adding Coverages to an Aggregate Limit

When you create a new aggregate limit, you can optionally add coverages. Each coverage can be a combination of
any of the following fields:
• Coverage Type – Displays a preconfigured list of types relevant to the policy type. For example, if you select a
commercial property policy, the following Coverage Type selections might be available:
◦ Building Coverage
◦ Business Income Coverage
◦ Business Personal Property - Separation of Coverage (Stock)
◦ Business Personal Property Coverage
◦ CPBlanket Coverage
◦ Extra Expense Coverage
Note: If you add a coverage to an aggregate limit, the Coverage Type is mandatory.
• Coverage Subtype (optional) – Displays a preconfigured list of potential subtypes dependent on the selected
Coverage Type. For example, if you select Building Coverage, the following Coverage Subtype might be available:
◦ Building Coverage
• Covered Item (optional) – Displays a preconfigured list of potential items that can be covered. The choices in the
list are also dependent on the choice of covered type and subtype. For example, if you select Building Coverage
as the coverage type and subtype, the following Covered Item might be available:
◦ Property #1
See also
• “Add Aggregate Limits” on page 115
Archiving Claims with Aggregate Limits

In ClaimCenter, you can archive a claim, even if it has aggregate limits associated with it. On the other hand, new
policy-level and account-level limits cannot be created for a claim that has been archived.
When a new aggregate limit is created, ClaimCenter checks if there are existing archived claims in the policy period
contributing to the limit.
If there are archived contributing claims for a given policy, the following conditions apply:
• You can change the limit amount, as needed.
• You must specify at least one coverage, including a covered item and a coverage type, for the new aggregate
limit. It cannot be defined as a general, policy-wide limit.
• You can create aggregate limits only on coverage types, covered items, and risk units if they are not being used in
an archived claim. ClaimCenter displays an error if you attempt to create an aggregate limit on a coverage type,
covered item, or risk unit used in an archived claim.
• You can add a coverage as long as it does not match any coverages with transactions used on archived claims.
• You can delete a coverage or the entire aggregate limit.
You can run the aggregate limits batch process, AggLimitCalc, as usual, and it calculates the limits incurred for all
contributing claims, including archived ones.

View Aggregate Limits

Procedure
1. Navigate to Policy→Aggregate Limits to see a list of all aggregate limits created on the policy.
See “Aggregate Limit Details Screen” on page 117.
2. To view claims contributing to an aggregate limit, click the amount in the Realized column.
The Realized by Claim panel shows a list of all claims contributing to the selected aggregate limit with the
amounts contributed per claim. See “Viewing Claims Contributing to an Aggregate Limit” on page 117.
Aggregate Limit Details Screen

In the Aggregate Limits screen, click the aggregate type in the Applies To column or the amount in the Realized column
to view the details of an aggregate limit.
The Aggregate Limit Details screen includes the following additional information on the aggregate limit:
• Realized–The used amount by coverage.
• Remaining–The remaining available amount by coverage.
See also
• “View Aggregate Limits” on page 117
Viewing Claims Contributing to an Aggregate Limit

In the Realized by Claim pane, you can view the claims contributing to the aggregate limit by Claim Number.
Additionally, claim contributions are broken down into the following details:
• Realized – The amount used by the claim based on the aggregate limit definition. The calculation used for the
Realized amount of each contributing claim is available by using the virtual property,
AggregateLimit.FinancialsCalculationDescription. For policy aggregate limits, ClaimCenter also displays
the calculation used in this pane.
• Net Incurred Contribution – Sum of all open reserves and total payments minus recoveries that apply to the
aggregate limit.
• Net Paid Contribution – Sum of all payments minus recoveries that apply to the aggregate limit.
Note: Clicking a claim number takes you to the claim’s Financials Summary screen and away from the AggregateLimit
Details screen.
See also
• “View Aggregate Limits” on page 117
Policies and the Data Model

Every policy is distinguished by a PolicyType typelist, which is the primary way to categorize policies. Main policy
types include personal and commercial auto, personal and commercial property, homeowners, liability, workers’
compensation, and so forth. Each typecode in this typelist contains the allowed categories of these other typelists:
• LOB Code – Each policy type is associated with one line of business, as defined in the LOBType typelist; a
policy type filters this typelist.
• Coverage Type – Each policy type is associated with one or more coverage types defined in the CoverageType
typelist, such as collision, comprehensive, or towing. A policy type also filters this typelist.
• Internal Policy Type – Another way to categorize policies. The only allowed values are business and personal.
A policy type filters the InternalPolicyType typelist.
Aggregate Limits 117

• Policy Tabs – A typelist that describes the possible menu links of the Policy screen in a claim. These include
Aggregate Limits, Endorsements, and List of Insured Vehicles and Properties. You specify these typecodes to customize
the Policy. The policy type also filters this PolicyTabs typelist.
Policies in ClaimCenter and PolicyCenter

ClaimCenter and PolicyCenter can be integrated so that you can issue a policy in PolicyCenter and then create
claims against that policy in ClaimCenter.
In ClaimCenter, the policy object is mostly an informational snapshot. It lists the coverages, limits, and covered
items or risks that determine the type of claim and payments you can make on it for a given date. PolicyCenter,
however, stores multiple versions of each policy to keep track of all modifications, cancellations, reinstatements, and
so on made over time to the policy. In addition, the PolicyCenter model is structured to support all the different
options an agent or underwriter has when putting together a policy.
The following example is a diagram of the ClaimCenter data model of Policy:
Policy Data Model
ClassCodes
* ClassCode
Coverage Code
PolicyCoverage Policy Address
Deductible * Coverages
PolicyLocations
EffectiveDate PolicyNumber
ExpirationDate
ExposureLimit Address
RiskUnits Vehicle
IncidentLimit
* *
Notes
LimitsIndicator RUCoverage RiskUnit PolicyLocation
* Coverages
State RUNumber
Type RiskUnit PrimaryLocation HighValueItems
Policy PolicySystemId
LocationNumber
PropertyRU VehicleRU Notes
*
1
CovTerm
Lienholders
PolicySystemID InlandMarineRU
CovTermOrder VehicleLocation
LocationBasedRU
CovTermPattern
ModelAggregation 1 PolicyLocation * *
Building
ModelRestriction Property Property
GeneralLiabilityRU Owner Item
Buildings
Building
BuildingNumber
Legend PolicySystemID
Notes
A relates to B
A B
B relates to A
BuildingRU WCCovEmpRU
A B A has 0 or more Bs
*
A B A is a subtype of B
Claim Policies and the Policy Administration System

ClaimCenter integrates with policy administration systems including PolicyCenter.
See also
• “Policy Administration System Integration” on page 573
• Installation Guide
• Integration Guide

chapter 9
Accounts and Service Tiers
Account managers can generate specific directions on how to handle a claim. These directions can be in the form of
an automatic email, text on the claim screen, or an automatic activity. These special handling instructions can be
based on accounts and predefined groups of policies called service tiers. They are common in, but not exclusive to,
commercial lines of business. For example, a large carrier can request special handling for their claims.
This topic explains how you can:
• Set up and manage accounts.
• Link the claim to the account.
• Set up and manage policy service tiers.
See also
• “Special Handling” on page 125
Accounts
While the concept of an Account is common across the Guidewire InsuranceSuite, the data modeling of Account is
different in ClaimCenter as compared to PolicyCenter. An account represents an organization or person that has one
or more policies. A single person or organization can be associated with multiple accounts. An account can have
zero, one, or many policies.
In ClaimCenter, for most policies, the account is represented by the AccountNumber field on the Policy entity. The
Account entity is only intended to be populated to take advantage of the application’s Special Handling capabilities.
Account Entity
In ClaimCenter, accounts are stored in the Account entity.
The Account entity, created upon claim creation, has the following key fields:
Accounts and Service Tiers 119

Field Description
AccountHolder Foreign key to the Contact entity. Points to the account holder. You can see information from the address
book about the account holder in the ClaimCenter user interface.
AccountNumber The alphanumeric account number comes from the policy administration system or PolicyCenter.
SpecialHandling Foreign key to AccountSpecialHandling, which is a subtype of SpecialHandling. This field contains any
special handling instructions and notification triggers that apply to any claims from policies associated with
the account.
Accounts and Policies

Accounts can be associated with zero or more policies. The 40-character AccountNumber text field on both the
Policy entity and the Account entity is used to associate policies and claims. To find associations between accounts
and policies, you can make a query that returns Policy and Account entity records that have matching
AccountNumber fields.
Note: There is no foreign key that links accounts and policies. The data model was designed this way to keep the
account out of the claim graph. The claim graph is the set of all entities owned by the claim. It is used to archive
and purge both the claim and data that is unique to the claim. Keeping the account out of the claim graph prevents
it from being purged or archived with a claim.
Account Manager Permissions

The Account Manager is the administrator of accounts in ClaimCenter. In the base configuration, the Account
Manager role has the permission to set up account information on the Administration→Special→Handling→Accounts
page.
Account Permissions
In the base configuration, the Account Manager role has been added to the Super User user with the login, su. It has
the following permissions:
Permission Code Description

Manage Account accountmng Permission to add, edit, or delete accounts.
View Account accountview Permission to view accounts.
Account-related Tasks
On the Administration→Special→Handling→Accounts screen, users with the Account Manager role can perform the
following account-related tasks:
• Add an Account by specifying an Account Number and an Account Holder.
• Edit an Account by changing one or both of its Account Number or Account Holder fields.
• Delete an Account.
• Add, modify, or delete Special Handling instructions, including:
◦ Automated notifications
◦ Automated activities
◦ Other instructions
Working with Accounts

Tasks involving account management in ClaimCenter include defining, adding, editing, and deleting accounts.
120 chapter 9 Accounts and Service Tiers
WARNING Refreshing a policy updates the policy snapshot’s account information, specifically the
AccountNumber. If the account number is changed due a refresh, the policy snapshot for that claim is
automatically disassociated from accounts having the old AccountNumber. The policy snapshot is also
automatically associated with any other accounts that have the new AccountNumber. Other policies where the
same account number changed on the policy must be refreshed at the same time. If they are not, the group of
policies in the account becomes incomplete or distributed over more than one account.
See also
• “Define an Existing Account” on page 121
• “Add an Account” on page 121
• “Edit an Account” on page 121
• “Delete an Account” on page 122
Define an Existing Account
Procedure
1. Click the account number on the Administration→Special→Handling→Accounts screen to open the Detail tab for
that account.
2. Click Edit to edit the following fields:
Account The account number must correspond to the value of the AccountNumber field of a verified policy. You must
Number find it and enter it manually, rather than browse to it, since it designed not to be directly linked to Policy.Ac
countNumber. See “Account Entity” on page 119 for more information.
You can find the policy’s account number by:
• Clicking an applicable claim’s Policy link to access the Policy: General screen where the policy account
number is listed under the Insured header.
• Finding it in a policy administration system or paper copy of the policy.
Account In the data model, this is the Account.AccountHolder field. The value of this field is set to a valid contact.
Holder Browse for a contact and add the name.
Once the Account Holder is defined, you can click the name to access the contact details. If the contact
information is linked to the Address Book, any changes made to the contact’s information in the Address Book
are updated and can be viewed in the claim.
Add an Account
Procedure
1. In Administration→Special→Handling→Accounts, click Add Account.
The New Account screen opens.
2. Enter the Account Number.
3. Find the Account Holder by browsing to a contact in the Address Book.
4. Click Update.
Edit an Account
Procedure
1. In Administration→Special→Handling→Accounts, click the account number of the account to be edited.
2. In the Detail tab, click Edit.
3. Modify the Account Number, if needed.
Working with Accounts 121

4. Modify the Account Holder, if needed.

5. Click Update.
Delete an Account
Procedure
1. In Administration→Special→Handling→Accounts, select the check box next to the account to be removed.
You can delete one or more accounts.
2. Click Delete.
ClaimCenter warns you that if you delete the account, it may affect existing policies that reference the
account.
3. Click OK.
Service Tiers
Special handling can be applied to predefined groups of policies called service tiers. A service tier represents the
customer service associated with a claim and categorizes policies by their level of importance. Policies can be set up
to be associated with a policy tier, such as platinum or gold, and you can define a set of special handling instructions
for each tier. These additional steps are implemented during claim processing for all claims associated with policies
in a service tier.
For example, if a policy is at the Bronze service tier, an associated claim might receive an activity to follow up with
a letter to the insured within 48 hours. If the policy is at the Silver tier, you might follow up with an activity to
contact the insured with a letter mailed within 24 hours. Finally, if the policy was at the Gold tier, you might follow
up with an activity to have the adjuster contact the insured through a phone call within 24 hours.
In the base configuration, two service tiers are provided as samples – Platinum and Gold. The Silver service tier is
available, but not activated. The Policy:General screen displays service tier information, if any. Service tiers are
represented by the typelist attribute, CustomerServiceTier, on the policy entity.
See also
• “Adding Service Tiers” on page 122
• “Deleting Service Tiers” on page 123
Adding Service Tiers

About this task
You can activate an existing service tier by adding it in the Service Tiers screen. The service tier must be included in
the CustomerServiceTier typelist in order to be available in the ClaimCenter Administration menu.
Procedure
1. In Administration→Special→Handling→Service Tiers, select AddServiceTier.
2. In the NewService Tier screen, select the Name of the service tier.
The drop-down list only displays pre-configured service tiers that have not been activated.
3. Select Update.

Next steps
See also
Deleting Service Tiers

About this task
You can deactivate a service tier by removing it in the Service Tiers screen.
Procedure
1. In Administration→Special→Handling→Service Tiers, select the service tier that you want to delete.
The screen shows only active service tiers.
2. Select Delete.
ClaimCenter displays a warning that this action can impact existing policies that reference the service tiers.
3. Select OK to confirm.
Service Tiers 123


chapter 10
Special Handling
For critical customer accounts or for a another segment of customers, ClaimCenter can be configured to include
enhancements during claims processing, collectively referred to as special handling.
Overview of Special Handling

Special handling enhancements can be of three different types:
• Automated notifications
• Automated activities
• Other instructions (claim headline comments)
Special handling instructions are triggered by two kinds of events:
• Changes in claim indicators
• Changes in financials, such as when financial thresholds are exceeded (triggered on financial transactions only)
Automated Notifications for Special Handling

Special handling notifications are emails that are sent typically to involved parties who are not ClaimCenter users,
such as underwriters or brokers. These emails can be created and sent automatically when a claim indicator or
financial indicator event trigger is fulfilled.
Email notifications can be sent to single or multiple recipients and are, in appearance, similar to other emails sent in
ClaimCenter. Emails can be sent to email addresses or to a person with a specific role on the claim.
Automated Activities for Special Handling

Special handling activities are generated to notify users to perform certain tasks when a claim indicator or financial
indicator event trigger is fulfilled.
Special Handling 125

Other Instructions for Special Handling

Other instructions for special handling are free text comments that can be accessed from the claim headline. These
comments are usually informative in nature.
Examples of Special Handling

• The account manager for a commercial auto policy carrier creates an automated notification, which is triggered
when an insured party files a claim with a fatality. When this happens, ClaimCenter automatically sends an email
to the carrier’s broker, alerting them to the event.
• A department manager sees an activity to write up a Large Loss analysis if certain claims have a loss over a
certain threshold.
• The account manager decides to create a set of instructions that will appear on a claim screen but do not need an
activity or email notification sent. In this example, an account tends to handle a high volume of claims that
involve litigation, but there might not be a specific name in the contact list to notify. So the text might state who
the point of contact is along with the contact’s email and phone number. It could also state that investigations
must not take place during peak hours, and then define what those hours are.
• In a set of instructions, the claim triggers the litigation indicator, meaning that the claim is now in litigation. The
adjuster must print all the claim screens and mail them to the account’s law firm. The instructions indicate the
contact person’s name and mailing address.
Special handling instructions can be associated with policies on a specific account or a predefined policy group or
service tier. The following sections describe these options in detail.
Adding Special Handling Instructions

Typically, special handling instructions are executed for claims generated against policies on large, high-value
accounts. Special handling instructions can be assigned to accounts or service tiers.
• Accounts are identified by account number in the Administration tab on the SpecialHandling→Accounts screen.
• Service tiers can be selected in the Administration tab on the SpecialHandling→Service Tiers screen.
You can add an automated notification, an automated activity, or other instructions.
Working with Automated Notifications for Special Handling

ClaimCenter can be instructed to create automatic notifications based on claim indicator events or financial events.
Create an Automated Notification for a Claim Indicator Event
Procedure
1. Select an account number or service tier.
• On the Administration tab, navigate to SpecialHandling→Accounts and select an account number.
• On the Administration tab, navigate to SpecialHandling→Service Tiers and select a service tier.
The Detail screen opens.
2. Click the Special Handling card.
3. In the AutomatedNotifications list view, click Add→Create automated notification for Claim Indicator Event.
The New Automated Notification screen opens.
4. If you need to limit the claim indicator trigger to a specified policy type, select a policy type, such as
Commercial Property.
The default policy type on this screen is All Policy Types.
5. Select the type of indicator for which you want notification.
126 chapter 10 Special Handling
The following indicators can be used as triggers on the claim:

• Coverage in Question – The claim’s coverage is in question.
• Fatalities – The claim involves one or more fatalities.
• Flag Details – The claim is flagged.
• Large Loss – The claim involves a large loss. The claim's Net Total Incurred value is greater than the Large
Loss Indicator value.
• Litigation – The claim’s litigation status is Open.
• SIU – The claim is under special investigation.
6. Select Turns On or Turns Off.
You can turn the event trigger on or off.
For example, you might want to be notified if, for some reason, the litigation indicator is turned off. A
notification is then sent to the manager to check on the resolution.
7. Search and select the Email Template to use for your notification.
Enter a topic or keyword to filter the results, and click Search.
The default template is Claim Indicator Automated Notification. The Keywords field defaults to the following
values for this template: automatednotificationhandler, ClaimIndicatorTrigger.
8. Enter the notification type.
Select single or multiple email recipients or Contactbasedonclaimrole.
9. Enter the email address of the person or persons to receive the notification, or enter the claim contact role. If a
role is selected, ClaimCenter retrieves the email address of the claim contact.
10. Click Update.
Result
In the base configuration, you can see a copy of the generated email in the Documents section. You can disable this
feature through configuration. You create and edit email templates in Studio. Refer to the Rules Guide.
Create an Automated Notification for a Financial Event
Procedure
3. Under Automated Notifications, click Add→Create automated notification for Financial event.
The New Automated Notification screen opens.
4. If you need to limit the financial trigger to a specific type of policy, select a policy type.
5. Select the type of threshold.
The threshold type, along with the threshold amount, forms the basic condition for the notification. When the
claim amount reaches the threshold amount value for the specified threshold type, the special handling
instruction is created.
Working with Automated Notifications for Special Handling 127

Select one of the following:

• Net Total Incurred
• Net Total Paid
• Total Paid
See “Claim Metric Limits” on page 549 for more information on how these threshold values are calculated in
ClaimCenter.
6. Enter a threshold amount.
The email is created and sent out when the claim amount reaches this value.
7. Search for and select the email template to use for the notification.
Enter a topic or keyword to filter the results, and click Search.
The default template is Financial Automated Notification. The Keywords field defaults to the values for this
template: automatednotificationhandler and FinancialThresholdTrigger.
8. Enter the notification type. Select single or multiple email recipients or Contactbasedonclaimrole.
9. Enter the email address of the person or persons to receive the notification, or enter the claim contact role. If a
role is selected, ClaimCenter retrieves the email address of the claim contact.
10. Click Update.
Working with Automated Activities for Special Handling

About this task
Automated activities are created and generated in a similar way to notifications, but the result is an activity instead
of an email. Activities are defined in activity patterns, and you need administrator permissions to create activity
patterns.
Next steps
See also
• “Working with Automated Notifications for Special Handling” on page 126
• “Understanding Activity Patterns” on page 234
Create an Automated Activity for a Claim Indicator Event
Procedure
3. Under Automated Activities, click Add→Create automated activity for Claim Indicator Event.
The New Automated Activity screen opens.
4. If you need to limit the activity trigger to a specific type of policy, select a policy type.
5. Select the type of indicator that you want to be notified of.

You can use following indicators as triggers on the claim:

• Coverage in Question – The claim’s coverage is in question.
• Fatalities – The claim involves one or more fatalities.
• Flag Details – The claim is flagged.
• Large Loss – The claim involves a large loss. The claim's Net Total Incurred value is greater than the Large
Loss Indicator value.
• Litigation – The claim’s litigation status is Open.
• SIU – The claim is under special investigation.
6. Select Turns On or Turns Off.
7. Select an activity pattern.
An activity pattern must be configured for special handling. See the Configuration Guide.
Choices in the base configuration are:
• Consult Account regarding fatality
• Produce claim strategy narrative
• Review all Special Handling instructions
• Review denial decision with Account Manager
• Review matter-related Special Handling instructions
• Review negotiation strategy with Account
8. You can select an email template or optionally choose Override Email Template.
• Browse to select an email template if there is no default one associated with the activity pattern.
• Override the default email template on the activity pattern.
The Keywords field defaults to automatedactivityhandler, ClaimIndicatorTrigger.
In the generated activity, there is an option to Send email that the person viewing the activity can use. No email
is generated automatically.
9. Click Update.
Create an Automated Activity for a Financial Event
Procedure
2. Select the Special Handling card.
3. Under Automated Activities, click Add→Create automated activity for Financial Event.
The New Automated Activity screen opens.
4. If you need to limit the financial trigger to a specific type of policy, select a policy type.
5. Select the type of Threshold.
The threshold type, along with the threshold amount, forms the basic condition for the notification. When the
claim amount reaches the threshold amount value for the specified threshold type, the special handling activity
is generated.
6. Enter a ThresholdAmount.
Working with Automated Activities for Special Handling 129

The activity is generated when the claim amount reaches this value.
7. Select an activity pattern. Choices in the base configuration are:
• Consult Account regarding fatality
• Produce claim strategy narrative
• Review all Special Handling instructions
• Review denial decision with Account Manager
• Review matter-related Special Handling instructions
• Review negotiation strategy with Account
8. You can select an email template or optionally choose Override Email Template.
• Browse to select an email template if there is no default one associated with the activity pattern.
• Override the default email template on the activity pattern.
The Keywords field defaults to automatedactivityhandler, FinancialThresholdTrigger.
In the generated activity, there is an option to Send email that the person viewing the activity can use. No email
is generated automatically.
9. Click Update.
Working with Other Instructions

About this task
You can create detailed instructions, special handling Other Instructions, that are included in the claim headline. These
instructions appear as read-only text on claims that are generated on policies in the account and can be viewed by
clicking View Other Instructions.
These instructions can be generated when specific claim events occur, such as when a new claim is created or when
a claim goes into litigation. These claim event triggers for other instructions are grouped under Instruction Category.
The InstructionType that you set depends on the selected Instruction Category.
Procedure
2. Click the Special Handling tab.
3. Under Other Instructions, click Add.
The Other Instruction screen opens.
4. If you need to limit the instructions to a specific type of policy, select a policy type.
5. Set the Instruction Category from the drop-down list.
These claim events, such as when a new claim is created or when a claim goes into litigation, cause
instructions to be generated.
6. Set the Instruction Type, which depends on the Instruction Category.
7. Enter Comments, if any.
8. Click Update.

Import Special Handling Instructions

About this task
With administrative permissions, you can import account and special handling data.
IMPORTANT If you import an account and special handling XML file, ClaimCenter creates instances of the entities
defined in the file. Do not delete these instances in a production environment, because doing so will prevent
ClaimCenter from starting.
Procedure
1. Click the Administration tab and navigate to Utilities→Import Data.
2. Choose the file to import.
Next steps
See also
Export Special Handling Instructions

About this task
With administrative permissions, you can export account and special handling data.
Procedure
1. Click the Administration tab and navigate to Utilities→Export Data.
2. Choose Special Handling in the DatatoExport field.
The exported XML file contains all account information and associated special handling instructions, if any.
Next steps
See also
Adding Special Handling Instructions 131


chapter 11
Claim History
Each claim has a non-editable History screen that provides an audit trail of a claim’s actions. ClaimCenter records
events associated with a claim, including minor events, such as each time a claim is viewed. To access a claim’s
history, open the claim and click History in the sidebar.
The History screen has a count of the history items at the top. There can be multiple pages if there are a lot of items.
Below the title bar are the following controls:
• Drop-down list on left – Filter the history list by the type of event, chosen from this drop-down list.
• Refresh – Show the latest list of history events for the last filter used.
Content of a Claim History

You open the History screen by opening a claim and clicking History in the sidebar. Claim history displays in a
sortable list view. The list view has the following columns:
• Type – The claim event causing the history entry. Events include the claim’s being opened or viewed, an
exposure’s being closed or reopened, a stopped check, and so on. Late in this topic is a full list of the events that
are recorded.
• Related To – Whether the event relates to the entire claim or one of its parts, such as an exposure or reserve line.
• User – Person who caused the event.
• Event Time Stamp – Date and time the event occurred.
• Description – Brief description of the event. You can add your own entries through the use of rules that create
custom history events. See “Adding History Events” on page 135 for more information.
Following are the types of history events supported in the base configuration, as shown in the HistoryType typelist:
History event type Description

Activity due date changed The due date of an activity was changed.
Activity escalation date The escalation date on an activity was changed.
moved
Approval or Rejection An item or transaction on this claim was approved or rejected.
Claim History 133

History event type Description

Archived Claim was archived.
Assigned The claim or one of its exposures was assigned.
Catastrophe warning The claim was identified as being eligible for inclusion as a listed catastrophe.
Check deleted A check was deleted.
Check stopped A check was stopped.
Check transferred A check was transferred to another claim, but not otherwise changed.
Check voided A check was voided.
Closed The claim or one of its exposures or matters was closed.
Custom A custom history event occurred. Custom history events are defined in the CustomHistoryType
typelist.
Flagged An indicator status was changed.
Imported A claim or exposure was imported.
Litigated A lawsuit was filed against the claim.
Opened A new claim or exposure was opened.
Policy edited A policy was edited, and thus marked as unverified.
Policy selected or refreshed A different policy was used for the claim, or the existing policy was refreshed.
Reopened The claim or one of its exposures or matters was reopened.
Retrieved An archived claim has been retrieved from the archive.
Viewed The claim or one of its exposures was opened and viewed by a user.
Claim Viewing History

Viewing is an event that notes each time the claim is opened. This event is helpful in tracking whether an adjuster
has been working on a claim or if non-authorized users have been viewing claims.
Financial Transaction History

The history of a claim does not include specific transaction events. However, all actions requiring approval do
become part of this history, so all financial events requiring approval are present. You can include other financial
events in the history by creating custom history event rules.
The claim itself keeps a record of all transactions and checks. To view them, see “View a Claim’s Existing
Transactions” on page 353.
Another type of financial action that becomes a part of the history is when a check is denied downstream. If the
check’s related payment has closed an exposure or claim, the reopening that occurs is noted in the history. See
“Downstream Denials of Recoveries and Checks” on page 361.
Claim History of a Policy

ClaimCenter displays another kind of history upon claim creation in the New Claim wizard. After you search for a
policy, adjusters can view the policy’s claim history. See “Selecting or Creating a Policy in the New Claim Wizard”
on page 88 for the details of this history.
134 chapter 11 Claim History

Adding History Events

Although you cannot rewrite the claim history, you can add to it. You can write rules in Guidewire Studio to monitor
the claim and determine if a specific change has occurred. The rules can then write an entry into the History screen.
For an example, see the ClaimPreupdate rule CPU13000 - Catastrophe History.
You can add your own types of events to the CustomHistoryType.ttx typelist, and then create rules that add the
event to the history. The following table lists the event types in CustomHistoryType in the base configuration.
Custom history Event type Description

Auto: No Fault rating Claim exception: fault rating is not set on auto claim.
Create recovery bill Create an invoice to bill for a recovery.
Data change Any claim data has changed.
Email sent An email was sent.
Exported to mainframe Integration: New claim exported to mainframe.
Exposure with no reserves Claim exception: no reserve is set for an exposure.
Guidewire catastrophe rules There was a change to catastrophe values.
Adding History Events 135

136 chapter 11 Claim History

chapter 12
Validation
Validation is a general application behavior that helps you avoid making mistakes and avoid saving invalid business
data. ClaimCenter validates data in the following ways:
• Field-level validation – Validation behavior tied to one or more specific fields of a datatype, which can be
implemented at:
◦ Data model level – Includes data types and field validators.
◦ User interface level by using validation expressions – Includes validation behavior tied to one or more
specific fields, which can be implemented at the user interface level in Gosu code.
• Validation Rules – By defining rules, you can configure ClaimCenter to verify the maturity of a claim or
exposure. You can also use rules to execute validation behavior at a global level when the error might not relate
to one specific field. For example, a carrier allows up to five vehicles to be covered on a single personal auto
policy. The underwriter enters six automobiles. The business data is invalid, but there is not any one field that is
causing the error.
Field-level Validation
Field-level validation works at both the data model level and the user interface level.
ClaimCenter performs validation on data types and field validators at the data model level. Each time you enter data
on a field with data model validation anywhere in ClaimCenter, the system checks to see if the entered data is in the
correct format. Additionally, you can add validation expressions to user interface fields for immediate validation.
Validation on Data Types

ClaimCenter validates several kinds of data types to ensure that the values are legitimate for the field’s underlying
datatype. For example, you must enter a date field in a particular way. If you do not, ClaimCenter shows an error
message identifying the problem so that you can correct it. Another example is a policy or claim number. Each must
be in a particular format, also called a pattern. Because this type of validation is in the base application, there is no
need for any configuration.
Validation 137
Validation on Field Validators

A field validator is a pattern tied to a field or datatype in the data model. If an entered value does not match the
pattern, ClaimCenter prevents the data from being saved and shows an error message so you can make corrections.
Field validators are used for simple data validation. You can use them to override validation for a specific field of a
datatype or to add validation to data types that do not have it.
For example, a social security number must be in a certain format. If you enter the number without two hyphens,
ClaimCenter will not save the number because it does not match the pattern of xxx-xx-xxxx. This field validation
occurs each time the field is used.
You create field-level validators in Guidewire Studio by creating an error message display key, creating the field
validator, and associating the field validator with the entity field.
Components of a Field Validator

Field validators consist of the following:
• name – Name of validator, such as SocialSecurityNumber.
• value – Pattern that must be matched, such as three digits, a hyphen, two digits, a hyphen, and four digits.
• description – Message to show when the pattern is not matched. For example, if you enter a social security
number with a letter, ClaimCenter shows a message indicating the correct format to be used.
• input-mask – Optional mask that helps you enter the correct pattern. For example, the social security number
field already has the hyphens in the correct place, and you need to enter only the numbers.
See also
Validation Expressions
A validation expression is an expression in Gosu code that is tied to a widget that uses field-level validation. When
the expression returns null, validation has succeeded, and the application saves the data. When the expression
returns a string, it is an error message saying how the validation failed. The error message describes what to do to
enter the correct data. For example, a validation might ensure that a date-of-birth field must occur in the past.
You create these expressions by using Gosu code embedded in PCF files. For example, if you want only one date-of-
birth field to be validated, use a validation expression in the applicable PCF file. However, if you want the validation
to apply to multiple date-of-birth fields throughout the system, write a rule for it instead. For more information, see
“Validation Rules” on page 138.
Validation Rules
ClaimCenter can enforce validation of data through rules. Rules can validate whether:
• A claim or exposure has matured to a certain level.
• A transaction can occur.
The system enforces validation through rules by performing validation checks on certain entities as the last step
before committing them to the database. For example, a claim is required to eventually have payments made on it.
Rules can ensure that the claim contains all required data to process it at the level that allows payments to be made.
Each time you click Update for a claim, ClaimCenter runs configurable validation rules in a certain order before data
can be saved to the database. These validation rules check the data and advance the maturity of the entity to the
maximum level it qualifies for.
138 chapter 12 Validation

IMPORTANT Claim objects are not allowed to move backwards in maturity because maturity levels often
correspond to information being sent to external systems.
ClaimCenter automatically performs validation checks on entities as the very last step before committing them to the
database and making them available for further processing. For example, you might write validation rules that occur
before:
• Saving a claim, ensuring that it contains sufficient information about its related policy, and that the loss type is
appropriate for the policy type.
• Closing a claim, ensuring that no open activities remain for it.
• Reopening an exposure, ensuring that its claim is already open.
• Scheduling a payment or increasing a reserve, ensuring that coverage limits are not exceeded.
Validatable Entities
An entity must be validatable to have pre-update and validation rules associated with it. ClaimCenter validates only
the following entities in the following order:
1. Policy
2. Claim
3. Exposure
4. Matter
5. TransactionSet (and ReserveSet, CheckSet, and other subclasses)
6. Group, User, and Activity (in no particular order)
7. Any other custom validatable entity
Claims, or any validatable entity with a field that triggers validation, can have related subobjects. Whenever the
claim itself is created or modified, claim validation rules run. Additionally, whenever a validatable subobject of the
claim is created or changed, such as the creation of a document or a change to a matter, claim validation rules run. A
change to a validatable subobject triggers claim validation because validation logic at the claim level can be related
to information at the subobject level.
Create Custom Validatable Entities
About this task

You can create custom entities that are validatable and have Preupdate and Validation rules run on them.
Procedure
1. Create the entity and implement the validatable delegate.
2. Create PCF components, if necessary.
3. Create rule sets and rules.
The rule set name must be named YourEntityNameValidationRules. If you use the reject method, you
must pass in an errorLevel. An error level is required because custom validatable entities do not mature.
Guidewire recommends a level such as New Loss Completion, which has code newloss, because it is usually
required. The method is used for both warnings and errors.
Validation Levels
Validation levels are defined in Guidewire Studio in the ValidationLevel.ttx typelist. The Load And Save, New
Loss Completion, and Ability To Pay levels are required by ClaimCenter and cannot be removed. You can remove
Valid for ISO or Send to External System. Additionally, you can configure more levels as described in the Rules
Guide.
Validation Rules 139
In the base configuration the validation levels are:
Validation Level Name Code Description

Load and save loadsave Claims and exposures imported from an external system must contain a minimal level of
information to be saved in ClaimCenter. However, the system needs more information
before an adjuster can work on them.
New loss completion newloss If you create a claim from the wizard, this level defines the minimum amount of
information for it to be saved as a claim.
Ability to pay payment This level ensures that a claim has all the required data needed to make a payment on it.
Valid for ISO iso (Optional) This level verifies that all required fields are complete before sending to ISO.
Send to external external (Optional) This level can verify if the claim has enough information before it is sent to an
system external system. In the base configuration, there is no functionality associated with this
level.
You can write integration code that is triggered when a claim reaches a certain validation level. For example, a claim
is sent to a back-end system only when the claim reaches Send to external system level. One reason that a claim cannot
go backwards in validation level is that it might already have been sent to an external system based on the validation
level achieved.
Note: Some entities have rules that are not tied to a particular level, such as Transaction Validation rules. These
rules can generate warning or error messages.
View Claim and Exposure Validation Levels in the User Interface
About this task

In the base application, you can see the validation level for a claim and an exposure.
• For an open claim, navigate to Summary Status. On the General Status screen, look at the Claim Validation Level field
to see the validation level of the claim.
• To see the validation level for an exposure of a claim, open the claim and then click Exposures in the sidebar to
open the Exposures screen. Click the exposure number to open the detail view for the exposure. The exposure
validation level is in the Validation Level field.
Preupdate and Validation Rules

If a validatable object or a subobject that triggers the validation of the parent is either created or modified, Preupdate
rules for that object run first. Validation rules fire after Preupdate.
• Preupdate rules – These rules can make or change data before validation rules run. For example, a document is
added to the claim and now someone needs to take action on it. Preupdate rules can create an activity so that the
correct person can review the document.
• Validation rules – These rules always promote an object to the highest possible level. Promotion also occurs as
far as possible, which could result in a promotion either to the next highest level or across multiple levels. As the
result of a change, the system allows the change if an object:
◦ Meets all the conditions at the next higher level.
◦ Does not violate any conditions at the current or lower levels.
Validation rules can also verify that rule conditions are met. If rule conditions are not met, the system can show
warning or error messages.

If the object fails validation, any work that was done by the Preupdate rules is also rolled back.
Validation Errors and Warnings

Validation rules support two types of failure, warnings and errors. You can implement one type of failure or both
types. Both types of validation messages are shown in the Validation Results worksheet, which opens if there are
messages. In most cases, you can click a particular message to go to the data that it references.
• Validation errors – These errors prevent you from continuing until you fix the errors. Error messages display
during an update only in the following two cases:
◦ You first save a claim or exposure, and it does not pass all validations at the Load and Save level.
◦ You edit a claim or exposure in such a way that would have forced the object to revert in maturity.
Note: ClaimCenter displays warning and errors only for validation levels that the object has achieved.
• Validation warnings – Rules that return a warning message do not perform any other action. For example, after
you attempt to save a claim, a rule can detect that an optional field is blank and show a message asking that the
field be filled in. If you update a second time after you have received warnings, the system allows you to save.
You see warning messages only for validations at levels that are at or below the level that the object is achieving
with the current save.
Handle Validation Errors and Warnings
About this task

Validation errors and warnings display in Validation Results worksheets.
Procedure
1. Click an error or warning in one of these worksheets to go to the object in question, enabling you to make
corrections.
You must correct all errors to proceed, but you can ignore warnings.
2. Click Update to continue.
Run Validation Rules Manually in the User Interface

About this task
You can validate a claim or exposure manually if you need to discover why a validation level has not been attained.
ClaimCenter checks all validation rules for the specified validation level and below. You can see if there are any
warnings or error messages generated by the validation rules for the claim or exposure.
Procedure
1. Open a claim and navigate to Actions→Claim Actions.
2. In Claim Actions, you can validate one of the following at any level:
• The claim only
• The claim and its exposures
• The policy.
For example, you want to make a payment on a claim but are unable to do so. Navigate to Actions→Claim
Actions→Validate Claim + Exposures→Ability to pay to run validation rules on the claim and its exposures. Doing
so can help you see what is preventing your payment.
Next steps
See also
Validation Rules 141

• Rules Guide

chapter 13
Claim Fraud
Fraudulent claims are a continuing problem for all who handle them, and identifying suspicious claims can be
difficult. Too often, flagging a suspicious claim is left to a manual process that might be different for each adjuster.
ClaimCenter provides a mechanism to help you determine when to further investigate a claim for possible fraud.
The centerpiece of the ClaimCenter fraud detection is its ability to analyze claims and determine a risk potential, or
Special Investigation (SI), score for them. ClaimCenter creates this score by using both a set of business rules to
analyze a claim’s information for possible fraud and a set of questions that the adjuster answers. As the adjuster adds
more data to the claim and answers the Special Investigation question set, this score can grow. If this score reaches a
preset threshold, ClaimCenter can then assign activities to review the claim for fraud.
Using business rules and question sets to trigger claim fraud investigations enables you to:
• Reduce leakage in handling claims.
• Enforce business processes evenly across the organization.
• Assign the same standardized weight to each suspicious fact in each claim.
• Have more transparency in the process of deciding what to investigate.
• Perform a fact-based evaluation of all claims.
• Keep an audit trail of why and how claims became suspicious.
These features can be important both financially and legally.
Claim Fraud 143

Overview of Fraud Detection

Special Investigation (SI) rules and question set answers identify suspicious characteristics of a claim and assign
points to each of these characteristics. The sum of these points is the Special Investigation score. Depending on your
business logic, you can set up your own suspicious claim analysis as follows:
• Create Special Investigation rules to detect conditions that your business practices have shown to be fraud
indicators. This set of rules analyze a claim each time information is added to it and collect and maintain a
running score of all the suspicious information it receives.
• Create Special Investigation question sets that an adjuster uses to detect conditions that your business practices
have shown to be fraud indicators. Answers are scored appropriately.
• Assign different point values to suspicious characteristics obtained from both rules and answers.
• Create a single Special Investigation score for each claim from the sum of all points.
• Select the score threshold at which to create an activity for further investigation.
The two Special Investigation scores from rules and question sets can be combined to reach one value that describes
the likelihood of fraud. Using this integrated score, you can make informed decisions on whether to start a fraud
investigation of a suspicious claim. When the score reaches a predefined value, for instances, the supervisor can
determine whether to assign the claim to a fraud investigator or Special Investigation team for further review.
Special Investigation Question Sets

Question sets are created in XML using the QuestionSet and related entities and imported into ClaimCenter. You
need administrative permissions to import and export question set files.
See also
• “Working with Question Sets” on page 282
Special Investigation Rules

Rules that flag suspicious claim activity are useful, because they do not require the adjuster’s time to ask a set of
questions. They are guaranteed to treat every claim equally.
Special Investigation rules reside in the Claim Preupdate rule set. ClaimCenter runs these rule regularly.
Some items that special investigation rules can look for are:
• After a certain time period, no claimant telephone numbers, police report, on-scene report, or witnesses exist.
• There has been an unreasonable delay in reporting the loss.
• Discrepancies exist between official reports and claimant’s statements.
• The claimant conducts business orally, so there is no record.
• The claimant has had other recent claims.
• The claim occurred just after the policy was purchased or renewed.
• The first notice of loss report (FNOL) is followed closely by attorney involvement.
• The driver is a minor and is not listed on the policy.
After creating these rules, you assign points to each one. The first time a Special Investigation rule is true,
ClaimCenter performs the following actions:
• Adds the rule description to a Special Investigation array for display. It also adds its score and any additional
information the rule gathers. For example, a rule finds an unlisted minor driver involved in an accident.
144 chapter 13 Claim Fraud

ClaimCenter adds the “Driver is a minor not listed on the policy” rule description to the claim’s Special
Investigation array. It also adds the driver’s name in the Additional Information part of the array.
• Increments the Special Investigation score by the value specified in the rule’s actions.
See also
• “When to Run Special Investigation Rules” on page 145
When to Run Special Investigation Rules

A good practice is not to run the Special Investigation rules when a claim is created, but to run them at later points in
the claim’s lifecycle. A claim preupdate rule, which runs daily as part of the claim exception rule set, advances the
stage of a claim’s lifecycle. Trigger rules, part of the claim preupdate rule set, then decide when to run, based on the
stage. The ValidationLevel typelist contains the validation level definitions used in validating an entity to
determine its lifecycle stage. This mechanism restricts rules to a specific claim lifecycle stage.
See also
• “Validation Levels” on page 139
• Rules Guide
Evaluating Risk Potential

The following flow diagram illustrates the process by which Special Investigation scores are created and evaluated
using question sets and rules.
Overview of Fraud Detection 145

Using Question Sets

Question sets answered by an adjuster or other fraud investigator can help to determine whether a claim might be
fraudulent. The following question sets contain sample questions that can help in that determination.

Points Questions for Any Claim Type

none Is claimant familiar with insurance claims terminology and procedures
no = 1 If yes, would claimant’s business give claimant this knowledge?
yes = 1 Does claimant avoid using fax, email, or mail and only communicate verbally?
yes = 2 Is claimant aggressively demanding settlement?
yes = 3 Will claimant accept a partial settlement if it is immediate?
yes = 1 Is claimant experiencing financial difficulties?
choice If yes, is claimant’s credit score low, medium, high, or unknown?
yes = 2 Are there discrepancies between claimant’s statements and official accident reports?
yes = 1 Are there discrepancies between claimant’s statements and those of witnesses?
yes = 1 Are the claimant’s lifestyle and income level inconsistent?
yes = 2 Has claimant provided an excess of documentation and supporting material?
yes = 1 Does claimant have other or prior injuries?
no = 2 If yes, are they consistent with other damage or injuries in the incident?
Points Questions for Auto Claims

none Was the vehicle purchased in another state or province?
none Was the vehicle stolen?
yes = 5 If yes to either of the above, does the vehicle have a salvage title?
yes = 1 If yes, does a salvage or auto repair shop have an interest in the claim?
yes = 1 If stolen, had the vehicle not been seen for some time?
choice If yes, how long - a week, a month, or two months, or more?
yes = 2 Do the involved vehicles have a disproportionate amount of damage?
yes = 1 Do accounts of the accident by drivers, passengers, or witnesses appear rehearsed?
yes = 2 Are accounts of the accident by drivers, passengers, and witnesses inconsistent?
yes = 1 Do neighbors, friends, and relatives have knowledge of the vehicle?
yes = 1 Do appraisal photographs show only close-up damage views, but not enough to identify the vehicle?
yes = 1 Was the vehicle repaired before the claim was reported?
Points Questions for Workers Compensation Claims

yes = 2 Is it possible that the injury is not job-related?
none Is claimant missing work due to the injury?
yes = 1 If missing work, is claimant resisting going back to work?
yes = 2 If missing work, does claimant have a new job?
You can create conditional questions for cases where a question is dependent on the response to another question.
The tab shows the conditional question only when the dependent question’s answer is positive.
Using Question Sets 147

Questions can display a choice list with several answers for the user to select from, each associated with a different
number of points. An example would be a question such as “What is the claimant’s credit score?” with possible
answers including Below 500 (3 points), 501-600 (2 points), and so on.
By assigning points to each question or answer choice, ClaimCenter can calculate their sum, which, along with the
points from the Special Investigation rules, comprises the Special Investigation score. It is this score that can trigger
new activities, such as evaluation by a carrier’s Special Investigation Unit. Using the full set of questions ensures
that all claims are examined in a uniform and fair way.
Each time Special Investigation questions are answered, ClaimCenter performs these actions:
• Adds the question description to the Special Investigation array for display, along with its score.
• Recalculates the Special Investigation score using any change in the question set’s total points.
Answer Special Investigation Question Sets

Procedure
1. In ClaimCenter, open a claim and navigate to Loss Details→Special Investigation Details.
2. Click Edit to respond to questions.
3. Click Update.
After you enter or change any answer, ClaimCenter recalculates the claim’s Special Investigation score.
Evaluating the Special Investigation Score

The Special Investigation score is the sum of the Special Investigation rules score and the Special Investigation
question set score. After the score reaches a defined threshold, a rule in the claim preupdate rule set creates an
activity for the claim handler’s supervisor to review this particular claim. A user with administrator privileges can
set this threshold.
Set the SI Review Score Threshold

Procedure
1. Click the Administration tab and navigate to Utilities→Script Parameters.
2. Set the SpecialInvestigation_CreateActivityForSupervisorThreshold script parameter. The default
value is 5.
The activity is assigned to a claim supervisor who can review the claim and escalate the claim to another user.
Review Claim for SI and Escalate

About this task
After the special investigation score reaches the defined threshold, a rule in the claim preupdate rule set creates an
activity for the claim handler’s supervisor to review this particular claim.
Procedure
1. Review the contents of the Loss Details→Special Investigation Details screen and the details of the claim.
2. Escalate the claim to a user in the Special Investigation group:
a. Click Edit.
b. In the Supervisor Review section, set Refer claim to SIU team to Yes.
c. Enter comments, if needed.
d. Click Update to save the changes.
ClaimCenter assigns the activity to a member of the Special Investigation group by round-robin
assignment. ClaimCenter also automatically adds that person to the claim in the role of Special
Investigation (SIU) investigator. If an investigator is already associated with this claim, ClaimCenter
sends the activity to that individual.
Next steps
See also
• “Set the SI Review Score Threshold” on page 148
Using the Special Investigation Details Screen

While viewing a claim, use the Loss Details→Special Investigation Details screen to view and track details of suspicious
claims. Click Edit to make changes to this screen. This screen contains:
• Section One - Possible fraud indicators detected – A list view that shows the Special Investigation rules this claim
violates and the points for each violation. There can also be additional information pertaining to the rule.
• Section One Score – Total of all fraud indicator points.
• Section Two - SIU Questionnaire – Depending on the claim, the questionnaire can have more than one question set.
◦ Auto SIU – The first Special Investigation question set for an auto claim.
◦ WC SIU – The first Special Investigation question set for a workers’ compensation claim.
◦ General SIU – The general Special Investigation question set is always present, including answers and
corresponding points if the questions have been answered.
• Section Two Score – Total of all question set points.
• Total Score (Supervisor notified at 5 or above) – Total points from rules and question sets.
• Supervisor Review – Section that supervisor fills out after reviewing SIU and claim information.
◦ Refer claim to SIU team – By default, this value is No. If the supervisor or other reviewer changes it to Yes, the
following two fields become visible. You cannot change it back to No directly, but if you click Cancel, the value
reverts to No.
◦ Date referred to SIU team – ClaimCenter fills in this date when the reviewer clicks Update.
◦ Supervisor Comment – Any additional comments by the supervisor who escalated the claim to the SIU team.
The Rules Guide provides general information about writing rules. Use Studio to write rules and add them to the
proper rule sets. See “Working with Question Sets” on page 282 for information on creating and editing question
sets.
Updating Rules and Answers for Special Investigations

After filling in the questions on the Special Investigations screen, saving the claim again runs the Special
Investigation rule set. With the correct permissions, you can see and edit the SI questions.
Click Edit to change SI responses, and click Update to save the answers.
See also
• “Special Investigation Permissions and Restrictions” on page 150
Manually Refer a Claim for SI Review

Before you begin
You must have the editSensSIUdetails permission to be able to edit the Special Investigation Details screen and to
manually refer a claim to the SIU team.
Using the Special Investigation Details Screen 149

Procedure
1. To access the Special Investigation Details screen, open a claim and navigate to Loss Details→Special Investigation
Details→Edit.
This action opens a drop-down list next to the Refer this claim to the SIU team field at the bottom of the screen.
2. Select Yes from the list.
3. (Required) Add a reason for the manual referral to SI team in the Supervisor Comments field.
4. Click Update.
Special Investigation Permissions and Restrictions

ClaimCenter considers special Investigation information to be privileged. Only the claim owner and managers with
the editSensSIUdetails permission can the following:
• View answers to the SI questions.
• Edit the answers.
• Access Date referred to SIU team and Total Score.
• Control what a specific user can view and change with permission settings. No one can edit the descriptions of
the rules that have fired or the Additional Information entered by any rule. The only editable fields of this screen are
answers to questions, Refer claim to SIU team, and Supervisor Comment.

chapter 14
Assessments
Assessment is the process of evaluating the value of lost or damaged property and then providing and monitoring the
services required to indemnify the insured and cover related expenses. Especially in the United States market, this
process is often managed by other systems, such as Mitchell International and CCC Information Services. When
managed by other systems, detailed damage assessments cannot reside in an insurer's claim system except as
attached documents. Outside the United States, assessment is more central to a claims system. ClaimCenter provides
a framework to manage the assessment information. This framework enables you to configure assessment based on
your business requirements.
IMPORTANT The assessment feature is not integrated with Services. It uses terminology in some cases that sounds
like Services terminology, but the functionality is entirely separate.
Assessment Overview
Assessments are important for many lines of business (LOBs), including auto, property, general liability, and
workers’ compensation. Auto claims typically have the most highly developed assessment systems, covering initial
damage estimates and the cost of replacement parts and labor. Medical claims, especially those involving
rehabilitation, can also be estimated by assessment procedures. One difficulty in doing assessments of medical
claims is determining how long it takes to perform rehabilitation services. Estimation of property losses can also be
complex, due to depreciation, uniqueness, and determining what constitutes equal replacement value.
ClaimCenter incorporates the assessments feature into both auto and property claims. This solution includes:
• Maintaining lists of sources, which are called evaluators or assessors. See “Source” on page 153.
• Itemizing and then categorizing property for assessment. See “Property Incident Assessment Line Item Sections”
on page 153.
• Managing documents and notes associated with the assessment process. See “Documents and Notes Used in
Assessments” on page 155.
• Sending work orders to multiple sources to perform evaluations.
• Collecting and evaluating the estimates and quotes generated by the work orders.
Assessments 151
• Agreeing to the loss value, typically a negotiation between the claimant and adjuster based on the assessments
obtained.
• Providing the necessary services to indemnify the insured for the loss, either repair or replacement. See “Source”
on page 153.
• Evaluating the quality of the indemnification. See “Property Incident Assessment Line Item Sections” on page
153.
• Maintaining a status display of the assessment work orders and repair orders. See “Property Incident Assessment
Line Item Sections” on page 153.
For vehicle losses, providing timely assessment services is a key component of controlling leakage. Ideally, the
every first notice of loss (FNOL) conversation concerning an auto loss includes notifying the insured of:
• Where and when to have the damaged vehicle assessed.
• The name of the appraiser.
The base configuration provides one assessment process for each vehicle, building, or group of property items. You
can access the assessment feature in the New Claim wizard, as well as in the claim at a later time. The assessments
feature is an extension to Incidents, and therefore to Exposures as well.
Working with Assessments

Each vehicle and property involved in a loss has an Assessment screen that stores and evaluates assessment
information. This topic discusses using the ClaimCenter Assessment screen.
Access Assessments Screen

Procedure
1. Navigate to a claim and click Loss Details.
2. Select a vehicle under the Vehicles section or a property under the Properties section.
3. Click the Assessment tab.
Assessment Tab
The Assessment tab contains has the following sections:
• “General” on page 152
• “Source” on page 153
• “Property Incident Assessment Line Item Sections” on page 153
• “Vehicle Incident Assessment Line Items” on page 154
General
This section of the Assessments tab is a general description of the vehicle or property and contains the following
fields:
• Involving – The property or vehicle. This information comes from the incident of the exposure.
• Description – A text field describing the assessment.
• Status – The status of the assessment process. It is Open until the insured party or claimant is satisfied, and then it
is Closed (from the AssessmentStatus typelist).
• Target Close Date – The estimated completion date of the entire assessment process.
• Comment – A text field that can be used for any purpose.
• Internal User – The adjuster or other user assigned to this part of the claim.
152 chapter 14 Assessments

Vehicle Incidents
For vehicle incidents:
• Total - Approved – The auto-generated total of all Estimate amounts of all Approved items in the Line Items table.
• Total - In Review – The auto-generated total of all Estimate amounts of all In Review items in the Line Items table.
Property Incidents
For property incidents, there are Detail Damage radio buttons:
• To Building? – Choosing Yes shows additional fields for Building Components, described later, and Building Estimate:
◦ Total - Approved – The auto-generated total of all Estimate amounts of all Approved items in the Building
Components table.
◦ Total - In Review – The auto-generated total of all Estimate amounts of all In Review items in the Building Components
table.
• To Contents? – Choosing Yes shows additional fields for Content Items, described later, and Content Value:
◦ Total - Approved – The auto-generated total of all Estimate amounts of all Approved items in the Content Items table.
◦ Total - In Review – The auto-generated total of all Estimate amounts of all In Review items in the Content Items table.
Source
The Source list shows all contacts—persons or vendors—who provide or will provide assessment services, including
estimating, quoting, repairing and restoration, and replacement. You can enter sources manually, or, if ClaimCenter
is integrated with ContactManager, you can use ContactManager to maintain lists of searchable sources. The list
contains these columns:
• Name – The name of the assessor, required unless the entry comes from ContactManager.
• Source Type – The category of assessor, such as internal appraiser or approved vendor.
• External Assessor – Whether or not the source is an employee of the carrier.
• Description – A text field that can be used for any purpose.
• Create Time – ClaimCenter creates this time stamp when this source is added.
• Event Lines – Events related to this source, each of which has the following fields:
◦ Date – The date on which the event occurred.
◦ Event – Events selected from a drop-down list. Events include Assignment Accepted, Assignment Canceled, Estimate
Accepted, Repair Complete, and so on.
◦ Notes – A text field that can be used for any purpose.
Property Incident Assessment Line Item Sections

If the incident is a property incident and To Building? in the General section is Yes, you see the Building Components
section. If To Contents? is Yes, you see the Content Items section. Both sections can be visible at once.
Both sections have buttons you can use to add, remove, approve, or deny one or more line items in the list.
Additionally, you can set the source for one or more line items or choose a source and click Associate With to
associate one or more line items with a source.
Assessment Tab 153

Note: The LineItemCategory and LineItemSchedule typelists used in the following line item sections are based on
IRS-Publication 584B: Business Casualty, Disaster, and Theft Loss Workbook. All these typelists are extendable.
Building Components
• Category – A building component that was damaged, selected from a drop-down list. Components include Air
Conditioning, Building, Heating System, Roof, and so on. These values are from the PropertyLineItemCategory
typelist.
• Description – A free-form field typically used to describe the item. Visible and selectable in the Building Components
list as Description.
• Action – Whether the amount for this item has been Approved or Denied or is undergoing Reviewing. These values
are from the AssessmentAction typelist.
• Estimate – Estimated cost to perform the work.
• Create Time – ClaimCenter creates this time stamp when this item is added.
• Comment – A free-form field typically used to add comments about the item.
• Source – The contact that produced the information, such as Estimate, shown in this line of the table.
Content Items
When you create or edit a content item, there are two sections, Summary and Financials.
The Summary section has the following fields:
• Schedule – A high level category for items covered in the policy. The drop-down list includes the following
schedules: Equipment, Homeowners, Information Systems, Office Furniture and Fixtures, Office Supplies, Other, and Travel.
These values are from the ContentLineItemSchedule typelist.
• Category – A building component that was damaged, selected from a drop-down list. Components depend on the
Schedule selected. For example, for the Equipment schedule, you ca n choose categories such as Calculator, Clocks,
Copiers, Microwave, and so on. These values are from the ContentLineItemCategory typelist.
• Number of Items – How many of this type of content item were damaged, lost, and so on.
• Brand – The brand name of the content item, such as Armani or Sony.
• Description – A free-form field typically used to describe the item. Visible and selectable in the Content Items list as
Description.
• Date Acquired – Date the item was bought or otherwise acquired.
• Action – The action taken on the amount for this item: Approve, Deny, needs a Review, or is To be Depreciated. These
values are from the AssessmentContentAction typelist.
• Related Source – A contact for this information.
The Financials section has the following fields:
• Purchase Cost – Original cost of the item when it was bought.
• Depreciation – Amount that the value of the item has decreased over time.
• Salvage – Value of the item if retrieved from the property.
• Item Value – A calculated value based on the entries for purchase cost, depreciation, and salvage.
Vehicle Incident Assessment Line Items

This list of line items shows damaged or lost property for a vehicle. Above the list are buttons you can use to add,
remove, approve, or deny one or more line items in the list. Additionally, you can set the source for one or more line
items or choose a source and click Associate With to associate one or more line items with a source.

Note: The LineItemCategory and LineItemSchedule typelists used in the following line item sections are based on
IRS-Publication 584B: Business Casualty, Disaster, and Theft Loss Workbook. All these typelists are extendable.
The vehicle incident Line Items list shows the following information for each line item:
• Category – A vehicle component that was damaged, selected from a drop-down list. Components include Body,
Brakes, Suspension, Wheels, and so on. These values are from the VehicleLineItemCategory typelist.
• Description – A free-form field typically used to describe the item. Visible and selectable in the Line Items list as
Description.
• Action – Whether the amount for this item has been Approved, Denied, or is undergoing Reviewing. These values are
from the AssessmentAction typelist.
• Estimate – Estimated cost to perform the work.
• Source – The contact that produced other information, from the Source list in the Vehicle Incident screen. If you
have not added a source in that screen, this one will just list <none>.
Documents and Notes Used in Assessments

Documents related to assessments, such as body shop quotes for repair of dents, are handled by the normal process
of attaching documents to claims. The same is true for notes.
Permissions
You do not need special or additional permissions to view or edit the Assessment card for a claim. Access to the
claim itself is sufficient to view and edit assessments.
Data Model for Assessments

There is one assessment process per vehicle or fixed property. Therefore, assessments are properties of to the
Incident entity. Entities related to assessments include:
Assessment entity Contents and Use

AssessmentSource Multiple parties can inspect and assess the same vehicle or property. The Incident array key Sourc
eLine is an array of AssessmentSource entities, which capture this information.
AssessmentLine Many events can take place related to an assessment. For example, assignments can be scheduled
and canceled. The AssessmentSource array key StatusLine is an array of AssessmentLine entities.
AssessmentItem Both vehicles and property have this itemized list of damages and costs to indemnify. The Incident
array key ItemLine is an array of AssessmentItem entities.
AssessmentContentItem Property, in particular, has both the structural component captured in the AssessmentItem array
and itemized content. This entity represents a single content item. The difference between the two
is the depreciation on the items. The Incident array key ContentItemLine is an array of Assessme
ntContentItem entities.
The assessment feature uses a number of typelists. All are extendable. The LineItemCategory and LineItemSchedule
typelists are based on IRS-Publication 584B: Business Casualty, Disaster, and Theft Loss Workbook. All these
typelists are extendable.
Assessment typelist Contents and Use

AssessmentAction Action taken for each estimate: Reviewing, Approved, or Denied. For auto and fixed property
losses, but not for contents that can depreciate.
Working with Assessments 155

Assessment typelist Contents and Use

AssessmentContentAction Action taken for each estimate: Review, Approve, To be Depreciated, or Deny. For contents
losses.
AssessmentEvent Events capture the time line of the assessment process. Some typical events include Assignmen
t Accepted, Estimate Complete, Estimate Accepted, Repair Date Set, and Repair Complete.
AssessmentSource The source of the assessment—the Insured’s Vendor, an Approved Vendor, an Internal Appr
aiser, a Third Party’s Vendor, or a Desk Review. A desk review is an appraiser’s combination
of assessments from different sources.
AssessmentStatus Open until the insured or claimant is satisfied, and then Closed.
AssessmentType Property, Auto, or Contents, which can be from either a damaged auto or building.
ContentLineItemCategory Items found in properties, such as appliances, electronics, televisions, printers, servers, and
monitors. They are categorized by typecodes of the ContentLineItemSchedule typelist.
ContentLineItemSchedule Categories of the items found in the ContentLineItemCategory typelist, such as Equipment, Ho
meowners, Information Systems, and Office Furniture and Fixtures.
PropertyLineItemCategory A building or its major parts, such as its Roof, Air Condiitoning, Heating System, Plumbing Sy
stem, or Lighting System.
VehicleLineItemCategory Major systems of a vehicle, such as Body, Brakes, Engine, Suspension, and so on.

chapter 15
Catastrophes and Disasters
The term catastrophe in the property insurance industry denotes a natural or man-made disaster that is unusually
severe. The industry designates an event a catastrophe when claims are expected to reach a certain dollar threshold
and more than a certain number of policyholders and insurance companies are affected. Carriers monitor the extent
and type of these losses, dates of occurrence, and geographic areas affected by the catastrophe-related claims to
forecast loss estimates and loss reserves. Carriers often group claims by the catastrophes that caused them. This
helps the carrier to:
• Estimate the severity of the catastrophe itself and its potential liability due to the catastrophe.
• Estimate the reserves it must set aside to cover future claims from the catastrophe.
• Manage its resources, such as mobile adjusters, in responding to the catastrophe.
• Create reports about the catastrophe and its financial consequences for the carrier.
Overview of Catastrophes
From a reinsurance perspective, it is in an insurance company’s best interest to associate every claim with an
applicable catastrophe. Carriers closely track their total exposure for catastrophes because they often have
reinsurance agreements that cover their exposure over a given amount. In this way, carriers can take on the large risk
associated with catastrophes.
In ClaimCenter, you can associate every claim that results from a catastrophe with that catastrophe, as described at
“Working with Catastrophes” on page 158. If you do not associate these claims with their catastrophes, you risk
leakage because you might not able to recover money for these claims from the reinsurer. You can also use rules like
the Claim Preupdate rule, Related to Catastrophe, to identify claims that match a catastrophe's profile but have not
yet been linked to that catastrophe. ClaimCenter can ensure that all the catastrophe-associated claims are caught and
marked appropriately.
ClaimCenter defines a catastrophe by the following characteristics:
• A date range – A start and end date
• A geographic region
• One or more perils – A combination of a Loss Type, such as property, and Loss Cause, such as wind
Catastrophes and Disasters 157

For example, a carrier declares Hurricane Katrina to be a catastrophe. This catastrophe involves claims in the states
of Florida, Alabama, Mississippi, and Louisiana for property damage due to flood, wind, or rainstorm. The
catastrophe occurred during the period from July 2005 to December 2005.
ClaimCenter assists carriers handling catastrophes in the following ways:
• Defining and maintaining a list of catastrophes. See “Catastrophe List” on page 158.
• Associating at most one catastrophe with a claim. See “Associating a Claim with a Catastrophe” on page 161.
• Providing a way to search for all claims associated with a catastrophe and see their distribution on a heat map.
You can access this heat map and catastrophe claims search capability by:
◦ Clicking the Administration tab and navigating to Business Settings→Catastrophes
◦ Clicking the Search tab and navigating to Claims→Catastrophe Search
Note: You must have certain permissions and perform some setup before you can see the Catastrophe Search
screen. See “Preparing to Access the Catastrophe Search Screen” on page 165.
See also
• “Catastrophe Dashboard” on page 163
Working with Catastrophes

You can manage catastrophes in several ways:
• Creating and maintaining a list of catastrophes.
• Associating a catastrophe with a claim.
• Finding and associating claims created prior to the catastrophe’s being entered into the system.
This section includes:
• “Catastrophe List” on page 158
• “Working with Catastrophes” on page 159
• “Catastrophe History” on page 163
• “Using Catastrophes Defined by ISO” on page 160
Catastrophe List
You can access the list of catastrophes by clicking Administration→Business Settings→Catastrophes.
The list of catastrophes shows fields that ClaimCenter maintains for each catastrophe. The following list includes
fields that you see on the Catastrophe Details page when you click a catastrophe in the list:
• Status – A catastrophe can have a status of Active or Inactive, controlled by the Activate and Deactivate buttons.
• Name – Any value is acceptable. The name is a value that can be used in a search.
• CAT No – You must assign each catastrophe a unique number. This number can be used for sort order as seen in
the Catastrophe drop down menu in the Loss Details screen. It is also a number that might have come from legacy
or other mainframe systems or a governing body, such as the United States state of Washington.
• Begin Date and End Date – The date range of the catastrophe.
• Type – Either Internal or ISO. ISO means that the data was generated from a governing body, such as ISO in the
United States. Internal means that the data was generated by other means, such as manually by the carrier. The
values come from the CatastropheType typelist. See “Using Catastrophes Defined by ISO” on page 160.
• PCS Serial Number – Optionally, there can be an ISO Property Claim Service (PCS) serial number. This field is
shown only on the Catastrophe Details screen.
• Comments – A free-form text field typically used to describe the catastrophe.
158 chapter 15 Catastrophes and Disasters

• Last Edited and Last User – The user that edited the catastrophe and the date of the last edit. These fields are visible
only on the list of catastrophes.
• Areas Covered – The geographical areas in which the catastrophe occurred, such as the U.S. state Florida.
• Zone Type – The type of geographical region in which the catastrophe occurred. You see Zone Type only on the
Catastrophe Details screen when you edit a catastrophe.
• Coverage Perils – Each coverage peril is defined by both a Loss Cause from the LossCause typelist and a Loss
Type from the LossType line of business typelist. Coverage perils are visible only on the Catastrophe Details
screen.
• History of Matched Claims – Shows all the claims that were matched to this catastrophe.
Working with Catastrophes

You can add, edit, deactivate, and active catastrophes.
Add a New Catastrophe
Procedure
1. Log into Guidewire ClaimCenter using an administrative account.
2. Click the Administration tab and navigate to Business Settings→Catastrophes.
3. Click Add Catastrophe.
4. Enter your data on the Details card.
5. Click the Policy Locations tab to enter data about policy locations to be included on the map.
Edit an Existing Catastrophe
Procedure
3. Click the name of a catastrophe to open the Catastrophe Details screen.
4. Click Edit and make your changes on the Details card.
• You can click Add to add Perils to the catastrophe.
• You can click the Policy Locations card to update information on policy locations.
5. Click Update when you are done with your changes.
Deactivate a Catastrophe
About this task

You cannot delete a catastrophe from the system, but you can deactivate it. Even after the time period for a
catastrophe has passed, many claims can continue to be associated with the catastrophe. The search features and
report generators must be able to find claims by their associated catastrophes.
Note: You cannot associate a claim with a catastrophe that has been marked inactive.
Procedure
3. Select the check box for an item on the list.
Working with Catastrophes 159

4. Click Deactivate.
The catastrophe status becomes Inactive.
Activate a Catastrophe
Procedure
3. Select the check box for the inactive catastrophe.
4. Select Activate.
This catastrophe status becomes Active.
Using Catastrophes Defined by ISO

In the United States, ISO produces a list of catastrophes that you can use to define your own list. The ISO list
defines for each catastrophe the same information that the ClaimCenter list contains. Also, ISO defines for each
catastrophe the loss severity, which is estimated total liabilities, and a catastrophe number, which can help correlate
your catastrophe data with other information. You can also use ISO severity data to help you estimate your own
liabilities and reserve levels.
Note: ISO provides this information in a CSV file.
Catastrophe Bulk Association

The topic “Overview of Catastrophes” on page 157 describes how to create a catastrophe profile in the ClaimCenter
Catastrophes screen before attaching claims to a catastrophe. You click the Administration tab and navigate to Business
Settings→Catastrophes to open the Catastrophes screen. Adjusters can create claims that are caused by the catastrophe
prior to the catastrophe’s being entered into the system. For example, a catastrophe might not have been entered yet
because the government has yet to deem the event a catastrophe and give it a CAT code.
If such a claim is already in ClaimCenter, you must link the claim to the catastrophe after creating the catastrophe
profile. You can search for claims that match the catastrophe profile but have not yet been linked. Not all claims
returned as a match are necessarily a result of the catastrophe, so you must decide whether to link the claim to the
catastrophe. For each matching claim, ClaimCenter creates a Review Claim for Catastrophe activity and assigns it to the
claim owner, who determines whether the claim is a result of the catastrophe. If so, the adjuster sets the cat field on
the claim and completes the activity. If not, the adjuster just completes the activity.
To learn how to find claims and associate them with a catastrophe, see “Associating Claims with Catastrophes” on
page 162.

Associating a Claim with a Catastrophe

On a claim, a catastrophe is a claim characteristic. A claim can be associated with at most one catastrophe. After
making this association, you can write rules to perform a number of useful functions:
• Assignment rules that assign claims to catastrophe management groups
• Rules that write reports to:
◦ Track reserves and payments for claims associated with the same catastrophe
◦ Determine the costs of a catastrophe
See also
• Rules Guide
Associate a Claim with a Catastrophe

Procedure
1. Navigate to a claim and select the Loss Details menu item on the left pane. You can also do this from the New
Claim wizard.
2. Click Edit.
3. Select a catastrophe name from the Catastrophe drop-down menu and click Update.
ClaimCenter performs the verifications described in “ClaimCenter Catastrophe Verification Checks” on page
161.
ClaimCenter Catastrophe Verification Checks

Whenever you add a catastrophe to a claim, ClaimCenter verifies the following:
• If the claim’s loss date is within the catastrophe’s date range.
• If the claim’s location matches the zone type for which the catastrophe is valid.
• If the claim’s cause of loss and loss type matches one of the catastrophe’s defined perils.
In the base configuration, the Claim Update and Claim Validation rules check that all these conditions are met.
ClaimCenter rules prevent you from associating a catastrophe with a claim that has a Loss Date or Loss Address that
does not match the catastrophe’s time period or region. If a rule finds such a claim, ClaimCenter issues an error
message. While ClaimCenter allows an association with a catastrophe if the claim’s Loss Cause or Loss Type does
not match the catastrophe’s Peril, ClaimCenter also issues a warning message.
The following table describes mismatches that cause errors and warnings.
Non-matching data Association allowed

date, place, and peril no, reject
peril yes (warning)
place no, reject
place and peril no, reject
date and peril no, reject
place and date no, reject
date no, reject
Associating a Claim with a Catastrophe 161

See also
• “Associate a Claim with a Catastrophe” on page 161
ClaimCenter Support for Associating a Claim with a Catastrophe

After you have entered the Loss Location, Loss Date, Loss Type and Loss Cause (peril), ClaimCenter can determine
whether the claim could be a caused by a catastrophe. ClaimCenter does not automatically make this association.
Instead, ClaimCenter alerts you by creating a Review Claim for Catastrophe activity for you to decide if you want to
make the association.
Matching data Association allowed ClaimCenter response

date, place, and peril yes Create one activity to alert you of a potential match to the catastrophe.
date and place, not peril yes Create one activity to alert you of a potential match to the catastrophe.
If a new claim matches a catastrophe category but is not so defined, ClaimCenter creates an activity.
Associating Claims with Catastrophes

ClaimCenter does not automatically associate a claim with a catastrophe. However, ClaimCenter can determine
whether a claim could be caused by a catastrophe, if you enter the following information into the claim:
• Loss Location
• Loss Date
• Loss Type
• Loss Cause (peril)
If this information matches the catastrophe information, ClaimCenter alerts you by creating a Review Claim for
Catastrophe activity for you to decide if you want to make the association.
Matching data Association allowed ClaimCenter response

date, place, and peril yes Create one activity to alert you of a potential match to the catastrophe.
date and place, not peril yes Create one activity to alert you of a potential match to the catastrophe.
If a new claim matches a catastrophe category but is not so defined, ClaimCenter creates an activity.
Associate a Group of Claims with a Catastrophe

3. Click the catastrophe name to open the Catastrophe Details screen.
4. Click Find Unmatched Claims.
ClaimCenter searches all active catastrophes. ClaimCenter uses a batch process to perform a search to find all
claims with the following criteria:
• Claim loss date is within the catastrophe's effective dates.
◦ Claim loss location matches one of the catastrophe's affected zones.
◦ Claim loss cause is one of the catastrophe's coverage perils.
◦ Claim does not already have an activity on it for potential catastrophe match.
5. ClaimCenter marks each claim to which the criteria applies.

If the number of found claims related to a catastrophe exceeds the system configurable limit for the number of
found claims, MaxCatastropheClaimFinderSearchResults, only that limited number of claims are
processed. The rest of the claims are processed the next day.
A section of the Catastrophe Details screen, History of Matched Claims, shows any claims that match the catastrophe
after the batch process completes. ClaimCenter creates a Review for Catastrophe activity for each claim that
has a potential match to that catastrophe. The count includes all claims that have a Review for Catastrophe
activity open.
6. To respond to a Review for Catastrophe activity, you must find the claim and navigate to its Loss Details screen.
You can search in one of two ways:
• Click the Desktop tab and navigate to Activities, and then change the filter on the Activities screen to All open.
The activity subject to choose is Review for Catastrophe.
• Click Search→Activities, and then specify one of the required search criteria. Then, next to Subject, click the
drop down menu and click Review for Catastrophe and click Search.
Catastrophe History
When a catastrophe is initially associated with a claim or the association with a claim has changed, the History tab
logs the event in claims associated with that catastrophe. This event is a custom event, and this behavior can be
removed. See “Claim History” on page 133.
Catastrophe Dashboard
You can access the Catastrophe Search screen by clicking the Search tab and navigating to Claims→Catastrophe Search.
This screen shows catastrophe claim and policy location search results on the Catastrophe Claim Dashboard.
Catastrophe Dashboard Overview

The default view of the Catastrophe Claim Dashboard shows the geographic distribution of catastrophe claims and
policy locations on a heat map. This map provides a quick visual impression of the location of hot spots—areas of
concentration for claims or policies—and the impact the catastrophe has had on the carrier.
ClaimCenter generates the heat map from a set of claims or policy locations overlaid on a geographical map. A
square marker represents each claim or policy location. As ClaimCenter shows claim or policy location counts, it
displays a single blue marker for each location that does not overlap any other markers.
If multiple markers overlap, the map shows a single marker with a color that represents the number of overlapping
markers. ClaimCenter shows ten or more overlapping markers in red. The map’s color legend on the right shows the
intermediate values that correspond to the other colors.
For map views that show financial amounts, ClaimCenter determines the color for each marker by the sum of the
values of the overlapping markers.
If you hold the shift key down and drag the mouse, you can select an area. The green rectangle created on the map
encloses the selected area. Just below the map, a message gives a summary of the data points in the selected area.
For example:
9 claims and 32 policy locations selected
The following figure shows a sample catastrophe heat map:
Associating a Claim with a Catastrophe 163

You can show subsets of catastrophe claims and policy locations on the heat map view by using the Catastrophe
Search filters and heat map navigation and selection controls. After you have selected a set of claims for further
analysis you can:
• Drill down into individual claims and policy locations.
• See below the map a tabular report of the claims and policy locations you want to further analyze.
• Produce a printed or exported version of the tabular report to aid you in your offline catastrophe workflow.
• Assign claims to an adjuster or other individual user, or assign them to a group.
• Perform other actions that require specialized configuration.
Map Views
The Catastrophe Dashboard provides five map views:
• Claims – The number and distribution of claims.
• Claim Total Incurred – Color coding represents the amount for the claim. The legend to the right of the map shows
colors and corresponding amounts. If an area is selected, you also see total incurred listed below the map.
• Claims and Policy Locations – The number and distribution of claims and the distribution of policy locations.
• Policy Locations – The number and distribution of policy locations.
• Total Insured Value – Color coding represents the total insured value for the policy location. The legend to the right
of the map shows colors and corresponding amounts.
Policy location views use data downloaded periodically from the policy system through the Catastrophe Policy
Location Download batch process. The batch process must be enabled for this data to be available. The batch
process downloads policy location data for a catastrophe within the Catastrophe Area of Interest for the effective
date defined in the Catastrophe Detail screen. The Catastrophe Area of Interest is the bounding box shown on the
Catastrophe Dashboard in light gray.
Map views that include policy locations—Claims and Policy Locations, Policy Locations, and Total Insured Value—are
visible only if the batch process has been enabled. They show data points only if the batch process has downloaded
data for the catastrophe. For more information on enabling this batch process, see the System Administration Guide.

Tooltips
Clicking a claim or policy location marker on the map displays a tooltip summarizing the key information for the
claim or policy location. For example, the Catastrophe Search search screen displays a tooltip for a policy location. If
the policy system supports this action, clicking the policy number in the tooltip opens the policy in a new browser
window.
Configuring the Heat Map

You can configure the Catastrophe Search heat map. For example, you can:
• Change the map colors.
• Add additional filters.
• Add new data sets or map views.
• Create other screens with heat maps that are independent of the Catastrophe Search screen.
For more information, see the Configuration Guide.
Preparing to Access the Catastrophe Search Screen

Before you access the Catastrophe Search screen, you must:
• Have the Catastrophe Admin role added to your user account, or have View Catastrophes permission.
• Perform the steps to enable the heat map described in the System Administration Guide.
This procedure calls for using the Bing Maps plugin and the Bing Maps AJAX Control v. 6.3. Additionally, if
you have PolicyCenter installed, this procedure calls for enabling the Catastrophe Policy Location Download
batch process.
See also
• You can learn more about the AJAX control at http://msdn.microsoft.com/en-us/library/bb429619.aspx.
• To use the Bing Maps plugin, your company must have its own account and application key with Bing Maps. For
more information, go to http://www.bingmapsportal.com, where you can set up a Bing Maps account and
obtain an application key. After you create a key, the application name is arbitrary and no application URL is
required.
• For more information on the batch process, see the System Administration Guide.
Accessing the Catastrophe Search Screen and Heat Map

Only users with the View Catastrophes permission can view the Catastrophe Search screen and heat map.
Access the Catastrophe Heat Map from the Search Screen
Procedure
1. Log in to ClaimCenter as a user with the Catastrophe Admin role or one that has the View Catastrophes
permission on your user account.
2. Click the Search tab and navigate to Claims→Catastrophe Search.
3. Use the Catastrophe drop-down list to select the name of a catastrophe.
Result
The catastrophe heat map appears.
Catastrophe Dashboard 165

Access the Catastrophe Heat Map from the Catastrophe Details Screen
Procedure
1. Log in to ClaimCenter as a user with the View Catastrophes permission.
3. In the Catastrophes screen, click the name of a catastrophe. The Catastrophe Details screen appears.
4. In the Catastrophe Details screen, click Show Map.
ClaimCenter redirects you to the Catastrophe Search screen with the catastrophe already selected.
Working with the Catastrophe Heat Map

After you access the Catastrophe Search heat map, you can use the map controls to show the area of interest.
You use the controls to do the following:
• Change the center point of the map – Click and drag the mouse.
• Center and zoom – Double-click the new center point.
• Zoom in / Zoom out – Move the scroll control on the mouse up and down or click the plus and minus buttons
under the directional buttons on the left.
• Select an area – Shift-click one corner of a rectangle, drag to the opposite corner, and release. A green rectangle
encloses the selected area.
Filter the Data on the Heat Map
About this task

You can do limited filtering of data in a map on the Catastrophe Search screen. You can select the Map View and set
Policy Locations to all policies, policies with claims, or policies without claims. Additionally, you can set filters that
apply by default to the maps shown for a catastrophe. It is possible to add additional filters through configuration.
Procedure
3. In the Catastrophes screen, click the name of a catastrophe. The Catastrophe Details screen appears.
4. Click Edit.
5. In the Catastrophe Details screen, click the Policy Locations card.
6. Change the settings on the screen, such as Policy Effective Date for policy retrieval or Map View to set the default
map view.
• For claims, set one or all of the Claim Status, Reported Date, and Assigned to Group drop-downs.
• For policy locations, set Policy Locations.
The map updates immediately.
Search in the Heat Map
About this task

You can create a list of all catastrophe claims in the selected region of the Catastrophe Search heat map.
Procedure
1. Select a region of the map that contains the claims that interest you. Shift-click the mouse at one corner of the
area you want to select and drag diagonally to create a bounding search rectangle with a green border.
2. The selection message located below the map shows how many claims and policy locations you have selected.
Lists of the claims and policy locations found in the search rectangle also appear under the map.
The search does not return more than 300 claims, for performance reasons. You can configure this limit in
Guidewire Studio by editing the config.xml file.
3. You can click a claim number to navigate to its claim summary. If your policy system supports it, you can
click a policy number to navigate to the policy in a new browser window.
4. To return to the map, click the Search tab and navigate to Claims→Catastrophe Search. The map opens with the
claim and policy list in the same view as before you navigated away.
Working with the Catastrophe Heat Map 167


chapter 16
Service Provider Performance Reviews
An important part of claim handling is using and recommending service providers that help resolve losses, such as a
body shop, assessor, attorney, or physical therapy clinic. ClaimCenter enables you to evaluate your carrier’s service
providers by gathering review information on them. Having this information helps in selecting the best providers,
controlling your claim costs, increasing customer satisfaction, and increasing claim processing efficiency.
In particular, you can:
• Conduct post-service reviews on any type of vendor.
• Score each review as part of the claim associated with the vendor’s work.
• Score each vendor by combining its individual review scores.
After you have collected reviews on your vendors, you can:
• Define lists of preferred vendors based on their past performance, as quantified by their reviews.
• Search for nearby vendors with high review scores.
• Assign nearby and high-rated vendors to provide services.
• Remove poorly performing vendors and steer business to high performers.
• Negotiate contracts with vendors for future services based on objective past performance standards.
Because this feature is available only if ClaimCenter is integrated with ContactManager, the full description is in the
Guidewire Contact Management Guide. See the Guidewire Contact Management Guide.
Service Provider Performance Reviews 169

170 chapter 16 Service Provider Performance Reviews

part 4
ClaimCenter Lines of Business

chapter 17
Homeowners Line of Business
The Homeowners line of business enables you to collect the data needed to track, manage, and, if necessary, pay on
the claim. Claimants typically file Homeowners claims when a loss occurred at the claimant’s property that affected
either the property itself or the contents of the property. Claimants can also file claims if someone was injured on the
property.
ClaimCenter handles Homeowners claims and provides the following features:
• Summary information located in one place – A quick view of the current status of the claim to help you
determine if you need to take action.
• View the policy – Both in ClaimCenter and in a policy administration system (PAS).
• New Claim wizard – Guides you through the FNOL claims intake process.
• Services can be arranged early in the claim intake process – Helps to accelerate the adjudication process and
mitigate further damage.
• Automatic incident creation – Assists in the claim intake process.
• Manage contents – Enables you to manage damaged items on a claim, including scheduled items.
Homeowners Screens
The homeowners line of business provides screens that capture information specifically needed to process that type
of claim. ClaimCenter organizes that data into sections.
The Summary, Claim Status, and Claim Health Metrics screens contain the most relevant information for you to determine
the status of a claim.
See also
• “Claim Status Screen” on page 436
• “Claim Health Metrics” on page 432
Homeowners Line of Business 173

Homeowners Loss Details Screens

The Loss Details screens contain information about the loss as it specifically relates to homeowners. These screens
are organized into General, Associations, and Special Investigation Details.
The Loss Details→General screen provides the following sections:
• Details – This card contains information about what occurred, the loss date, loss location, cause, fault rating, if
there was a catastrophe, or if weather was a factor.
• Damage Type – If fire or water was selected in the New Claim wizard and the questions were answered, this section
of the Details card shows those selections: Fire or Water or both. You can also edit the Loss Details screen and select
Fire or Water or both under Damage Type. If neither damage type is selected, you do not see this section.
• Loss Items – This section can show any or all of the following incidents. If you click Edit and then click Add under
Loss Items, you can see the entire drop-down list and make changes in a screen for each incident type.
◦ Dwelling – There can be only one loss related to a dwelling. This section contains sections that describe the
damage, services, related exposures, and repairs, if any.
◦ Injury – Captures information about people who might have injuries.
◦ Living Expenses – The living expenses incident is associated with the Loss of Use coverage type. This section
captures information about temporary dwelling costs and duration and meal costs. Additionally, there might be
related exposures and services that had to be performed, both of which can also be captured in the Living
Expenses screen.
◦ Other Structure – This incident captures information about structures other than the main dwelling, such as a
secondary building like a shed or artist’s studio. This section is also where you enter data if a shared fence was
damaged. Additionally, there might be related exposures and services that had to be performed, both of which
can also be captured in the Other Structure screen.
The Other Structure screen also provides an Assessment card that captures information about damage to the
structure. The information includes a description, estimated loss amount, if already repaired, and if any fences
were damaged. Additionally, there might be related exposures and services that had to be performed, both of
which can also be captured in this card.
◦ Personal Property – The personal property incident is associated with the personal property coverage type. Use
this section to capture the list of damaged content items, including scheduled items. Additionally, you can add
any services needed related to that property damage. See “Homeowners Line Items” on page 175.
◦ Property Liability – Use this screen to capture any damage to third party property. Additionally, you can specify
any services needed that are related to that property damage and information about repairs.
The Property Liability screen also provides an Assessment card that captures information about the assessment of
damages. Among other things, the information can include who the assessor was, when the assessment will be
done, details on the damage, and estimates of the costs. See “Assessments” on page 151.
• Line Items – This section shows specific line items that are mentioned in the policy. See “Homeowners Line
Items” on page 175.
• Witnesses – In edit mode, you can list witnesses that might be important to the claim.
• Officials – If any official, such as a police officer or coroner, was involved and wrote a report, you can enter that
information in this section.
• Metropolitan Reports – If you received any reports, you can list them in this section and link to the document.
• Notification and Contact – Use this section to document how the claim was reported, who reported it, who is the
main contact, and so forth.
174 chapter 17 Homeowners Line of Business

Notes
• In the base configuration, the ISO card is not enforced. If you want to use that feature for ISO or any other
statutory reporting organization, you must set up ISO rules in Studio.
• If you try to create exposures for all the earthquake and flood coverage subtypes and exposure types,
ClaimCenter displays a warning.
Homeowners Line Items

A claimant’s policy can contain specific items that are mentioned in the policy. Examples could include a heirloom
grandfather clock or a wedding ring. If these items are damaged or stolen, the way an adjuster determines those
amounts depends on the claimant’s policy.
There are two ways to determine the amount of money that the insurer pays to indemnify the claimant for a
particular line item. This is the replacement value (RCV) or actual cash value (ACV). Depending on the type of
coverage the insured has, reimbursement is either by RCV or ACV.
• Replacement Cost Value (RCV) – The maximum amount the carrier pays the claimant for damage to covered
property without a deduction for depreciation. The RCV payment uses the current cost to replace the property
with new, identical, or comparable property. For example, five years ago the insured paid $100, plus sales tax, for
a table. It is no longer available, but a comparable item currently costs $125. With RCV coverage, the maximum
amount the carrier pays the insured for the item is $125, plus sales tax.
• Actual Cash Value (ACV) – The amount the carrier pays the claimant for damage to covered property with a
deduction for depreciation. The formula is:
When the RCV value is null, then the ACV is equal to the original cost minus depreciation: ACV = Original cost
– Depreciation.
Otherwise, the ACV is equal to the RCV minus depreciation: ACV = RCV – Depreciation.
For example, five years ago the insured paid $100, plus sales tax, for a table. Since ACV is the current
replacement cost less depreciation, you must consider wear and tear, if any. If the table had a reasonable life
expectancy of 10 years, and the insured used it for five years, the table might have depreciated 50% of its value.
The item, or a comparable equivalent if the item is no longer available, currently costs $125. With ACV
coverage, the maximum amount the carrier pays the insured for the table is $62.50, plus sales tax: current
replacement cost, $125, plus sales tax, less 50% depreciation.
Homeowners policies normally have limits for each of the line item categories in the policy language. If the policy
has a limit for a particular content category being itemized on the personal property incident, then you enter that
limit into the Limit Amount field. Since there is no transactional validation in the base configuration, you must
configure rules to restrict this programmatically.
Homeowners Associations Screen

To open this screen, with a homeowners claim open, navigate to Loss Details→Associations.
Use this screen to associate any other claims with this claim. For example, if there was a large accident because a
tree fell and there were several claimants, you might associate all the claims together.
Homeowners Special Investigation Details

To view special investigation information on a homeowners claim, navigate to Loss Details→Special Investigation
Details.
This screen provides a question set that, depending on the answers provided, can trigger an investigation to rule out
fraud. To learn about this feature see “Claim Fraud” on page 143.
Homeowners Loss Details Screens 175

Policy Screens
The Policy screens provide information related to the policy. ClaimCenter organizes these screens into Locations,
Locations, Endorsements, and Aggregate Limits screens.
• Policy: General – Enables you to edit the policy, refresh it, select another policy, and view the policy in a policy
system.
Action Description
Edit ClaimCenter warns you that if you edit a policy, then it is marked as unverified. Edits made to the
policy are saved only in ClaimCenter.
Refresh Policy This selection replaces policy information with a fresh policy snapshot.
Select Policy Selecting a new policy removes any references on the claim, such as vehicles, properties, and
coverages.
View Policy in Policy If the policy is verified and ClaimCenter is integrated with a policy administration system or with
System Guidewire PolicyCenter, a new browser window opens that application.
See the Installation Guide.
The General screen contains information related to the policy, such as policy number, type, dates, status, agent,
underwriter, data on the insured, and other related information. If you edit this information, you cause the policy
to be no longer verified it with the policy system.
See “Working with Policies in Claims” on page 101 to learn more.
• Policy: Locations – Provides address details of the locations and details on the type of coverage. For example, a
policy can have earthquake coverage with a $5,000 USD deductible and an incident limit of $800,000 USD. If
you add or edit locations, you cause the policy to be no longer verified it with the policy system.
• Policy: Endorsements – Lists any endorsements that might be on the policy. For example, the homeowners policy
has a limit of $4000 USD for jewelry, but the insured decided to have a separate endorsement for a very
expensive heirloom necklace.
• Aggregate Limits – An aggregate limit is the maximum financial amount that an insurer is required to pay on a
policy or coverage during a given policy period. For more information, see “Aggregate Limits” on page 114.
Homeowners Coverage Types

The ClaimCenter base configuration provides coverage types for Homeowners. To see these coverage types, you can
open the CoverageType typelist in either the Data Dictionary or Guidewire Studio. Examine the typecodes that start
with HO.
View the Homeowners Line of Business

About this task
To identify the relationships between coverages, subtypes, exposures, and incidents, you can view the lines of
business in Guidewire Studio.
Procedure
1. Open Guidewire Studio:
a. Open a command prompt and navigate to the ClaimCenter installation directory.
b. Enter the following command:
gwb studio

2. In the Studio Project window, navigate to configuration→config→Extensions→Typelist, and double-click

PolicyType.ttx.
3. In the Typelist editor, expand PolicyType→Homeowners→Children to see the list of coverage types in the table
that follows.
• Expand a coverage type and then expand Children to see its coverage subtypes.
• Expand a coverage subtype and then expand Children to see its exposure type.
• Expand an exposure type and then expand Other Categories to see the type of incident.
Homeowners Coverage Types, Subtypes, Exposures, and Incidents

The following table lists the relationships among homeowners coverage types, subtypes, exposures, and incidents.
Coverage Type Name Coverage Subtype Exposure Type Incident

Dwelling Theft Dwelling Theft Content PropertyContentsIncident
Earthquake Coverage Earthquake - Other Structures Other Structure OtherStructureIncident
Earthquake Coverage Earthquake - Personal Property Content PropertyContentsIncident
Earthquake Coverage Earthquake - Property Damage Dwelling DwellingIncident
Fire Dwelling Dwelling Fire - Dwelling Dwelling DwellingIncident
Fire Dwelling Loss of Use Dwelling Fire - Loss of Use Living Expenses LivingExpensesIncident
Fire Dwelling Medical Payments Dwelling Med Pay Med Pay InjuryIncident
Fire Dwelling Ordinance Or Law Dwelling - Ordinance or Law Property FixedPropertyIncident
Fire Dwelling Other Structures Dwelling - Other Structures Other Structure OtherStructureIncident
Fire Dwelling Personal Liability Personal Liability - BI Bodily Injury InjuryIncident
Fire Dwelling Personal Liability Personal Liability - Gen. Damages General Incident
Fire Dwelling Personal Liability Personal Liability - PD Property FixedPropertyIncident
Fire Dwelling Personal Property Dwelling - Personal Property Content PropertyContentsIncident
HO Personal/Advertising Injury HO Personal/Advertising Injury General Incident
Homeowners Dwelling HO Dwelling Dwelling DwellingIncident
Homeowners Loss Of Use HO Loss of Use Living Expenses LivingExpensesIncident
Homeowners Medical Payments HO - Med Pay Med Pay InjuryIncident
Homeowners Ordinance Or Law HO - Ordinance or Law Property FixedPropertyIncident
Homeowners Other Structures HO Other Structures Other Structure OtherStructureIncident
Homeowners Personal Liability HO Liability - BI Bodily Injury InjuryIncident
Homeowners Personal Liability HO Liability - Gen. Damages General Incident
Homeowners Personal Liability HO Liability PD Property FixedPropertyIncident
Homeowners Personal Property HO Personal Property Content PropertyContentsIncident
Inflation Guard HO Inflation Guard General Incident
Limited Fungi, Wet or Dry Rot or Bacteria HO Fungi - FL cov Property FixedPropertyIncident
Florida
Limited Fungi, Wet or Dry Rot or Bacteria HO Fungi etal Property FixedPropertyIncident
Other Insured Locations Occupied By HO Other Insured Residences Other Structure OtherStructureIncident
Named Insured
Homeowners Coverage Types 177


Other Structures Off The Residence HO Off Premises Structures Other Structure OtherStructureIncident
Premises
Other Structures On The Residence HO Other Structures on Premises Other Structure OtherStructureIncident
Premises
Personal Property At Other Residences HO Personal Prop at Other Content PropertyContentsIncident
Residences
Scheduled Personal Property HO Scheduled Personal Property Content PropertyContentsIncident
Section I Deductibles HO Property Deductibles General Incident
Section II - Limited Coverage For HO Ltd. Computer Liability General Incident
Computer Related And Other Electronical
Problem
Section II Limited Fungi, Wet Or Dry Rot HO Ltd. Fungi Liability General Incident
Or Bacteria
Special Limits Personal Property HO Special Limits - Personal Property Content PropertyContentsIncident
Specific Structures Away From The HO Specific Structures Off Premises Other Structure OtherStructureIncident
Residence Premises

chapter 18
Personal Travel Line of Business
Travelers can purchase insurance to cover the risks associated with traveling. These policies are short term, usually
for the duration of the trip. The policy typically covers issues such as lost or stolen luggage, medical payments while
on the trip, or issues resulting from delayed, canceled, or interrupted flights. There are several types of travel
insurance available such as:
• Personal – Purchased for the duration of a specific trip and based on your itinerary.
• Group – Purchased by a travel agency for groups of people on the same trip.
• Business – Typically purchased by your company as a multi-region, annual policy.
The ClaimCenter default configuration contains the Personal Travel line of business, which includes a single person
or families.
Personal Travel Insurance Overview

There are a number of reasons why you might purchase a travel policy, the policy type of personal travel. There are
also items that are not covered under this policy.
Personal Travel Coverage Scenarios

There are multiple reasons that a traveler might purchase a personal travel policy. Following are some scenarios.
Personal Property/Baggage/Contents
A traveler might need this coverage for any of the following scenarios:
• The insured traveler loses a bag with personal possessions in a foreign country and must purchase essentials to
last through the trip. The insured mails a claim form to the carrier with the appropriate documentation. The
Personal Travel Line of Business 179

carrier issues a check after assessing the line items for items that were replaced. Items include clothes, toiletries,
small electronics, and so forth that are claimed as a loss, without a replacement.
• The insured traveler files a claim for the loss of high value electronic items such as cameras, video cameras, and
laptop computers. If there is no proof of purchase or ownership, ClaimCenter flags the claim and creates
activities to check for fraud.
• The insured traveler loses travel documents such as a passport. Personal property coverage covers costs incurred
for additional travel to obtain new travel documents.
Cancellation or Interruption
Examples of cancellation can be the need to cancel a flight, hotel, and rental car due to a death in the family, with
proof. The carrier pays out cancellation fees for all bookings as well as agent fees, if applicable, up to the maximum
covered.
Delay
This coverage applies to costs arising from a delayed or canceled departure. If a claim has not yet been filed, the
insured must file a claim against the travel provider, as well as proof of delay. Usually, the insured must be delayed
for at least six hours for the claim to be valid. The insured receives a payment for every 24 hour delay thereafter up
to the coverage limit. Costs can also be for hotel, car rental, and meal expenses.
Health/Medical
This coverage applies to health-related costs for a disabling injury, sickness, or disease. Costs paid can include
medical bills, ambulance costs, accommodation costs, and so forth. However, the insured cannot have any associated
pre-existing conditions in the set time period.
Rental Car
The insured has an accident in the rental car. The auto policy covers a portion of all damages incurred. The rental car
coverage pays for auto damages in excess of the coverage provided by the purchased auto rental insurance. The
insured is liable for any further excesses. The liability coverage pays for damage to a third party's property or death.
Travelers typically need to provide proof when submitting a claim such as:
• Travel vouchers, boarding cards, passport copies, and entry/exit visas
• Police report filed within a reasonable time frame
• Doctor’s notification of illness
• Other supporting documentation such as military reporting date or jury reporting date
• Proof of baggage loss
Personal Travel Non-covered Items

The travel policy determines what is covered. Typically, policies do not cover:
• Delay due to detention by customs, government officials, or other authorities
• Missed flight due to mechanical failure of a personal car
• Existing medical conditions
• Theft, loss, or damage if proper care was not taken, such as failing to lock the car or hotel room or leaving
possessions unattended
Work with the Personal Travel Line of Business

About this task
You can work with a personal travel claim by using the New Claim wizard.
180 chapter 18 Personal Travel Line of Business
Procedure
1. Click the drop-down button on the Claim tab, and then click New Claim.
The New Claim wizard opens.
2. In Step 1, you must either find a policy to associate with the claim or create an unverified policy.
a. If you are creating an unverified policy, indicate if it is regular Travel, Quick Claim Baggage, or Quick Trip
Cancel. Your choice determines which wizard you complete. Use Travel for this example.
b. If you find a policy, enter a loss date. At this point, you can use either the New Claim wizard, the Quick
Claim Baggage wizard, or the Quick Trip Cancel wizard. This example uses the New Claim wizard.
3. Step 2 of the wizard gathers information. Optionally, you can edit the contact information.
4. Use Step 3 of the wizard to enter loss details. Select a loss cause where you can create the following type
incidents: trip, baggage damage, injury, vehicle, and property damage. Click the buttons Add Trip, Add Baggage
Damage, Add Injury, Add Vehicle, and Add Property Damage in turn to create each kind of incident.
5. Use Step 4 of the wizard to assign the claim and exposures and save your claim.
Personal Travel Screens

The travel line of business provides screens that specifically capture information that is needed to process that type
of claim. ClaimCenter organizes data in meaningful groups. While you might see some of these screens in the New
Claim wizard, it is possible that an adjuster might have limited information when the claim is first entered. The
adjuster can return to the claim to add more information or to work on the claim. This section provides descriptions
of screens and fields that specifically pertain to this line of business.
Personal Travel Summary Screens

The Summary, Claim Status, and Claim Health Metrics screens contain the most relevant information for you to determine
the status of a claim. You can determine the following:
• How long the claim has been open.
• What occurred, such as that the claimant lost her passport.
• If any monies have been paid.
• If there are any high risks to this claim.
• What exposures are on the claim and their status.
• Where the incident occurred.
• Who was involved.
• If there are any planned activities.
From the Summary screen, you can click an exposure under the Exposures section. Clicking an exposure displays the
Exposures Details page, where you can edit, assign, create a reserve for, or close the exposure.
See also
• “Claim Performance Monitoring” on page 431
• “Claim Status Screen” on page 436
Personal Travel Loss Details Screens

The Loss Details screens contain information about the loss as it specifically relates to travel, and are organized into:
Loss Details, Associations, and Special Investigation Details. If you click Edit on the Loss Details screen, an edit page opens.
Personal Travel Screens 181

The editable Loss Details screen contains the following sections:

• Loss Details – Contains information about the incident. Of note is the drop-down list for Loss Cause, which enables
you to set the cause of the loss. For example, the cause of the loss was that the passport document was lost. This
list is configurable.
• Loss Location – Contains geographical details concerning where the loss occurred.
• Notification and Contact – Captures information regarding how the loss was reported, who reported it, and who is
the main contact.
• Witnesses – Witness information, including if the witness gave a statement and where they were when they
witnessed the incident.
• Contributing Factors – Captures additional information if applicable. For example, the default choices for Category
are driver or environmental conditions. You can enter data indicating that the driver was driving too fast or that
the highway had no barrier.

• Loss Items – The incidents are listed as follows:

◦ Trip – Captures details of the trip incident, which is a subtype of Incident. Adding a trip opens the Trip Incident
screen. Use this section to capture details of the trip, reason for the cancellation or delay, and any transportation
and accommodation details such as associated fees. For example:
◦ Baggage & Contents – Captures details of the Baggage exposure type, which has a baggage incident type. You
must select a baggage type, such as backpack, tote, suitcase, or travel documents. There are also baggage and
contents line items that can be listed. To see how to calculate the value of a line item, the details of how the
claimant is to be reimbursed, see “Personal Travel Loss Details Line Items” on page 183.
◦ Injuries – Editing this section displays the Injury Incident screen. Enter any injury details.
◦ Vehicles – Capture information on vehicles if they were involved.
◦ Properties – The new property incident if there was property damage.
◦ Officials – If any official, such as a police officer or coroner, was involved and wrote a report, you can enter it
that information in this section.
Note: In the base configuration, the ISO card is not supported. If you want to use that feature for ISO, or any
other statutory reporting organization, you must set up ISO rules in Studio.
Personal Travel Loss Details Line Items

A claimant’s policy can contain specific items that are mentioned in the policy. Examples could include cameras,
computers, electronics, and so forth. If these items are damaged or stolen, the way an adjuster determines those
amounts depends on the claimant’s policy.
There are two ways to determine the amount of money the insurer pays to indemnify the claimant for a particular
line item: replacement value (RCV) and actual cash value (ACV). Depending on the type of coverage, the insured is
either reimbursed by RCV or ACV.
• Replacement Cost Value (RCV) – The maximum amount the carrier pays the claimant for damage to covered
property, without a deduction for depreciation. The RCV payment is based on the current cost to replace the
Personal Travel Loss Details Screens 183

property with new, identical, or comparable property. For example, five years ago the claimant paid $100, plus
sales tax, for a camera. That model of camera is no longer available, but a comparable item currently costs $125.
With RCV coverage, the maximum amount the carrier pays the claimant for the item is $125, plus sales tax.
• Actual Cash Value (ACV) – The amount the carrier pays the claimant for damage to covered property, minus a
deduction for depreciation. The formula is as follows:
When the RCV value is null, then the ACV is equal to the original cost minus depreciation. (ACV = Original cost
– Depreciation)
Otherwise, the ACV is equal to the RCV minus depreciation. (ACV = RCV – Depreciation)
For example, five years ago you paid $100, plus sales tax, for a camera. Since ACV is the current replacement
cost less depreciation, you must consider wear and tear, if any. If the camera had a reasonable life expectancy of
10 years, and you used it for five years, the camera could have depleted 50% of its value. The item, or a
comparable equivalent if the item is no longer available, currently costs $125. With ACV coverage, the
maximum amount the carrier will pay you for the camera is $62.50, plus sales tax (current replacement cost,
$125, plus sales tax, less 50% depreciation).
Travel policies normally have limits for each of the line item categories in the policy language. If the policy has a
limit for a particular content category being itemized on the incident, then you enter that limit into the Limit Amount
field. Since there is no transactional validation in the base configuration, you must configure rules to restrict this
value programmatically.
Personal Travel Loss Details Associations Screen

Use this screen to associate any other claims with this one. For example, if there was a large accident at a beach
resort and several claimants, you could associate all the claims with one another.
Personal Travel Loss Details Special Investigation Details

This section contains a question set that depending on the answers, can trigger an investigation to rule out fraud. To
learn about this feature see “Claim Fraud” on page 143.
Personal Travel Coverage Types

Personal travel has the following coverage types:
• Baggage – General coverage for items such as suitcases, the contents inside suitcases, personal property such as
electronics, cell phones, cameras, wallets, and documents such as passports
• Health – Medical payments
• Hired Auto – Generally excesses for hired or rented autos
• Liability – Third-party liability
• Trip – If your journey was canceled or delayed
View the Personal Travel Line of Business

About this task
To identify the relationships between coverages, subtypes, exposures, and incidents, you can view the Personal
Travel line of business in Guidewire Studio.
Procedure
1. Open ClaimCenter studio by navigating in a command window to the ClaimCenter installation directory and
entering gwb studio.
2. Navigate in the Project window to configuration→config→Extensions→Typelist, and then double-click
PolicyType.ttx.

3. In the Typelist editor, expand PolicyType→Personal Travel→Children to see the list of coverage types.
Next steps
See also
• “Personal Travel Coverage Types, Subtypes, Exposures, and Incidents” on page 185
Personal Travel Coverage Types, Subtypes, Exposures, and Incidents

The following table lists the relationships among personal travel coverage types, subtypes, exposures, and incidents.

Baggage Baggage - Loss, Damage, or Delay Baggage BaggageIncident
Health Travel - Medical Expenses Med Pay InjuryIncident
Hired Auto Hired Auto Damages Vehicle VehicleIncident
Liability Liability - Auto Damages Vehicle VehicleIncident
Liability Liability - Bodily Injury Damage Bodily Injury InjuryIncident
Liability Liability - General Damage General Incident
Liability Liability - Property Damage Property FixedPropertyIncident
Trip Trip - Cancellation or Delay Trip Cancellation or Delay TripIncident
Personal Travel Coverage Types 185


chapter 19
Workers Compensation Line of

Business
A workers compensation claim is a specialized claim typically involving an employer, employee, and a work-related
incident. The ClaimCenter workers' compensation line of business is designed to collect the data needed to track,
manage, and make payments on these specialized claims.
See also
• “Overview of Workers' Compensation” on page 187
• “Working with Workers' Compensation Claims” on page 189
• “Compensability Decision” on page 194
• “Finding Injured Workers” on page 195
• “Jurisdictional Benefit Calculation Management” on page 196
• “Workers’ Compensation Administration” on page 198
• “Workers' Compensation Coverage Types” on page 198
Overview of Workers' Compensation

Usually, employers file workers' compensation claims when employees are injured at their place of employment.
Injured employees might seek medical treatment and possibly reimbursement of pay for missed work. The most
serious claims involve injuries that are permanent, and awards might be paid to the injured worker. Employers file
these claims with their insurance carrier, and ClaimCenter assists in the handling of these claims.
Workers Compensation Line of Business 187

ClaimCenter provides the following features:

• Summary– Located in one place, the claim summary offers a quick glimpse of the current status of the claim and
helps determine if you need to take action.
• Medical details – Grouped in sections for convenience, this includes views of summary information, details,
medical case management, and ISO status.
◦ Body Parts – Provides specific details on the injured body part.
◦ Medical Diagnosis – Tracks diagnosis to injury using international standards.
◦ Medical Notes – Automatically marked for security reasons, so that only those with requisite permissions can
view them.
◦ Activities - Displays any activities associated with the claim.
• Indemnity – Includes views of summary and benefits information. The benefit information includes type of
disability, waiting period, other jurisdictional factors and information on settlements that you can modify.
• Search – Ability to find workers’ compensation claims by injured worker.
Workers' Compensation Incidents and Exposures

When you create a workers' compensation claim by using the New Claim wizard, the system automatically creates a
corresponding injury incident at the claim level and two exposures, Medical Details and Indemnity. The claim injury
incident is always created. Creating the exposures depends on the data you enter in the wizard. For example, if no
time loss occurred due to the injury, an Indemnity exposure is not created.
The claim injury incident is visible on the Loss Details→General screen in the Injury section and contains the main
information on the injury incurred. You can access ClaimInjuryIncident in Gosu as follows:
claim.ClaimInjuryIncident
claim.ensureClaimInjuryIncident()
The exposures, Medical Details and Indemnity, are menu links in the sidebar.
Note: After a workers' compensation claim is created, two additional incidents are also created corresponding to
the two automatically created exposures. These are merely placeholder incidents and can be ignored.
After claim creation, you can then create the Employer Liability exposure if necessary. All exposures are accessed
from menu links in the sidebar in ClaimCenter.
Workers' Compensation Exposures

Workers' compensation claims, when complete, can generate three associated exposures:
• Medical Details – A Medical Details exposure is created when one of the following is set in the LossDetails step
of the New Claim wizard:
◦ Yes to Incident Only? and Yes to Medical treatment
◦ No to Incident Only? and Yes to Medical treatment
◦ No to Incident Only? and No to Medical treatment
• Indemnity – An Indemnity exposure is created when you choose Yes to Lost time from work? in the Lost Time
section.
Both the Medical Details and Indemnity exposures are created upon completion of the New Claim wizard.
• Employer Liability – After claim creation, if there is employer liability, you can add this exposure by navigating
to the Loss Details→General screen. In the Classification section, select Yes for Employer Liability.
188 chapter 19 Workers Compensation Line of Business

Working with Workers' Compensation Claims

The workers' compensation line of business provides screens that capture information that is specifically needed to
process this type of claim. ClaimCenter organizes claim data into meaningful groups so an adjuster can process the
claim efficiently. While you might see some of these screens in the New Claim wizard, it is possible that an adjuster
might have limited information when the claim is first entered. The adjuster would then need to return to the claim
either to add more information or to work on it. The following topics describe workers' compensation screens and
associated fields in more detail.
Status of a Workers’ Compensation Claim

The Summary, Status, and Health Metrics screens contain the most relevant information for you to determine the status
of a claim.
In the Summary screen, for example, you see the number of days the claim has been open, financial data, information
on the loss, and any associated services, exposures, and activities. The current work status and 3-point contact
activity status are also shown in this screen.
Initiating 3-Point Contact

Workers' compensation claims include activities to establish communication with the three main parties involved in
the claim—the employee, the employer, and the medical provider. When a workers' compensation claim is saved
and assigned, the 3-point contact process is initiated.
Activities are created and assigned to the appropriate parties, as follows:
• The activity to contact the employee and employer is assigned to the owner of the medical exposure.
• The activity to contact the medical provider is assigned to the Nurse Case Manager, if one is assigned to the
claim. Otherwise, it is assigned to the owner of the medical exposure.
All 3-point contact activities are prioritized as Urgent. The 3-Point Contact indicator in the Summary section is color-
coded based on the status of the generated activities. The indicator is green if the activity has been completed,
cancelled, or skipped, that is, a decision was made on it. It is coded red if the activity is open past the due date.
The 3-Point Contact indicator does not appear if all associated activities have been completed.
Working with Workers' Compensation Claims 189

See also
• “Claim Summary Screens” on page 35.
• “Claim Performance Monitoring” on page 431.
Loss Details for Workers’ Compensation

The Loss Details screens contain information about the loss as it relates to workers’ compensation. Specific screens
include Loss Details, Associations, and Special Investigation Details.
Loss Details Screen

The Loss Details screen is editable and provides the following sections:
• Loss Details – Information about the incurred injury and where it occurred.
• Injured Worker – Standard information about the claimant.
• Injury – Description of the injury. The severity of the injury can trigger a high-risk indicator. For example, if the
claimant died, a fatality risk indicator would be shown in the Info bar and Summary screen.
• Body Part Details – Specifies the area of the body that was injured, including the body part, side, and Permanent
Partial Disability (PPD) compensation percentage. You can also indicate if a decision was made whether to
accept or deny compensability.
• Employment Data – Work-related information such as the average weekly wage, date of hire, state of hire,
employment status, and pay period.
• Concurrent Employers – Information on other employers, if any.
• Other Benefits – Specifies if the claimant is receiving any other benefits, such as from the government or other
parties. You can list them along with the amount and duration.

• Officials – Information on any official, such as a police officer or coroner, who was involved in the incident and
wrote a report.
• Metropolitan Reports – Any reports received can be listed in this section with links to the relevant documents. See
“Metropolitan Reports” on page 605.
• Compensability Factors – Section that helps determine if the claim is compensable using a set of questions. The
subsection, Compensability Decision, captures more details on the decision made, such as the date, whether the
claim is to be accepted or not, and the reason for it.
Note: Even if you refuse the claim, you must still close it.
• Classification – Various ways you can classify a claim. If you select Employer Liability, ClaimCenter creates that
exposure, and the Employer Liability menu link becomes available in the sidebar.
• Key Dates – The dates relevant to the claim, such as the date of injury, date employer was notified, and time of
injury.
• Notification and Contact – Information on how the injury was reported, who reported it, and the main contact.
Note: In the base configuration, even though you can see the ISO card, you must first integrate ISO to be able to use
this card. See the Integration Guide.
Associations Screen
Use this screen to associate any other claims with this one. For example, if there was a large accident at work and
there were several claimants, you could associate all the claims together.
Special Investigation Details Screen

This screen provides a question set that, depending on the answers, can trigger an investigation to rule out fraud. See
“Claim Fraud” on page 143 to learn more about this feature.
Working with Medical Details for Workers’ Compensations Claims

A Medical Details exposure is typically created as a result of information entered in the New Claim wizard during
the creation of a workers' compensation claim. The Medical Details screen is organized into Summary, Details, Medical
Case Mgmt, and ISO cards.
There are several actions that you can perform in the Medical Details screen.
• You can edit certain fields, such as Alternate Contact or Nurse Case Manager.
• You can assign the exposure to someone else, either by using automated assignment or by directly finding
another adjuster.
• You can choose to close the Medical Details exposure by selecting Close Exposure. You then select an Outcome for
the closure, and choices include Completed, Duplicate, Fraud, Mistake, Payments complete, and Unnecessary.
• You can create a reserve from this screen. If you select Create Reserve, the items added or changed on the Set
Reserves screen are submitted as a group. Any line item that has not been changed is not saved. Any line item
with Pending Approval reserves that has its New Available Reserves set to equal its Currently Available reserves
will have those Pending Approval reserves deleted. Comments are saved only when another field on the line has
changed.
Summary
The Summary card provides the following sections:
• Exposure – Contains basic information related to the exposure, including the adjuster, the creation date, the
validation level, and any alternate contacts.
• Financials – Lists the remaining reserves, future payments, total paid, total recoveries, and net total incurred.
• Coding – Records basic information collected when the claim was first entered into the system, such as the
segment and handling strategy.

• Body Parts – Lists the physical areas affected, which are determined either through the New Claim wizard or later in
the Loss Details screen.
• Medical Diagnosis – Shows any codes that an adjuster has entered. You enter or update codes from the Medical Case
Mgmt tab.
• Activities – Lists any activities associated with this Medical Details exposure.
• Medical Notes – Lists any medical notes made concerning the exposure. Choose Actions→Note to create a medical
note for the claim.
Details
The Details card provides the following sections:
• Medical Provider Network – Confirms if the physician and the injured worker are in the medical provider network.
• Maximum Medical Improvement – Details the date on which the claimant has reached the Maximum Medical
Improvement (MMI) limit, defined by one of the following events:
◦ The claimant’s condition cannot be improved any further.
◦ The claimant has reached a treatment plateau.
◦ The claimant has fully recovered from the injury.
◦ The clamant's medical condition has stabilized, and no major medical or emotional change is expected.
When a claimant who is receiving workers’ compensation benefits reaches the MMI limit, their condition is
assessed and a degree of permanent or partial impairment is determined. This degree impacts the claimant’s
benefit amount.
The MMI limit indicates that treatment options have been exhausted. Temporary disability payments are
terminated and a settlement is worked out regarding the condition of the worker at this point.
• Initial Provider Contact – Section in which the initial provider records the complaints as reported by the claimant
and assesses the condition based on the provider’s medical background.
• First Report of Injury – Captures critical information, including the attending doctor, the diagnosis, and if further
treatment is needed.
• Settlement – Indicates if there was a settlement date and method.
Medical Case Mgmt

The Medical Case Mgmt card provides the following sections:
• Medical Personnel – Information on the medical people involved.
• Medical Treatment Approvals – Lists the medical treatments that have been approved for the claimant.
• Medical Actions and Information – Lists the medical actions that were reported, such as the condition of the claimant,
who the provider was, source of information, treatment status, and the next follow-up date.
• Medical Diagnosis – Section to add, edit, or remove a medical diagnosis, make a diagnosis primary, and reconfirm
the diagnosis. The medical diagnosis uses ICD codes that are accepted worldwide. Using these codes ensures that
the diagnosis matches the treatment.
Workers' compensation is one of several lines of business that uses ICD codes as seen in the Medical Diagnosis
section. See “Managing ICD Codes” on page 546 to learn more about these codes.
Typically, an adjuster receives a form with one or more ICD codes. You can enter these codes on the Medical Case
Management screen and you can also view them on the Summary tab of the Medical Details screen. If there is more than

one code, then you must make one primary. Making a code primary is necessary for sovereign organizations, such as
the ISO in the United States.
You can also enter dates and comments and indicate whether there is compensability on the exposure. This check
box serves as a reminder that the incident is compensable. You can also select a diagnosis and reconfirm it.
Reconfirming has two purposes. It serves as a reminder that you looked at the medical diagnosis and are certain that
it still applies. It also adds an entry to the Diagnosis Notes and Medical Notes sections of the screen.
Note: The link to the ICD number can open a new browser window providing a complete description of the
diagnosis.
The Medical Diagnosis section is located in different areas of the user interface depending on the line of business. For
example, in a personal auto claim, you would navigate to the Loss Details screen and click the name of a person in the
Injuries section. The Medical Diagnosis section is then accessible on the Injury Incident screen.
• IME Medical Actions – Lists any independent medical evaluations by experts.
• Drugs Prescribed – Lists the drugs prescribed for the injured party, the prescribing physician, date of prescription,
and expiration date.
Indemnity Screen for Workers’ Compensation Claims

The Indemnity screen is organized into Summary and Benefits cards, and there are several actions that you can perform
that are the same as in the previous topic.
Summary Card
The Summary card provides the following sections in the base application:
• Exposure – Information on the exposure, including the type and status.
• Return to Work – Details if the injured employee can return to work with full or modified duties.
• Compensation – The average weekly wage defined in the Employment Data section on the Loss Details screen. This
value is read-only in this screen. You can also enter a PPDPercentage value.
• Dependents – Information on dependents of the injured employee.
• Lost Time/Work Status – Information on the duration of the claimant’s time lost from work and ability to work.
• Wage Statement – Information from the claimant’s pay stub.
• Coding – Basic information, such as claim segment and validation level, collected when the claim was first
entered into the system.
• Financials – Some financial information is repeated in this section for convenience and is not editable.
Benefits Card
The Benefits card is used to add or remove defined benefit periods and provides the following sections:
• Claim Parameters – Lists the amounts the claimant earned before and after the injury. You can also identify the
jurisdiction state or province.
• The following four sections in Benefits derive their data from jurisdictional parameters entered on the WC
Parameters screen. You cannot override the amounts. Only the weekly compensation rate can be entered manually
in this page.
◦ Temporary Total Disability (TTD)
◦ Temporary Partial Disability (TPD)
◦ Permanent Total Disability (PTD)
◦ Permanent Partial Disability (PPD)
See “Jurisdictional Benefit Calculation Management” on page 196 for definitions of these parameters.

Note: You must set up these parameters by clicking the Administration tab and navigating to Business
Settings→WC Parameters so that they display in the Benefits tab.
• Waiting Period – Data from the Jurisdictional Benefit Calculation Management section. Some portions in this
section are editable. See “Jurisdictional Benefit Calculation Management” on page 196.
• Other Jurisdictional Factors – Read-only section that obtains its data from the WC Parameters screen, which contains
additional information that a carrier can capture. To open this screen, click the Administration tab and navigate to
Business Settings→WC Parameters.
• Settlements – Indicates any settlements on the claim.
Employer Liability Exposure for Workers’ Compensation Claims

The Employer Liability exposure is created either in the New Claim wizard or by clicking Yes in the Employer Liability
field on the Loss Details screen.
The Employer Liability screen provides the following sections:
• Exposure – Includes information on the exposure, such as the type, status, and validation level.
• Damage – Describes the damage, if any, and the estimated loss.
• Settlement – Details on the settlement, including the date and method.
• Coding – General information on the claim, including the jurisdiction state, segment, and handling strategy.
• Financials – Summarizes the exposure’s key financials in one location.
Compensability Decision
The compensability decision, indicated in the Loss Details screen, involves determining if a workers' compensation
claim is valid and hence, payable. There are several factors to consider when determining compensability. For
example, an adjuster can ask a series of questions, such as, “Was safety equipment used?” or “Was the person using
illegal substances?”. The adjuster also needs to determine if the incident was accidental in nature or in the course of
employment, or if there was jurisdiction. Jurisdiction addresses time, place, and employment relationship.
How Jurisdiction Affects the Compensability Decision

Carriers must adhere to the jurisdictional deadline to accept or deny a claim. This deadline, which changes by
jurisdiction, is based on either of the following:
• A number of predetermined days after the loss date
• The date that the employer was notified
Use ClaimCenter to manage the jurisdictional deadline and the related process.
For example, an employer contacts the insurance company to create a new claim. The adjuster enters the Loss Date
and the Date Employer Notified in the New Claim wizard. The insurer now has a number of days to accept, deny, or
delay the claim. The number of days is based on what each state mandates. These dates are kept in the
Compensability Parameters reference table on the WC Parameters screen. To open this screen, click the Administration
tab and navigate to Business Settings→WC Parameters. See “Managing WC Parameters” on page 539 for details.
Working with Jurisdictional Compensability

When a workers' compensation claim is created, ClaimCenter generates an activity, Determine compensability, to
determine whether to accept or deny compensability. This activity is based on the activity pattern, claim_acceptance.
You see this activity in your Desktop→Activities list. If you select it and then click Update: Determine Compensability
Decision on Loss Details, ClaimCenter displays the Loss Details screen. You can select the compensability decision in
the Compensability field, include a reason for the decision and complete the activity.

How the Activity Due Date is Calculated for a Compensability Decision

If a valid record exists in the Compensability Parameters reference table, the reference data is utilized to indicate which
formula to use, as follows:
• Formula 1 – Y days after the Notice Date
• Formula 2 – X days after the Loss Date
• Formula 3 – Greater of X days after the Loss Date or Y days after the Notice Date
If a valid record does not exist in the reference table, ClaimCenter uses the default value from the activity pattern. In
the base configuration:
• The imported data for the claim_acceptance activity pattern is set to five business days after the claim notice date.
• The escalation date is three days prior to the due date.
• The claim's Compensability Due Date is also set to the activity's due date. The Claim entity field for this value is
DateCompDcsnDue.
Managing Denial of Compensation for Workers’ Compensation Claims

In the case of some workers' compensation claims, compensation can be denied or in question. ClaimCenter
evaluates these claims based on the compensability parameters, as follows:
• Compensability is denied for the claim – You cannot create reserves or payments. ClaimCenter displays a
validation error indicating that the claim’s compensation has been denied.
• Compensability is disputed and claim cost reserves/payments are being created – ClaimCenter displays a
warning requesting confirmation to complete the financial transaction.
• Compensability is not determined, that is, it has no value or is Pending – The CompensabilityParameters in
Business Settings→WC Parameters in the Administration tab determine how financials are handled. Navigate to
Compensability Parameters and locate the claim’s jurisdiction.
When a claim cost reserve or payment is created, one of the following actions occurs:
• If Benefit Payment Implies Acceptance is set to Yes for the claim’s jurisdiction, ClaimCenter displays a validation
error informing you that making a payment before compensability is determined implies acceptance.
• If Benefit Payment Implies Acceptance is set to No for the claim’s jurisdiction, ClaimCenter displays a warning asking
you to confirm if you want to proceed with the financial transaction.
Note: The claim’s Loss Date or Notice Date is used in the Denial Period Formula in the Compensability Parameters
screen. The Denial Period Formula, in combination with the jurisdiction, determines the number of days past these
dates that compensability is determined.
See also
• “How Jurisdiction Affects the Compensability Decision” on page 194
Finding Injured Workers

Because a company can have more than one injured worker, ClaimCenter can be configured to enable you to sort by
injured worker. You can view the list of injured workers in the following locations:
• The adjuster’s Desktop→Claims link.
• The Claim Search screen in the list of search results.
For all users, in these two screens, there is a Claimant column. This column is not sortable.
For many claim types, such as the personal auto line of business, there can be many claimants associated with one or
more exposures. For adjusters whose default claim loss type, as defined by the administrator, is workers'
compensation, the claimant column is actually Injured Worker, and that column is sortable.
Compensability Decision 195

See also
• “Change a User’s Sort Criteria” on page 196
Change a User’s Sort Criteria

About this task
You can change a user’s sort criteria to enable the user to search for injured workers instead of claimants. A
workers’ compensation adjuster might find this search useful because the claimant will be the carrier, and the insurer
can have multiple injured workers.
Note: If you log in as a user without these workers’ compensation settings, on the claim search screen you see a
column with the header Claimant rather than Injured Worker. For loss types other than workers’ compensation, there
can be multiple claimants, and for those loss types, sorting on this column is meaningless.
Procedure
1. Log in as a user that has a role with administrator permissions.
2. Click the Administration tab and navigate to Users & Security→Users.
3. Find the user and click the user’s link.
4. Click the Profile card and click Edit.
5. Under Policy Type, click Workers’ Compensation.
6. Under Loss Type, click Workers’ Comp.
7. Click Update.
Next steps
To test, log in as that user and click the Search tab and then click Claims. Search for claims and see that there is an
Injured Worker column in the search results.
Jurisdictional Benefit Calculation Management

One of the key activities that a workers' compensation adjuster performs is calculating the payments for lost time
due to disabilities, the Indemnity exposure. You can see this information on the Indemnity→Benefits card. Benefits
calculations for the following categories vary by jurisdiction in accordance with regulatory formulas.

The primary categories are:

• Temporary Disability (TD)
• Permanent Disability (PD)
Temporary Disability (TD)

If an employee is injured, but the expectation is that the employee will make a recovery or return to work, there are
two possibilities for temporary disability:
• TPD - Temporary Partial Disability – An example is an employee who is injured in a relatively minor way,
such as falling and spraining a wrist. The injured worker can work, but in a reduced capacity.
• TTD - Temporary Total Disability – An employee who is injured on the job and cannot return to work
immediately is entitled to receive TTD benefits during the convalescence. An example is a worker who suffers an
injury at work that requires surgery. The worker cannot perform work duties for some period of time.
Permanent Disability (PD)

If an injured worker is still totally or partially disabled after reaching the Maximum Medical Improvement (MMI)
limit, then permanent disability benefits are determined.
• PPD - Permanent Partial Disability – An example is an employee whose finger is cut off or who loses an eye.
The loss is permanent, but at some point, the employee can still work. PPD can vary depending on the body part
that is injured.
• PTD - Permanent Total Disability – PTD benefits are payable to employees who are never able to return to
gainful employment. An employee who is determined to be permanently and totally disabled because of an on-
the-job injury is entitled to PTD benefits.
A workers compensation benefit manager or administrator can calculate and enter disability amounts by clicking the
Administration tab and navigating to Business Settings→WC Parameters.
The calculations, which are defined in Gosu code, use these numbers. For example, you can calculate the comp rate,
the weekly benefit for the injured worker, based on the worker’s baseRate and the applicable jurisdictional
parameters. You can also configure the maximum number of weeks to pay the benefit. However, an adjuster can
manually override those amounts from the Indemnity→Benefits card in a claim.
Jurisdictional Waiting Period

A key component to managing benefit payments is the jurisdictional waiting period. Each state can mandate a set
number of days the employer must wait before paying benefits. The Waiting Period section on the Benefits card
provides details on the jurisdictional waiting period.
Jurisdictional Benefit Calculation Management 197

See also
• For information on calculations, administering benefits, and the workers compensation reference tables that are
accessed from the user interface, see “Managing WC Parameters” on page 539.
Workers’ Compensation Administration

On the Administration tab, you can change the following workers' compensation settings if you have appropriate
permissions:
• WC Parameters – Enter the benefit parameters, PPD minimum and maximum values, PPD weeks, and
compensability parameters. See “Managing WC Parameters” on page 539.
• ICD Codes – Administer the codes that are used in medical diagnosis. See “Managing ICD Codes” on page 546.
See also
• “Workers’ Compensation Permissions” on page 545.
Workers' Compensation Coverage Types

The ClaimCenter base configuration provides coverage types for Workers' Compensation. To see these coverage
types, you can open the CoverageType typelist in either the Data Dictionary or Guidewire Studio. Examine the
typecodes that start with WC.
View Workers' Compensation Coverage Types

About this task
To identify the relationships among coverages, subtypes, exposures, and incidents, you can view the lines of
business in Guidewire Studio.
Procedure
1. Open ClaimCenter studio by navigating in a command window to the ClaimCenter installation directory and
entering gwb studio.
2. Navigate in the Project window to configuration→config→Extensions→Typelist, and then double-click
PolicyType.ttx.
3. In the Typelist editor, expand PolicyType→Workers’ Compensation→Children to see the list of coverage types.
Next steps
See also
• “Workers' Compensation Coverage Types, Subtypes, Exposures, Incidents” on page 198
Workers' Compensation Coverage Types, Subtypes, Exposures, Incidents

The following table lists the relationships among workers' compensation coverage types, coverage subtypes,
exposure types, and incidents.
Coverage Type Coverage Subtype Exposure Type Incident

Federal Employer's Liability Federal Employer's Liability Employer Liability Incident

Coverage Type Coverage Subtype Exposure Type Incident

Other States Insurance Other States Insurance - Med Only Medical Details InjuryIncident
Other States Insurance Other States Insurance - Other than Med Indemnity InjuryIncident
Statutory Workers' Comp WC Coverage - Other than Med Indemnity InjuryIncident
Statutory Workers' Comp WC Coverage -Med Only Medical Details InjuryIncident
Workers' Comp Employer's Liability Workers' Comp Employer's Liability Employer Liability Incident
Workers' Comp State-Specific Deductible State Specific Deductible - Med Only Medical Details InjuryIncident
Workers' Comp State-Specific Deductible State Specific Deductible - Other than Med Indemnity InjuryIncident
Workers' Compensation Coverage Types 199


part 5
Additional Features of ClaimCenter

chapter 20
Work Assignment
All work in ClaimCenter has an owner, someone who is responsible for making sure the work is done properly.
After work is assigned to someone, that ClaimCenter user becomes its owner. All work is assigned to both a user
and group. See “Assignable Work” on page 204 for a definition of work.
Work is often assigned when it is first created, but can be assigned or reassigned later to a different owner.
ClaimCenter can make assignments automatically, based on rules that model your business practices. ClaimCenter
also provides the ability to assign work manually, enabling managers and supervisors to choose who they assign
work to.
How Assignment Models the Way an Insurer Distributes Work

ClaimCenter mimics the way assignment is manually determined in an organization. Manual assignment often
proceeds as follows:
1. An executive learns of a task and determines that it belongs to one of the executive’s departments.
2. The department manager decides that a certain team will work on the assignment.
3. The team supervisor either chooses one of the employees or assigns the work to a queue from which
employees take the work items.
4. Assignment is complete. The employee assigned the work is now its owner and is responsible for its
completion.
In this example, individuals—users—are ultimately assigned work, and the groups into which users are organized
play a critical role in the assignment process. ClaimCenter provides a variety of ways of organizing users into
groups to facilitate work assignment.
Each of those decisions is made independently, and the logic of each is simple to describe. Each assigner needs to
know only how to direct the work to the right group or person within the assigner’s authority.
ClaimCenter takes a similar approach. For every main work item, assignment rules model the step-by-step process
of assigning a person responsible for performing the work. The assignment logic passes down through the group
hierarchy to find the correct group, and then the appropriate group member.
Assignment takes into account the area that a group covers, the special capabilities of a group, the amount of work
already owned by the group, and other considerations. During automatic assignment, business rules make
Work Assignment 203

assignments by considering these factors. There are automatic methods that assign based on location, proximity,
special talents, workload, and other factors. Use these flexible methods to model an assignment process to match
your manual assignment process.
Assignable Work
Work is assigned to both a group and a user or queue. Work falls into the following main areas, each corresponding
to a main ClaimCenter entity:
• Activity – Often assigned to the owner of the related claim or exposure. ClaimCenter can also look for
particular types of activities and assign them to specialists such as local inspectors, clerical workers, or medical
reviewers. Activities can also be assigned to a queue; users can then pick activities off the queue and assign them
to themselves or others. See “Working with Activities” on page 225.
• Claim – Can be assigned based on its attributes, such as its segmentation type, number and type of exposures,
and geographic location.
• Exposure – Can be assigned to the claim owner, or can be assigned to someone else based on exposure attributes.
• Matter – Often assigned to the claim owner or to a user with a special role or a custom user attribute, like a legal
expert.
• ServiceRequest – Can be assigned to the claim owner or can be assigned to someone else based on service
request attributes.
• Subrogation – Can be assigned to a member of the subrogation team or can be assigned to anyone else who
would be handling the subrogation.
You cannot make any other entities in the base configuration of ClaimCenter assignable. However, you can make
extension entities that you create assignable. See “Assigning Other Entities” on page 208.
Viewing Your Assignments

You can view all claims for which you are assigned work. Note that you cannot view all matters to which you have
been assigned.
View Claims to Which You are Assigned
Procedure
1. Use the All open owned or New owned (this week) filters in the Desktop→Claims screen or the Desktop→Exposures
screen.
2. Review the activities in the Desktop→Activities.
View all Matters Related to a Specific Claim
Procedure
1. Open a Claim and click Parties Involved in the menu on the left.
2. Click Users.
Your matters, if any, appear in the User Details tab.
View all Matters Assigned to Anyone
Procedure
1. Open a Claim and click Litigation in the menu on the left.
2. Review the matters on the Matters screen.
204 chapter 20 Work Assignment

How ClaimCenter Assigns Work

Global and default rule sets define how assignments are made. See “Global and Default Rule Sets” on page 205.
You can assign work to an owner—the person responsible for completing it—as follows:
• By explicit or manual assignment.
• By automatic assignment, which can mean:
◦ The assignment engine runs the global and default rule sets.
◦ The rule set is called from Gosu in a PCF file. See “Assignment Without Using the Assignment Engine” on
page 207.
◦ You write your own version of automated assignment. See “Dynamic Assignment” on page 207.
Global and Default Rule Sets

For historical reasons, ClaimCenter contains both a global and default rule set for each assignable entity. The
assignment engine runs the global rule set before the default rule set. The main purpose of a global rule set is to
consider all groups and make an assignment to the proper one. The global rule set runs either as soon as the work is
created or when a user requests automated assignment.
Multiple Default Rule Sets

Although each entity has a single global rule set, different subentities can have their own default rule sets.
For example, after the global rule set has selected a group, the group’s default rule set runs to finish assignment. It
targets first the group or one of its subgroups, and then a user. The default rule set can also assign the item to a
queue or create an activity to assign it into the group supervisor’s Pending Assignment queue.
Assignment Engine
The assignment engine is the normal way ClaimCenter executes the global and default rule sets, where the global
rule set is executed first. It handles all assignment methods. You can call it at any time. It is commonly run just after
a new assignable object is created. The overall logic of the assignment engine is:
Global assignment rules run first. There are several outcomes possible:
• A rule assigns both a group and a user. In this case, assignment is finished and the assignment engine exits.
• One of the rules assigns a group, but no user. The assignment process continues with the Default rule set.
• No group or user is assigned. The entity is assigned to a default user and group, and the assignment engine exits.
Default assignment rules run only when the assignment engine has assigned a group, but not a user, as follows:
• A default rule assigns a user. In this case, assignment is finished and the assignment engine exits.
• No rule assigns a user, but a rule assigns a different group. The assignment engine runs the default rules again.
• No rule assigns a user, but the group assignment does not change. In this case, the assignment has failed, and the
assignment engine exits.
Note: This logic can cause the default rule set to execute more than once. Write rules carefully to avoid this
situation. Also, the engine-run rules are not guaranteed to succeed. See “Global and Default Rule Sets” on page
205 and the Rules Guide for more information.
Default Owner
The application’s assignment engine can fail to make an assignment. However, if the customized assignment rules
do not cover all cases, and the engine cannot find any group and user for assignment, it makes the assignment to a
user. This user is from the sample data and is called Default (first name) Owner (last name). Never delete this user,
and never assign anything to this user. Instead, write a rule to reassign all items assigned to this Default Owner, and
to correct the assignment rules that cause the assignment engine to fail. See the Rules Guide for a description of how
to write assignment rules that do not fail.
How ClaimCenter Assigns Work 205

Manual Assignment
After you assign work explicitly, specify the user. You can assign work:
• To a user – Select the owner’s name. The group can already have been chosen by the global rule set for that type
of work. There is a list of group members and a search option to help consider subgroups. If the final group has
not already been chosen, then, in specifying the user, you also specify the group to which that user belongs.
• To a group – You choose the group, and then run the group’s default assignment rule set. This rule set either
assigns the work to a user or the supervisor’s Pending Assignment for later assignment to the final owner.
• To a queue – You can assign activities directly to a activity queue.
• From a queue – You can pick activities for yourself, or with the correct permissions, you can assign work from a
queue to others.
To assign work manually, you can select a specific owner or use a search tool to select the assignee from the list that
ClaimCenter provides.
Search and Manual Assignment

After searching through a list of group members during an assignment activity, you can search for potential
assignees. This search returns workload statistics—how many open activities each potential assignee already has—
which is the same information that shows on a supervisor’s calendar. Clicking the calendar icon that accompanies
the search results returns the user’s personal calendar.
An important feature of manual assignment is the use of calendar information, which you can see before making an
assignment. In the standard search return values, workload information—the same data shown on a supervisor’s
calendar—is included. This feature enables you to make assignments based on workload.
You can also view a user’s calendar before making an assignment. Each assignment search returns, by default, a
calendar row. Clicking the calendar icon on this row opens the particular user’s calendar:
Automated Assignment
ClaimCenter uses business rules in the work’s global and/or group’s default assignment rule sets to determine how to
assign an item automatically. These rules typically consider certain attributes of the item being assigned, the
workload of each owner being considered, any special skills that are required, and more.
For example, a claim can be assigned to the members of a local group by using round-robin selection. Each adjuster
has a balanced workload, or the claim can be assigned to a member of a specialty group that has experience with the
particular type of loss.
Auto-assignment runs when the work is created, or when, while performing manual assignment, you choose the
auto-assignment option.
Auto-assignment typically results in the following outcome, depending on the rules in the default rule set:
• The item is assigned directly to an individual owner.
Round-Robin Assignment
Round robin assignment methods assign work to a user in the group specified in the method.
Other round-robin assignment methods can use a set of criteria to construct the set of potential assignees, which can
span groups. The criteria, not group membership, are important. Load factors cannot be used.

How to Remove a User from Automated Assignment

It is often desirable to temporarily remove a user from receiving assignments by round-robin. ClaimCenter provides
mechanisms for this.
• Set the user’s load factor to 0 by using the Administration or Team screen.
• Set the user’s Vacation status to On Vacation (Inactive) so the user does not receive automated assignments. Use
the Administration or Team screen.
• Choose Inactive in the user’s User Profile. However, doing so also disables access to ClaimCenter, and the user
receives no assignments at all by any means, not just round-robin.
Note that the Inactive status is also used to remove former employees from ClaimCenter.
Reassignment
After reassigning a claim or an exposure, ClaimCenter tries to reassign all related work to the new owner
automatically. This feature is called cascading assignment because the new assignment for the top-level item
cascades down to other related items. You do not have to write rule sets to get this behavior, as ClaimCenter rule sets
perform cascading assignment by default.
ClaimCenter uses the following logic to automatically cascade assignments:
• If a claim is reassigned, ClaimCenter reassigns activities, exposures, and matters that were assigned to the
previous claim owner, as follows:
◦ Reassigns the previous claim owner’s activities that are connected to that claim, and not to any specific
exposure, to the new claim owner.
◦ Reassigns the previous claim owner’s non-closed exposures that are connected to that claim to the new claim
owner.
◦ Reassigns matters associated with the claim to the new claim owner.
• If an exposure is reassigned, ClaimCenter reassigns all its related activities to the new exposure owner, unless the
activity was already assigned outside his group.
If the reassigned claim or exposure is kept for manual assignment, assignment cascading proceeds in two steps. All
related work remains unassigned until the final claim or exposure owner is selected. Related work is then assigned to
the new claim or exposure owner.
Assignment Without Using the Assignment Engine

You can make assignments without using the assignment engine to run the global and default rule sets. You do so by
writing your own Gosu in PCF pages to call assignment rules and methods directly. For example, you can add an
Assignment button to any saveable PCF page and complete the assignment as you save that page.
Note: Some assignment methods cannot be used in rules that execute independently of the assignment engine.
Dynamic Assignment
About this task
Use the Dynamic Assignment interface and its methods to create your own assignments. These can reflect your own
logic, such as selecting users across groups, and creating your own measures of work load. Dynamic assignment is
not an assignment method, but a generic hook for you to implement you own assignment logic, for both users and
groups. It is intended to supplant round-robin assignment when it is not sufficient for proper automatic assignment.
Dynamic assignment can allow automated assignment under more complex conditions:
• Round robin assignment to users in different groups because you do not want to have your group structure mirror
your assignment logic.
• Automatic assignment that also considers a user’s current workload.
• Automatic assignment that takes into account assignments made outside of round robin assignment.
How ClaimCenter Assigns Work 207

ClaimCenter provides an interface that enables you to define and implement your own strategy for assignment. In
general, you define these steps, and provide methods to help implement them.
Define and Create Assignments Dynamically
About this task

In the base configuration, ClaimCenter does not implement dynamic assignment because it is potentially time-
consuming. All methods of this type are a trade-off between speed and accuracy, and this implementation requires
more database queries and locks. However, Guidewire does provide a package, key methods, and sample code.
In general, if you wish to implement dynamic assignment, you need to perform the following steps.
Procedure
1. Find the set of users who might get the assignment in question.
2. Get and acquire the locks that control workload and related information for these users.
3. Select a user based on this set of information.
4. Update this information, release the locks, and return the selected user.
Dynamic assignment is not yet complete after these steps. This is because during FNOL intake or creating a
new claim in a wizard, assignment occurs and your workload information for future assignments updates
before the claim is saved. If ClaimCenter cannot save the claim, the database still shows the increase in your
workload. So this mechanism allows for the failure with the steps that follow.
5. If the commit fails, roll back all changes made to the user’s information, if possible.
6. Otherwise, save the user name and reassign that user to the item whenever it is saved.
Next steps
See also
• If you want to implement a version of dynamic assignment, see the Rules Guide.
Assigning Other Entities

You can make extension entities assignable. For example, you can define a subrogation entity if you decide that a
payment you made might be recoverable. Assign that entity to a member of the subrogation group, along with an
activity.
Assignment Methods
There are two basic kinds of assignment methods:
• Methods that choose an appropriate group to which you can assign work. These methods can also redefine the
current group.
• Methods that assign work to subgroups and then to users within the current or a selected group.
In addition, there are methods useful for:
• Auto-assignment and manual assignment.
• Assignment of groups and users by proximity to a location—an address.
• Assignment based on both location and user attributes, such as assigning a user either by attribute and location or
by location using proximity search, or assigning a group by location.
• Random assignment to users in a group—round-robin assignment.
• Assignment to a user or group based on your calculation of total workload—dynamic assignment.
• Assignment based on an attribute of a user, such as workload factor or user attribute.

• Immediate assignment using autoassign.

See also
• Rules Guide
Using Group Types and Load Factors in Assignment

Assignment rules can consider a group’s group type attribute. For example, when assigning a minor claim, a rule can
insist that it be given only to a group of the type local office, since no special expertise is needed. The GroupType
typelist contains these types.
A group’s load factor attribute can be used for assignment, similarly to a user’s load factor (see “Load Factors” on
page 481.
Using Regions in Assignment

You can give a group the attribute of a region to help in determining how best to assign work. Each group can
belong to multiple regions. See “Understanding Regions” on page 484 for more details.
For example, a group can be defined as belonging to a region consisting of all ZIP codes between 90000 and 90999.
In addition, the group can belong to another region consisting of Los Angeles and San Bernadino counties.
Administrators define these regions when creating or editing groups. This information can also be imported.
The assignGroupByLocation method uses regions as part of making assignments to a group. This feature is
restricted to counties, states, and ZIP codes in the United States, and the method looks for a matching region.
Using Security Zones Indirectly in Assignment

You can configure a list of security zones, and an administrator can then associate each group with one of these
zones.
Since assignment gives ownership to both a user and the user’s group, the group’s security zone is associated with
the assigned claim. Access Profiles can grant preferred permissions to view or edit claims to users related to the
claim by being in the same security zone. “Access Profile Creation and Editing” on page 494 describes claim
Access Control, and how to grant permissions to users in the same security zone.
Assigning to Roles
A role is a collection of permissions. Users possess one or more roles. Their permissions enable users to view or edit
different ClaimCenter objects. It is useful to assign work to a user who has the permission to perform it. For
example, assigning a claim to an adjuster guarantees that the user has the necessary permissions to complete the
work. Administrators can create roles, add permissions to them, and grant them to users.
User Assignment by Proximity

User proximity to a certain geographical location can be used as one of the criteria for assignment. Proximity is an
important factor in assigning often-performed, simple tasks.
Some examples:
• You want to assign claims to adjusters who live or work near the loss site.
• If the activity pattern is a vehicle inspection and the vehicle location is known, perform a proximity search and
choose an activity owner by round-robin from the closest users.
• If the accident location is within five miles of the center of a Spanish-speaking community, find the closest
Spanish speaking adjusters, and chose a claim owner by using round-robin.
• You can search for all preferred vendors, such as auto repair shops within five miles of the claim loss location
who specialize in European cars. After retrieving a list of contacts that fit the criteria, you can use an assignment
rule to add one of those contacts to a claim.
• The user in the current group who is closest to a location you specify.
Assignment Methods 209
• The closest user in the group and all its subgroups, and, if several users are approximately the same distance
away, choose one by round-robin.
• The user who best satisfies a pre-defined search criterion, such as within 10 miles, or no further than 50
kilometers from a chosen location. This technique can also perform a round-robin selection of users within a
similar distance of the chosen location.
User Assignment by Activity Pattern

Although you assign most activities to the claim or exposure owner or both, some activities are best performed by a
specialist, such as a field inspector or specialty medical group. A useful way of choosing is to look at the activity’s
activity pattern. Activity patterns contain an identifying Code value that Gosu can associate with a particular user.
For example, a claim activity assignment rule assigns a Get Witness Statement to the claim user, but a matter activity
assignment rule assigns the similar activity to a legal expert. Each activity is created with a different pattern.
User Assignment to the Current Group

Global assignment rules typically drill down the group hierarchy until they find the correct group. During this
process, each rule can move another step down a hierarchy. ClaimCenter keeps the group chosen by the last rule and
passes it to the next rule. CurrentGroup is the way such assignment rules communicate.
After the global assignment rule set finishes, the current group is available to the rules in the current group’s default
rule set, unless global assignment rules finish assignment. ClaimCenter can again redefine the current group as it
looks for subgroups and finally finds a user.
After a rule finds the correct group and starts looking for a user in that group, the notion of the current group is no
longer important. Most assignment rules in a global assignment rule set move one level down the hierarchy, and the
next rule moves down another level. The current group is the selection of the first rule, which becomes the starting
point for the next one. All rules require a current group as an argument.
Queues
ClaimCenter can create, maintain, and show queues of activities for each group. Assignment to one of a group’s
queues is an alternative to assignment to one of a group’s members. Activities in a queue wait for a group member to
take ownership of them. After any group member claims an activity in a queue, assignment of an activity to a user is
complete.
The assignActivityToQueue method assigns the current activity to the current group. It also generates the
necessary queue if the queue does not already exist.
Only activities can be assigned to a queue. Claims, exposures, and matters cannot be assigned to a queue.
How to Use a Queue to Assign Claims

Although it is only possible to use a queue to assign activities directly, it is possible to indirectly assign claims,
exposures, or matters using a queue. The following workflow illustrates how to use a queue to assign first notice of
loss (FNOL) claims:
• After you import an FNOL, ClaimCenter triggers the rule sets listed in the following table.
• These rule sets generate review activities and places the activities on a queue.
• A group member then takes an activity from the queue and completes it by manually assigning the FNOL to a
final user and group.
The following table summarizes these tasks:
Task performed by rule Rule set Action

Assign FNOL claim to an intake Global Claim Assignment Choose the current group that will make the final claim
group assignment.

Task performed by rule Rule set Action

Assign claim to the group Default Group Claim Assign the claim to a temporary owner until it can be properly
supervisor Assignment assigned.
Create FNOL review activity Claim Workplan Use a pre-defined activity pattern to make a new activity.
Assign FNOL review activity to same Global Activity Now both the claim and the activity have the same current
group Assignment group.
Assign FNOL review activity to Default Group Activity A current group’s user takes the activity from the queue and
queue Assignment manually assigns the claim to another group and user.
Using the Pending Assignment Queue

After assignment selects a group, the confirmManually method puts an activity for manually assigning the work in
that group supervisor’s Pending Assignment queue. By completing this activity, the supervisor assigns the related
work. For example:
activity.CurrentAssignment.confirmManually(activity.CurrentAssignment.AssignedGroup.Supervisor)
Until supervisors are comfortable with automatic assignment, rules can put most work into their pending assignment
queues. The Pending Assignment queue is part of the Desktop, but visible only by administrators and supervisors.
Queues 211

chapter 21
Weighted Workload
ClaimCenter provides the ability to assign work based on the efficiency of an adjuster and the complexity of the
workload, also known as weighted workload. Weighted workload assignment gives you a robust and configurable
way to balance work.
Note: Weighted workload is one of the methods that can be used with Automated Assignment in ClaimCenter. See
“Automated Assignment” on page 206.
See also
• “Work Assignment” on page 203
Overview of Weighted Workload

In ClaimCenter, all assignable objects, such as claims and exposures, are assigned to users, who become their
owners.
Automated assignment can be done by using one of the following methods:
• Round robin – Users in a group are assigned work based on knowledge of past assignments and other defined
criteria. The load and difficulty of assignments is not a factor.
• Weighted workload – Users in a group are assigned work based on the a calculated weight that represents the
complexity of their current assignments.
Weighted workload can be used for any assignable object.
Weighted Workload 213

Note: In the base configuration, weighted workload is not enabled. When enabled, it is configured for claims and
exposures. Additional configuration is required to enable weighted workload assignment for other types of
assignable entities such as matters and activities.
See also
• “Assignable Work” on page 204
Round Robin Versus Weighted Workload Assignment

In automated assignment using the round-robin method, work is assigned in a cyclical fashion, and users in a given
group end up with the same number of assignments. The idea is to evenly distribute work across the group.
The drawback of round robin assignment is that it does not take into account how efficient a worker is or how
complex or time-consuming a specific assignment could be.
The following figure illustrates a round-robin example.
Round-Robin Assignment
Adjuster #1
Adjuster #2
Assign
Adjuster #3
Assignable Work
In the example, round-robin assignment results in Adjuster #3 being assigned the next assignment. An adjuster
might be more efficient, and one assignment can be more or less time-consuming than another, but these factors are
not relevant.
In the case of weighted workload assignment, each assignable object is given a specific integer value, which is its
weight. As work gets assigned to users, their workload, a cumulative number comprised of the individual objects
they own, is calculated. The workload determines the owner of the next assignment.
The following figure illustrates a weighted workload example.
214 chapter 21 Weighted Workload

Weighted Workload Assignment
Weight = 10
Weight = 20
Weight = 10
Adjuster #1 Weight = 10
n Adjuster #2 Weight = 50
sig
As
Adjuster #3
Assignable Work
Weight = 10
In this case, weighted-workload assignment results in the adjuster with the lightest load, Adjuster #2, being assigned
the work. The weight of each user’s workload is calculated from the weight of the assignable objects owned by the
user. Calculations can be customized to take into account other factors, such as a user’s load factor.
The total number of objects assigned to each adjuster does not figure in the assignment.
Weighted Workload Classifications

Each claim, exposure, or other assignable object needs to have an associated weight value, a non-negative integer,
for weighted workload balancing. ClaimCenter uses predefined workload classifications, based on the complexity of
the job, whose values are then matched to the assignable objects.
For example, if you have a new personal auto claim, and the Personal Auto Claim classification has a weighted value
of 8, the claim is given a weight 8. If an assignable object does not match any existing classification, it is assigned
the default global workload weight, which is defined in config.xml.
Classifications are managed in the Administration→Business Settings→Weighted Workload→Weighted Workload
Classifications screen. You require the appropriate permissions to view and manage classifications. See the
Configuration Guide.
Note: Weighted workload balancing must be enabled in configuration for these screens to be available.
Add Classifications
About this task
In the base configuration, you can create weighted workload classifications for two types of assignable objects,
claims and exposures.
Weighted Workload Classifications 215

Procedure
1. Click the Administration tab and navigate to Business Settings→Weighted Workload→Weighted Workload
Classifications.
2. Navigate to one of the following:
• Add Classification→Add Claim Classification
• Add Classification→Add Exposure Classification.
3. Enter information in the General section on the classification, including the Name, Description, and whether or
not the classification is Active.
4. Enter the following:
• Rank – A non-negative integer that represents the priority given to the assignable. The Rank is used only
when a claim matches more than one classification, and the lower the Rank, the higher the priority assigned
to the claim.
• Weight – A non-negative integer.
5. Enter Criteria for potential matches.
Criteria can be restrictive, requiring an exact match on specified fields, or non-restrictive, where at least one
value must match.
• Enter the following restrictive criteria:
Criterion Description
ClaimLossType Required field.
ClaimLineofBusiness
ClaimPolicyType
• Enter the following non-restrictive criteria:
Criterion Description
Exposures Select All, or select Restrict to any of the following, click Add, and enter a Coverage Type, Coverage
Subtype, and Loss Party.
Claim/Exposure Select All, or select Restrict to any of the following, click Add, and enter a Segment.
Segments
Claim Loss Causes/ Select All, or select Restrict to any of the following. If you select the latter, select Add and enter a Lo
Exposure Incident ss Cause or Incident Severity.
Severities
Service Tiers/ Select All, or select Restrict to any of the following. If you select the latter, select Add and enter a Se
Exposure rvice Tier or Jurisdiction.
Jurisdictions
6. Click Update.
ClaimCenter displays a message indicating that to apply this newly created classification to existing open
claims and exposures, you need to run the Weighted Workload batch process.
7. Click OK.
Edit Existing Classifications

About this task
You can edit an existing workload classification.

Note: It is recommended that changes to workload classifications be made early in the planning stages of
implementation. Once assignable objects such as claims and exposure are created, any subsequent changes will
need to be manually adjusted by executing the User Workload Update batch process. See the System Administration
Guide.
Procedure
1. Click the Administration tab and navigate to Business Settings→Weighted Workload→Weighted Workload
Classifications.
2. Select a classification name from the list.
3. Click Edit.
4. Make the necessary changes and click Update.
Types of Weights Used in Workload Balancing

ClaimCenter uses weighted workload balancing to match a classification to an assignable object, and then gives the
assignable object the weight of the associated classification. ClaimCenter then assigns the object to the most suitable
user in a group by using weighted workload calculations.
There are various types of weights used by ClaimCenter to calculate the workload of a user.
Classification Weight
The weight of a predefined workload classification.
Total Weight
The total weight of an assignable object is calculated as follows:
Total Weight = (Workload Classification Weight or Default Global Workload Weight) + Supplemental Weight
Note: The Default Global Workload Weight is used if a claim or exposure does not match any existing workload
classification.
Supplemental Weight
An additional integer value specified by the supervisor for an individual claim or exposure that further refines the
level of effort required. Supervisors can define the supplemental weight for a claim, for example, in the
Summary→Status screen under the Workload section. The corresponding SupplementalWorkloadWeight field on the
Claim entity can also be used in rules.
Supplemental weight values can be positive or negative. A positive value increases the level of difficulty of the
assignable object, and a negative value reduces it.
Default Weight
The default weight is defined in configuration and is only used when an assignable object does not match any
existing classification.
Adjusted Weight
The adjusted weight is used for users within a group before assignment. This type of weight calculation takes into
account the load factor of the group.
The adjusted weight of a user within a group is calculated as follows:
Adjusted Weight = (Total Weight * 100)/Load Factor
In the base configuration, the adjusted weight is used in the default assignment strategy.
Types of Weights Used in Workload Balancing 217

Group Weight
A user’s Group weight is the sum of the weights of all of the user’s assigned claims and exposures in a given group.
The group weight is the default weight value used by the weighted workload engine to determine assignment
Absolute Weight
A user’s absolute weight is the total weight of the user’s assigned claims and exposures across all of ClaimCenter.
The absolute weight is unaffected by group associations.
In the case of users in multiple groups, the absolute weight is the sum of all of a user’s group weights.
Weighted Workload Assignment

When a new claim, exposure, or other assignable object is created, ClaimCenter applies weighted workload
balancing by using the following process to complete the assignment:
1. Calculate the total weight of the assignable object using existing classifications and supplemental weights, if
any. See “Types of Weights Used in Workload Balancing” on page 217.
When an assignable object matches more than one classification, the weight of the classification with the
lowest Rank value takes precedence and is assigned to the object.
2. Assign the object to the most suitable group and user. This step is described in more detail in the next section.
Assigning Objects to Users

After its total weight is calculated, an assignable object is routed to the most eligible user in the appropriate group.
An eligible user is one who has the requisite permissions to own the object, is active, and has an AtWork Vacation
Status.
The user with the lowest weighted workload within the group is selected for assignment. Each user’s Adjusted
Weight is used for this process.
Weighted workload assignment within a group adds an additional level of precision by using dynamic assignment
strategies to process assignment decisions. In the base configuration, the default assignment strategy is
GroupUserWorkloadAssignmentStrategy.
Assignment strategies and their calculations are configurable.
See also
Resolving a Tie
If the weighted workload values of two or more users are equal, ClaimCenter applies the following additional
conditions in the following order of preference:
1. Select the user whose total workload was updated least recently. If unavailable, select the most recently
updated user.
2. Select the user based on the sort order of the User Name, which is always unique.
A user with a group load factor of zero is blocked from assignment.
View Weights
About this task
You can view the weights associated with an individual claim or exposure.

Note: Supervisors can also view the weights associated with claims or exposures in the Desktop tab by clicking
Claims or Exposures.
Procedure
1. Open a claim.
2. Navigate to Summary→Status to view the claim’s associated weights in the Workload section.
3. Click the Exposures menu link.
4. Click an individual exposure to see the associated weights in the Workload section.
View Weights 219


chapter 22
Claim Segmentation
Claims are segmented into logical groups to enable multiple users to handle different parts of a claim.
Automated Claim Setup

After the initial claim information is entered into ClaimCenter, automated processes set up the claim to go to its new
owner, ready to be worked on. Setup rules determine claim segmentation, assign the work, and generate a workplan.
For claims generated in ClaimCenter, these setup rules run on exiting the New Claim wizard. If the claim does not
pass final validation at the New Loss level, all setup rule actions are reversed. For imported claims, these setup rules
again run prior to your saving the claim. The claim must then pass validation at the New Loss level.
Call Center
receives FNOL
(First Notice of
Business Rules Help in
Loss) Creating a claim
collect, input create rules rules setup

information exposures, assign populate complete;
start
(who, what, rules segment claim and workplan’s begin claim
when, where) them and claim exposures activities processing
va
lid
los pol
s d icy
ate on
start new claim Policy
with the New system
Claim Wizard
Claim Segmentation 221

Claim Segmentation
Segmentation enables you to categorize incoming claims and their exposures into both segments and strategies
based on business criteria, such as:
• Segments that describe the type and severity of losses, such as multi-car, single car, injuries, and glass only
• Segments that describe the loss location, such as close to field office
• Strategies based on policyholder type, such as normal, preferred, sensitive, or questionable
These category pairings, called segmentation, help assignment rules make good choices when deciding how to
handle the loss. For example, if the segment is Theft and the strategy is Preferred, then assign the claim to the
closest office for fast-track processing.
Assignment of Work
Assignment determines the baseline strategy to be applied to the claim and defines the preliminary handling.
ClaimCenter makes assignments based on claim attributes and adjuster profiles, including adjuster skills, current
workload, and any other available information. Besides assigning new claims to adjusters, the ClaimCenter rules
make assignments both for individual exposures within the claims and for activities associated with the claims.
See also
Workplan Generation
The claim’s workplan is its list of all activities. In creating a new claim, ClaimCenter uses business rules to create an
initial set of activities for processing each new claim. The workplan’s list of activities show finished and unfinished
tasks, including any activities that are overdue or escalated. The claim owner or supervisor can add or reassign these
activities. ClaimCenter can also add activities, such as resolving escalations.
Segmentation Rules
ClaimCenter uses segmentation rules to set the segment and strategy properties of claims and exposures. These
properties categorize the claim and exposures. Other rules can then take category-specific actions on them. After
you select automated assignment for a new claim or exposure, ClaimCenter runs segmentation rules prior to running
assignment rules. Typically, values set for the segmentation and strategy for a claim or exposure are later used to
assign the claim or exposure.
Arriving at a decision on the segment of an exposure requires examining the fields on the exposure. For example, for
an injury there could be fields like severity, body part injured, nature of injury, and first-party as opposed to third-
party claimant. Other possible fields on the claim can be: cause of loss, loss location, or type of insured.
It is easier to make decisions about the segmentation of the claim as a whole after each exposure has been
categorized. For example, an auto claim can be categorized as complex if there are any third-party injury exposures.
For this reason, the exposure segmentation rule set runs before the claim segmentation rule set.
Segmentation Rule Example

The following code is in the claim segmentation rule CSG011 - Auto, which segments auto losses:
Rule Conditions:
true
/* This example claim segmentation rule is not as efficient as the one found in CSG02100 - Property,
but it is more easily understood. If efficiency of claim segmentation is of primary concern, you
should consider using the model from the other rule instead.
*/
222 chapter 22 Claim Segmentation

Rule Actions:
uses gw.api.util.Logger
/* Find an exposure with the most important segmentation. If not found, repeat for
the rest of the segmentations in reverse order of importance. As soon as an
exposure is found in any of these searches, segment the claim in the manner of
the exposure and then leave the claim segmentation rules. If no exposure is found,
leave this rule and drop into the default rule.
*/
var highestExposure = claim.Exposures.firstWhere(\ e -> e.Segment == "auto_high")
if (highestExposure == null) {
highestExposure = claim.Exposures.firstWhere(\ e -> e.Segment == "auto_mid")
}
if (highestExposure == null) {
highestExposure = claim.Exposures.firstWhere(\ e -> e.Segment == "auto_low")
}
if (highestExposure != null) {
claim.Segment = highestExposure.Segment
Logger.logDebug(displaykey.Rules.Segmentation.Claim(actions.ShortRuleName))
Logger.logDebug(displaykey.Rules.Segmentation.Claim.SegmentedTo(claim.Segment))
actions.exit()
}
Segmentation Values Example
ClaimSegment typelist could contain these segment values for an auto claim ClaimStrategy typelist could also contain
or exposure these strategy values for an auto claim or
exposure
auto - glass, auto - low complexity, auto - mid complexity, auto - high complexity Auto - Fast Track
single car, pedestrian, two-car, multi-car normal
injury - low complexity, injury - mid complexity, injury - high complexity Auto - Investigate
Comparing Strategy to Segmentation

The Strategy property, similar to the segmentation property, is a second way to categorize claims and exposures.
Rules can assign strategies for both claims and exposures defined in the ClaimStrategy typelist. ClaimCenter
provides only two strategies, which can then be used as super-groups of segments.
You can use the strategy property as a superset of segments. The base application has investigate and fast-track for
auto claims. With this small number of choices, it might be appropriate to assign the strategy as soon as the segment
has been determined:
If claim is of type auto, then set strategy to be "investigate"

If claim segment is "Auto - Glass" or "Auto - Low", then set strategy to "fast-track"
There are other uses for the strategy property:

• Strategies can be an orthogonal way of classifying claims. If you segment an auto exposure by severity of vehicle
damage, you can assign a strategy based on the age of the vehicle. You can make decisions based on both these
properties.
• Using many segment values can result in more accurate assignment and in the creation of more specialized
workplans. But a smaller number of strategies can be useful for looking at the statistics of claim outcomes.
• Another use of strategies might be to randomly assign claims with the same segmentation into two strategy
groups. Then you could use different approaches to handling the claims, based on the claim’s strategy value. You
can then compare the effectiveness of the old and new approaches.
Comparing Strategy to Segmentation 223

Uses of Segmentation
The original, and most common, purpose of segmentation is to assist assignment rules in assigning work to the best
group and the most capable user. A rule that examines the segment and loss location parameters can determine
whether to assign the exposure to a local or regional office. This assignment would be based on both the severity, as
described in the segment, and the location. However, the segment can also determine other claim-related actions, as
described in the topics that follow.
Segmentation and Reserve Levels

One common use of segmentation is to set reserve levels. For example, you can write a series of rules to set an
exposure’s reserves based on its segment value:
If the exposure is part of an auto claim,

If the exposure’s segment is "Auto - Glass", set the reserve level to a very low level.
Else if the exposure’s segment is "Injury - High Complexity", set a much higher reserve level.
Else if "Injury - Low Complexity" segment value, set another reserve value.
Claim Segmentation Based on Exposure Segments

You can use segmentation rules to categorize the entire claim, independent of its exposures’ segment properties.
However, it can be more useful to assign the most serious segment found among the claim’s exposures to the entire
claim. You can also set the strategy in this rule set.
Segmentation and Activities

Activities appropriate to some types of exposures are inappropriate to others. For example, a claim can have an
exposure segment of Injury - High Complexity and a loss severity of High. This is useful in deciding whether to
create medical review activities and assign them to a nursing case manager.
Segmentation and the Data Model

Segment and Strategy are properties—single fields—of both Claim and Exposure objects. The ClaimSegment and
ClaimStrategy typelists provide the values for both claims and exposures. You can extend both typelists.
224 chapter 22 Claim Segmentation

chapter 23
Working with Activities
ClaimCenter tracks all tasks, or units of work, involved in handling a claim. Actions such as inspecting a vehicle,
reviewing medical information, negotiating with the claimant, making payments, and so on are called activities.
Activities are the central mechanism for tracking completion of all varieties of tasks. ClaimCenter divides the work
for a claim into activities and provides a list of these activities to enable you to track them to completion. These
activities track everything that must be done to settle every claim.
The claim segmentation process creates an initial set of activities for a new claim. Additional activities can be added
to the claim at any time. Multiple users can be assigned activities on a single claim. Assigned activities represent
units of work for the claim and enable the work units to be divided among users.
Tracking work by using activities enables claim owners to perform all necessary claim-handling tasks and identify
missed tasks. Supervisors and managers can also track assigned work and identify problem claims, such as claims
with many overdue or escalated activities.
See also
• “Claim Segmentation” on page 221.
Activities
Activities are the tasks to be performed in handling a claim. Examples include inspecting a vehicle, reviewing
medical information, negotiating with the claimant, and making payments. ClaimCenter tracks all activities.
Supervisors use activities to identify problem claims and to assign workloads based on the number of activities of
each team member. For example, an adjuster with many overdue or escalated activities might be overworked and
need to have activities reassigned to another adjuster.
You can generate and assign an activity either manually or automatically. Automatic generation and assignment uses
business rules and activity patterns to assign work to users based on their workloads, special skills, or locations.
See also:
• “Activities as Tasks” on page 226
• “Elements of an Activity” on page 226
Working with Activities 225


• “Activity Escalation” on page 232
Activities as Tasks
Activities are tasks necessary to process claims. Each activity is a single task that can be assigned to a person and
completed, including work that cannot be completed directly in ClaimCenter. ClaimCenter tracks the assignment
and completion of all activities to ensure that the claim is correctly handled.
Activities store information about what needs to be done, who does it, and a history of information about the activity
after it is completed. Activities themselves do not store the results of the work. Some examples of work resulting
from activities are:
• An externally stored, signed agreement document.
• A note within ClaimCenter summarizing the activity’s investigative results.
• A new reserve that was set up, or a settlement plan that was created.
Elements of an Activity
The following fields define an activity:
• Subject – Activity name.
• Description – Text describing the activity.
• Related To – Indicates if the task is a claim level task or is related to a person or a covered item that is part of the
claim.
• Due Date – The date the activity is scheduled to be completed, after which the activity appears in red.
• Escalation Date – The date on which ClaimCenter sends alerts that the activity is overdue or generates other
activities to deal with the overdue activity.
• Priority – Used for sorting a list of activities. Values are urgent, high, normal, or low.
• Calendar Importance – Used for calendar display of the activity. Values are Top, High, Medium, Low, or Not On
Calendar.
• Mandatory – Indicates whether or not the activity can be skipped. If not mandatory, an activity is just a suggestion.
• Externally Owned – Indicates whether the activity is to be done by an outside group or user.
• External Owner – If externally owned, name of the user who owns the activity.
• Document Template – Name of the template used by a correspondence activity to generate a document.
• Email Template – Name of the template used to generate an email.
• Assign To – Indicates whether the task is assigned automatically or assigned to a specific user, to the claim or
exposure owner, or to the company or the Super User.
• Recurring – Indicates whether or not the activity repeats. If the activity repeats, completing the activity creates a
new one.
The activity template associated with the activity gives the initial, or default, values for these attributes.
Some of these fields are visible on the Desktop→Activities screen. Most of the fields are visible when you click an
activity’s Subject field to open the Activity Detail worksheet for the activity.
226 chapter 23 Working with Activities

See also
• “Workplans and Activity Lists” on page 233.
Creating Activities
Because activities are central to the claim process, they can be created in a number of ways:
• By users in the ClaimCenter user interface. Users create activities for themselves or, with authority, for other
users.
• Externally, by using API calls.
• By running batch processes, which can generate activities.
• By ClaimCenter rules, which can create activities while ClaimCenter is:
◦ Generating workplans.
◦ Responding to escalations or claim exceptions.
◦ Handling manual assignments.
◦ Obtaining approvals, investigating fraud, and processing other events.
Automated Activity Generation

During a new claim’s setup process, ClaimCenter uses your organization’s business rules to create activities
automatically. After you enter an auto claim, for example, ClaimCenter can create activities to contact the witnesses,
get the police report, and have the vehicle inspected. Claim segmentation often determines which activities are
appropriate. For example, an auto claim would produce one set of activities, while a property claim would produce
several different activities.
ClaimCenter can also automatically create activities to convey information or to require someone to make a
decision. For example, in the base configuration, if you try to issue a payment that exceeds your authority,
ClaimCenter automatically creates an activity for your supervisor to review that transaction. If rejected, ClaimCenter
creates another activity to inform you that the activity was rejected.
The workplan rule sets for claims, exposures, and matters generate activities in this way.
Batch Processes and Activities

Several batch processes can identify claims and activities for which you might want to create new activities. For
example, new activities can be created for claims and activities that have reached their escalation dates or have not
been looked at for a long period. Some useful batch processes include:
Batch process What it finds Parameter name

Activity Escalation Activities that have reached their Escalation Days or Hours, set in the Activity Pattern
escalation dates
Claim Exception Claims with exceptions (new, since none
last run)
Idle Claim Open claims with no activity for a IdleClaimThresholdDays in config.xml—defaults to 7 days
Exception defined period
Idle Closed Claim Closed claims with no activity for a IdleClosedClaimThresholdDays in config.xml—defaults to 7 days
Exception defined period
See also
• “Automated Claim Setup” on page 221
Activities 227
Create a New Activity
About this task

You can create activities for yourself and for other users, as follows:
Procedure
1. Open a claim.
2. Navigate to Actions→New Activity and select an activity type.
Choose the general activity type and then the specific activity type, an activity pattern, from the menu actions
under New Activity. If the specific type of activity is not present, you can create a new one by creating a new
activity pattern.
3. On the New Activity screen, enter the activity details. See “Elements of an Activity” on page 226 for the
meanings of individual fields.
4. For Assign To, indicate how or to whom the activity is to be assigned. Do one of the following:
• Click Select from list and use the drop-down list. You can choose Use automated assignment and have the
application use rules to assign the activity, or you can choose the assignee.
• Click Search for user, group, or queue to find an assignee, and then click Assign for the one you want.
5. Click Update to save the activity.
Next steps
See also
• “Automated Assignment” on page 206
• “Creating and Editing Activity Patterns” on page 235
Assigning Activities
An activity must eventually be assigned to a user after it is generated. Many activities, including those generated
after new claim creation, are assigned to the owner of the new claim. If you have created an activity, you can assign
it either to yourself or to someone else. You can also reassign an activity that you own.
Assign Activities from a Queue
About this task

Automatic assignment, often used in conjunction with automated activity generation, can put automatically
generated activities on a queue. From this queue, you can assign activities to yourself or others, as follows:
Procedure
1. Navigate to Desktop→Queues and choose a queue.
2. Filter the queue’s list of activities to locate those of interest.
3. Assign the selected activities, depending on your user permissions.
Not a manager You have the following choices only:

or supervisor • Click Assign Next in Queue to Me.
• Click the Subject field of an activity to open it in the Workplan screen so you can assign it.

A manager or You have the same choices listed previously. Additionally, you can select a check box for each activity
supervisor you want to manage and then you have the following choices:
• Click Assign Selected to Me.
• Click Assign and then, depending on the radio button you select, you can do the following:
◦ If you choose Select from list to do the assignment, choose an item from the list and click Assign to
perform the assignment. If you are taken to a screen showing the Update button, click that button
to complete the reassignment.
◦ If you chose Find as user, group, or queue to do the assignment, find the user, group, or queue, and
then click Assign for the one you want.
Next steps
See also
• “Automated Assignment” on page 206
• “Reassign an Activity” on page 229
Reassign an Activity
About this task

With the correct permissions, an activity owner or the supervisor can reassign an activity to another group member.
Also, activities belonging to a claim or exposure are automatically reassigned to the new owner after the claim or
exposure is reassigned.
Procedure
1. On the Claim tab under Activities on the left, click Workplan.
2. Depending on your permissions, you can do one of the following to assign an activity on the list:
• Select an activity by clicking its check box, and then click the Assign button.
• Click the subject of an activity to open its Edit screen below the list of activities, and then click Assign.
3. Chose one of the following options on the Assign Activities screen to assign the activity.
• If you choose Select from list to do the assignment, choose an item from the list and click Assign to perform
the assignment. If you are taken to a screen showing the Update button, click that button to complete the
reassignment.
• If you chose Find as user, group, or queue to do the assignment, find the user, group, or queue, and then click
Assign for the one you want.
Completing or Skipping Activities

About this task
To avoid having a finished activity marked overdue and escalated, you must mark it as complete when you finish the
associated task. After the activity is marked completed, ClaimCenter changes its status to Complete, logs this event,
and creates an entry in the claim history.
Assigning Activities 229

Next steps
See also
• For information on claim history, see “Claim History” on page 133.
Mark an Activity as Complete
Procedure
1. Locate the activity in either a Claim→Workplan activity list or in the Desktop→Activities list.
2. Select the check box for the activity and then click Complete.
Before clicking Complete, you can click the activity’s Subject link and view or edit the Activity Detail worksheet
for the activity.
Next steps
Some activities can recur, meaning ClaimCenter create another activity whenever this activity completes. On the
Activity Detail worksheet, look under Activity Tracking to see the setting for Recurring.
Skip an Activity
About this task

Activities that are not Mandatory are skippable. To skip a non-mandatory activity, do the following:
Procedure
1. Locate the activity in the Claim→Workplan activity list or in the Desktop→Activities list.
2. Select the check box for the activity and then click Skip.
ClaimCenter treats skipped activities similarly to completed activities. ClaimCenter changes the status to
Skipped, logs this event, and creates an entry in the claim history. You cannot resurrect a completed or skipped
activity. You must create a new activity instead.
Complete a Recurring Activity
About this task

You can schedule the next occurrence while completing the current recurring activity.
Procedure
1. Locate the recurring activity in the Claim→Workplan activity list or in the Desktop→Activities list.
2. Click the Subject field of the activity to open the Activity Detail worksheet.
3. Enter the dates and any other information needed to complete the current activity.
4. Click Complete and Create New.
5. Edit the dates and any other part of the new activity and click Update.
Completing a Review Activity
About this task

If adjusters schedule payments that exceed their authority, ClaimCenter creates approval activities that are assigned
to the adjuster’s supervisor. If you fill this supervisory role in your organization, you can be assigned the activity of
reviewing the payment and either approving or rejecting it. To perform this type of activity:

Procedure
1. Locate the activity. For example, navigate to Claim→Workplan or Desktop→Activities.
2. Click the Subject field of the activity to open its Activity Detail worksheet.
3. Review the payment in the Activity Detail worksheet.
4. Enter the reason you approve or deny the payment in the Approval Rationale box.
5. Select either Approve or Reject to complete the activity.
Result
ClaimCenter generates an activity for the original issuer of the payment if the payment is rejected. It also logs the
decision and notes it in the claim history.
Complete a Correspondence Activity
About this task

Sending a letter or an email is a correspondence activity. Typically, whenever the activity is created, a document or
email template is attached to be used for the correspondence task.
Procedure
1. Click the Subject field for the activity and open its ActivityDetail worksheet.
2. Click either Create Email or Create Document as appropriate and complete the correspondence.
3. Print and mail the document as needed or click Send Email to send the document electronically.
After you complete the correspondence, the Activity Detail worksheet opens again.
4. If you have created a document that you want to link to the activity, you can click Link Document to find the
document and link it.
5. Click Complete to indicate that you have sent the letter or email.
Next steps
See also
• “Working with Email in Claims” on page 241
• “View Documents for an Activity” on page 591
• “Using an Activity to Create a Document” on page 596
Working with Documents in Activities

Documents related to activities appear in the Documents section of the Activity Detail worksheet. In this section, you
can view, link, search for, and delete documents directly from the originating activity.
The Link Document button enables you to search for and associate a document with the activity. You can find and
select existing documents by using search criteria such as author, document type, and so on. This page is similar to
the Documents page.
Note: Linking a document is different from relating a document to an entity. A document can be related only to one
entity, but it can be linked to many entities, such as notes, activities, and financials.
See also
• “Using an Activity to Create a Document” on page 596
• “Link a Document to an Activity” on page 599
Completing or Skipping Activities 231

Activity Escalation
After an activity reaches its due date, the date appears in red, and a star symbol appears in the Desktop→Activities list.
If the activity later reaches its escalation date, this event triggers escalation rules that expedite handling of the
activity. For example, a rule can create a new activity for the supervisor of the user who owns the escalated activity,
requesting that the supervisor intervene.
The Activity Escalation Rules rule set contains the rules that determine the actions to take after an activity reaches
its escalation date. The Activity Escalation batch process, which in the base configuration runs every 30 minutes,
executes this rule set.
Activity Statistics
ClaimCenter keeps statistics that measure how you are handling your workload. These measurements include open,
overdue, and completed activities, and open, new, and closed claims. Supervisors can also see statistics for their
teams, including overdue activities and open, new, and closed claims. To see these statistics from the Desktop tab,
select Actions→Statistics. The Statistics tab at the bottom of the screen shows statistics about your activities and
claims and, if you are a supervisor, your team’s activities as well. Supervisors can see details for their teams by
clicking the Team tab and drilling down to the level of detail needed.
Statistics are recalculated on a predetermined schedule, so you do not always see the latest numbers.
See also
• “Team Management” on page 443
• “Claim Health Metrics Calculations” on page 433
Viewing Activities
Activities are central to claim handling, and ClaimCenter displays them in a number of ways:
• To see a list of all your activities for all claims, navigate to Desktop→Activities. On the Activities screen, in the base
configuration, by default you see your activities for the current day. You can filter activities in several ways in
addition to My activities today, such as:
◦ Due within 7 days – Activities that are open and due in the next week.
◦ All open – All activities that are open regardless of status or due date.
◦ Overdue only – Activities that are overdue or will become overdue at today’s end.
◦ All open external – All activities assigned to people without access to ClaimCenter.
◦ Closed in last 30 days – All activities closed in the last 30 days.
• To see a list of all the activities of one claim, including those owned by others, open the claim and click Workplan.
• To see a list of all activities belonging to your group that are open, overdue, and completed today, click the Team
tab. You must have the viewteam permission to see this tab.
• If navigate to Desktop→Actions→Statistics, you can see the summary of activity statistics.
• To find specific activities, choose Search→Activities and enter your search criteria.
Calendars also display lists of activities. See “Activity Calendars” on page 237 for details. After viewing any list
or calendar of activities, clicking the Subject field of an activity opens its Activity Detail worksheet.
See also
• “Workplans and Activity Lists” on page 233.
• “Team Management” on page 443.

Workplans and Activity Lists

All activities are associated with a specific claim or a bulk invoice. The workplan is a screen showing all activities
related to one claim. The Workplan screen displays the following information for each activity:
• New or Updated –A icon in this column indicates that the assigned activity new, has been reassigned to you
by someone else, or has been edited by someone else recently.
• Escalated –A icon in this column indicates that the activity has been escalated.
• Due – Indicates the activity’s targeted completion date. The due date is red if the date has passed, indicating that
the activity is overdue.
• Priority – The importance of the activity, typically Urgent, High, Normal, or Low. You work first on activities that
are escalated or new, and then on urgent or high priority activities.
• Status – Whether the activity is open, complete, skipped, or cancelled.
• Subject – The title of the activity. Clicking an activity’s Subject field opens its Activity Detail worksheet.
• Exposures – Any associated exposure.
• External –Whether the activity is owned by a user without access to ClaimCenter.
• Ext Owner – Indicates who the owner is if external.
• Assigned By – The user that assigned this activity, if any.
• Assigned To – The owner of the activity.
The Workplan screen provides the following buttons that help in managing the activities, some of which are visible
only if you are a manager or supervisor:
• Filter – Show the activity list after being filtered by various criteria, such as showing just today's activities,
activities due within seven days, overdue activities, or all open activities.
• Assign – Assign an activity to someone else, either by selecting a user or group or by using automated
assignment.
• Skip – Skip non-mandatory activities.
• Complete – Change the status of the activity to completed, and mark the completion date as today.
• Approve – If the activity is to approve a transaction for another user, then approve it and mark it complete.
• Reject – If the activity is to approve a transaction for another user, then reject it.
• Print/Export – Save the list of activities as a PDF file or export them to a CSV file.
The Desktop and Activities

The Desktop→Activities list of activities shows all your activities for all claims. The information is similar to that
shown in the Workplan screen, but has none of that screen’s information about other users. The Activities screen has
the same buttons as the Workplan screen.
The following fields are the same as in the Workplan screen:
• New or Updated, Escalated, Due, Priority, Subject, Exposures, and External.
In addition, the Activities screen provides the following fields for each activity:
• Claim, Insured, LOB, State – Information about the claim with which the activity is associated.
See also
• For information on the Workplan screen, see “Workplans and Activity Lists” on page 233.
Searching for Activities

Procedure
1. Click Search→Activities to find activities.
Viewing Activities 233
2. Specify one of the following search criteria:

• Claim Number – Claim to which the activity belongs.
• Assigned to Group – The group to which the activity was assigned.
• Assigned to User – The user who is working on the activity.
• Created by – The user who created the activity.
• External Owner – Activities owned by users who do not have access to ClaimCenter.
3. Specify optional criteria to narrow the search results, such as:
• A particular Status, Description, Subject, Priority, Due date, Closed date, or Creation date
• A specific time period, such as activities due in the last 30 days
• A Completed late date or activities that are Pending Assignment or are Overdue Now
Next steps
See also
• For descriptions of some of these search criteria, see “Workplans and Activity Lists” on page 233.
Team Activities
As a supervisor, you have access to lists of activities for all the groups, or teams, that you manage. You reach these
lists through the Team tab.
See also
Activity Detail Worksheet

Clicking the Subject field of an activity opens a detailed view of its fields. The fields of the Activity Detail worksheet
are described in “Elements of an Activity” on page 226.
See also
• “Viewing Activities” on page 232
Understanding Activity Patterns

Activity patterns are templates that standardize the way ClaimCenter generates activities. Both rules and selections
made in the user interface create activities based on these patterns. Each pattern describes one kind of activity that
might be needed in handling a claim. For example, Get vehicle inspected is a common activity pattern for auto claims.
It is used to generate a Get vehicle inspected activity when needed as part of an auto claim.
Activity patterns contain default characteristics for each activity, such as name, relative priority, and due date. After
an activity is added to a claim’s Workplan, ClaimCenter uses the pattern as a template to set the activity’s default
values, such as Subject, Priority, and Target Days. You can override these default values, either as you create activities
or through rules.
An activity pattern and an activity created from the pattern can have the same name. The default activity name is
that of the activity pattern. You can think of a pattern as an entity, and the corresponding activity as an instance of it.
You can see the list of available activity patterns by opening a claim and clicking Actions. Click each menu action
under New Activity to see the activity patterns in the submenu.
Administrators can view, create, and edit patterns by navigating to Administration→Business Settings→Activity Patterns.
Users and rules can create activities based on these patterns, as can external systems using API calls.

See also
Activity Pattern Types and Categories

Every activity pattern has both a type and a category. A category classifies activity patterns into related groups. Each
typecode of the ActivityCategory typelist is an activity pattern category and relates each category attribute to the
typelist ActivityType.
Each activity pattern has a defined type. You can add an activity pattern only with a General type and only if you
have administration permissions. General activities are patterned after a diary—work for a claim that is assigned to a
person and has a deadline. For example, getting a vehicle inspected has a general activity pattern type.
See also:
•
Creating and Editing Activity Patterns

About this task
With administrator permissions, you can edit or create new activity patterns.
Procedure
1. Navigate to Administration→Business Settings→Activity Patterns and then click Add Activity Pattern.
2. On the New Activity Pattern screen, you must specify:
• Subject – The activity’s name, which is shown both in lists of activities and in lists of patterns.
• Short Subject – Names the activity in a calendar entry or for a subject name that too long to display in full.
There is a limit of 10 characters.
• Class – Determines if the activity is a Task and has either a due date (target days) or an Event, which does not
have target days. For example, trial dates are events—they occur on a given date, but cannot become
overdue or escalated.
• Type – All patterns that you create or change must be of type General. ClaimCenter reserves all other types
for the patterns it uses to generate activities. The ActivityType typelist defines these types. See “Activity
Pattern Types and Categories” on page 235.
• Category – ClaimCenter uses this value to show available activity patterns in its New Activity drop-down list.
Pick a category that is appropriate for the activity pattern. For example, in the base configuration, the
Interview category includes the Get a statement from witness, Make initial contact with claimant, and Make initial
contact with insured patterns.
• Code – Name used in Gosu code. The maximum length is 30 characters and the convention is to use a name
similar to the subject that uses lowercase letters with underscores. For example, the code name for the Make
initial contact with insured activity pattern is contact_insured.
• Priority – Enables ClaimCenter to sort activities into urgent, high, normal, or low priority in a list of
activities.
• Mandatory – Indicates whether the activity must be completed or can be skipped.
• Calendar Importance – Indicates the importance for display in the calendar. Values are Top, High, Medium, Low,
or Not On Calendar. For the activity to display in the desktop calendar, the value must be Top or High. For the
activity to display in the claim calendar, the value must be Top, High, or Medium.
• Claim loss type – Type of claim loss—auto, liability, property, travel, or workers’ compensation—for which
the pattern is allowed.
• Automated Only – Indicates whether an activity can be created only by rules or if a user can also create an
activity based on the activity pattern.
Understanding Activity Patterns 235

You can use this field instead of removing an activity pattern, which is not recommended. To effectively
remove an activity pattern, set this value to true. Doing so prevents users from creating new activities from
this pattern, but does not break existing rules that use the pattern.
• Available for closed claim – Set to true if it the activity can be added to a closed claim.
• Externally Owned – Indicates if an outside group or user can own the activity. This setting is used for activities
not under the control of the owner, such as a car repair, which a vendor completes in a time not under owner
control.
• Document Template – Optionally appears on the activity. Useful if the activity is sending a letter or other
document.
• Email Template – Optionally appears on the activity. Useful if the activity is sending an email.
• Recurring – Indicates if the activity recurs—when one activity ends, another is created.
• Description – A text description that is visible when looking at the activity’s details.
3. Each activity pattern includes two calculated dates and the settings used to calculate them. Enter target and
escalation information:
• Target Date – Date on which to complete the activity, after which ClaimCenter displays the activity in red.
This value determines the due date.
The following settings determine the Target Date:
– Target days – Days between the start and target date.
– Target hours – Hours between the start and target date.
– Target start point – Activity creation date, loss date, or notice date.
– Include these days – All days or only business days. If you select Businessdays, the additional
Businesscalendartype drop-down list is shown. From this list, you can select types of business days to include,
such as company or federal holidays. If you select ClaimLossLocation in the Businesscalendartype field, the date
will be calculated considering holidays in the region of the claim's loss location.
the activity will be generated for business days in the region specified by the claim’s loss location.
• Escalation Date – Date on which ClaimCenter sends alerts that the activity is overdue or generates other
activities to deal with the overdue activity.
The following variables determine the Escalation Date:
– Escalation days – Days between the start and escalation date.
– Escalation hours – Hours between the start and escalation date.
– Escalation start point – Activity creation date, loss date, or notice date.
– Include these days – All days or only business days. If you select Businessdays, the additional
Businesscalendartype drop-down list is shown. From this list, you can select types of business days to include,
such as company or federal holidays. If you select ClaimLossLocation in the Businesscalendartype field, the date
will be calculated considering holidays in the region of the claim's loss location.
Next steps
See also
• “Activities and the Data Model” on page 239 for information of how to define holidays and weekends after
calculating dates.
Generating an Activity from an Activity Pattern

Activity patterns are used to generate activities in several ways:
• You can manually generate an activity in the ClaimCenter user interface. Open a claim and click Actions, and then
click a menu action under New Activity to see its activity patterns. The menu actions under New Activity are

categories, and their submenus show activity patterns. You click an activity pattern to create an activity. When
you create an activity, you can override all default values set by the pattern.
• Rules can automatically create activities in response to the following events:
◦ Making a workplan during claim creation.
◦ Escalations, claim exceptions, or other events.
◦ Assistance needed with manual assignment.
◦ Actions requiring approval.
• External systems can also create activities through API calls.
Activity Assignment
An activity pattern does not control how an activity is assigned. There are, however, several ways activity patterns
can assist assignment:
• Assignment rules can assign an activity based on the activity pattern by using its code value. For example,
writing a request to Get an initial medical report is an activity that might be assigned to a medical case manager.
• While creating a new activity, you can choose auto-assignment rules or select a user manually by using a search
feature on the activity creation screen.
• After searching through a list of group members during an assignment activity, you can search for potential
assignees. This search returns workload statistics—how many open activities you have already—which is the
same information as seen on a supervisor’s calendar. Selecting the calendar icon that accompanies the search
results returns your personal calendar.
Activity Calendars
In the base configuration, ClaimCenter provides a variety of calendars to help organize activities. They show
activities in both monthly and weekly views. You can access these calendars from either the Desktop tab or the Claim
tab, and you can filter the listed activities in a number of ways. For example, you can filter the activities to show
those related to legal matters. Supervisors can also view activities of other users.
Calendar Displays
On the Desktop tab, click Calendar in the sidebar to open your calendar. If you are a manager or supervisor, you can
also open a Supervisor calendar. Select a calendar to show:
• Calendars for the current week and month, or any other start date. Weekly calendars always start with the current
day. The monthly calendar always starts on the previous Monday.
• Activities related to all claims and matters, those unrelated to legal matters, or those related only to matters.
◦ If looking at matter-related activities, either a display of all such activities or just all trial dates.
• Activities assigned any priority, or just activities of a specific priority, such as Urgent.
After opening a claim, you can open a calendar showing all activities, including matter activities, relating to just that
one claim. With a claim open, click Calendar in the sidebar to open both the current monthly and weekly calendar.
You can view all the activities for this claim that are assigned to anyone, or just the activities assigned to you.
Activity Calendars 237

Information in the Monthly View

If you need to obtain more calendar details, do the following in the monthly view:
• Calendar items are truncated – Hover your mouse over a truncated item to reveal the full name. If you click
the name, the Activity Detail worksheet opens to show more information.
• Calendar cells show up to four items – If there are more than four items on one date, the calendar cell displays
More. Click More to see that day’s activities.
• Calendar items are numbered – The numbering correlates with the numbering in the weekly view and with
extra information that appears below the calendar. This extra information is either the claim number and name of
the insured if the activity is claim-related or the name of the matter if related to a matter.
• An activity has been escalated – An escalated activity is red.
• A calendar becomes cluttered – A supervisor’s calendar can look at a large number of subordinates. To avoid
clutter, the calendar can show only the total number of open activities of each priority owned by each supervised
group. These totals reflect all the activities of each employee. In the totals are the activities the supervisor
assigned and the activities assigned to the supervisor’s subordinates by virtue of their membership in other
groups. This feature helps a supervisor get a better assessment of the total workload.
Information in the weekly view

If you need more calendar details, do the following in the weekly view:
• Calendar items are truncated – Hover your mouse over a truncated item to reveal the full name. If you click
the name, the Activity Detail worksheet opens to show more information.
• An activity has been escalated – An escalated activity is red.
• Each claim-related activity shown has standard information – Includes its name, claim number, and the
insured name.
• The calendar might show only trial dates – The detail shown includes the insured, the venue, the jurisdiction,
and the names of the opposing attorneys.
• A supervisor’s calendar shows limited information – Lists the activities with highest priority.
Calendar Importance Governs What Shows in a Calendar

Activities have a Calendar Importance tag, which is assigned after the activity is created. The default value comes
from the value of the Calendar Importance field of the activity pattern that helped create the activity. You can
assign an importance level of Top, High, Medium, Low, or Not On Calendar. These values come from the
ImportanceLevel typelist.
The calendar uses the importance of each activity to determine whether to display it. Whether an item displays
depends on the calendar:
• Desktop Calendar – The item displays only if the importance is Top or High.
• Claim Calendar – The item displays only if the importance is Top, High, or Medium.
Calendars and Manual Assignment

Using calendar information can be helpful in making a manual assignment. In the standard search for potential
assignees, workload information appears. This information is the same data as that seen on a supervisor’s calendar.
Viewing this information helps you in making assignments based on workload.
You can also view a user’s calendar before making an assignment. Each assignment search returns, by default, a
calendar row. Selecting the calendar icon on this row displays the particular user’s calendar.
Calendars and Holidays

The calendar displays all days of the week, but does not show weekends or holidays.

Activities and the Data Model

This topic lists the main entities and typelists that relate to activities.
Main Entities Related to Activities
Entity Description
Activity The main entity. It has foreign keys to Claim, Exposure, Matter, ServiceRequest, Document (array), Trans
actionSet, ActivityPattern, and BulkInvoice with which it is associated or previously was associated.
It also has foreign keys to Group, and User. It also contains typekeys to the ActivityClass, ActivityStat
us, ActivityType, ImportanceLevel, and Priority typelists, shown in the following table.
ActivityView Displays activities efficiently as lists. Has the following subtypes for specialized views:
• ActivityDesktopView – View in the Desktop tab.
• ActivitySearchView – For search results and the claim summary screen.
• ActivityTeamView – For the Team pages.
• ActivityUnassignedView – For the Awaiting Assignment display.
• ActivityVacationView – For the Vacation display.
• ActivityWorkplanView – In the Workplan screen.
ActivityPattern The template used to create activities. See “Creating and Editing Activity Patterns” on page 235 for more
information.
Typelists Related to Activities
Typelist Description
ActivityCategory Used by activity patterns to create different categories. Examples are Approval, Interview,
Litigation, File Review, New Mail, Request, ISO.
ActivityClass Used to indicate if an activity is a task, which has a due date, or an event, which does not.
Used by activity pattern.
ActivityStatus Whether an activity is open or complete, or has been canceled or skipped.
ActivitySubjectSearchType Whether to search for an activity by its ActivityPattern or by text it contains. Used by the
activity search entity ActivitySubjectSearchCriteria.
ActivityType Activities you create must be of type General. All other types are used internally.
CalendarContext Used to retrieve and sort activities for different calendar views.
ImportanceLevel Set by activity patterns. Sorts calendar displays.
Priority Choices are urgent, high, normal, or low. Priority is used by activity patterns. ClaimCenter
sorts list of activities by priority, and then alphabetizes each priority group.
Activities and the Data Model 239


chapter 24
Email
Email is a communication tool that can be used by adjusters and other users involved with the claim resolution
process. From ClaimCenter, you can write and send emails. You have the ability to:
• Define and store a variety of email templates.
• Create email messages from templates or from scratch.
• Fill in names and email addresses by using contact information or by doing it manually.
• Send emails from all claim screens.
• Send attachments with emails.
• Define activity patterns that enable the sending of emails from activities created by the pattern.
• Create activities that involve sending emails.
• Store and retrieve emails as claim documents.
• Use Gosu to automatically create a history event when you send an email.
• Use Gosu to send an email, including emails that contain attachments, from a rule.
ClaimCenter sends emails only in the context of a specific claim. ClaimCenter can store sent emails as documents
attached to that claim.
Note: You must configure email in Guidewire studio before you can send email in ClaimCenter. See in the
Integration Guide.
Working with Email in Claims

You compose and send mail from the Email worksheet. There are multiple ways to access this worksheet, all of
which require that you have a claim open.
Opening the Email Worksheet

You can open the Email worksheet from any claim and from some activities.
Email 241
Access the Email Worksheet from a Claim
Procedure
1. In Guidewire ClaimCenter, open a claim.
2. From a claim, there are two ways to open the Email worksheet:
• Enter Email in the QuickJump box and press Enter to open the Email worksheet.
• Choose Actions→New→Email.
Access the Email Worksheet from an Activity
About this task

An activity created with an activity pattern that specifies an email template includes a Create Email button.
Procedure
1. In Guidewire ClaimCenter, open an activity for sending an email.
2. Click the Create Email button to open the main Email worksheet.
This Email worksheet is the same one that you reach directly from a claim, except that it lacks the Use Template
button. Instead, it displays the subject and body of the template specified by its activity pattern.
3. Use the template’s text as the email body, or modify or delete the template text.
You have to work with the email template provided by the activity pattern. You cannot work with different
template in this worksheet.
Next steps
See also
Configure an Activity Pattern to Send an Email
Procedure
1. After creating or editing an activity pattern, specify an email template name in the optional field.
All activities created from this pattern provide the Create Email button.
2. Click the Create Email button to open the main Email worksheet.
3. Continue with the email creation.
Next steps
See also
• “Creating and Editing Activity Patterns” on page 235
Using the Email Worksheet

You compose and send email in the Email worksheet. This worksheet has the functionality of a typical email client,
enabling you to specify recipients, subject, and attachments, and to enter text in the body of the email. You can also
send and store an email from this worksheet. Closing the Email worksheet returns you to the claim.
You can use the worksheet to:
• “Select an Email Template” on page 243
• “Select Email Recipients” on page 243
• “Add Attachments to an Email” on page 244
242 chapter 24 Email
• “Send an Email” on page 244

• “Save an Email” on page 244
See also
• “Access the Email Worksheet from a Claim” on page 242
Select an Email Template
Before you begin

You must have the Email worksheet open to perform this task. See “Access the Email Worksheet from a Claim” on
page 242.
About this task

An email template provides a body and a subject field for your email. If you do not use a template, you can enter the
subject and body directly into the Send Email screen.
Procedure
1. To use a template, click Use Template to open the Find Email Templates screen that searches for templates.
2. Search by Topic or for one or more Keywords, or both. You can also click Search without entering any values.
The email template specifies topics and keywords on which you can search. Each template has a topic
attribute and a keywords attribute used by the template creator to specify one or more values. To search by
topic or keyword, you must enter topics and keywords. There is no drop-down list from which to select.
3. Click Search to display the search results.
4. Click Select next to a template to choose it.
The Email screen opens with the subject and body specified by the template.
5. Cancel the template selection by clicking Cancel or Return to Email.
6. Conduct another search by clicking Reset.
Next steps
See also
• “Access the Email Worksheet from a Claim” on page 242
• Rules Guide
Select Email Recipients
Before you begin

page 242.
About this task

Each email must have at least one recipient.
Procedure
1. Add email recipients as follows:
• Click Add to add each primary recipient.
• Click Add CC Recipients to add copy recipients.
• Click Add BCC Recipients to add copy recipients who are hidden from the other recipients.
Using the Email Worksheet 243

2. After clicking one of these buttons, click Add to add each recipient of this type.
3. Enter a name and email address or, if ClaimCenter is integrated with a contact management system, such as
ContactManager, click Search to search for recipients.
Next steps
See also
• “Working with Contacts in ClaimCenter and ContactManager” on page 582
Add Attachments to an Email
Before you begin

page 242.
Procedure
1. Click Add in the Attachments section of the Email worksheet to open the document search screen.
2. Select any document already associated with the claim.
The document must be present either in ClaimCenter or in the document management system with which
ClaimCenter is integrated. You cannot attach documents that are not already present.
After you select a document, it is added to the list in the Attachments section.
3. To remove a document from the list, select its check box and click Remove.
Send an Email
Before you begin

page 242.
About this task

Click the Send Email button in the Email worksheet to send the email and close the worksheet.
Save an Email
Before you begin

page 242.
About this task

If you select the Save as a New Document check box in the Email worksheet, the email becomes a document stored in
the document management system.
Saving an email as a document mixes the email with other documents.
Sending an Email from a Rule

Gosu provides methods that you can use in rules that send emails and email attachments and that create history
events.
See also
• Rules Guide

How Emails are Sent

ClaimCenter sends emails asynchronously by using its messaging subsystem. You must also register an email
MessageTransport class to hold the email messages and do the actual sending. Email messages are processed and
sent one at a time, like any other message.
Because emails are sent by using the normal messaging mechanism, emails that fail to reach their recipients are
treated just as other messages. An administrator gets a report of these messages and must take action, so the sender
is not directly notified.
See also
• Rules Guide
Handling Incoming Email

Some document management systems accept incoming emails, parse them to read the claim number they contain,
and store them as documents attached to that claim. Such systems accept either scanned email or emails from an
email server. Linking ClaimCenter to incoming emails requires you to integrate with a document management
system with such capabilities. You must configure this feature.
How Emails are Sent 245


chapter 25
Incidents
ClaimCenter uses the Incident data entity to track important items related to a claim. In ClaimCenter, an Incident
entity subtype captures specific information such as vehicles, property, and injuries involved in the claim. For
example, the LivingExpensesIncident entity tracks living expenses related to a homeowners claim.
IMPORTANT The insurance industry uses the term incident differently from Guidewire. Most commonly in the
insurance industry, an incident is an event or accident or near-miss that might or might not develop into a claim.
ClaimCenter supports this alternate concept as well with the incident-only claim. If you indicate that a claim is
incident-only, ClaimCenter sets the Claim.IncidentReport to true. See “Incident-Only Claims” on page 252 for
more information.
ClaimCenter uses incident subtypes to ensure that you can capture a large amount of information, independent of
selecting coverage and creating an exposure. For example:
1. A call center representative (CSR) does not have enough information to create an exposure on a claim or does
not have permission to create an exposure. The CSR captures details about the claim in an incident report.
2. An adjuster decides at a later date to use those incidents as the basis for exposures, potentially resulting in
payments against the claim.
Overview of Incidents
Typically, you gather information about incidents during the intake process. This information is useful in
determining the indemnities—the claim costs—needed to pay for the claim. The nature of this information varies
according to line of business. For example:
• In an auto claim, the list of incidents can include vehicles.
• In a property claim, the list of incidents can include fixed properties such as buildings.
• In a workers' compensation claim, an incident typically includes an injury.
• In an homeowners claim, incidents can include living expenses incurred during the time that the claimant is
unable to live in a house that was damaged by fire.
Incidents 247
Incidents serve these primary purposes:

• Capturing information about the loss without having to create exposures – This purpose is useful for a CSR
who does not have sufficient expertise to create exposures. An incident is also useful if the CSR is unsure of what
exposures are necessary at the time the claim is created. For example, it might not be immediately obvious which
coverage covers the loss.
• Sharing information about a lost or damaged item across multiple exposures – This purpose is useful if a
single item suffers multiple losses covered by multiple exposures, such as an auto policy with separate vehicle
damage and towing coverages.
You can use ClaimCenter incidents for the following purposes:
• To gather injury, vehicle, and property damage data that is independent of exposure creation.
• To view all injuries, vehicles, or properties associated with a claim from a single screen.
• To see the relationships between a contact and vehicles or properties.
• To view injury fields in each claim contact record and to store incident injury information.
Incident Permissions
You do not need any special permissions to create or edit incidents.
• If you have the Edit Claim permission claimedit, you can create and edit incidents.
• If you have the View Claim permission claimview, you can link an incident to an exposure, but you cannot
further edit the exposure.
See also
Incidents, Exposures, and Claims

In working with incidents, claims, and exposures, it is important to understand the following:
• Incidents capture the information about what was lost, hurt, or damaged. They do not capture coverage, coding,
financials, or other carrier involvement.
• Incidents and claims have a many-to-one relationship—a single claim can have multiple associated incidents.
• Incidents and exposures have a one-to-many relationship—a single incident can have multiple associated
exposures.
It is possible to associate an incident with an exposure, but you do not have to do so. For example, you do not
associate an incident with an exposure in the following circumstances:
• You do not know what coverage is to be applied. Or, it is possible that you do not have the authorization to
choose a particular coverage.
• No claim or exposure will result from the incident. If an incident describes damage to abandoned property, there
is no claimant in that case.
Initially, all incidents relate to a claim. At a later date, you can associate an incident with a specific exposure. You
can also create an incident when you create an exposure if no incident currently exists. For example, in the Personal
Auto line of business, if you create an exposure after creating the claim, you must identify an incident before you
update the new exposure. At this point, you can also choose to edit the incident details before updating the exposure.
ClaimCenter displays the Vehicle Incident screen so you can add more information.
See also
Incident Data Model

The Incident entity has a number of subtypes. Additionally, every exposure type maps to the Incident entity or to
one of its subtypes.
248 chapter 25 Incidents

Incident Entity and Its Subtypes

The following diagram illustrates the relationships between the Incident entity and its subtypes in the ClaimCenter
base configuration. For more information on the Incident entity and its subtypes, see the ClaimCenter Data
Dictionary.
Incident Entity and Subtypes
Incident
InjuryIncident PropertyIncident TripIncident
MobilePropertyIncident FixedPropertyIncident LivingExpensesIncident
BaggageIncident
DwellingIncident
PropertyContentsIncident
OtherStructureIncident
VehicleIncident
Mapping Between Exposures and Incidents

Every exposure type maps to the Incident entity or to one of its subtypes. Every exposure has at least one
underlying incident. As you create a new exposure, ClaimCenter also creates and initializes an incident. The link
between ExposureType and Incident identifies the type of incident to create and initialize. The following table lists
these relationships.
ExposureType Incident subtype Description

Baggage BaggageIncident Loss, damage, or delay of baggage. Also includes the loss of travel
documents, such as tickets and passports.
Bodily Injury InjuryIncident Generic for all lines of business, contains all injury-related data for
workers’ compensation (WC), auto, Personal PIP, and Medical Payments
(MP).
Content PropertyContentsIncident Includes items such as electronics, jewelry, furniture, and similar items.
Dwelling DwellingIncident Covers damage to a dwelling, such as a damaged roof or rooms in a

building. Also includes property damaged by an earthquake.
Employer Liability Incident Used mainly for employer liability, both private and federal, associated
with workers’ compensation. Contains just description and loss
estimate.
Incident Data Model 249

ExposureType Incident subtype Description

General Incident Generic for use with all lines of business, contains just description and
loss estimate.
Living Expenses LivingExpensesIncident Captures food and lodging details.
Loss of Use PropertyIncident Used for all kinds of property damage, including third-party and rental
car loss of use.
Med Pay InjuryIncident Generic, for use with all lines of business.
Medical Details InjuryIncident Generic, used mainly for workers’ compensation injury exposures.
Other Structure OtherStructureIncident Covers another building on a property.
Personal Property MobilePropertyIncident Primarily for loss of the contents of a vehicle, such as theft or vehicle
loss, or for moveable property such as a cellular phone.
PIP InjuryIncident Generic, primarily for personal injury protection, not commercial
losses.
Property FixedPropertyIncident Loss unrelated to a vehicle, for example, a building and its contents,
inland marine, and similar items.
Theft VehicleIncident Auto coverages related to vehicle theft.
Time Loss InjuryIncident Mainly for workers’ compensation, contains just description and loss
estimate.
Towing and Labor VehicleIncident Auto coverages, especially towing and labor.
Trip Cancellation or TripIncident If you missed your destination due to trip cancellation or delay.
Delay
Vehicle VehicleIncident Covers auto coverages related to vehicle damage.
Creating Incidents
To create an incident, you can do any of the following:
• You can manually enter all information to create incidents in the New Claim wizard.
• You can manually enter the required information to create an incident as you create an exposure on a claim.
• You can indicate that one of the risk units on the policy, such as a vehicle on an auto policy, is involved in the
claim. ClaimCenter then uses that risk unit as the basis for an involved incident.
Creating an Incident by Manually Entering Information

Typically, you identify an incident during the intake process through the New Claim wizard in the Loss Details screen.
In many cases, ClaimCenter requires that you create an incident as you create an exposure on the claim.
Add an Incident in the New Claim Wizard
Procedure
1. In ClaimCenter, create a new claim by using the New Claim wizard.
2. Access the Loss Details screen.
3. Select an incident type from those shown at the bottom of the screen.

For example, depending on the claim type, it is possible to see one or more of the following incident types:
• Add Vehicle
• Add Property Damage
• Add Pedestrian
4. Click the appropriate incident type.
ClaimCenter opens a screen for that incident type.
5. Enter the details about the incident.
For example, if you elect to add a new vehicle incident, ClaimCenter opens the Vehicle Details screen. Use this
screen to enter information about the vehicle type, year, make, and model, as well as information on the driver
of the involved vehicle.
Add an Incident to an Existing Claim
Procedure
1. Access the claim to which you want to add an incident.
2. Navigate to the Loss Details screen for that claim.
3. Click Edit.
4. Select an incident type from those shown at the right side of the screen.
For example, depending on the claim type, it is possible to see one or more of the following:
• Vehicles
• Properties
• Injuries
5. Click Add.
ClaimCenter opens a screen in which you can enter the details about the incident.
6. Enter the details for the incident.
For example, if you elect to add a new vehicle incident, ClaimCenter opens the New Vehicle Incident screen. Use
this screen to enter information about the vehicle type, year, make, and model, as well as information on the
driver of the involved vehicle.
Create an Incident on an Exposure
Procedure
1. Open the claim to which you want to add an incident.
2. Click the Actions menu and choose one of the following from the New Exposure section:
• Choose by Coverage Type
• Choose by Coverage
3. Choose a specific coverage.
4. Enter the incident information as requested.
ClaimCenter requires that you associate incident information with each exposure as you create it. It is possible
to update this information at a later time.
Creating an Incident by Using Policy Information

It is possible to use policy information from a policy administration system as the basis for potential incident
descriptions. In the base configuration, you have the option of selecting information that can be the basis of an
Creating an Incident by Manually Entering Information 251

incident if you are working with a verified policy. Selecting information in this way helps to minimize mistakes that
might arise from entering the information manually.
For example, if you have already selected a verified policy, you can do the following in the New Claim wizard of a
personal auto claim:
• You can select one or more vehicles to include on Claim as incidents from the list of vehicles in the Basic Info
screen of the New Claim wizard.
• You can add information regarding other vehicles, pedestrians, or property damage in the Loss Details screen of
the New Claim wizard.
• You can add driver and passenger information on the Vehicle Details screen.
See also
Incident-Only Claims
In the base configuration, the Loss Details screen of the New Claim wizard provides an Incident Only selection option.
Clicking this option sets a Boolean IncidentReport property on the Claim entity. Set this indicator to true if you
expect that you will never have to make payments on a claim, for any reason.
IMPORTANT The Claim.IncidentReport property has nothing to do with the Incident entity. Setting this
property does not create an incident. Rather, it marks a claim to indicate that there is no intention of ever making
payments against it. You create or add an incident through the Incident screens that you access through the Loss
Details screen of the claim. You can also add an incident when you add an exposure to a claim.
See also

chapter 26
Legal Matters
Most claims are settled without conflict. Some, however, cannot be settled without mediation, arbitration, or
lawsuits, all of which are called matters in ClaimCenter.
Overview of Legal Matters

ClaimCenter provides tools that organize information for the following methods of conflict resolution:
• A formal legal process, involving hearings and lawsuits.
• Arbitration as a formal alternative to a legal process.
• Mediation, an informal alternative.
• Simple negotiations with no legal underpinning. ClaimCenter handles negotiations differently from legal matters.
In these cases, you determine the possible extent of your legal liability by evaluating your possible and maximum
settlement costs. You can either track and manage your legal costs in the Budget Lines card or use the Evaluations
screen.
The Matters feature enables you to:
• Create matters screens that support both informal mediation and formal legal process flows.
• Show information relevant just to new matters.
• Create screens for each matter in a claim, then manage multiple issues on each matter’s single screen.
• Organize information as separate matters of different types—General, Lawsuit, Arbitration, Hearing, and
Mediation.
• Manage your legal costs with a Budget Lines card that tracks both budgeted and actual legal expenses.
• Show all matters on a legal calendar.
• Prevent deletion of a user who has an open matter.
• Use Access Control Lists to divide matters into different security classes and define security for each one.
Legal Matters 253

Matters Screen
If you have defined one or more matters for a claim, you can open the claim and click Litigation in the sidebar to see
the Matters screen. This screen shows some information about each matter. In this screen, you can select one or more
matters and then click:
• Assign – Assign a matter to another user.
• Refresh – Refresh the list of matters.
• Close Matter – When all work on a matter is complete, you can close it.
• New Matter – Start a new matter.
• My Calendar – See a calendar showing your scheduled work for the matter.
The information shown for each matter in the list view is:
• Name – The name of the matter. Click the name to open the details screen for the matter.
• Case Number – An identifying value assigned to the case. For example, the court might assign a case number for a
litigation matter.
• Final Settlement – The total final cost of the settlement.
• Trial Date – The date the trial is scheduled, or the date it occurred.
• Assigned To – The user, such as a claims adjuster, that is tracking the matter for the claim.
See also
• “Working with Matters” on page 259
Matter Details Screen

If you have defined one or more matters for a claim, you can open the claim to see the Matters details screen. Click
Litigation in the sidebar, and then click the name of a listed matter.
The Matter details screen shows the following information:
• The name of the matter at the top.
• Sections that describe the details of the matter, such as Matter, Litigation Details, Primary Counsel, Trial Details, and
Resolution. These sections vary by matter type. Click Edit to change the information in these sections.
• A Calendar button, which displays the Legal Calendar.
• A Status Lines list view where you enter matter status milestones, each of which has a Start Date and a Completion
Date. Milestones include Matter Filed, Discovery Completed, Trial Begun, and other litigation status types listed
in the MatterStatus typelist.
• A Secondary Attorney list view where you can add and delete contacts by using a contact picker. There is an
Attorney contact subtype for this claim contact.
• A Planned Activities list view that shows all activities created by certain activity patterns, such as Arbitration Date,
Hearing Date, and Legal Review.
• The Latest Notes relating to the matter. You see each note along with the name of the user who created it.
The following example shows a matter open for edit. This edit screen shows the elements of the General matter type.
254 chapter 26 Legal Matters

See also
• “Matter Type Sections in the Matters Detail Screen” on page 255
• “Activity Calendars” on page 237
Matter Type Sections in the Matters Detail Screen

The Matters detail screen displays different information that depends on the matter type selected. There are several
types of matters specified in the MatterType typelist provided in the base configuration. Each matter type tracks
different kinds of information.
The following table lists the types of matters that are in the base configuration. Each section that shows in the Matters
detail screen for a matter type is indicated by a dot. You can modify the matter types to include other information
needed by your business model, and you can add new types. The General type includes all the sections except
mediation details.
Matter Type Matter Litigation Primary Trial Arbitration Hearing Mediation Additional Resolution
Details Counsel Details Details Details Details Details
General • • • • • • • •
Lawsuit • • • • • •
Arbitration • • • • •
Hearing • • • • •
Mediation • • •
Overview of Legal Matters 255

The sections that can appear on the Matters screen are described in the following topics:
• “Matter Section” on page 256
• “Litigation Details Section” on page 256
• “Primary Counsel Section” on page 257
• “Trial Details Section” on page 257
• “Arbitration Details Section” on page 257
• “Hearing Details Section” on page 258
• “Mediation Details Section” on page 258
• “Additional Details Section” on page 258
• “Resolution Section” on page 259
Matter Section
The Matter section on the ClaimCenter Matters screen contains the basic information needed by any matter type. All
fields are optional except Name. The fields are as follows:
• Name – The name of the matter.
• Case Number – The assigned case number, if any.
• Owner and Group – Who the matter is assigned to and which claim group that user belongs to. These fields are set
by ClaimCenter when you create the matter or when you reassign it.
• Type – Values in the base configuration can be <none>, General, Lawsuit, Arbitration, Hearing, or Mediation. Default is
General.
• Plaintiff and Defendant – You can choose from a list, search for contacts, or enter new contacts manually. Use the
picker to search for or create a contact. Searching returns results only if a contact management system, like
ContactManager, is integrated with ClaimCenter.
• Related to Subrogation? – Subrogation often involves legal action. This field helps classify the matter.
• Close Date – ClaimCenter enters this date for you when you close the matter, and it removes the date if you reopen
the matter.
• Reason Reopened – After you reopen a closed matter, this field shows a description of why you did so.
See also
• “Subrogation” on page 289
• “ContactManager Integration” on page 581
Litigation Details Section

The Litigation Details section on the ClaimCenter Matters screen contains information used by General and Lawsuit
matter types:
• Court Type – In the base configuration, Federal, State, and County are the choices in the drop-down list, which come
from the MatterCourtType typelist.
• Court District – In the base configuration, you can choose any state of the United States from the drop-down list.
The choices come from the MatterCourtDistrict typelist.
• Legal Speciality – In the base configuration, values of the drop-down list can be Personal injury, Motor vehicle liability,
General liability, and Workers' compensation, all from the LegalSpeciality typelist.
• Primary Cause – Primary cause of the legal suit, such as Unreasonable Demand or Low settlement offer. The choices in
the drop-down list come from the PrimaryCauseType typelist.

Primary Counsel Section

The Primary Counsel section on the ClaimCenter Matters screen contains the following information used by all matter
types except Mediation:
• Plaintiff Attorney
• Plaintiff Law Firm
• Defense Attorney
• Defense Law Firm
You enter these contacts either by selecting a contact from the list or by searching for or entering a new contact. Use
the picker by each entry to search for or create a contact. Searching returns results only if a contact management
system, like ContactManager, is integrated with ClaimCenter.
Additionally, there are two entries related to defense attorneys:
• Defense Appointed Date – The date a defending attorney was appointed. You can enter a date by clicking the
calendar .
• Sent To Defense Date – The date the matter was sent to the defending law firm or attorney. You can enter a date by
clicking the calendar .
See also
Trial Details Section

The Trial Details section on the ClaimCenter Matters screen contains the following information used by General and
Lawsuit matter types:
• Trial Date – The date that the trial is scheduled or already took place. You can enter a date by clicking the calendar
.
• Trial Venue – Pick an existing venue or add a new one by clicking the contact picker icon. There is a Legal Venue
contact subtype. Use the picker to search for or create a venue. Searching returns results only if a contact
management system, like ContactManager, is integrated with ClaimCenter.
• Room – Enter text identifying the room where the trial is to take place.
• Judge – Pick an existing judge or add a new one. There is an Adjudicator contact subtype. Use the picker to
search for or create a contact. Searching returns results only if a contact management system, like
See also
Arbitration Details Section

The Arbitration Details section on the ClaimCenter Matters screen contains information used by General and Arbitration
matter types. This information is analogous to that for Trial Details:
• Hearing Date – The date on which the arbitration hearing is scheduled or took place. You can enter a date by
• Arbitration Venue – Pick an existing venue or add a new one. There is a Legal Venue contact subtype. Use the picker
to search for or create a venue. Searching returns results only if a contact management system, like
• Room – Enter text identifying the room where the arbitration is to take place.
• Arbitrator – Pick an existing arbitrator or add a new one. There is an Adjudicator contact subtype. Use the picker
to search for or create a contact. Searching returns results only if a contact management system, like
Matter Type Sections in the Matters Detail Screen 257

See also
Hearing Details Section

The Hearing Details section on the ClaimCenter Matters screen contains information needed by General and Hearing
matter types. This information is analogous to that for Trial Details:
• Hearing Date – The date on which the hearing is scheduled or took place. You can enter a date by clicking the
calendar .
• Hearing Venue – Pick an existing venue or add a new one. There is a Legal Venue contact subtype. Use the picker
• Hearing Room – Enter text identifying the room where the hearing is to take place.
• Hearing Judge – Pick an existing judge or add a new one. There is an Adjudicator contact subtype. Use the picker
to search for or create a contact. Searching returns results only if a contact management system, like
See also
Mediation Details Section

The Mediation Details section on the ClaimCenter Matters screen contains information needed by the Mediation matter
type. This information is analogous to that for Trial Details.
• Mediation Date – The date on which the mediation meeting is scheduled or took place. You can enter a date by
• Mediation Venue – Pick an existing venue or add a new one. There is a Legal Venue contact subtype. Use the picker
• Room – Enter text identifying the room where the mediation is to take place.
• Mediator – Pick an existing mediator or add a new one. There is an Adjudicator contact subtype. Use the picker to
search for or create a contact. Searching returns results only if a contact management system, like
See also
Additional Details Section

The Additional Details section on the ClaimCenter Matters screen contains information that can be required by all
matter types except Mediation. All fields are optional:
• Docket Number – Enter text in the field.
• Filing Date – The date that the matter was filed. You can enter a date by clicking the calendar .
• Filed By – Pick an existing contact or add a new one. Use the picker to search for or create a contact. Searching
returns results only if a contact management system, like ContactManager, is integrated with ClaimCenter.
• Service Date – The date that legal documents are scheduled to be served or were served on the recipient. You can
enter a date by clicking the calendar .
• Method Served – The method used to serve legal documents on the recipient. Values available in the base
configuration are Certified Mail or Sheriff, which come from the MatterMethodServed typelist.
• Response Due, Response Filed – Enter these dates by using the calendar icon. You can enter a date by clicking the
calendar .

• Ad Damnum? – Click Yes if there are any actual or anticipated costs so far. Click No if you know that none will be
coming.
• Punitive Damages? – Click Yes if punitive damages are being claimed. Click No if you know that none will be
claimed.
See also
Resolution Section
The Resolution section on the ClaimCenter Matters screen, shown in all matter types, tracks:
• Resolution – The outcome of the matter, such as Summary judgment, Verdict for the plaintiff, or Dismissed. The values in
this drop-down list come from the ResolutionType typelist.
• Final Legal Cost, Final Settlement Cost – You must enter these costs directly.
• Final Settlement Date – The date on which the settlement became final. You can enter a date by clicking the
calendar .
Budget Lines Card

Legal costs can be considerable, and knowing what they are or could become, can be critical in deciding if and how
to pursue legal action. ClaimCenter provides a Budget Lines card to estimate legal costs and track payments made on
them. This card tracks all reserve lines that have the cost category of Legal.
ClaimCenter defines a number of line item categories and associates these categories with matter types. For
example, there are Deposition and File Review line items for all matter types, but the Hearing line item is available only
for General, Hearing, and Lawsuit matter types. See the LineCategory typelist for the complete list. After you
create exposures, ensure that you use the cost category of Legal, so that these line item categories are available.
In the base configuration, the Budget Lines card is not visible.
See also
• For information on making this card visible and using it, see “Organizing Financial Legal Information” on page
261.
Payments and Matters

ClaimCenter not only enables you to estimate and track legal payments, but also creates checks for legal matters that
include the matter type and the line category. Both check wizards require that you enter a line item category when
making a payment on a reserve line with a legal cost category. The printed check also reflects this information.
Working with Matters

You can use the matters screens of ClaimCenter both to track legal related financial costs and to organize people,
venues, and dates.
Open a Matter
About this task
You can open an existing matter for a claim.
Procedure
1. In ClaimCenter, open a claim and click Litigation in the Sidebar.
2. Click a matter name in the table to open it.
A list view opens that displays all matters pertaining to that claim.
Matter Type Sections in the Matters Detail Screen 259
Create a Matter
About this task
You can create a matter for a claim.
Procedure
1. In ClaimCenter, open the claim.
2. Do one of the following:
• Click Actions→New→Matter.
• Click Litigation in the Sidebar to open the Matters screen, and then click New Matter.
3. To assign the matter, do one of the following:
a. For a new matter, as you create the matter, select a value from the Owner drop-down list.
You can choose automated assignment or you can choose an assignee directly.
b. For an existing matter, click Assign and assign the matter.
Close a Matter
Procedure
2. Select a matter and then click Close to close it.
3. Choose a Resolution from that drop-down list, which gets its values from the ResolutionType typelist.
4. (Optional) Enter a note describing the reason for closing the matter.
5. Click Close Matter.
Reopen a Matter
Procedure
1. Open a claim and click Litigation in the Sidebar.
2. Click the name of a closed matter to display its Details view.
3. Click the Reopen button.
4. Choose a reason from the Reason drop-down list.
This drop-down list obtains its values from the MatterReopenedReason typelist.
5. (Optional) Enter a note describing the reason for reopening the matter.
Result
Reopening a matter removes its Close Date from the Matter section and fills in the Reason Reopened item chosen from
the Reason drop-down list.
Setting a Matter Type

You can select a matter type for a specific matter by clicking the Type field in the Matter section of the ClaimCenter
Matters screen for that matter.

If the matter begins as a negotiation, and then becomes a lawsuit, and is finally settled by a binding arbitration, you
can track these changes in several ways:
• Open and close in turn a Negotiation, then a Lawsuit, and finally an Arbitration matter type.
• Open a single Matter and edit its Type as the matter progresses.
• Open a General matter, which contains all panes in all matter types, and use it until there is a resolution.
See also
• “Open a Matter” on page 259
Organizing Financial Legal Information

You can edit the Budget Lines card to organize financial information for a matter. This card has a list view that shows
the following for each line item category of reserve lines that has a legal cost type:
• The estimated cost for each line item of that reserve line
• The sum of all payments made on that reserve line
• The difference between the expenses and payments
Display the Budget Lines Card

Before you begin
You must have the required administrative privileges, to set the UtilizeMatterBudget script parameter to display
the Budget Lines card.
Procedure
1. In ClaimCenter, click the Administration tab and navigate to Utilities→Script Parameters.
2. Set the value of the UtilizeMatterBudget script parameter to true.
After setting this script parameter, each time you open a matter, you see a Budget Lines card.
Next steps
See also
• “Edit the Budget Lines Card” on page 261
Edit the Budget Lines Card

About this task
In the Matters screen, the Budget Lines list view is initially empty. You can edit it and add information.
Note: It is not possible to edit the actual payments made. ClaimCenter adds the budget line information whenever
you write a check that includes a payment with the line item category that matches the category of a line in this
table.
Procedure
2. Click a matter name in the table to open its Details view.
3. Click the Budget Lines card.
4. Click Add, and then choose a Type to add a line with the line item category you have chosen.
Budget line types include Court Costs, Deposition, Hearing, and other values that are typecodes in the
LineCategory typelist and have the legal cost category and the mattertype category list.
Organizing Financial Legal Information 261

5. Enter Estimated Expenses on the line you add, or change Estimated Expenses on the other lines while in edit
mode.
An estimated expense is independent of the reserve amount of that reserve line.
Next steps
See also
• “Budget Lines Card” on page 259
• “Making Payments Connected to a Matter” on page 262
Making Payments Connected to a Matter

After you write a check, both check wizards detect payments made on reserve lines with the legal cost category.
You must enter the category, the line item.
You enter the line item category on screen two of the Check wizard and on screen one of the Quick Check wizard.
ClaimCenter updates the Total Payments column of the Budget Lines list view when the check status becomes
submitting or notifying.
See also
• “Edit the Budget Lines Card” on page 261

chapter 27
Notes
One of an adjuster’s tasks is adding notes that track the progress of a claim and associate detailed information with
the claim. Notes enable you to keep a detailed record of all of the information, actions, and considerations related to
the processing of each claim. Notes cannot exist independently, but are always associated with a specific claim or
one of the claim’s parts.
You can use the Notes feature to:
• Create a note in most claim related screens, including all claim, exposure, financial, and matter screens, as well
as all New Claim wizard screens.
• Create general notes without a note template.
• Create notes with a note template for specific note types.
• Attach a note to a single claim or to one of its exposures, activities, matters, or claim contacts.
• Make a note confidential.
• Add additional security with ACLs.
• Edit and delete notes, if you have the proper permission.
• Search for notes with a wide variety of filters.
• Link external documents to a note.
• Create a note with rules or in workflows.
• Create new note templates.
Differences Between Notes and Documents

Notes and documents have distinct functions in ClaimCenter, and the application handles them differently. The
following table highlights the main differences.
Characteristics of Notes Characteristics of Documents

Written in plain text. Can have many different MIME types, such as PDF, Word, or Excel.
Notes 263
Characteristics of Notes Characteristics of Documents

Created by a user or through Gosu. Created by a user, or through Gosu, or in an external document management
system.
Stored only in the ClaimCenter database. Stored either in the ClaimCenter database or in a document management system.
Related to one claim or claim entity. Can be related to one claim, linked to many others, and attached to notes.
See also
• “Document Management” on page 587
Working with Notes

The primary screens and worksheets related to notes are:
• Notes – This screen has a search area in its upper part with fields that enable you to search by text, author, topic,
and date range. The main screen shows the results of the last search in its lower section.
You can also search by related exposure, activity, matter, or claim contact.
To reach this main Notes screen, you can click Notes in the sidebar if you have either a claim or the New Claim
wizard open.
• New Note – This worksheet is where you create notes. You can optionally use a template. You can also search for
note templates. To access this worksheet, click Actions→New→Note.
• Activity Detail – This worksheet is where you create notes that are related to an activity. For example, you can
navigate to Desktop tab Activities. If you then click the Subject of an activity assigned to you, Activity Detail
worksheet of that activity opens below the list of activities. The worksheet has a New Note section.
• Summary – This screen, opened by clicking Summary in the sidebar, has a Latest Notes section that displays notes
related to the claim.
• Matters Details – This screen, opened by clicking Litigation in the sidebar and then clicking a matter Name field, has
a Latest Notes section that displays notes related to the matter.
Searching for Notes

To search for notes, open a claim and click Notes in the sidebar to open the Notes screen. Use the search section at the
top of the Notes screen to search for notes.
The only required field is Related To, which in the base configuration defaults to Claim.
You can use the following filters and search fields:
• Find Text – Search for a word or text string in the subject or body of the note.
• Author – The user who wrote the note. ClaimCenter attaches the name of the user to a note when it is created. You
cannot change the author of a note.
• Related To – A note created in an exposure, activity, or matter is related to that entity. This required filter finds
notes related to the claim or to a specific exposure, activity, matter, or claim contact. A note can be related to just
one entity.
• Topic – A typecode that classifies the note, which you choose from a drop-down list. This list is populated from
the NoteTopicType typelist.
This typelist has typecodes with names like First notice of loss, Coverage, and Medical issues, Litigation, Denial,
and General.
• Date Range – Search for a preselected time period, such as Today or Last 7 Days, or enter a range of dates.
264 chapter 27 Notes

• Sort By – Sort the results by author, date, exposure, subject, or topic in either ascending or descending order.
These values are typecodes from the SortByRange typelist. In the base configuration, the default sort is by date
in descending order.
In the base configuration, you cannot search for the Note fields SecurityType or Confidential.
Viewing Notes
Use the Notes screen to see the most recent notes, and use the upper search section of the screen to find notes. If the
note appears in a list, click it to see it.
The most recent notes related to an exposure, a matter, or and activity are also visible on the claim Summary, Matter,
and Activity screens.
To view the details of a note, click Edit. All the note’s attributes display in the Edit Note screen.
You can configure the Notes screen to show more than the default information available in the base configuration.
See also
• “Configuring Notes and Note Templates” on page 268
Viewing Notes Related to an Activity or Matter

A note created in an Activity worksheet or in the Notes editor for an existing matter is linked to that activity or matter.
You can view these notes as follows:
• Clicking View Notes on the Activity Detail screen opens a search screen similar to the Search pane on the Notes screen
that can find notes linked to that activity.
• If you click Litigation and open the detail view of a Matter, you can see notes for that matter in the Related Notes
section.
Edit a Note
Before you begin
If you have the noteedit and noteeditbody permissions, you can click Edit for each note.
Procedure
1. Click Edit to start editing.
2. Click Update to save.
Delete a Note
Before you begin
If you have the notedelete permission, you can click Delete for each note.
About this task

Note: The note is deleted immediately, so be sure you want to delete it before clicking Delete.
Click Delete to delete a note.
How to Print a Note

To print a note, you must have permission to view it.
You can print a note from the Notes screen’s list of notes.
Click Print for any note you see in the list.
Working with Notes 265

The note is converted to a PDF file. You can view the PDF file in Acrobat Reader and print from that application, or
you can save the file.
Create a Note
Procedure
1. In ClaimCenter, choose Actions→New…Note to open a Note worksheet.
2. Choose values for the required attribute fields—Topic, Related To, and Confidential—and optionally fill in the
Subject and Security Type attributes. The Security Type field specifies the access control list (ACL) for the note.
3. Enter the note text. Notes must always contain some text.
4. Click Update after you are finished with your note.
Create a Note from a Note Template

Before you begin
Before using a template, you must first find one.
About this task

You can use a template to create a note.
Procedure
1. In ClaimCenter, choose Actions→New→Note.
2. In the Note worksheet, click Use Template.
3. In the Find Note Template screen, optionally select template attributes to limit the search, and then click Search.
The search returns a list of templates matching your search criteria, or all templates if you enter no criteria.
4. Click Select to choose the template to use for creating the note.
After you select a template, the template’s attributes and text populate the Note worksheet.
5. Change any information added by the template and edit other fields and body text as needed.
6. Click Update when you are finished.
Creating a Note in an Activity

To create a note associated with an activity, use the New Note section in the Activity Details worksheet.
See also
Linking Documents to Notes

You can link documents to a note only when you create the note. In the Note worksheet, click Link Document to embed
a link to a document at the cursor position in the Text field of the note. A document link is formatted with the ID of
the document, such as $ccDocLink(1). The link is text, and while you are still creating the note in edit mode, you
can move it wherever you want in the body of the note. After you save the note, you can no longer edit the body of
the note, the Text field.
When you view a saved note, this link is rendered as a readable link, the name of the file. Clicking the link
downloads the document’s content to your web browser.
You can link only to documents that already exist in your document management system. A document that indicates
existence of a hard-copy document has no content on the system, and therefore the link text created for it is not an
active link.

See also
• “View Documents for a Note” on page 592
• “Link a Document to a Note” on page 600
Note Security
ClaimCenter provides a set of system permissions to provide security for all notes, listed in “Permissions Related to
Notes” on page 267. Use these permissions to define different security types for notes and assign permissions to
users that relate to these ACLs.
Select the ACL to which you want the note to belong by specifying its Security Type when you create the note.
See also
• “Access Control for Exposures” on page 500
Permissions Related to Notes

The following system permissions provide security for notes.

Create notes notecreate Permission to add notes
Create notes on closed claims notecreateclsd Permission to add notes on closed claims
Delete medical note delmednote Permission to delete a medical note
Delete notes notedelete Permission to remove notes
Delete private note delprivnote Permission to delete a private note
Delete sensitive note delsensnote Permission to delete a sensitive note
Edit medical note editmednote Permission to edit a medical note
Edit note noteedit Permission to edit any part of a note
Edit note body noteeditbody Permission to edit the body of notes
Edit internal notes editintnote Permission to edit an internal note
Edit private note editprivnote Permission to edit a private note
Edit sensitive note editsensnote Permission to edit a sensitive note
View claim Notes page viewclaimnotes Permission to view the Notes page of a claim or matter
View confidential notes noteviewconf Permission to view confidential notes

View medical note viewmednote Permission to view medical notes
View notes noteview Permission to view notes
View private note viewprivnote Permission to view private notes
View sensitive note viewsensnote Permission to view sensitive notes
Confidential Notes
After you create a note, you can mark it confidential. A confidential note that you create is visible only to:
• You, the creator of the note.
• The chain of supervisors in the claim’s assigned group.
• Anyone with noteviewconf permission, which enables viewing of confidential notes.
Note Security 267

All users have the permission to set the Confidential field of notes they write. You can find, edit, and delete
confidential notes that you write. However, the noteviewconf permission is required to view and edit a confidential
note that you did not write, unless you are in that claim’s assigned group’s supervisory hierarchy. ACLs are
independent of this field.
Configuring Notes and Note Templates

The Notes feature requires little configuration.
The file config.xml supports the following configuration parameters:
• MaxNoteSearchResults – The maximum number of note search results to display before showing a warning in
the user interface. The default in the base configuration is 25. If the limit is exceeded, the user sees a warning and
no search results.
• CreateNoteWithArchiveUpgradeIssues – Indicates if a note will be created for a restored claim that required
upgrading, but the upgrade encountered problems. The default value of this parameter is true.
If a claim was archived in a previous release of ClaimCenter and then ClaimCenter was upgraded and the claim
is restored, the claim must be upgraded during the restore. If there were problems with the upgrade that did not
prevent the restore from succeeding, they are recorded in a note that is attached to the restored claim. Setting this
parameter to false prevents the note from being created.
You cannot add and delete search filters in the search-config.xml file, as you can for other types of searches.
Note Plugin Interfaces

There are two plugin interfaces associated with notes. They do not affect the primary use of notes, which are stored
in the database and do not require an external system, such as a document management system. They are related to
note templates, which can be a customized method of creating notes. The plugin interfaces are:
• INoteTemplateSource – Retrieves note templates—INoteTemplateDescriptor objects—that are used to help
create notes. The default implementation is gw.plugin.note.impl.LocalNoteTemplateSource. This Gosu
class retrieves templates from the server file system, but can also be customized to get them from a document
management system.
• INoteTemplateSerializer – Customizes reading and writing of INoteTemplateDescriptor objects.
Note Fields
Notes and note templates have a set of fields, also called properties. ClaimCenter uses these fields to attach the notes
to various claim entities and to search for notes and note templates.
The following table describes the fields of a Note that are visible in ClaimCenter screens.
Attribute Name Definition of Attribute How Set Search for Editable?

Note?
Author Logged-in user who wrote the note By ClaimCenter yes no
Body Contents, the text of the note By author in editor yes - any string yes
AuthoringDate Date the note was originally written By ClaimCenter yes - and by no
range
NoteRelatedTo Must exist and be unique By author in editor yes yes
Confidential Boolean value in note By author in editor no yes
SecurityType Value from the NoteSecurityType typelist By author in editor no yes
Topic Value from the NoteTopicType typelist By author in editor or by yes yes
template

Attribute Name Definition of Attribute How Set Search for Editable?

Note?
Subject Defined in the template and given to its notes By author in editor or by no yes
template
The author, body, date, related to, confidential, and security type are fields unique to notes and are not a part of note
templates.
The following fields are used in note templates. The first two are applied by the note template to a note created from
it.
Field Name Definition of Field Search for Search for Editable in

Template? Note? Note?
Subject The subject of the template and of notes created from it. no no yes
Topic The topic of the template and of notes created from it. A typecode yes yes yes
of the NoteTopicType typelist.
Type A typecode of the NoteType typelist, such as diagram, action plan, yes no no
or status report. You can add others.
Creating a Note Template

A note template is a pair of Gosu files, a .gosu file and a .gosu.descriptor file. To access the files, open
Guidewire Studio and navigate in the Project window to configuration→config→resources→notetemplates.
The easiest way to create a new template is to modify copies of two existing files for one of these templates. Then
save the two files with new, matching names in the same location as the other note template files.
Note Template Files

A note template consists of two separate files:
• A descriptor file with a name ending in .gosu.descriptor. The file contains metadata about the template.
For example, ActionPlan.gosu.descriptor.
• A template file with a name ending in .gosu. This file contains the text for the body of the note.
For example, ActionPlan.gosu.
In the base configuration, a note descriptor file has the following fields.
Field Description
name A String value that is a unique, readable name for the template. Can be used in template search.
type A String value that is the type of the note, a string that matches a typecode from the NoteType typelist. Can be
used in template search.
Base configuration values include actionplan, diagram, interviewreport, reviewactivity, and statusreport.
lob The loss type that the note is associated with, a String value that matches a typecode from the LossType typelist.
For example, AUTO, GL, PR, TRAV, or WC.
Can be used in template search.
keywords A String value, a comma-separated list of keywords that can be used to search for the template.
topic The topic of the note, a String value that matches a typecode from the NoteTopicType typelist.
For example, general, fnol, medical, salvage, or settlement.
Can be used in template search.
subject The subject of the notes created with this template, a String value.
Configuring Notes and Note Templates 269

Field Description
body A String value that is the name of the Gosu file containing the body of the note. Be sure to include the .gosu
extension.
See also
• An external system can retrieve and validate note templates. For information, see “Document Management” on
page 587
Note Template Example

The sample file ActionPLan.gosu.descriptor defines an Action Plan descriptor file.
<?xml version="1.0" encoding="UTF-8"?>

<serialization>
<notetemplate-descriptor
name="Action Plan"
type="actionplan"
lob="gl"
keywords="claim"
topic="evaluation"
subject="Case Action Plan"
body="ActionPlan.gosu"
/>
</serialization>
The ActionPlan.gosu.descriptor file pairs with the template file ActionPlan.gosu, which contains:
Claim Number: <%= claim.ClaimNumber %>
Case Strategy:
Brief statement (a few words or a sentence at most) about the direction
of the case at this particular time.
Examples might be "Investigate", "Settle", "Deny" or "Defend"
Current Status/Liability Assessment:

Brief statement on where the case stands. What's been established so far.
Example might be "Liability probable, damages unknown" or
"Liability questionable, soft tissue injuries alleged".
This is not a recap of the entire file.
Target Investigation ACES:

What area of the claim do we need to focus on to bring it to conclusion?
Examples might be "Obtain damages" or "Investigate liability, obtain damages".
This section is intended to be a brief statement on the direction or
target of the planned future claim activity.
Action Items:
This is a list of specific items or tasks that need to be completed
in order to address the "Target Investigation ACES" above.
This is a "to do" list which gets us to the targeted issues.
Each item should have its own due date based on reasonable time needed
to complete that task.
Due dates should be proactive, but realistic.
Avoid batching items such as "Complete liability investigation".
Instead show the actual items you need to complete and when they are to be completed.
Is LCE/ECE adequate?
Should reserves be updated in view of any newly developed information?

chapter 28
Holidays and Business Weeks
Holidays, weekends, and business weeks define the ClaimCenter business calendar. Holidays can vary according to
zone, such as country. For example, some countries might have an accepted practice of working half the day on
Saturdays. You can also, for example, define a zone to be a state or ZIP code in the United States. Business weeks
and business hours can vary by zone. A large international company might need to track differing business days and
holidays of multiple locations to ensure that work is handled in a timely manner. The ClaimCenter business calendar
calculates these dates and ensures the correct usage of holidays, weekends, and business weeks.
Some examples:
• Activities usually reach their due dates and escalation dates after a defined number of business days. The activity
patterns calculate the number of business days by using the holidays of the area in which the activity is
performed.
• A regulatory agency specifies the maximum number of business days to perform an activity. The corresponding
activity can use the holiday schedule of that agency’s area to calculate the due date.
• Auto-assignment of an activity by location can determine who is assigned the activity. It can also consider how
much time can be allocated for the activity based on the business calendar, or holiday schedule, of the claim’s
region.
• Recurring checks use business days to schedule checks. Checks need to arrive on time, and the mail is affected
by the holiday schedules of all countries the mail passes through. Determining how long it normally takes for
international mail to arrive must take into account the mail holidays of all these countries.
Specifying Holiday Dates

In the base configuration, ClaimCenter determines weekends and work days by using configuration parameters in
the config.xml file. However, you specify holidays through the user interface. Using the user interface gives you
more flexibility in defining holidays, and you can make changes without having to restart the server.
Holidays and Business Weeks 271

To specify the holidays observed by your business, on the ClaimCenter Administration tab, navigate to the Business
Settings→Holidays screen. ClaimCenter stores all holidays you define in this screen in the database. All holidays are
editable. With administrator privileges, you specify:
• Name – There is no limit on the holidays or on the names you give them. Each holiday is one day, so you must
enter all the actual days if a holiday results in multiple days off. For example, you must specify two holidays for
Thanksgiving in the United States if the company gives employees Thursday and Friday off.
• Date – The dates of some holidays vary each year, so this screen enables annual updates.
• Applies to All Zones – Determines who observes the holiday. You can further select the type of zone, such as state,
county, or city in the United States if the holiday does not apply to all zones.
• Types – Provides one way to categorize holidays. You can also define other types.
Default values in the base configuration, defined in the HolidayTagCode typelist, include General, Federal Holidays,
and Company Holidays.
Holiday Types
You can give holidays different classifications, or categories, which their Type field captures. For example, after
deciding when to mail a letter, a rule can consider excluding only holidays when mail is not delivered. The Federal
Holidays type, which refers to federal holidays, describes this subset. If you are sending mail to another country, you
can have another type to describe days when mail is not delivered in that country as well. You can write Gosu code
that checks a mail address. If going to another country, the code could consider both types of holidays to determine
the correct number of business days to allow for mail delivery.
As another example, if your company grants a holiday to all employees on the birthday of the company founder, you
can create a Birthday holiday type. This rule avoids scheduling due dates on that date.
Holiday Zones
You can configure zones to apply to any area. In the United States, for example, you can define zone type by
jurisdiction, city, county, and ZIP code. To correctly add Martin Luther King Day as a holiday, you must include
every state where it is observed.
ClaimCenter provides zone data for the United States and Canada in the base configuration. You can configure
ClaimCenter to have other zones.
Working with Holidays, Weekends, and Business Weeks

This topic describes how to work with holidays in the user interface.
Add a Holiday
Before you begin
To add a holiday, the ClaimCenter user must be logged in with administrator privileges.
Procedure
1. From the Administration tab, select Business Settings→Holidays to open the Holidays screen with its list of
holidays.
2. Click Add Holiday to create a new holiday.
3. Enter the holiday name, date, and type.
4. If you choose No for Applies to All Zones, you can further refine your choices of the zones that apply by
specifying Zone Type and Zones.
5. Click Update.
272 chapter 28 Holidays and Business Weeks

Edit a Holiday
Procedure
1. From the Administration tab, select Business Settings→Holidays to view the Holidays screen and the list of
holidays.
2. Select the holiday to edit by clicking its link in the Holiday column. The holiday’s field values are shown.
3. Click Edit.
4. Edit the field values.
You can assign both Type and Zone to any choices that already exist, but you cannot create new choices for Type
or Zone in this screen.
5. Click Update.
Next steps
You might need to change the Date of some holidays annually.
Delete a Holiday
Procedure
1. From the Administration tab, select Business Settings→Holidays to view the Holidays screen and the list of
holidays.
2. Select the holiday to delete.
3. Click Delete.
Next steps
See also
• “Managing Holidays” on page 526 for more information about adding, editing, and deleting regional holidays.
Create a New Zone or Type

Procedure
1. In Guidewire Studio, navigate to the typelist that you want to modify.
2. Edit the typelist fields.
• Zone Type – Defined by the ZoneType typelist, includes the typecodes city, county, state, province,
postalcode, and fsa. You can add other types to this typelist.
• State – Defines the states of the United States, Australia, and Germany, provinces of Canada, and prefectures
of Japan that are in the State typelist.
• Type – Defined by the HolidayTagCode typelist. You can add other types to this typelist.
The HolidayTagCode typelist includes the typecodes General, FederalHolidays, and CompanyHolidays.
Using Gosu Methods to Work with Holidays

You can write Gosu code to set business days differently for various tasks.
Working with Holidays, Weekends, and Business Weeks 273

For example:
• A regulatory requirement mandates that a task be completed within a defined number of business days. Your
code can take into account the holiday schedule of an agency in a certain jurisdiction.
• After auto-assigning a task to be completed in a certain number of business days, Gosu code can take into
account the holiday schedule of the assignee.
• Gosu code can check General holiday types in all zones through which the mail passes to determine the correct
number of days to allow for mail to be delivered. Use this code for determining when to send time-sensitive mail.
Use Gosu methods that use holiday Type and Zone to determine the correct number of business days.
Gosu Holiday Methods that Use Zones and Types

The methods getConfiguredHolidays, addBusinessDays, and businessDaysBetween on the Date entity get lists
of holidays, add business days to dates, or compute business days between dates. Depending on the parameters,
these methods can take into consideration holiday types or zones. You can find these methods in
gw.util.GWBaseDateEnhancement, and you call them by using a Date object.
See also
• “Gosu Methods for Business Hours” on page 276
Business Weeks and Business Hours

ClaimCenter can accommodate your business schedule by specifying your exact work week and hours. For example,
the normal business hours of an insurer begin on Monday and end on Saturday. For this insurer, you configure
ClaimCenter to have the hours from Monday to Friday begin at 8 a.m and end at 7 p.m. For Saturday, you configure
the business hours to begin at 10 a.m and end at 2 p.m.
The config.xml file contains business calendar parameters. ClaimCenter applies these parameters system-wide.
These parameters are the default values.
The business calendar parameters enable you to specify:
• For each day of the week, whether it is a business day. For example, to make Monday a business day, set
IsMondayBusinessDay to true.
• The time that each business day starts and ends. Set BusinessDayStart and BusinessDayEnd.
• The day that is the end of the business week. Set BusinessWeekEnd.
• The time that marks the start of a new business day. Set BusinessDayDemarcation.
You can configure business weeks at a more granular level and in one place. Click the Administration tab and navigate
to Business Settings→Business Week. The values you set in this screen override the configuration parameters in
config.xml.
A result of setting the business week on the Business Week screen is that you can define business weeks based on
zones. For example, your main claim office is based in California and is open Monday through Friday 8:00 a.m. to
5:00 p.m. However, the customer service center in Arizona is open until 9:00 p.m. on weeknights and on Saturdays
from 8:00 a.m. to 3:00 p.m. You can define by zone how business weeks and hours are defined.
See also
• “Work with business weeks” on page 275
Business Week Implementation

BusinessWeek.eti defines the table schema for the BusinessWeek entity. This entity stores data identifying the
days of the week that are business days and what the business days’ business hours are. You can also specify the

zones to which a business week applies or specify that it applies to all zones. You accomplish these tasks in the
Business Weeks screen. Open this screen on the Administration tab by navigating to Business Settings Business Week.
There are config.xml parameters that ClaimCenter uses when no BusinessWeek entity exists in the database. If at
least one BusinessWeek is active in the database, ClaimCenter uses the BusinessWeek that best matches the relevant
zone. The relevant zone can be explicitly passed in as a parameter or inferred from a passed-in address.
For example, the BusinessWeek entity has the following behavior.
• If at least one BusinessWeek is active in the database, ClaimCenter uses the BusinessWeek that best matches the
relevant zone. You can explicitly pass in the relevant zone as a parameter, or ClaimCenter can infer it from a
passed-in address.
• If only one BusinessWeek is in the database and its AppliesToAllZones field is true, all business calendar
calculations use this defined business week. The config.xml parameters are ignored.
• If the database contains a business week that is linked to the zone Arizona and a business calendar calculation
specifies the same zone, then this Business Week is used.
• If the database contains two Business Weeks, matching is first attempted on zones of deeper granularity of
ZoneType. For example, the first Business Week has the California zone and the second has the San
Francisco zone. Additionally, a business calendar calculation specifies an Address with State="California"
and City="San Francisco". In this case, the San Francisco BusinessWeek is used. In this example, City is a
more granular ZoneType than State.
If a BusinessWeek entity does not exist in the database, ClaimCenter uses the business week parameters defined in
config.xml.
See also
Business Day Demarcation

The BusinessDayDemarcation field on BusinessWeek is a time value, such as 5:00 p.m., that is helpful when a
time falls between the business hours of two days.
For example, your business days start at 8:00 a.m. and end at 5:00 p.m., and a claim is called in at 6:00 p.m.
ClaimCenter uses BusinessDayDemarcation to determine whether that claim is considered part of the previous
business day or the following business day.
BusinessDayDemarcation cannot be set to a time that is within your defined business hours.
See also
Work with business weeks

Procedure
1. From the Administration tab, select Business Settings→Business Week.
2. Click Add Business Week. The New Business Week screen opens.
3. Enter a business week name and indicate if it applies to all zones.
4. If you select No, you must define the zones to which this business week applies.
5. Define the day that ends your business week and the business day demarcation.
6. Define for each day of the week if it is a business day and, if so, the hours in that day.
Business Weeks and Business Hours 275

Business Hours
Business hours are defined in the BusinessDayStart and BusinessDayEnd configuration parameters. These times
are based on the server clock. ClaimCenter provides Gosu methods that calculate elapsed hours by using these
defined business hours. However, these defined hours do not deal with holidays accurately.
Specifying holidays affects only dates, not hours. However, you can write Gosu code for a task usually
accomplished in hours rather than in days by using Gosu business hour methods. These methods take holidays into
consideration after calculating business hours.They are completely separate from business day methods.
For example, an insurer promises to respond to all inquiries and claims within two hours after receiving an inquiry.
You call the insurer on Friday at 4:30 p.m., and Monday is a holiday. The insurer must respond by Tuesday, one and
a half hours after the business day starts.
Gosu Methods for Business Hours

The methods addBusinessHours and businessHoursBetween on the Date entity add business hours to dates or
compute business hours between specific dates. Depending on the parameters, these methods can take into
consideration holiday types or zones. The methods also use the settings for business hours, days, and weeks in the
config.xml file.
The methods are defined in gw.util.GWBaseDateEnhancement, and you call them by using a Date object.
While certain methods might appear to be similar, they can have different results.
• The method addBusinessDays works differently from addBusinessHours. For example, in the base
configuration, a business day runs from 8:00 a.m. to 5:00 p.m. Adding one business day to Sunday 12:00 a.m.
results in Monday 12:00 a.m. However, adding nine business hours to Sunday 12:00 a.m. results in Tuesday
8:00 a.m. In the base configuration, for calculation purposes, a business day includes the times 8:00 a.m. through
4:59 p.m. Therefore, adding 9 hours to a weekend day goes past the next business day, Monday, to 8:00 a.m. the
following day, Tuesday.
• The method businessDaysBetween works differently from businessHoursBetween. If the business day is
between 8:00 a.m. and 5:00 p.m., calling businessDaysBetween for Sunday 12:00 a.m. and Monday 12:00 a.m.
returns a value of 1. Calling businessHoursBetween for Sunday 12:00 a.m. and Monday 12:00 a.m. returns 0.
Holiday Permissions
The following system permissions control whether you can view the Holidays screen and edit the holidays.
• holidayview
• holidaymanage
In the base configuration, the Super User role has these permissions.
Business Week Permissions

The following system permissions control whether you can view and edit the Business Week screen.
• buswkview
• buswkmanage
In the base configuration, the Super User role has these permissions.

chapter 29
Vacation Status
If you are unable to work on claims because you are not in the office, ClaimCenter can redistribute your work load
through the vacation status feature. You can change your vacation status and designate a backup user in your
absence.
ClaimCenter assigns work to users, such as work on claims, exposures, or activities, either through assignment rules,
such as by round robin, or by manual assignment. Vacations and other time off must be taken into account in
assigning and reassigning work.
Vacation status can affect both current and new work assignments. These status values are available in the Vacation
Status worksheet, as described in “Set Your Vacation Status” on page 278. They are defined in the
VacationStatusType typelist, which in the base configuration provides typecodes supporting the following
statuses:
• At work – You receive new assignments. This setting is the default value.
• On vacation – You continue to receive new work, but current work assignments go to your designated backup.
Your backup must check the Vacation tab to see these assignments.
• On vacation (inactive) – This status is identical to On Vacation with one exception: You are not assigned new
work by an assignment rule that considers multiple assignees. For example, the assignToCreator method
assigns work, but the assignUserByRoundRobin method does not.
These rules apply to claims, exposures, and activities of the person who is on vacation.
If you have administrative permissions, you can change vacation status and backup users through the Administration
tab.
Additionally, a user who has the group’s View load factor permission can see load factors, vacation statuses, and
backup users for all team members in the Load and Vacation screen. On the Desktop tab, navigate to Actions→Load and
Vacation. A user who has the load factor permission Admin for the group can also edit this screen and change load
factor, vacation status, and backup user for any team member. For information on setting these two permissions, see
the discussion of the Load and Vacation screen at “Overview of Team Management” on page 443.
Vacation Status 277

Set Your Vacation Status

About this task
Use the following steps to change your status.
Procedure
1. Log in to ClaimCenter.
2. On the Desktop tab, navigate to Actions→Vacation Status.
3. On the Vacation Status worksheet, select the status At work, On vacation, or On vacation (Inactive) from the Vacation
Status drop-down list.
4. To select a backup user to do your work while you are on vacation, use the Backup User drop-down list or select
a user by using the picker drop-down menu. If possible, choose a user with the same permissions, from the
same security zone, and with the same authority limits as you.
The Backup User drop-down list shows users in your group.
The picker enables you to:
• Search for a User – Useful if you know someone in another group who can fill in for you.
• Select User – Shows a hierarchical list of all the groups in your organization.
5. When you return from vacation, navigate to the Vacation Status worksheet and select At work from the Vacation
Status drop down menu.
Access the Vacation Tab as a Backup User

About this task
You can view work assigned to you as a backup user by another user currently on vacation.
Click the Vacation tab.
This tab is not available if there is no work for you. This tab is where you select any activities, claims, or exposures
assigned to you to work on as a backup for another user who is on vacation.
Next steps
See also
• “Backup Users and Permissions” on page 278
Backup Users and Permissions

Generally, the Backup User feature works best if the backup user is in the same office and has the same level of
responsibility as the person going on vacation.
System permissions are not inherited by the backup user from the user who is on vacation. Therefore, ideally, the
backup user would have the same set of permissions as the person on vacation so the backup user can assume the
same level of responsibility. For example, if the user on vacation can work on sensitive claims, but the backup user
does not have those permissions, the backup user cannot work on those sensitive claims.
Additionally, security zones cannot be inherited, so it makes sense to have a backup user from the same security
zone as the user going on vacation.
Another factor to consider is authority limits. Ideally, the backup user would have the same authority limits as the
user on vacation. If the backup user does not have the same or greater authority limits, the backup user cannot see
any activities that require those authority limits. For example, if the backup user does not have the appropriate
authority limit, the user cannot see the activity to approve reserves on the Activities screen of the Vacation tab.
278 chapter 29 Vacation Status
IMPORTANT If you are designated as a backup user, and you go on vacation, ClaimCenter does not send any
activities to your backup. The system also does not warn you of this behavior.
Backup Users and Activities

The person designated as a backup user can edit activities owned by the vacationing user. Backup users can update,
complete, skip, assign, or link a document to an activity. They can also view notes on an activity, but only if they
have the same permissions. However, backup users cannot approve approval type activities unless they have the
actapproveany permission. For example, a supervisor wants to assign his or her manager as the backup user, but
the manager has not been assigned the supervisor’s role.
In the base configuration, you can do the following:
• If you are the backup user and you have the permissions and authority limits to approve a certain type of activity,
you can reassign the activity to yourself. Then, in the Activities screen on the Desktop tab, you can find the
reassigned activity and approve it.
• An administrator can add the permission Approve any approval activity (code is actapproveany) to the backup
user’s role. This permission grants the user approval rights to any approval activity and is not restricted to being
used in the backup role. The backup user still must have the correct authority limits. In the base configuration,
this permission is not found on the supervisor’s role, but on the manager’s role. While this choice is an option, it
might not best serve your business requirements.
Backup Users and Activities 279

280 chapter 29 Vacation Status

chapter 30
Question Sets
Question sets are defined sets of questions used to help an interviewer obtain complete information. They regularize
the information gathering and create a searchable record of the answers. In ClaimCenter, question sets are used:
• To help build a database of recommendations for service providers.
• To help assess the risk that a claim is fraudulent.
IMPORTANT Question sets are not designed to be substituted dynamically based on changes in the user interface.
After a user has answered any questions in a question set, the question set is static and cannot be switched out for
another question set.
Service Provider Question Sets

IMPORTANT This feature requires that ClaimCenter be integrated with ContactManager. For more information, see
the Guidewire Contact Management Guide.
A claims adjuster for an auto claim might have to choose a body shop from a list of providers. To help in this
selection, the adjuster can rely on question sets that do the following:
• Find out from the claimant how much value is placed on perfect work versus rapid body work, or if the claimant
has previous experience from a particular provider.
• Find out the claimant’s level of satisfaction after the work is completed for entry into the list of providers.
• Find out from the adjuster a way to sort the provider’s list on the basis of good performance.
ClaimCenter calculates the average scores from question sets for individual service providers. The application then
displays these results for each provider, ranks providers by score, and searches on the scores to select service
providers.
Question Sets 281

See also
• This feature is described in detail in the Guidewire Contact Management Guide.
Fraud Question Sets and Points

An adjuster or special investigator can determine whether a claim is fraudulent. The score of a question set,
containing a list of questions similar to the ones in the following table, can help in that determination:
Risk points Possible questions in the Fraud Evaluation question set for auto claims
none Is claimant familiar with insurance claims terminology and procedures?
no = 10 If yes to the previous question, then would claimant’s business give claimant this knowledge? (Show only if the
previous answer is yes.)
yes = 5 Does claimant refrain from using mail, fax, or other traceable types of communication?
yes = 15 Is claimant aggressively demanding settlement?
yes = 30 Will claimant accept a partial settlement if it is immediate?
yes = 10 Is claimant experiencing financial problems?
yes = 20 Are there discrepancies between claimant’s statements and official accident reports?
yes = 10 Are there discrepancies between claimant’s statements and those of witnesses?
yes = 10 Is the claimant’s lifestyle inconsistent with the claimant’s income level?
yes = 20 Has the claimant provided an excess of documentation and supporting material for the claim?
Grouping and saving these questions in a single place (a question set) ensures that all questions are asked. By
assigning risk points to each question, ClaimCenter can calculate their sum, a suspicious claim score. Using the full
set of questions and the risk point feature ensures that all claims can be examined in a uniform and fair way.
See also
• “Using Question Sets” on page 146
Working with Question Sets

You create QuestionSets and their related entities by creating XML files and then importing them through the
application.
Import Question Sets and Questions

About this task
With administrative permissions, you can import question sets.
IMPORTANT If you import a question set XML file, ClaimCenter creates instances of the entities defined in the
file. Do not delete these instances in a production environment, because doing so will prevent ClaimCenter from
starting. Additionally, while it is possible to retire entities, do not retire the QuestionSet, Question,
QuestionChoice, or QuestionFilter entities that are part of a service provider performance review. Existing
reviews might still be using them. See the Guidewire Contact Management Guide.
Procedure
1. Click Administration and navigating to Utilities→Import Data.
2. Choose the file to import.
282 chapter 30 Question Sets

Result
Importing a question set XML file adds the QuestionSet and its Question, QuestionChoice, and QuestionFilter
entities to your installation. The import can occur while the server is running.
Next steps
See also
Export Question Sets

About this task
With administrative permissions, you can export question sets.
Procedure
1. Click Administration and navigate to Utilities→Export Data.
2. Choose Questions in the DatatoExport field.
Next steps
See also
Creating a Question Set

Each QuestionSet consists of Question entities, which can in turn point to the allowed set of answers to the
question, a QuestionChoice entity. The Question entities you create have the following requirements:
• Each Question must have a foreign key back to the QuestionSet it appears in.
• To be scored, the QuestionType field must have the value Choice. You can use other values, such as Boolean,
Integer, or String, but questions with these types will not be scored.
• Any Question with its Required field set to true must be answered before the QuestionSet is complete.
• Priority sets the order in which the question is listed in its QuestionSet. The values start with zero, and count
upwards.
• The QuestionFormat field is optional and can be ChoiceSelect or ChoiceRadio or null. The field can be null
only for a QuestionType other than choice.
• Each Question entity of type Choice must point to a QuestionChoice entity.
Define a Question in an XML file as follows:
<Question public-id="question13">
<DefaultAnswer/> 
<Indent>0</Indent> 
<Priority>12</Priority> 
<QuestionSet public-id="generalquestionset"/> 
<QuestionType>Choice</QuestionType> 
<Required>false</Required> <-- if question must be answered or have non-null default -->
<ShouldRetireFromImportXML>false</ShouldRetireFromImportXML <-- if retired or active -->
<Text>Did the claimant present excessive documentation?</Text> 



<QuestionFormat>ChoiceRadio</QuestionFormat>
</Question>
Similarly, a QuestionSet looks like this:
Working with Question Sets 283

<QuestionSet public-id="AssignValue">
<Name>Repair Timeliness</Name> 
<Priority>0</Priority> 
<QuestionSetType>autorepair</QuestionSetType> 

<ShouldRetireFromImportXML>false</ShouldRetireFromImportXML <-- if retired or active -->
</QuestionSet>
Creating a QuestionChoice
A QuestionChoice is one of the allowed answers for a Question of QuestionType=Choice. You must create one of
these entities for each choice of each question, as defined in XML as follows:
<QuestionChoice public-id="carquestion11yes">
<Code>Yes</Code> 
<Description>Yes</Description> 
<Name>Yes</Name> 
<Priority>0</Priority> 
<Question public-id="question11"/> 
<Score>0</Score> 
</QuestionChoice>
See also
• “Creating a Question Set” on page 283
Creating a Conditional Question

You can create conditional follow-up questions by using a question filter. Conditional questions can be useful for
tailoring a single question set to obtain information from a number of similar cases. Consider the following partial
sequence of questions that determine if an auto claim needs special investigation:
• Question siucarquestion1: “Was vehicle stolen?”
◦ If yes to siucarquestion1, then conditional siucarquestion2: “Was vehicle purchased outside of State?”
◦ If yes to siucarquestion1, then conditional siucarquestion3: “Does the stolen vehicle have salvage title?”
The following example is in the sample questions sets you can import as part of ClaimCenter sample data. It uses
QuestionFilter elements at the bottom and shows how to code the previous sequence of questions:
<Question public-id="siucarquestion3">
<DefaultAnswer/>
<Indent>20</Indent>
<Priority>2</Priority>
<QuestionSet public-id="siucarquestionset"/>
<QuestionType>Choice</QuestionType>
<Required>false</Required>
<ShouldRetireFromImportXML>false</ShouldRetireFromImportXML>
<Text>Does the stolen vehicle have salvage title?</Text>
</Question>
<QuestionChoice public-id="siucarquestion3no">
<Code>No</Code>
<Description>No</Description>
<Name>No</Name>
<Question public-id="siucarquestion3"/>
<Score>0</Score>
</QuestionChoice>
<QuestionChoice public-id="siucarquestion3yes">
<Code>Yes</Code>
<Description>Yes</Description>
<Name>Yes</Name>
<Score>1</Score>
</QuestionChoice>
<DefaultAnswer/>
<Indent>20</Indent>

<Text>Was vehicle purchased outside of State?</Text>
</Question>
<Code>No</Code>
<Name>No</Name>
<Score>0</Score>
</QuestionChoice>
<Code>Yes</Code>
<Name>Yes</Name>
<Score>1</Score>
</QuestionChoice>
<DefaultAnswer/>
<Indent>0</Indent>
<Text>Was vehicle stolen?</Text>
</Question>
<Code>No</Code>
<Name>No</Name>
<Score>0</Score>
</QuestionChoice>
<Code>Yes</Code>
<Name>Yes</Name>
<Score>0</Score>
</QuestionChoice>
<QuestionFilter public-id="siucarfilter1">
<Answer>Yes</Answer>
<FilterQuestion public-id="siucarquestion1"/>
</QuestionFilter>
<QuestionFilter public-id="siucarfilter2">
<Answer>Yes</Answer>
<FilterQuestion public-id="siucarquestion1"/>
</QuestionFilter>
This series of questions looks like the following for an auto claim. The user navigated to the Loss Details→Special
Investigation Details screen and clicked Edit to fill out the questionnaire:
Working with Question Sets 285

Reusing Questions
You can use the same question set in various settings. Questions can be used by only one question set. A question is
associated with only one question set, and a question choice must be associated with a single question.
Localization of Question Sets

Question sets are not localized. If you want to configure multiple question sets for different locales or languages, use
the gw.api.util.LocaleUtil.getCurrentUserLanguage method. Then use that result to select the correct
question set to use.
See also
• “Creating a Question Set” on page 283
Question Set Entities

The following entities relate to question sets:
Entity Description
Answer Answers to questions can be text, boolean (yes or no), dates, numbers, or a question choice. This entity has
foreign keys to Question, QuestionChoice, and AnswerSet.
AnswerSet A group of answers that correspond to a user answering one question set form. There is a foreign key to Que
stionSet.
QuestionChoice A type of answer, designated in the question by setting the question’s type. Question choices can be scored.
There is a foreign key to Question.
Question A question the user sees on the screen. ClaimCenter typically uses questions to gather information
regarding fraud and service provider recommendations. Question types can be boolean, choice, string, and
integer and are defined in the QuestionType typelist.
QuestionFilter A filter that controls the visibility of a question based on the answer to a previous question in a question
set. Has foreign keys to Question and QuestionFilter.
QuestionSet Question sets are groups of questions, typically used in the risk qualification process or to develop
supplemental underwriting information. The value of the typekey QuestionSetType, which uses values
defined in the typelist QuestionSetType.ttx, determines what kind of question set it is.

Entity Description
SubQuestion In the user interface, a subquestion is the text that displays as a bulleted list following a question. Has
foreign key to Question.
The fraud investigation question set is an array, SIAnswerSet, in the Claim entity. This array field points to an array
of SIUAnswerSet entities, which correspond to sets of answers for the claim.
IMPORTANT While the QuestionSetFilter entity exists in the product, Guidewire recommends that you not use
it. It is reserved for future use.
Question Set Entities 287


chapter 31
Subrogation
Subrogation is the legal technique by which one party represents another party, using their rights and remedies
against a third party. In the insurance industry, a carrier sometimes settles a claim, knowing that another party can be
liable for the costs. The carrier then attempts to recover those costs from the other party on behalf of their insured.
Most insurance policies cede the insured’s recovery rights to their carriers.
A common example is pursuing recovery after an insurer pays its insured client for accident costs for which a third-
party person or insurer is liable. The insurer then has the right to pursue a recovery effort from the third-party person
or the third party’s insurance company. In other words, the insured client subrogates these recovery rights to the
insurance company. Another use of subrogation is to recover damages from a company that has made a defective
product. For example, if a tire failure due to a manufacturing defect causes an accident, a carrier’s subrogation rights
enables them to sue the tire manufacturer.
Subrogation typically involves recovering costs from the liable party’s insurance company, usually through informal
negotiations between the two carriers involved. If the third party has no insurance, however, subrogation can involve
legal action or collection agencies.
Subrogation can be managed at the claim level and the exposure level. This topic describes the subrogation feature
and includes:
Note: In ClaimCenter, the third party is also known as the Adverse or Responsible Party. The data model uses
Adverse for brevity, and the user interface uses the term Responsible because it is less confrontational.
Working with Subrogation

In ClaimCenter, a subrogation is an assignable object and can be associated with the claim or with individual
exposures. A subrogation typically involves a third party, whose fault rating can also be specified for the claim or if
needed, for each exposure that is in subrogation.
The following figure is a conceptual overview of a subrogation process:
Subrogation 289
Subrogation Workflow
Subrogation not worth pursuing
START
Get 3rd Party Data/ Yes
Identify Subro Assign Group 3rd Party
Investigate/
Opportunity and User Insured?
Find At-fault %
No
Uninsured Not worthwhile

Fail, Try to Collect Negotiate with Negotiate with
3rd Party 3rd Party Insurer
Fail, Try Again Fail, Try to Sue Fail, Don’t sue

Agree
Send Details to
Collection Agency Arbitrate
File Lawsuit Agree
Recover
Win or Settle Win
Agency Obtain and Succeed Attempt to Obtain and Note

Fails Note Recovery Collect Recovery
Fail or Fail or not

not worthwhile worthwhile
Close
Subrogation
DONE
A subrogation primarily involves the following activities:

• “Start a Subrogation” on page 290
• “Recording a Subrogation Investigation” on page 292
• “Refer a Claim to Subrogation” on page 294
• “Viewing Responsible Parties” on page 294
• “Assigning a Subrogation” on page 295
• “Pursuing a Subrogation Strategy” on page 296
• “Working with Subrogation Recoveries and Recovery Reserves” on page 297
• “Schedule Delayed Recovery Payments” on page 298
• “Requirements for Closing a Subrogated Claim” on page 298
Start a Subrogation
About this task
In a claim, a subrogation typically involves a third party. For more information on subrogation, see “Subrogation”
on page 289.
290 chapter 31 Subrogation

Procedure
1. Start a subrogation in one of the following ways:
• Edit the Loss Details screen of a claim to signify that the other party is at fault. See “Edit the Loss Details
Screen for Subrogation” on page 291.
• Specify a Loss Cause in the Loss Details screen of a claim that implies that the other party is at fault. For
example, Rear-end collision.
• Set the Subrogation Status of the claim to Open or Review. See “Set Subrogation Status” on page 291.
2. Access the Subrogation screen by opening a claim and clicking Subrogation in the sidebar.
Edit the Loss Details Screen for Subrogation
About this task

Typically, to start a subrogation, you edit the Loss Details screen.
Procedure
1. Open a claim, click Loss Details in the sidebar, and click Edit.
2. Set the Fault Rating field to Other party at fault.
The Fault Rating determines whether some other party bears some responsibility for the loss. Values come from
the FaultRating.ttx typelist that you can extend in Guidewire Studio. In the base configuration, the values
you can select are <none>, Other party at fault, Fault unknown, Insured at fault, and No fault.
This field is not available in workers compensation claims.
3. Set the Fault Rating to Insured at fault.
Insured’s Liability % displays below Fault Rating.
4. Set Insured’s Liability % to less than 100%.
In this case, someone else shares responsibility, and a claim contact with a Responsible Party role exists.
Next steps
You can write rules in Guidewire Studio that evaluate values in the Loss Details screen to determine if subrogation is
to be pursued.
See also
• “Insured’s Liability Percentage for a Subrogation” on page 291
Insured’s Liability Percentage for a Subrogation

The Insured’s Liability % is the amount of responsibility the insured bears for the loss. The field displays on the Loss
Details screen after you set the Fault Rating field to Insured at fault.
In auto claims, especially, subrogation is possible only if the other driver, or another party, bears a significant
amount of responsibility for the loss. Determining this value and deciding whether another party is mostly at fault
are critical in identifying whether there is an opportunity for subrogation. In auto claims, police reports are often a
good first source of information.
Set Subrogation Status
About this task

In addition to setting the fault rating, you can make the Subrogation menu item visible by setting the Subrogation
Status. After you have started a subrogation, Subrogation Status is also available from the Subrogation screen.
Start a Subrogation 291

Procedure
1. Open a claim and navigate to Summary→Status.
2. On the Claim Status screen, click Edit.
3. Set the Subrogation Status field to Open or In Review.
The Subrogation menu link becomes visible in the sidebar.
Next steps
See also
• “Edit the Loss Details Screen for Subrogation” on page 291
Recording a Subrogation Investigation

ClaimCenter provides Subrogation screens that can help you organize each subrogation investigation. The screens are
available from the Subrogation menu link in the sidebar. You must have started a subrogation for this menu link to be
visible.
Navigate to Subrogation→Summary to open the Subrogation: Summary screen, which provides an overview of the
subrogation. The summary is automatically created when it is determined that there is an opportunity for
subrogation. A subrogation summary can have one or more subrogations. It includes general details such as the
jurisdiction, status, subrogation owner and deductible information. It also lists information on the Responsible
Parties and Statute of Limitations. You can associate notes and documents with subrogations as well.
The Subrogation: Summary screen has three cards: General, Notes, and Documents.
General Card of the Subrogation Summary

Use General to record:
• Jurisdiction – Specifies the jurisdiction state of the subrogation. This value is derived from the Loss Details screen
and is read-only.
• Fault – Determines whether some other party bears some responsibility for the loss. Values are derived from the
FaultRating.ttx typelist, which you can extend in Guidewire Studio. This field is the same as Fault Rating in the
Loss Details screen. See “Edit the Loss Details Screen for Subrogation” on page 291.
• Insured’s Liability % – The amount of responsibility the insured bears for the loss. The field displays directly under
Fault Rating after you set the Fault Rating field to Insured at fault. This is the same as Insured’s Liability % in the
Loss Details screen. See “Edit the Loss Details Screen for Subrogation” on page 291.
• Subrogation Status – This field has the following possible values, three of which are defined in the
SubrogationStatus.ttx typelist:
◦ <none> – No subrogation has been attempted for this claim.
◦ Closed – The subrogation attempt has been completed or abandoned.
◦ Open – A subrogation pursuit has been started.
◦ In Review – The subrogation opportunity or pursuit is awaiting review by the adjuster’s manager or another
ClaimCenter user, such as a member of a subrogation team.
In cases where there is more than one subrogation, the Subrogation Status value shown is an aggregate of
individual values. If at least one subrogation is InReview, the summary status is considered In Review as well.
Otherwise, if at least one subrogation is Open, the Subrogation: Summary status is considered Open. In all other
cases, the subrogation is considered Closed.
• Externally Owned – Indicates whether subrogation for this claim has been assigned to an outside firm, like a
collection or arbitration agency. If you answer Yes, enter the name of the External Subrogator.

In the case of claims in subrogation, the deductible to be returned to the insured is a calculated value based on the
expected recoveries. The deductible might be prorated, that is, adjusted according to the affected time period or
damage incurred, or paid in full.
In the Deductible section, you can record the following information:
• Prorate Deductible – Boolean value that specifies if the deductible amount is prorated or not. In the base
configuration, the default value is True.
• Deductible to Repay – Displays the calculated deductible amount to be repaid to the insured, typically the total of
the deductible amount and expected recovery percentage across all exposures and responsible parties. This
amount is based on how much of the deductible the carrier has collected, either by receiving a recovery from the
insured or by applying the deductible on a payment.
• Deductible Repaid – Boolean value that indicates if the deductible amount above has been repaid to the insured or
not. In the base configuration, the default value is No. Deductibles are reimbursed by creating a check to the
insured and applying the deductible.
Note: If the Deductible to Repay is greater than zero and the Deductible Repaid value is No, the subrogation cannot
be closed.
In addition to these fields, the General tab displays summaries of:
• Responsible Parties – This editable list view displays all responsible parties with a few of their characteristics, such
as their responsibility percentages. You can add or remove responsible parties in this screen, or you can use the
Responsible Parties screen to add, remove, or provide more information about them. See “Detail Card for
Subrogation Responsible Parties” on page 294.
• Exposures in Subrogation – Subrogation can be handled at the exposure level as well. Click Subrogate Individual
Exposures to display the Exposures in Subrogation list view. All the exposures for the claim are listed in this section,
and you can edit various details of each exposure, such as the Subrogation Status, Close Date, and Outcome. The
Close Date and Outcome fields are editable only when the Subrogation Status is set to Closed, and Outcome is a
required field.
In the base configuration, the Outcome field has the following choices:
• Compromised
• Discontinued
• Full Recovery
• Not Pursued
• Uncollectible
These values are derived from the SubroClosedOutcome.ttx typelist, which you can view and modify, if needed, in
Guidewire Studio.
Note: The status in this screen refers to the subrogation state only, not the state of the exposure itself. If the
Subrogation Status is Closed, the subrogation related to the exposure is closed.
• Statute of Limitations – It is important to track the statute of limitations laws that govern the time after which
subrogation is no longer possible. These laws are different for injuries and property damage, and governments
are governed by different statutes. In the list view on the subrogation screen, you can add and remove statutes of
limitations, and you can view and enter the following information:
◦ Type – The subrogation type can be Medical costs, Property Damage, or Other.
◦ Jurisdiction – The state, province, or other jurisdiction of the statute, depending on the country.
◦ Description – Text describing the subrogation.
◦ Statute Deadline – The deadline imposed by the statute.
Notes Card of the Subrogation Summary

Use this card to add new notes to the subrogation or to edit, delete, or print a note.
Recording a Subrogation Investigation 293

Documents Card of the Subrogation Summary

Use this card to create new documents, edit documents, or link documents to the subrogation.
Refer a Claim to Subrogation

About this task
In the Subrogation: Summary screen, you can refer a claim to a subrogation specialist group by using the following
steps:
Procedure
1. Click Refer to Subrogation to refer the claim to a group that is previously designated to handle subrogation.
2. In the Referto Subrogation screen, enter a Referral Comment.
3. Click Update.
You cannot change Refer to Subrogation to No after you have entered Yes for this field.
After you click Update, the Referral Date and time of referral also appear on the Subrogation: Summary screen.
Next steps
See also
• “Notes” on page 263
• “View Documents for a Subrogation” on page 591
• “Link a Document to a Subrogation” on page 598
Viewing Responsible Parties

The Subrogation→Responsible Parties screen includes details on the parties responsible for the loss, financial
information for the subrogation, and associated documents.
The Subrogation: Responsible Parties screen has three cards: Detail, Financials, and Documents.
See also
Detail Card for Subrogation Responsible Parties

This screen shows the same information as the Responsible Parties list view in the Subrogation: Summary screen on the
General card. Select any party and edit information that is important for deciding whether to attempt to collect from
this party, and, if so, how to pursue collection.
Some of the fields you modify on this screen are:
• Name – The name of the responsible party. You can pick from a list of names already associated with the policy or
enter a new name.
• Liability % – Your estimate of the legal percentage of fault for the loss, often based on police reports or precedents
from similar situations. The sum of these percentages from all responsible parties must be no more than 100%.
• Expected Recovery % – Your estimate of the actual amount that you expect to recover.
If the configuration parameter UseRecoveryReserves is set to true, entering a percentage enables the Set Open
Recovery Reserve button in the ClaimTotal: Financials card. Clicking that button sets the open recovery reserves to the
amount based on that percentage. If you edit that amount, you must click the button again so ClaimCenter can
recalculate new values.
• Classification – Values, from the SubroClassification.ttx typelist, which are limited in the base configuration
to <none>, Insured, and Uninsured. The Classification governs the Strategy choices that you see. If you select Insured,

you must also specify at least the name of the responsible insurance company in the contact information for the
party.
• Strategy – What to do in pursing a subrogation recovery against this responsible party. The choices come from the
SubroStrategy.ttx typelist. The strategy choices are often set or reset after a review, usually by the
subrogator’s manager. The party’s Classification categorizes these choices.
• Government Involved? – If a government agency is a responsible party, or if a private responsible party is
performing work for a government agency, then other information must be collected. This information includes
the name and jurisdiction of the government agency, a description of the agency’s involvement, and any time
limitations due to a statute of limitations restriction. Enter the actual information in the Statute of Limitations table
in the General tab of the Subrogation screen.
• Primary Contact – Optional information about the person to contact. It can be the same as the responsible party.
Finally, this screen contains a summary of the recoveries already received and to be received from each party. The
summary values are:
• Total Amount Recovered – This amount includes all recoveries from this contact for all cost types, such as expenses
and claim costs. Although you might not expect any recoveries of this kind from the responsible party, any non-
subrogation recovery types, such as Salvage, are included in the total.
• Total Claim Costs Recovered via Subrogation – The portion of the Total Amount Recovered for the cost type Claim Costs
and the recovery category Subrogation.
• Scheduled Payment - Applicable? – Choosing Yes opens additional fields that can help in tracking the expected
recovery receipts.
See also
• “General Card of the Subrogation Summary” on page 292
• For information on the differing strategies available for insured and uninsured parties, see “Pursuing a
Subrogation Strategy” on page 296.
• For information on tracking recovery receipts, see “Schedule Delayed Recovery Payments” on page 298.
Using the Financials Card for Subrogation Responsible Parties

The Financials card shows the claim financials and corresponding subrogation financials for each responsible party.
You can also view the subrogation financials for the entire claim by clicking the Claim Total row. Use this view to
create open recovery reserves based on pending recoveries. See “Working with Subrogation Recoveries and
Recovery Reserves” on page 297 for more information.
The Financials card list view displays claim financials data and subrogation financials data listed by exposure.
Following are some industry best practices that the base configuration of ClaimCenter uses to display financial
information related to subrogation recoveries. If your organization handles subrogation differently, this feature
requires configuration.
• Claim costs are more likely to be recovered than claim expenses, so the Financials card shows reserve lines only
for non-expenses. Additionally, the reserve lines shown are only for the claim cost types supplied with the
application. If you want to show expenses, or if you have added other non-expense cost types that you want
ClaimCenter to show, you must configure ClaimCenter to do so.
• The field titled Net Paid displays the true net cost of the claim to the insurer after recoveries, such as salvage, and
prior to any recoveries from subrogation.
Assigning a Subrogation
A subrogation is an assignable object in ClaimCenter. You can assign a subrogation by using automatic or manual
assignment. When initially created, a subrogation is unassigned until referred to a subrogation unit. Once referred, it
can then be reassigned manually.
Viewing Responsible Parties 295

To assign subrogation activities to experts in subrogation, first identify the experts in one of the following ways:
• Place qualified users in a special group, such as a Subrogation Specialists group.
• Grant users a special user role in the UserRole typelist.
• Define and use a new user attribute of UserAttributeType.
See also
• “Users, Groups, and Regions” on page 477
Pursuing a Subrogation Strategy

After identifying and deciding to pursue a subrogation opportunity, you must decide on a strategy and pursue the
actions it specifies. See the diagram in “Working with Subrogation” on page 289 for a visual representation of these
strategies.
You enter the Strategy in the Responsible Parties screen, described at “Detail Card for Subrogation Responsible
Parties” on page 294. The Strategy field lists options for the common ways to proceed. The values listed depend on
the value of the Classification field, <none>, Uninsured, or Insured.
You can choose to add rules in Guidewire Studio that use the strategy value as a Strategy condition to create
activities. For example, a rule indicates that if the strategy is Pursue and no letter has been sent to ask for payment,
then create an activity to send the first one. Available strategies are in the SubroStrategy.ttx typelist.
Classification for Liable Party Is Uninsured

In the Responsible Parties screen, a value of Uninsured in the Classification field of the Detail card limits choices to the
following Strategy values:
• Pursue – Send a series of collection letters. Negotiate directly with the party. You can write a series of dunning
letters and create activities to send the letters at predetermined times.
• Utilize Collection Agency – Use a collection agency and share any recovery with that agency. If you select this
option, you must enter the name and other contact information for the agency. Also, the Strategy value can trigger
a rule to create the activity to contact the selected agency.
• Lawsuit – Take legal action and absorb the costs of litigation. Use the Matters screen, available from the Litigation
menu link.
• Drop Pursuit – Do not pursue subrogation. The time and cost of recovery are not worth the effort.
If the result of these strategies is a promissory note, a section of the Financials card can track the note and its received
payments. See “Schedule Delayed Recovery Payments” on page 298.
Classification for Liable Party Is Insured

In the Responsible Parties screen, a value of Insured in the Classification field of the Detail card limits choices to the
following Strategy values:
• Pursue against Insurer or Negotiate against Insurer – These strategies are similar to the previous Pursue strategy.
• Arbitration – Use the services of an arbitrator or arbitration agency.
• Lawsuit – Take legal action and absorb the costs of litigation. Use the Matters screen, available from the Litigation
menu link.
• Drop Pursuit – Do not pursue subrogation. The time and cost of recovery are not worth the effort.
As part of some of these strategies, all recoveries are recorded in the Financials card of the Subrogation: Responsible
Parties screen.

Working with Subrogation Recoveries and Recovery Reserves

This topic is applicable if your company sets recovery reserves. You can set recovery reserves directly, and you can
record subrogation recoveries and let ClaimCenter generate corresponding recovery reserves. You might want to set
a recovery reserve directly if you want to track an expected total recovery amount and no recoveries have yet come
in.
See also
• “Recoveries and Recovery Reserves” on page 348.
Set a Subrogation Recovery Reserve Directly
About this task

You can enter a subrogation recovery reserve directly.
Procedure
1. Navigate to Actions→New Transaction→Other→Recovery Reserve.
2. Click Add to create a new recovery reserve.
3. Set the Recovery Category to Subrogation and other fields as appropriate.
Next steps
See also
• For information on some of the fields in this screen, see “Working with an Existing Subrogation Recovery
Reserve” on page 297.
Working with an Existing Subrogation Recovery Reserve

For an existing subrogation recovery reserve, you can set the value of the New Open Recovery Reserves field to the
expected total recovery amount.
Alternatively, on the Subrogation: Responsible Parties screen, you can use the Set Open Recovery Reserves button to
update recovery reserves.
The Set Open Recovery Reserves button is visible but not available to be selected if one of the following conditions is
true:
• The total Expected Recovery Percentage from all responsible parties is equal to or more than the Anticipated
Recovery %.
• The current recovery is already greater than the expected percentage in one or more reserve lines.
• The Net Paid value is zero or less.
Note: If a recovery on an individual reserve line exceeds the Expected Recovery %, ClaimCenter does not
recalculate this value. Instead ClaimCenter shows the message, “Current recovery is already greater than the
expected percentage in one or more reserve lines.” For example, you have already recovered 65% of the costs
on one reserve line and 15% on a second reserve line, and the expected recovery is 50%.
• Multicurrency reserving is turned on. That is, EnableMulticurrencyReserving is set to true in config.xml.
Enter a Subrogation Recovery
Procedure
1. To enter a subrogation recovery, navigate to Actions→New Transaction→Other→Recovery.
2. Set the Recovery Category to Subrogation and enter the recovery information.
ClaimCenter also generates a recovery reserve, if necessary.
Working with Subrogation 297

3. In the On Behalf Of field, enter the party on whose behalf the recovery is being paid.
This field enables a third-party insurance company to submit a check directly to your company and have the
correct responsible party be credited for this payment. In this case, the insurance company of the responsible
party is the Payer, and you would enter the responsible party in the On Behalf Of field.
4. Confirm on the Financials card in the Subrogation: Responsible Parties screen that the payment has been applied to
the correct Responsible Party.
Schedule Delayed Recovery Payments

About this task
Sometimes, the result of a subrogation is that an uninsured responsible party agrees to make a recovery payment, but
cannot do so immediately. Alternatively, a responsible party agrees to binding arbitration, the result of which is that
a recovery payment must be made. In both cases, a subrogation feature helps you track the expected recovery
payments.
Procedure
1. With the claim open, navigate to Subrogation→Responsible Parties.
2. Select the Responsible Party to open the Detail card.
3. Click Edit.
4. Under Scheduled Payment, set Applicable? to Yes.
5. Enter the Type, either Promissory Note or Arbitration Settlement.
• If you select Promissory Note, enter the Note Sent date and the signed Note Received date.
• If the Type is Arbitration Settlement, these fields do not appear.
6. Under Scheduled Payments, click Add and then add Date of Planned Payment and Installment Amount for each
recovery you expect.
Requirements for Closing a Subrogated Claim

Typically, you do not close a claim while a subrogation is pending. ClaimCenter prevents you from closing a claim
if any condition in the following list is true:
• The claim has a subrogation status of Open or In Review. To close the claim, the status must be Closed.
• A payment has been made on the claim and the Fault Rating is Unknown or Other Party at Fault.
• If you select Other Party at Fault and the total Liability % is less than 100%.
• If you select Insured at Fault and the Insured's Liability % is less than 100%.
Although it is not mandatory, set the Strategy to Drop Pursuit before closing the claim.
Working with Salvage

About this task
If a vehicle has been completely destroyed or damaged and the insurer decides it is not worth fixing the damage, it is
consigned to salvage. After reimbursing the claimant for the value of the vehicle, the insurer can take possession of
the vehicle and rebuild it or attempt to sell it for its parts.
In ClaimCenter, you can assign an exposure to salvage by marking it as a total loss. You can then enter and manage
salvage-related activities in the Salvage screens. Currently, salvage is used only for vehicle damage exposures and the
Auto line of business.

Assign an Exposure to Salvage

Procedure
1. Navigate to Claim→Loss Details.
2. Click Edit.
3. Select the exposure to be assigned, such as an involved vehicle.
4. In the Vehicle Incident screen:
a. Click Yes for Total Loss.
b. Click OK.
c. Click Update.
d. Click the Exposures menu link.
e. Select the exposure that you modified.
The VehicleSalvage card displays.
f. You can edit this card to enter a Salvage Service, for example, and financial information for the salvaged
vehicle.
The following figure shows the salvage-related fields for a vehicle incident.
Salvage-related roles specified in this screen, such as Salvage Service and Salvage Buyer, are included in the
claim’s Parties Involved screen.
5. Select the Workplan menu link. You can now view two salvage-related activities that were generated.
Working with Salvage 299

For example:
• Recover Vehicle
• Salvage Vehicle
Because this vehicle incident has been indicated as a total loss, existing exposures and future exposures
created on this incident will have the same two salvage-related activities generated for them.
Salvage Rules
You can open Guidewire Studio to see the rules related to salvage. The following descriptions are for some of the
scenarios in the base configuration for salvage-related rules.
Create Activities for Salvaged Exposures

This rule is part of the configuration→config→Rule Sets→Preupdate→ExposurePreupdate rule set.
• Condition – The exposure’s TotalLoss field is set to True, marking it for salvage.
• Action – Generate salvage activities, such as salvage_vehicle or recover_vehicle.
Populate Vehicle Recovery Date when Salvage Vehicle Activity is Completed

This rule is part of the configuration→config→Rule Sets→Closed→ActivityClosed rule set.
• Condition – The salvage_vehicle activity is complete.
• Action – Populate the date of vehicle recovery automatically with the current date.
Check Salvage Costs for Negative Recoveries

This rule is part of the configuration→config→Rule Sets→Validation→ExposureValidationRules rule set.
• Condition – The recovery amount from the salvage (towing and storage) is negative.
• Action – Reject or accept the salvage recovery.
Enabling Subrogation
To enable full subrogation functionality in ClaimCenter, you must set the UseRecoveryReserves configuration
parameter. The other parameters are already set in the base configuration. All configuration parameters are in the
config.xml file, which you can open and edit in Guidewire Studio.
Parameter Location Description

UseRecoveryReserves The Financial Parameters section in con Setting this parameter to true enables recovery reserves
fig.xml. to show in the Financials tab of the Subrogation screen.
Additionally, a setting of true enables the Set Open
Recovery Reserves to Expected Recovery % button, the Open
Recovery Reserves field, and Anticipated Recovery % on the
ReserveLine list view.
Financials See the Financials section in config.xm Setting this parameter to entry enables use of all
l. financial screens.

Permissions for Subrogation

The following permissions govern subrogation and are added to both the Adjuster and the Claims Supervisor roles in
the base configuration:
• viewsubrodetails
• editsubrodetails
• subroown
Roles Used in Subrogation

The subrogation feature uses the following claim roles in the base configuration:
• Subrogation Owner (exclusive to exposure)
• External Subrogation Firm
• Subrogation responsible party insurer
• Collection agency
• Investigator
• Third party (accident participant, the base role for a responsible party)
Subrogation Rules and Scenarios

You can find the financial rules governing subrogation in Guidewire Studio. Navigate to configuration→config→Rule
Sets→Preupdate→ClaimPreupdate.
The following descriptions are scenarios for subrogation rules you could add to your application.
Flag a claim as a Possible Subrogation Opportunity

• Condition – The claim’s subrogation status has not been set and the loss cause is a rear-end collision.
• Action – Set the claim’s subrogation status to Review and the reason to Rear-end collision.
You can add more conditions that flag a claim for possible subrogation, or you can add an action to create an activity
to review the claim.
Create an Activity to Send the First Subrogation Letter

• Condition – The Strategy is Pursue, and this activity does not exist.
• Action – Create an activity that creates and sends the first dunning letter with a particular template.
Create an Activity to Send the Second Subrogation Letter

This rule can be part of the Activity Closed rule set. An activity to send a third demand letter would be similar.
• Condition – The previous activity is complete and a certain time has passed.
• Action – Create an activity that completes and sends the second dunning letter by using its particular template.
Subrogation Data Model

The following object model diagram shows the data model relationships between the main entities relating to
subrogation. For complete information, see the Data Dictionary.
Enabling Subrogation 301

Subrogation Data Model
Claim
0..1
SubrogationSummary
ProrateDeductible
Exposure
0..1
0..* 0..*
Subrogation SubroAdverseParty
Status Fault
CloseComment ExpectedRecovery
Outcome
CloseDate
SubroAdversePartyOverride
0..* Fault 0..*
ExpectedRecovery
Legend
0..n
Subrogation Typelists
Subrogation uses the following typelists:
Subrogation Typelist Values

AdversePartyDenialReason.ttx License Suspended, Policy Lapsed
MatterType.ttx General, Lawsuit, Arbitration, Hearing, Mediation
StatuteLimitationsType.ttx State Involved, Federal Involved, City Involved, Medical, Damage, Other
SubroClassification.ttx Insured, Uninsured
SubroClosedOutcome.ttx Full Recovery, Compromised, Uncollectable, Discontinued, Not Pursued
SubrogationStatus.ttx In Review, Open, Closed
SubroGovernmentInvolved.ttx Yes or No. Categories of StatuteLimitationsType.ttx.
SubroSchedRecoveryType.ttx Prommissory Note, Arbitration Settlement
SubroStrategy.ttx Pursue against insurer, Negotiate against insurer, Arbitration (against insurer), Pur
sue, Utilize Collection Agency (against uninsured), Lawsuit, Drop Pursuit (both
insured and not)
Entities that Support Subrogation

The following entities support subrogation:

Entity Description
Claim The following fields on Claim are related to subrogation:
• SubrogationSummary – Foreign key to SubrogationSummary
• subrogator – Derived property returning Contact, the external subrogation firm for the claim.
Matter There are two fields on Matter that are related to subrogation:
• SubrogationSummary – Foreign key to SubrogationSummary
• SubroRelated – Boolean indicating if the matter has a related subrogation
StatuteLimitations Represents a statute of limitations for a subrogation. The field SubrogationSummary is a foreign key to
Line the associated SubrogationSummary entity. There is also a derived key for the associated claim.
The SubrogationSummary entity has an array key, StatuteLine, to support multiple statute
limitations.
SubroAdverseParty Stores subrogation-related information for a third party who is the subject of a subrogation recovery
for a claim. This entity does not represent the third party’s insurance company. This entity has a
derived field for the associated claim, and it has an AdverseParty foreign key to Contact and a foreign
key to SubrogationSummary.
The field SubroAdverseParty on SubroPaymentSchedule is a foreign key to this entity. Additionally,
the SubrogationSummary entity has an array key, SubroAdverseParties, to support multiple adverse
parties.
SubroAdversePartyO Represents customization for a party’s fault and expected recovery for a specific exposure on a claim.
verride
Subrogation Represents the subrogation work done by a user for a claim. A Subrogation is an assignable object
and can be linked to at most one exposure.
SubrogationSummary Represents a subrogation for a claim. An object of this type is instantiated when a subrogation is
initiated on a claim. Each claim can have at most one SubrogationSummary. A SubrogationSummary
can be claim-level or exposure-level and can have one or more Subrogation objects.
Configuration points include the Claim Preupdate rule CPU10800 - Create Subro Summary, which calls
a configurable enhancement method to determine if subrogation is activated. The method is Activat
eSubroModule in GWSubroNonFinancialClaimEnhancement.gsx.
SubroPaymentSchedu Represents a promissory note schedule for an adverse party who is the subject of a subrogation. The
le field SubroAdverseParty is a foreign key to the associated SubroAdverseParty entity.
Subrogation Data Model 303


chapter 32
Archiving in ClaimCenter
Archiving is the process of moving data associated with aged, closed claims from the active ClaimCenter database to
a document storage area from which they can be retrieved or purged.
Archiving Overview
• “Archiving Claims versus Purging Claims” on page 305
• “Archiving Components” on page 306
• “Whether to Enable Archiving” on page 306
• “More Information on Archiving” on page 306
Archiving Claims versus Purging Claims

In ClaimCenter, you generally archive a claim if preserving access to information about the claim fulfills a business
need, such as litigation or proof of regulatory compliance. Claims that have this type of enduring future use often are
archived. Claims that do not serve such a purpose typically are purged instead.
So that archived claims can provide potential future business uses, ClaimCenter lets you search for archived claims
for review. ClaimCenter keeps a summary of each archived claim in its database.
If the summary information about an archived claim is insufficient for a specific future business use, you can
retrieve it from the archive and activate it again. For example, you might you need to:
• View more than just the summary information of the archived claim.
• Work on the claim.
After you retrieve an archived claim, it behaves like any other closed claim in ClaimCenter
Archiving in ClaimCenter 305

See also
• “Claims and Claim Entities not Possible to Archive” on page 309
Archiving Components
In the base configuration, ClaimCenter supports archiving with the following three components:
• Archiving Item Writer Batch Process – Converts aged, closed claims from the ClaimCenter database to XML
documents and then moves them to an archiving data store for long-term retention.
The archive batch process performs the following steps:
• Reads Guidewire internal and user-defined rules to skip or exclude certain claims that are otherwise eligible for
archiving based on their closed status and age.
• Calls a class, ClaimInfoArchiveSource, that implements the IArchiveSource plugin interface to store the
claim’s XML representation in the archiving data store.
• Writes summary information to ClaimInfo and other Info entities to enable searching on the archived claims.
See “Archiving Item Writer Batch Process” on page 308.
• Archive Search Interface – Finds summary information about archived claims by using the following entities:
◦ ClaimInfo
◦ ClaimInfoAccess
◦ ClaimInfoSearchView
◦ ClaimInfoCriteria
◦ ContactInfo
◦ LocationInfo
See “Searching for Archived Claims” on page 310.
• Archive Retrieval Process – Retrieves archived claims from the data store and puts them back in the
ClaimCenter database for display and use in the ClaimCenter application.
This process relies on the ClaimInfoArchiveSource class to interact with the archiving data store. The data that
was originally written to the Info entities during the archive batch process is deleted when the claim is
successfully retrieved and stored.
You can use the ClaimInfoArchiveSource and ArchiveSource classes as templates to write your own class to
retrieve archived claims. For example, you might want to leave the archived claim in the archiving data store or
remove it.
Note: If you create your own class, register it as a plugin in the IArchiveSource.gwp plugin registry.
Whether to Enable Archiving

Archiving in ClaimCenter is not enabled in the base configuration because not all ClaimCenter installations benefit
from archiving. The main reason to archive claims is to improve ClaimCenter performance in high volume systems
or in ClaimCenter systems deployed on lower-capacity hardware.
If the hardware used in your ClaimCenter deployment is adequate to handle your claim volume, you might see no
advantage in archiving. In this case, it might make sense to keep all claims in the active ClaimCenter database until
they no longer serve any business need, and then purge them. You do not have to create and maintain a separate
archiving data store.
More Information on Archiving

You can find more information about archiving in the following topics:
• Rules Guide
306 chapter 32 Archiving in ClaimCenter

• Upgrade Guide
ClaimCenter Preparations for Archiving

ClaimCenter uses the archiving framework to:
• Set the boundary of an entire claim so that all its relevant objects can be correctly identified and archived during
Archive batch processing.
• Define the summary information that is written to the ClaimCenter database to enable locating an archived claim
later.
Defining the Boundary of an Archived Claim

The boundary of the claim for purposes of archiving is defined by its archiving domain graph. In ClaimCenter, the
root entity of the archiving domain graph is the Claim entity type.
The archiving domain graph starts at the entity Claim and proceeds outward to all entities that:
• Implement Extractable
• Directly or indirectly related to the Claim entity through ownership relationships
Entities included in the archiving domain graph include the policy snapshot, incidents, exposures, notes, calendars,
activities, matters, and access control lists (ACLs) for the claim.
Whenever ClaimCenter creates a claim, it also creates a ClaimInfo entity instance, which implements the delegate
RootInfo. The ClaimInfo instance remains in the active database after ClaimCenter archives the claim.
See also
WARNING Incorrect configuration of the archiving domain graph can prevent the application server from
starting.
Defining Claim Summary Data

ClaimCenter uses claim summary data to search for and review archived claims without retrieving them. Claim
summary data is written to the ClaimCenter database when the claim is archived. It is deleted from the ClaimCenter
database if the claim is retrieved.
Claim summary data is written into ClaimInfo and entities associated with ClaimInfo. The entities include the root
entity ClaimInfo, as well as ContactInfo, LocationInfo, ClaimInfoAccess, and CoverageLineMatchDataInfo.
ClaimInfo and these other associated entities serve multiple purposes:
• They contain enough information to retrieve the original claim, such as the ClaimNumber.
• They enable searching for the archived claim.
• They enable you to see summary information about an archived claim.
These purposes can overlap. For example, ClaimNumber in ClaimInfo is useful for all three purposes. The
PolicyNumber in ClaimInfo is useful for searching and summary information. The LocationInfo entity is used
only for summary information.
A ClaimInfo entity instance retains all links to bulk invoices, aggregate limits, and claim associations. This linkage
permits a retrieved claim to remain connected to these multi-claim entity instances, which are outside the domain
graph and therefore always in the ClaimCenter database.
ClaimCenter Preparations for Archiving 307

When a claim is archived, the CoverageLineMatchDataInfo entity keeps track of coverage lines with transactions.
This tracking is useful for preventing the creation of additional coverage lines that might match these transactions
while the claim is still archived.
You can extend these Info entities. An example would be if you have added new entities and want information on
them to be available when the claim is archived.
See also
• “Info Entities and their Part in Search” on page 311
• “Archiving Claims with Aggregate Limits” on page 116
Archiving Item Writer Batch Process

The archive batch process, Archiving Item Writer, and its work queue operate on closed, aged claims and do two
things with the data for a claim:
• Store the entire claim graph in the archiving data store.
• Retain enough information in the ClaimCenter database about the claim to make it possible to find the archived
claim and retrieve it.
Note: In the base configuration, this batch process is not visible in the Server Tools tab. You must set the
ArchiveEnabled configuration parameter in config.xml to true and restart ClaimCenter to see it.
ClaimCenter archives claims based on the value of Claim.DateEligibleforArchive and other claim data
described later in this topic. For the archive batch process, if the value of DateEligibleforArchive is in the past,
the claim qualifies for initial evaluation. The ClaimClosed rules in the base configuration set this value when the claim
is closed. The value is the sum of the date the claim is closed plus the value of the DaysClosedBeforeArchive
configuration parameter in the config.xml file. See the Configuration Guide.
You can write ClaimClosed rules to set DateEligibleforArchive to a different value.
To process these eligible closed claims, run the archive batch process in one of two ways:
• Configure the scheduler to run the process at defined intervals. For more information, see the System
Administration Guide.
• Use the Server Tools page to start a single run of the Archiving Item Writer batch process. Alternatively you can
run the batch process from the command line by navigating to ClaimCenter/admin/bin and entering
maintenance_tools -password password -startprocess archive. For general information, see the System
Administration Guide. See also .
Archive Item Writer Batch Process Execution

Running the Archiving Item Writer batch process causes ClaimCenter to do the following:
1. Queue the claims that are active for which DateEligibleForArchive is in the past and the
ExcludeFromArchive flag is not set on the claim’s ClaimInfo entity instance.
The Archiving Item Writer performs a simple query to find all initially eligible claims based on the
DateEligibleForArchive. Claims marked as excluded from archiving are not returned.
2. The Archiving Item Writer does a series of verifications to determine which eligible claims to reject. These
verifications, which are not configurable, include:
• Verifying the date again and skipping it for this iteration if the date is no longer eligible.
• Rejecting any claim with any active messages or workflows and skipping it for this iteration.
3. Rules in the Archive→DefaultGroupClaimArchivingRules rule set mark claims that must not be archived. These
rules can mark claims either to be skipped for the current run of the batch process or to be excluded from all

future runs of the batch process. You can configure these rules. In the base configuration, these rules cause
claims to be skipped that:
• Are not closed. Claims that were reopened since the archive process started.
• Are linked to a bulk invoice item with a status of Draft, Not Valid, Approved, Check Pending Approval, or
Awaiting Submission.
• Have open activities.
• Have vendor reviews that are incomplete or not yet synchronized with ContactManager.
• Have transactions that have yet to be escalated or acknowledged.
4. Use the claim graph to tag entities in claims that pass the exclude and skip rules.
5. Convert tagged entities on each claim to an XML stream.
6. Write data to the XML archive file and the Claim Center database as follows:
a. Call a plugin implementing the IArchiveSource interface to store XML in the archive file.
b. Delete the claim from ClaimCenter, creating a Claim Archived History record on the claim.
c. Write data to Info entities, including any additional data defined in the IArchiveSource plugin
implementation.
In the base implementation, ClaimCenter calls the method updateInfoOnStore on the plugin
implementation gw.plugin.archiving.ClaimInfoArchiveSource. You cannot edit this class, but you
can use it and the ArchiveSource classes as guidelines for your own class. If you want different
behavior, you must write your own class that implements IArchiveSource and register the class in the
IArchiveSource.gwp plugin registry.
You can also extend the existing Info entities or create new ones to preserve more information in the
ClaimCenter database than can be stored in ClaimInfo, ContactInfo, and LocationInfo.
7. Generate a ClaimInfoChanged event to indicate whether archiving succeeded or failed.
8. Write information on the archive batch process to the data store and to ClaimCenter logs. Some of the
ClaimCenter log data is viewable from the Server Tools page.
Claims and Claim Entities not Possible to Archive

In the base configuration of ClaimCenter, there are a number of entities associated with claims that cannot be
archived. Additionally, it is not possible to archive all claims. There are internal conditions that cannot be configured
that prevent a claim from being archived. Finally, there are rules that mark claims to be excluded or skipped. These
rules can be configured.
Entities That Cannot Be Archived

In the base configuration of ClaimCenter, it is not possible to archive the following entities:
• BulkInvoice
• ClaimInfo
• ClaimAssociation
• AggregateLimit
• PolicyPeriod
Non-Configurable Exclusions from Archiving

In the base configuration, the following conditions are evaluated internally and prevent ClaimCenter from archiving
a claim or a claim entity. These conditions are not configurable.
Claims and Claim Entities not Possible to Archive 309

Condition Description
Claims with pending messages The pending messages table must be empty. It cannot contain messages that have
been sent. It is unlikely that an old, closed claim will be in this condition. If it is, the
archiving batch process skips this claim and tries later, until it finds that there are no
more active messages.
Claims that are part of an unfinished It is not possible to archive a claim that has an active workflow.
workflow
Previously excluded claims Claims already marked as excluded are not processed for archiving.
Claims for which DateEligibleForAr You can set the DateEligibleForArchive field and make settings that affect its value.
chive is null or in the future However, you cannot configure ClaimCenter to archive a claim when this value is null
or has a date that has not yet occurred.
Configurable Exclusions from Archiving

In the base configuration, the following conditions are evaluated in the DefaultGroupClaimArchivingRules rule set and
the claims are marked to be skipped during archiving. These rules are configurable.
Condition Description
The claim is open. A claim cannot be archived if it was reopened between the time the claim was queued for
archiving and the time the archive batch process processes it.
The rule ARC01000 - Claim State Rule marks such claims to be skipped during archiving.
The claim is linked to a bulk A claim cannot be archived when it is linked to a bulk invoice item with one of these
invoice item with a status of statuses. Archiving the claim might force the user the user to retrieve the claim when the
Draft, Not Valid, Approved, item is ready to be escalated. The In Review and Rejected statuses do not prevent archiving,
Check Pending Approval, or since an invoice item can retain those statuses long after its bulk invoice is escalated and
Awaiting Submission. cleared.
This behavior is defined in the rule ARC03000 - Bulk Invoice Item State Rule.
The claim has open activities. Claims with open activities are not archived. If a claim were archived with open activities,
those activities would disappear from the owner’s Desktop and would not be found or closed
unless the claim was retrieved.
The rule ARC04000 - Open Activities Rule marks claims with open activities to be skipped
during archiving. This rule is run in case an activity was opened between the time a claim
was queued for archive and the time the archive batch process processes it. The rule skips
the claim. Guidewire recommends that you not modify this rule.
The claim has vendor reviews Claims with incomplete or unsynchronized vendor reviews cannot be archived until the
that are incomplete or not yet reviews are completed and synchronized.
synchronized with The rules ARC05000 - Incomplete Review Rule and ARC06000 - Unsynced Review Rule mark
ContactManager. these claims to be skipped during archiving.
The claim has transactions that Claims with unesclated or unacknowledged transactions cannot be archived until the
have not been escalated or transactions are escalated or acknowledged.
acknowledged. The rule ARC07000 - Transaction State Rule marks these claims to be skipped during
archiving.
Searching for Archived Claims

Archiving claims, instead of simply purging them, enables you to review or reopen the claims to accomplish a
business purpose.
The ClaimCenter claim search pages on the Search tab under Claims enable you to locate claims that have been
archived. ClaimCenter provides a search against archived claims on both the Simple Search and the Advanced Search

pages. The search query elements on these pages use fields that are written to ClaimCenter Info entities at the time
of claim archiving.
• Simple claim searches – The query fields in the Simple Search page are a subset of those found in ClaimInfo
entity, ContactInfo entity, and other Info entities. Using these fields, Simple Search can find both active and
archived claims. Simple Search shows active claims in the search result set in the Simple Search page and provides a
link to the Advanced Search screen for viewing archived claims.
• Advanced claim searches – The query page for active claim searches can contain fields that are not on Info
entities. The query page for archived searches has fields that are only on the Info entities. The Source drop-down
list enables you to search for either active or archived claims.
Info Entities and their Part in Search

In ClaimCenter, when a claim is archived, a set of summary information about the claim is stored in entities called
Info entities. These entities and their creation are described in “Defining Claim Summary Data” on page 307. The
data stored in these entities determines:
• How search queries are formed against archived claims.
• Who can view a given archived claim in a search results set.
It is useful when designing your archiving implementation to establish the reasons that you want to retrieve claims
from the archive. These reasons determine the set of query fields you provide on the ClaimCenter Simple Search and
Advanced Search screens. The fields you provide will determine whether you need to extend the provided Info entities
or create new ones.
For example, you might need to revisit some legal issues with catastrophe claims. To do so, you create fields on Info
entities that enable finding archived claims filed in connection with catastrophes. You can extend the ClaimInfo
entity to include these fields. Optionally, you might want to create a whole new CatastropheInfo_Ext entity to
make this information available for search and display.
You can also use Info entities to limit who can see particular claims in a search query results set. The
ClaimInfoAccess entity determines who can view each archived claim in the search results. For instance, some
archived catastrophe claims with associated fraud investigations might have access restricted to only the Fraud
Manager or the Fraud Management group.
Simple Search for Archived Claims

It is possible to use any of the following criteria for simple claim searches.
• Claim number
• Policy number
• First name
• Last name
• Organization name
• Tax ID
Note: You cannot perform a simple search by loss date or notice date.
In a simple claim search from the Search tab under Claims→Simple Search, you cannot specify whether to search for
active or archived claims. ClaimCenter always searches for both types. The application displays summaries only for
the active claims it finds.
Searching for Archived Claims 311

If ClaimCenter finds an archived claim when you perform a simple search, you see a link directing you to the
Advanced Search screen. You can do one of two things with an archived claim listing:
• If you are certain that the claim is the one you want, click Retrieve from Archive to retrieve it.
• If you are not certain that the claim is the one you want, click the claim link. Doing so opens the Archived Claim
Summary screen, in which you can view summary information for the claim.
Note: In a simple search for archived claims, you cannot search for additional insured or any party involved. These
search criteria are defined in the ClaimSearchNameSearchType.tti typelist.
Perform a Simple Search for Archived Claims
Procedure
1. In Guidewire ClaimCenter, click the Search tab and navigate to Claims→Simple Search.
2. Enter at least one search criterion on the Search Claims screen and then click Search.
The search results show summaries of active claims only.
3. To view summaries of the archived claims found, click View archived claims. ClaimCenter displays the Advanced
Search screen.
4. In the lower section of the screen are the Search Results. You can:
• Click the claim to view its details on the Archived Claim Summary screen.
• Select a claim and click Retrieve from Archive to retrieve the claim.
Advanced Search for Archived Claims

In an advanced claim search from the Search tab under Claims→Advanced Search, if you select Archive, your search
criteria are limited to archived claims. Alternatively, you can use the Search for Date field. You must enter either a
date or a range of dates for this field.
Perform an Advanced Search for Archived Claims

1. Click the Search tab and navigate to Claims→Advanced Search.
2. In the Source field, select the type of claim to search for, Active Database or Archive. In this example, select
Archive.
Unlike simple searches, an advanced search displays each claim found.
3. In the lower section of the screen are the Search Results. You can:
• Click the claim to view its details on the Archived Claim Summary screen.
• Select a claim and click Retrieve from Archive to retrieve the claim.

Finding Archived Claims without Searching

There are two methods to find archived claims without searching.
• Enter the number of an archived claim, Claim #, in the Claim tab drop-down list.
• Select an archived claim by entering its number in the QuickJump box. However, if you select an archived claim in
this way, you must retrieve the claim from the archive before you can work with it.
About Retrieved Archived Claims

Whenever you retrieve a claim, ClaimCenter does the following:
• Reassigns the claim.
• Generates an activity for the user assigned to the claim.
• Generates a note on the claim.
• Generates a ClaimChanged event used by the claim history generation and reporting systems.
The retrieved claim is identical to a claim that has never undergone the archiving process, except that:
• The history for the claim shows that ClaimCenter archived and retrieved the claim.
• Metadata about the archiving status of the claim has changed in the ClaimInfo entity and on the Claim entity
itself.
• Custom code in your IArchiveSource plugin implementation might have made further changes to the claim after
it was restored to the ClaimCenter database.
See also
• “Retrieve an Archived Claim” on page 313
Retrieve an Archived Claim

After you have located an archived claim and reviewed its search results or summary page, you might still need to
retrieve the full claim for further review or work.
1. To retrieve a claim, click the Retrieve from Archive button available on the Advanced Search or Archived Claim
Summary screen.
2. Enter a comment about the retrieval and click Retrieve from Archive again.
You must enter a comment before you can retrieve the claim.
Permissions Needed to Retrieve a Claim

The ClaimInfoAccess entity controls when a user sees any given claim. Archiving permissions further determine
whether the Retrieve from Archive button is visible or is enabled or disabled for a particular user. To retrieve an
archived claim, you must have both view and edit permissions on the claim. If the claim has an access control list
(ACL), you must qualify according to the ACL to be able to retrieve the claim.
Archived Claim Retrieval Process

The archived claim retrieval process executes as a single database transaction, including adding the history record,
note, and activity at the very end of the process. In detail:
1. The user clicks the Retrieve from Archive button available on the Advanced Search or Archived Claim Summary
screen.
2. The archived claim retrieval process locates the ClaimInfo entity for the selected archived claim and passes it
to the registered class that implements the IArchiveSource plugin.
3. The class that implements the IArchiveSource plugin interface, by default ClaimInfoArchiveSource,
retrieves the archived claim from the data store and saves it in memory as a serialized XML document.
Searching for Archived Claims 313
4. The archived claim retrieval process clears the ClaimInfo and other Info entities of all data except metadata
describing the retrieval.
5. The archived claim retrieval process runs upgrade steps on the XML representation of the claim as necessary
to bring it up to the current data model version.
6. The class that implements the IArchiveSource plugin interface, by default ClaimInfoArchiveSource, makes
user-defined changes to the ClaimInfo entity and other Info entities before committing the claim to the
database.
These changes typically consist of deleting fields populated by ClaimInfoArchiveSource when the claim
was archived. The ClaimInfo entity is the only Info entity that persists. If any changes to ClaimInfo are
made, then a ClaimInfoChanged event is generated.
7. The archived claim retrieval process recreates the claim in the ClaimCenter database, and then:
a. Resets Claim.DateEligibleforArchive by using the current date plus the value set in the config.xml
configuration parameter DaysRetrievedBeforeArchive.
b. While restoring the claim, the class that implements the IArchiveSource plugin interface is called to
make any user-defined changes to the Claim entity and its foreign keys. This class, by default
ClaimInfoArchiveSource, can also delete the claim from the archiving data store at this time. This class
can also perform any other type of document or metadata cleanup required in the archiving data store.
c. The claim is assigned as described in “Reassigning Retrieved Claims” on page 314.
d. After the claim has been restored, the archived claim retrieval process creates a note and an Archived
Restored History record. See “New Note Generation in Retrieved Claims” on page 315.
e. The archived claim retrieval process also creates activities by using the activity pattern set in the
RestorePattern configuration parameter in config.xml. ClaimCenter creates at least two activities and
assigns one to the current user and one to the assigned user for the claim. See “New Activity Generation
in Retrieved Claims” on page 314.
8. You can now view and work with the claim as usual in the ClaimCenter user interface.
Reassigning Retrieved Claims

All retrieved claims must be assigned, just as all newly created claims are. The AssignClaimToRetriever
parameter in the config.xml file determines claims assignment. If you want to reassign retrieved claims to the user
who retrieves them, set this parameter to true. The default is false, which assigns a retrieved claim to the group
and user who owned it at the time ClaimCenter archived the claim.
If it is not possible to reassign to the original user, ClaimCenter assigns the retrieved claim to the supervisor of the
group. If ClaimCenter cannot reassign the retrieved claim to the original group, ClaimCenter assigns the claim to
defaultowner.
The default owner in the base configuration has no roles and is in the root group. Its purpose is to provide an owner
for claims that ClaimCenter cannot reassign to anyone.
IMPORTANT Do not delete the default owner from the application. If you do, there can be problems assigning
retrieved claims if the retrieved owner is not a member of a group.
New Activity Generation in Retrieved Claims

Retrieving a claim creates at least two activities by using the activity pattern defined in the config.xml parameter
RestorePattern. These activities notify the claim owner and the retriever of the claim that this retrieved claim is
again available in the ClaimCenter user interface. If the owner of the claim is inactive, ClaimCenter sends a
notification to the inactive user's supervisor.
The activity can also enable its recipient to reassign the activity. Reassigning the activity might be necessary if the
retrieve process assigns an activity to a user who no longer exists or no longer has permission to see the claim. If
you have configured the activity to do so, it can contain an Assign button at the top of the activity screen. Use this
button to reassign the activity to someone else.
New Note Generation in Retrieved Claims

Retrieving a claim generates a new note that is attached to the claim. This note contains the comment that you enter
after clicking Retrieve from Archive. If you retrieve a claim using the -restore maintenance tool command, Guidewire
recommends that you enter the body of the note in the -comment option of the command. If you use an API call, you
also add a comment to create the new note.
Purging Archived Claims

You can purge claims from the archive. When you do so, you also remove the ClaimInfo entity for the claim from
the ClaimCenter database. After you purge a claim, and you can no longer find the claim when you search for
claims. The only way to get a purged claim back into ClaimCenter is to retrieve it from a backup.
ClaimCenter notifies the archive that an archived claim record is to be deleted by calling the delete(RootInfo)
method on the class that implements the IArchiveSource plugin interface. This class is ClaimInfoArchiveSource
in the base configuration. The delete method is actually defined in the class ArchiveSource, which
ClaimInfoArchiveSource extends.
Note: When a claim that contributes to an aggregate limit is purged, the purged claim no longer contributes to any
aggregate limit on the policy period.
See also
About Retrieved Archived Claims 315


chapter 33
Personal Data Destruction
Note: The data destruction features described in these topics provide a set of features that help enable insurers to
comply with some of their data destruction requirements. These requirements may be driven by insurers’ policies
and practices, as well as by their interpretation of various regulatory requirements. Such regulatory requirements
may come from, for example, the European Union General Data Protection Regulation (GDPR) or the New York
State Cybersecurity Requirements for Financial Services Companies law.
ClaimCenter supports destruction of some kinds of data. Destruction can mean either purging the data completely
from the database or it can mean obfuscating data, making the original contents permanently unreadable.
Guidewire recognizes the need for insurers to be able to destroy personal information both on an on-demand basis or
on a time-based basis. Destruction can be mandated by regulation or business practices, within the requirements of
regulation, codes of conduct, or other business practices.
ClaimCenter provides support for data destruction and obfuscation that can be configured in Guidewire Studio.
See also
Encapsulation of Business Logic for Retention and Destruction

Regulations, codes of conduct, and other generally accepted business practices vary from jurisdiction to jurisdiction.
Additionally, business policies and interpretation of conflicting legal requirements vary from insurer to insurer.
Therefore no single approach meets the needs of all insurers. To accommodate varying needs, ClaimCenter provides
a configurable solution that captures business logic for retention and destruction in one place.
There is a configurable plugin that has access to the business objects to be removed through a root object. For
example:
• Contact
• Claim
The examination of objects to be destroyed starts with the root object and traverses a graph of objects, enabling
detailed examination of the business objects. You can mark requests requiring user review for those data destruction
requests that require special handling, prior to the destruction actually occurring.
Personal Data Destruction 317

See also
Notification of Data Protection Officer on Errors or Conflicts

Requirements for destruction and for retention can conflict with each other. While the plugin class might be able to
resolve conflicts in a generic way, situations can arise when the two sets of requirements are not reconcilable.
Additionally, the data destruction process can encounter errors. In these situations, notification is done through a
configurable plugin.
The default behavior of this plugin is that a message is logged that describes the situation.
After the situation has been resolved, the destruction request can be queued again for reprocessing.
See also
Wide-swath Data Destruction

In many situations, there is a need to destroy the personal data related to a specific business object. This data might
be:
• A contact (a person)
• A record of a contract
• A record related to performance of a contract (claim)
These objects can affect many individual data objects. A single call allows the entirety of related data to be removed.
In the case where these business objects are nested, a best-effort destruction is performed.
ClaimCenter components provide the ability to purge rows from the database for business objects such as Contact
and Claim and their related data. This approach is suitable for high-volume data destruction.
See also
Individual-entity Data Destruction

While wide-swath data destruction meets the needs of the insurer in most cases, there are special cases where
specific personal data cannot be deleted. For example, there might be database integrity concerns, or the data to be
deleted, such as data for previous employee, might be related to a large number of claims.
In such cases, where individual instances of data cannot be deleted, ClaimCenter provides the ability to obfuscate
data. Obfuscation can include wiping a field completely, replacing it with a neutral value, or replacing it with a
unique, irreversible value.
The entities and fields to which obfuscation can be applied, as well as the method for determining the replacement
value, are configurable.
See also
Integration with Other Systems

ClaimCenter needs to be able to respond to data destruction requests from external systems, as well as have the
ability to notify data consumers of data destruction.
318 chapter 33 Personal Data Destruction

ClaimCenter provides a web service that:

• Takes a reference to an individual contact.
• Takes application-specific action to destroy the data related to that contact.
• Reports back to the caller on the level of success of the request. Callers can query the status of a given request.
See also
Notification of Downstream Systems

ClaimCenter provides a messaging system to assist you in ensuring that the destruction of personal data flows into
systems connected with components. Additionally, you might need to notify outside organizations that process data
on your behalf. The messaging system supports broadcasting personal data destruction response messages.
These messages are delivered by using the existing ClaimCenter guaranteed-delivery messaging system.
See also
Notification of Downstream Systems 319

320 chapter 33 Personal Data Destruction

part 6
ClaimCenter Financials
chapter 34
Claim Financials
The financial features of ClaimCenter focus entirely on the monetary aspects of settling a claim. These aspects
include estimating settlement costs, making payments, and optionally recovering money from other sources to offset
certain costs. You can use the ClaimCenter financials features to provide estimates of potential claim costs. You can
also track and put financial controls on the flow of money used to satisfy the claim.
See also
• “Multiple Currencies” on page 373
• “Bulk Invoices” on page 391
Overview of ClaimCenter Financials

The financial component is critical to the ClaimCenter application. Not only does the system track claims, but it also
records the finances associated with each claim or exposure. You can create reserves for claims, make payments, and
create recovery reserves.
ClaimCenter Financials Example

An adjuster receives a claim for an auto accident, and as part of the claim process, the adjuster creates several
exposures and the reserves that are affiliated with each exposure.
• There is a reserve line for potential auto damage costs and a reserve line to estimate medical costs of an injured
driver. These reserve lines enable the adjuster to track each type of potential payment.
• Payments consist of transactions. As these costs become clear, the adjuster approves these payments and issues
checks against these reserves, decreasing the reserves.
• The adjuster readjusts reserve levels and then determines that another driver was at fault. The adjuster then
creates a recovery reserve for the amount expected from that driver’s insurance carrier.
• After the carrier sends the adjuster a check, the adjuster notes this amount as a recovery, which decreases the
claim’s recovery reserve.
Claim Financials 323

To manage these financial tasks, ClaimCenter uses these concepts:
Financial concept Description

Reserve Lines ClaimCenter uses reserve lines to track specific costs that are related to a claim. A reserve line represents
the categorization or coding of a transaction, and is a combination of exposure, cost type, and cost
category.
Reserves Estimates of how much money might be needed to satisfy future claim liabilities and associated costs.
Transactions Modify the amount of money in a reserve line. A reserve transaction modifies the amount of money set
aside for the reserve line. A payment transaction moves money from a reserve line to a payment to a
claimant or other party.
Payments Records of all claim related disbursements made to satisfy the claim, in part or whole.
Checks A single transfer of money from one or more reserve lines to one or more individuals or organizations.
Recovery Reserves Estimates of how much money might be recovered from others while settling the claim.
Recoveries The receipt of claim costs from others, including salvage and subrogation.
Transactions
The transaction is the basic unit of all financial operations in ClaimCenter. The Transaction object is the main
financial entity in ClaimCenter. It has the following subtypes:
• Payment
• Reserve
• Recovery
• RecoveryReserve
The following list describes the transaction subtypes:
Financial Item Description

Reserves Can be created, updated, approved, or deleted. Payments usually decrease them.
Payments Can be created, updated, and approved or canceled. Payments are usually made by checks.
Recovery Reserve Transactions similar to negative reserves. Recoveries always decrease recovery reserves.
Recoveries Negative payments—checks received. Recoveries can be entered, updated, approved, or deleted.
See also
• See “Financials Data Model” on page 367
Transaction Approval
ClaimCenter provides transaction approval rules that ensure that you have authorization to submit certain financial
transactions. A transaction set contains one or more transactions that are submitted as a group for approval. If you
attempt to save a transaction set, ClaimCenter rules can ensure that the transaction be marked as requiring approval.
You can write rules that allow transactions based on a financial condition.
You can give a user a role that contains permissions and approval limits to do the following:
• Govern the upper limit of reserves the user can set.
• Set the payments the user can approve.
• Set the checks the user can write.
324 chapter 34 Claim Financials

See also
• “ClaimCenter Financial Calculations” on page 367
• “Security: Roles, Permissions, and Access Controls” on page 487.
Checks and Payments

ClaimCenter distinguishes checks from payments. A payment is closely associated with a reserve and is the way
ClaimCenter tracks the claim’s settlement costs. A check is the physical transfer of funds to make a payment.
One check can make more than one payment to a claimant. For example, an insured can receive payments for both
medical costs and car damage in one check. However, several checks can be issued to make one payment. An
example is compensation payment for an injury that is split into a check for the injured person and a percentage
going to the injured’s lawyer through a second check.
Transactions and Transaction Line Items

The transaction is the main financial entity in the ClaimCenter data model. It is an abstract entity with the final
subtypes Payment, Reserve, Recovery, and RecoveryReserve. Every transaction contains one or more transaction
line item objects that hold the monetary amount, or a part of the monetary amount, of the transaction. Payments and
recoveries can contain more than one transaction line item. Reserves and recovery reserves can contain only one
transaction line item. The amount of a transaction is the sum of all its transaction line item amounts. Each
transaction line item contains a line category field that further categorizes the amount beyond the CostType and
CostCategory of the entire transaction.
For example, the LineCategory field of a TransactionLineItem on a Payment or Recovery can further divide the
transaction amount. You might have a reserve line with a cost category called Fees, and you might set aside money
for all fees by creating reserves on that reserve line. By adding line categories of Management Fee, Surveyor Fee,
and so on, you can make more granular distinctions when creating a payment or recovery. However, you cannot
access the line categorizations through financial calculations. Financial calculations track amounts only at the
reserve line level.
See also
• “Payments” on page 332
• “Recoveries and Recovery Reserves” on page 348
Transaction Sets
All transactions made at the same time are grouped together in a transaction set. The TransactionSet entity also
groups together checks created at the same time to make a payment. This grouping occurs even if the checks are
issued on separate dates or to different payees or both. See also TransactionSet entry in the “Financials Data
Model” on page 367.
Reserves
Reserves are estimates of how much it will cost to satisfy a claim or part of a claim. Reserves are the primary way a
carrier estimates its future liabilities. Such estimates are required both for internal business decisions and for
regulatory purposes. A unique reserve line categorizes each of a claim’s reserves. Initially, reserves are estimates. As
the claim process progresses, a reserve amount can be updated for better accuracy or if higher liabilities seem
probable.
Note: Increasing reserves can also indicate a problem, such as fraud.
Unless defined otherwise, payments decrease reserves. If the reserve levels have been set correctly, payments
deplete them by the time the claim is settled.
Transactions 325
See also
• For more information on payments and their effect on reserves, see “Eroding and Non-eroding Payments” on
page 333.
Estimating Reserve Amounts

There are two ways to estimate reserve amounts: Case Reserves and Average Reserves.
Case Reserves – Use case reserves to estimate reserves and then adjust them on a case-by-case basis. To be most
effective, first subdivide claims into exposures, cost types, and cost categories, each with its separate reserves.
Estimating these smaller pieces makes the overall estimate of the needed reserves more accurate. After applying
case reserves, you can monitor the decrease of reserves as payments are made to determine if a claim is resolved
within normal cost limits. This method is the one used in the base configuration.
Average Reserves – Use average reserves to estimate claim or exposure reserves based on actuarial information
about the cost to settle similar claims in the past. The claim’s liability estimate does not change and is not affected
by any payments made. Business rules can even set reserves levels automatically. In this case, you segment the
claim into exposures, such as vehicle collision. Rules classify the exposure into high, medium, or light damage, and
then set reserves by using this classification. The average reserves method works best when allocating reserves to
each exposure rather than to the claim as a whole.
Many carriers base their current claim liability on the sum of reserves tailored to the specific claim that are still
remaining, plus the payments already made. Other carriers set reserves to averages based on actuarial information
from similar claims. They continue to use this initial value in estimating their liabilities, not altering this initial
estimate as normal payments are made, only considering extraordinary payments to it.
Note: The base configuration is set up for case reserves. You can configure the system for average reserves.
Uses of Reserves
Reserves drive the application’s financials. Specifically, reserves do the following:
• Categorize liabilities by coverage (exposure) – You can subcategorize reserves into smaller divisions, such as a
bodily injury exposure dividing into physician, hospital, therapy, and administrative costs. Categorizing reserves
makes tracking of specific claim costs more accurate.
• Track projected costs of claims as soon as they are created – This tracking enables timely and more compete
estimates of a carrier’s liabilities. Regulatory agencies often require up-to-date estimates of expected claim
liabilities to compute carrier solvency. They want to include claims whose details are not yet well known.
• Prevent excessive payments made on a claim – ClaimCenter controls who can set or increase reserve levels
and can stop payments in excess of reserves. These actions can help identify fraud.
• Ensure that a claim can be paid – After a reserve is associated with an exposure, and therefore a coverage, it is
easy to compare the policy’s coverage limit with the potential claim amount.
• Help in assigning claims – For example, steer claims with large potential liabilities away from inexperienced
adjusters.
• Assess adjusters’ performance – You can compare actual settlements to the amount of reserves.
Effect on Reserves of Closing a Claim or Exposure

After a reserve lines’s claim or exposure is closed, its open reserves are set to zero. Zeroing the open reserves
reduces total reserves to the sum of all eroding payments made against it. On closing of the claim or exposure, total
reserves become equal to all eroding payments, and total incurred becomes the total of all payments, eroding and
non-eroding.
Note: The reserve amounts are stored in multiple currencies– transaction, reserving, claim, reporting– and the
zeroing transaction will zero in all these amounts. See “Overview of Multicurrency” on page 373.
For example, a reserve is set to $1000, payments of $600 are made, and the claim is closed. Total Reserves would no
longer be $1000, but rather $600 with an offsetting, zeroing transaction of $400. Open Reserves remain at zero.

See also
• For more information on zeroing reserves, see “Payments and Zeroing Reserves” on page 336.
• For more information on open reserves, total reserves, and total incurred, see “Definitions of Reserve
Calculations” on page 327.
• For information on eroding and non-eroding payments, see “Eroding and Non-eroding Payments” on page 333.
Payments and Available Reserves

Payments can exceed reserves when the AllowPaymentsExceedReservesLimits configuration parameter in
config.xml is set to true. Large enough payments can produce negative values for available reserves and
remaining reserves. Negative values for these reserves typically result from a payment that is scheduled for the
future, eroding its reserve before a requested reserve increase is approved.
However, open reserves cannot be negative. If the system escalates a check, such as through the FinancialsEsc
batch process, its payments can make open reserves negative. ClaimCenter then creates the offsetting reserves to
keep the open reserves at zero.
For other ways for reserves to be negative see:
• “Eroding and Non-eroding Payments” on page 333
• “Negative and Zero Dollar Transactions and Checks” on page 335
Definitions of Reserve Calculations

Reserves can decrease as payments are made against them. ClaimCenter defines several reserve calculations that
differ depending on when the payments that decrease reserves are recognized.
The following are calculations used in reserves.
• Total Reserves – All Approved reserves, with no payments deducted. Total Reserves is never changed by
payments while the reserve line’s claim or exposure is open. On a closed claim, the Total Reserve value is equal
to the sum of all eroding payments. See “Effect on Reserves of Closing a Claim or Exposure” on page 326.
• Open Reserves – Total Reserves minus all eroding payments made today or earlier.
• Remaining Reserves – Open Reserves minus all Approved eroding payments to be made after today.
• Available Reserves – Remaining Reserves minus all eroding payments that are Pending Approval.
Note: Payments on open claims never decrease Total Reserves, and recoveries never change any reserves. Eroding
payments do decrease Remaining Reserves.
See also
• “Eroding and Non-eroding Payments” on page 333.
• For a full list of financial calculations, see the Configuration Guide.
Definitions of Total Incurred Calculations

The Total Incurred value on the title bar of each Financials screen provides a quick indicator of a claim’s current cost.
Total Incurred on these screens is the financial calculation Total Incurred Net described in the following definitions.
ClaimCenter defines three types of Total Incurred:
• Total Incurred Gross – Open Reserves plus Total Payments.
• Total Incurred Net – Total Incurred Gross minus Total Recoveries.
• Total Incurred Net Recovery Reserves – Total Incurred Gross minus Total Recovery Reserves.
Eroding payments do not affect Total Incurred on open claims, but supplemental payments on a closed claim or
exposure do affect Total Incurred.
Reserves 327
The following terms are used in the definitions of Total Incurred:

• Open Reserves – Total Reserves minus all eroding payments made today or earlier. See “Definitions of Reserve
Calculations” on page 327.
• Total Payments – Sum of all Submitted payments and payments Awaiting Submission with a scheduled send
date either before or on the current date.
• Total Recoveries – Sum of all Submitted recoveries.
• Total Recovery Reserves – Sum of all Submitted recovery reserves.
For a full list of financial calculations, see the Configuration Guide.
Set Reserves
About this task
You can add reserves directly.
Every time you change the amount of reserves for a reserve line, ClaimCenter creates anew reserve transaction. You
can see this on the Financials→Transactions screen by selecting Reserves from the drop-down list. A new entry exists
with the new date, amount, and current status.
Procedure
1. Open a claim and click Actions.
2. Under New Transaction, click Reserve to open the Set Reserves screen.
3. Double-click each drop-down field to select an exposure, a cost type, and a cost category.
4. Enter the available reserves, optionally enter a comment, and click Save to add the reserve.
ClaimCenter adds the reserve with a status of Pending Approval. Or, if the reserve does not need approval,
ClaimCenter immediately escalates the status to Submitting.
How ClaimCenter Displays Reserves

In most of its financial screens, ClaimCenter typically displays either Open Reserves, or both Remaining Reserves
and Future Payments.
ClaimCenter shows Available Reserves when you are creating or updating reserve amounts. It shows:
• Currently Available Reserves – Same as Available Reserves.
• New Available Reserves – New available reserve amount that you enter.
Available Reserves is the most conservative estimate of unused reserves. All payments—current, future, and not
yet approved—have been deducted.
• Change – Defined as New Available Reserves minus Currently Available. This value will be the amount of the
newly created reserve transaction.
On the Set Recovery Reserves screen, the Change column is equal to New Open Recovery Reserves minus Open
Recovery Reserves.
Configuring the Set Reserves Screen

The Set Reserves screen can run in two modes depending on the SetReservesByTotalIncurred configuration
parameter in the config.xml file.
In the base configuration, the SetReservesByTotalIncurred parameter is set to false, and the Set Reserves screen
shows the New Available Reserves column. This default mode focuses on how much reserve you have left to make
payments.
You can configure the Set Reserves screen to show Current Total Incurred and New Total Incurred columns by setting the
configuration parameter SetReservesByTotalIncurred to true. The column New Total Incurred replaces New

Available Reserves. This mode puts the focus on how much you are increasing the Total Incurred of the claim by
increasing reserves.
Note: Total Incurred on this screen is the calculation Total Incurred Net, which takes recoveries into account.
See also
• “Definitions of Total Incurred Calculations” on page 327
• “Recoveries” on page 349
Reserves in Multiple Currencies

In ClaimCenter, financial calculations are typically conducted in the Claim Currency, the currency inherited by the
claim from the associated policy. You can write checks, create reserves, and make payments in the claim currency.
Although you can conduct financial transactions in other currencies, in all calculations, this currency is effectively
converted to the claim currency.
ClaimCenter configuration also enables you to specify if you want to use multiple currencies in your financial
transactions. If you enable multicurrency, you can create reserves, checks, and make payments in different
currencies. Apart from the claim currency, each reserve, then, has a designated Reserving Currency. Payments erode
reserves in the corresponding reserving currency.
Set Reserves in Multiple Currencies

About this task
If you enable multicurrency, you can create reserves in multiple currencies in the Set Reserves screen.
IMPORTANT After you save a reserve, the currency selection, like the cost type and cost category, cannot be
changed.
Procedure
1. Open a claim and click Actions.
2. Under New Transaction, click Reserve.
3. Select Add to add a new reserve.
4. Select the currency of choice in the ReservingCurrency column.
ClaimCenter updates the NewAvailableReserves column to show the new currency symbol.
5. Enter the reserve amount.
After you specify the reserving currency, ClaimCenter shows all amounts and calculations for the reserve in
this currency.
Next steps
See also
• “Reserves in Multiple Currencies” on page 329
• “Effect of Single Currency Setting on Reserves” on page 329
Effect of Single Currency Setting on Reserves

If multicurrency is disabled in ClaimCenter, the reserve currency defaults to the claim currency specified in the
configuration file. All financial calculations are conducted in the claim currency.
Reserves 329
With multicurrency disabled, you can use the Enter an amount in another currency icon to calculate and create a reserve
in another currency. For example, an adjuster planning to create payments in another currency could use this feature
to set a reserve to that currency.
The Enter an amount in another currency icon is enabled only when the claim currency equals the reserve currency. The
following figure shows a set of these icons with a red box around them.
Note: In the base configuration, ClaimCenter tracks reserves only in the claim currency. You can create a reserve in
another currency to help you determine the amount of claim currency to put aside to make a payment.
Multicurrency payments are made against the reserve in claim currency.
For information on enabling multicurrency, see “Configuring Multiple Currencies” on page 375.
Enter Reserve Amount in Another Currency Screen

The following figure shows the screen that displays when you click the multicurrency icon. In this screen, you can
change the currency in the Currency column and choose whether the new exchange rate is entered manually or looked
up automatically.
Amounts are shown in two currencies with the primary amounts in the selected currency. In this example, the
primary amount is in Euros. The selected currency becomes the transaction currency for the new reserve. Secondary
amounts are in the claim currency and are shown under the transaction amount.
Exchange Rates and Setting Reserves

If you change the currency to a non-claim currency, the screen shows exchange rate information with the automatic
exchange rate mode button selected.
This button is enabled if you have the Exchange Rate Manual Override permission, exchratemanual. If you do not
have that permission, the Exchange Rate Mode button is disabled.

Reserve Lines
A reserve line represents a unique combination of exposure, cost type, and cost category. It is used to categorize and
track transactions.
All transactions are related to a reserve line. A reserve line, in a sense, categorizes a transaction, which is a
combination of an exposure or claim, a cost type, and a cost category. Each transaction, whether setting or changing
a reserve amount, making a payment against a reserve, creating a recovery reserve, or recording a recovery, is
marked against one reserve line. There is a ReserveLine entity created for each unique combination of Exposure or
Claim, CostType, and CostCategory if a transaction has been created with that combination.
The Exposure entity can be null, which means that the reserve line is not at the exposure level, but rather at the
claim level. In fact, that is how you set a claim level reserve on the Set Reserves screen. If you do not select an
exposure, the system creates the reserve line at the claim level.
However, CostType and CostCategory are both required values. On that same screen, you must select a cost type
and cost category. You can select an Unspecified Cost Type and Unspecified Cost Category from the drop down menus.
ClaimCenter refers to the combination of exposure, cost type, and cost category fields as the transaction's coding.
These fields exist on both the Transaction and ReserveLine entities. You categorize a transaction by setting up
those coding fields, and then the transaction is associated with the ReserveLine that uniquely represents that
coding. As a result, transactions with the same coding are associated with each other through a reserve line, to track
their totals for financial calculations.
The ReserveLine is the most granular level at which ClaimCenter tracks financial calculations. You can filter the
totals for financial calculations in many different ways, such as Total Payments with a cost type of claimcost,
which applies across the entire claim. This filter would select all reserve lines on the claim with a cost type of
claimcost, and then add up the Total Payments value for each reserve line. There are additional fields for further
categorization of transaction amounts, such as RecoveryCategory on Recovery and LineCategory on
TransactionLineItem. However, the ReserveLine entity, and hence financials calculations, do not take these
fields into account. There are no breakdown amounts.
If you save a new transaction, ClaimCenter either finds the existing reserve line that matches the transaction’s
coding or creates a new one. You do not create reserve lines directly. The Exposure, CostType, and CostCategory
values for the ReserveLine derive from the same fields on the Transaction entity. These values are set either by
you through the user interface or by Gosu code.
In the user interface, you can see how reserve lines are created. When you create a new transaction from
Actions→New Transaction→Reserve, the Set Reserves screen opens. In this screen you can either edit or add to the
Available Reserves on a reserve line. Rows that are pre-populated represent a claim’s existing reserve lines with
their corresponding reserve amounts. If you add a new row, you create a new reserve transaction on a new reserve
line coding combination, causing ClaimCenter to create a reserve line.
Note: The reserve line is created during transaction setup, so the reserve line on a transaction will have been set up
when the PostSetup and PreUpdate rule sets were run. See the Rules Guide for additional information.
When you make a payment or you record receipt of a recovery, if no reserve or recovery reserve yet exists,
ClaimCenter creates a reserve line.
Viewing reserve lines on the Financials Summary screen

Multiple reserve lines itemize different kinds of costs for the claim. The Financials Summary screen, which displays
one reserve line on each row, shows how reserve lines logically categorize a claim’s financial information.
Reserve Lines 331

This figure illustrates the following:

• There are three exposures visible, which are numbered.
• There are no claim-level reserve lines. If there were, you would see what looks like a fourth exposure labeled
Claim Level.
• Cost types divide each exposure’s costs into two major areas, administrative expenses and claim costs.
• Cost categories further subdivide these major areas, making them unique.
• There are six reserve lines visible. Each reserve line is a unique combination of exposure, cost type, and cost
category, as shown in the following table:
Exposure Cost Type Cost Category

(1) 1st Party Vehicle - Ray Newton - Collision Claim Cost Auto body
(1) 1st Party Vehicle - Ray Newton - Collision Expense A&O Other
(2) 1st Party Med Pay - Stan Newton - Medical Payments Claim Cost Medical
(2) 1st Party Med Pay - Stan Newton - Medical Payments Expense A&O Other
(3) 3rd Party Vehicle - Bo Simpson - Liability - Bodily Injury and Property Damage Claim Cost Auto body
(3) 3rd Party Vehicle - Bo Simpson - Liability - Bodily Injury and Property Damage Expense A&O Vehicle Inspection
Payments
Payments encompass all monetary amounts paid to satisfy a claim. This money includes the claim’s liabilities and its
associated LAE (Loss Adjustment Expenses) and other administrative expenses. Payments have the following
associations:
• Every payment is associated with a specific reserve line to categorize the payment amount.
• Every payment belongs to a check.
A payment is classified as either eroding or non-eroding. An eroding payment decreases the amount of available
reserves on its reserve line. If you create an eroding payment that exceeds the amount of available reserves,
ClaimCenter creates a new reserve transaction to bring the reserves back up to zero. An exception is payments that
you schedule to be sent on a future date.
Note: Payments are not the same as checks. See “Checks” on page 338.
There are different types of payments, each of which is used for different purposes.

Eroding and Non-eroding Payments

ClaimCenter defines two kinds of payments:
• Eroding – A payment that decreases the available reserves on its reserve line by the payment amount.
• Non-eroding – A payment that does not affect available reserves.
Every payment, independent of its type, can be denoted as eroding or non-eroding. The following are examples of
non-eroding payments:
• Supplemental payments made after a claim or exposure is closed and therefore has zero reserves. There are no
more reserves to erode.
• If a carrier does not include its LAE estimates in its reserves, it can make LAE payments non-eroding.
• If the carrier measures its liabilities by using Total Incurred instead of Open Reserves, eroding reserves are not
important. Only non-eroding payments increase Total Incurred.
Payments and Negative Reserves

All eroding payments reduce their associated reserves. If the AllowPaymentsExceedReservesLimits parameter in
config.xml is set to true, payments can exceed the amount of available reserves.
To prevent negative reserves, ClaimCenter creates an offsetting reserve for such payments. However, these reserves
are not created until the scheduled send date for the payment's check. Therefore, reserves remain negative from the
time the payment is approved to the day it is sent in the case of a future-dated check. Otherwise, an offset will be
created when the check is issued.
The offset reserve is created as soon as an eroding payment is in Awaiting Submission status. An offset reserve is
not created for non-eroding payments.
Partial, Final, and Supplemental Payment Types

During the check writing process, a payment type is applied to a payment. Payment types complement reserve lines
in providing an additional way to classify payments. In the New Check wizard, the Payment Type drop-down list
choices can be Partial, Final, and Supplemental depending on the situation. For example, the Partial option is available if
the open claim or exposure has reserves.
Note: It is not possible to add other types to the PaymentType typelist.
Partial Payments
A partial payment transaction is a transaction that usually pays for some of, but not all, the financial obligation of
the reserve line on an open claim or exposure. The available reserves remaining in the reserve line will presumably
be used in some future check to complete the financial obligation. These partial payments are eroding unless you
specify otherwise. If you are creating eroding partial payments and the AllowPaymentsExceedReservesLimits
parameter is set to false, the reserve line must have the available reserves to cover those amounts. If it does not,
then you must either increase the reserves to cover that amount or create a new reserve.
Partial payments are not allowed when the reserve line does not already have reserves and the
AllowPaymentsExceedReservesLimits parameter is set to false. This setting is the default in the base
configuration. Setting this parameter to true means that you can make a partial payment with available reserves that
are less than the partial payment amount. In that case, ClaimCenter automatically adds reserves to the reserve line to
prevent the available reserves from becoming negative.
Final Payments
A final payment transaction is a transaction that completes the financial obligation of the reserve line. Because the
financial obligation has been met, there is no need to keep money set aside in the reserve line. The purpose of final
payments is to close exposures and, potentially, even close the claim. Final payments can be either eroding or non-
eroding.
Payments 333
On creation, the final payment zeroes out the Open Reserves on its reserve line. ClaimCenter automatically creates
an additional reserve transaction that zeroes out the reserve line.
A final payment performs the following actions when its check is escalated by the Financials Escalation batch
process:
• If there are no reserves on the exposure and the CloseExposureAfterFinalPayment configuration parameter in
the config.xml file is true, the final payment attempts to close the payment's exposure. Other reserve lines on
the exposure with non-zero reserves prevent closing of the exposure. If the Close Exposure Validation rules fail
while closing the exposure, a warning activity is created and the exposure is not closed.
• If all exposures on the claim are closed and there are no claim level reserves and the
CloseClaimAfterFinalPayment configuration parameter is true, ClaimCenter attempts to close the claim. If
the Close Claim validation rules fail while closing the claim, a warning activity is created and the claim is not
closed.
To automatically close claims and exposures, two financial parameters in the config.xml file must be enabled,
CloseClaimAfterFinalPayment and CloseExposureAfterFinalPayment. These parameters are enabled by default
in the base configuration. For more information, see the Configuration Guide.
Note: ClaimCenter does not ensure that a final payment is the last payment. Generally, if a final payment has not
been escalated, you can make an additional partial payment. If it has been escalated, you can make a supplemental
payment.
You can also use final payments to quickly deal with small, simple claims. They can even be made before a reserve
has been specified. For example, a single First and Final payment can often settle a personal auto claim. If reserves
have not been set, a final payment creates an offsetting reserve to cover it.
Supplemental Payments
Supplemental payments are additional payments that are made on an already closed claim or exposure. They are the
only way to make a payment on a closed claim or exposure without opening the exposure or claim. They can be
submitted on the current date, or you can specify a future date. They are always non-eroding. A closed claim’s or
exposure’s available reserves will have already been zeroed, so there is nothing to erode.
Note: If you think you have a future liability, do not make a supplemental payment on a closed claim. Instead,
reopen the claim, create a reserve, and make payments against it.
Supplemental Payments Without Any Previous Payments

If the AllowNoPriorPaymentSupplement configuration parameter in config.xml is set to true, then you can make
supplemental payments if no prior payments existed. In this case, the reserve line drop-down list in the New Check
wizard shows the reserve lines of all closed exposures, including those with and without a prior payment.
Modifying Payments
Depending on its Transaction Status, you can edit, delete, void, or stop a payment or a check. You can also recode
and transfer a check, as described at “Transaction and Check Status” on page 356.
Editing or Deleting Payments

You can edit or delete a payment as long as it belongs solely to ClaimCenter. The check must not have been sent to
be entered into an external accounting system. Editing and deleting are possible when a payment is Pending
Approval, is Awaiting Submission, or has Rejected status. The claim or exposure must be open to edit or delete a
payment in Rejected status. See also “Lifecycles of Transactions” on page 357.
Recoding a Payment to Another Reserve Line

Recoding involves moving a payment to another reserve line or changing the line category of the payment’s
transaction line items after the payment is sent downstream. You can consider a check to be recoded when you
recode its payments, but checks are unaffected by recoding—their amount is unchanged.

Note: If a check is in Awaiting Submission status or an earlier status, you can edit the check and its payments any
way you like, but you cannot recode. After the check is escalated to Requesting status and is sent downstream to
the check processing system, the only way to fix a coding error is to recode the payment. For more information on
check statuses, see “Lifecycles of Checks” on page 359.
Using Recode, you can split an amount from one payment into multiple payments, but you cannot consolidate
multiple payments on an escalated check into fewer payments. However, multiple payments on the same check can
have the same reserve line, so you can always recode the right amount of money onto the proper reserve line. The
amount might be split across multiple payment transactions with that same reserve line.
Recode a Payment
About this task

Recoding is available on the Payments screen of the Transactions tab of the Financials screen.
If you are using multicurrency reserving, only reserve lines in the same currency as the reserve line of the payment
will be available for selection. All payments on a check must be from reserve lines with the same reserving currency.
Procedure
1. Select a claim.
2. Click Financials in the Sidebar on the left.
3. Click a payment amount to open the Transactions screen.
4. Click the Amount link of a Payment transaction.
This action opens the Payment Details screen.
5. Click Recode.
The Recode Payment screen opens.
6. In the Recode Payment screen, you can do the following:
• Change the reserve line.
• Enter a comment.
• Add additional line items and set the line category and amount for each line item.
• Click Add Payment and then edit the reserve line and amounts of the payments to reflect the new reserve line
and amount on each. Their amounts must add up to the original payment's amount.
Transferring a Payment to Another Claim

You cannot transfer a payment to another claim, at least not directly. You can transfer a check, and when you do so,
all payments on the check are also transferred. For more information, see “Transferring Checks from One Claim to
Another” on page 343.
Voiding or Stopping a Payment

After a check is submitted to an external check writing application to be issued, its payments are also submitted.
While they can no longer be edited or deleted, ClaimCenter does provide both a Void and a Stop mechanism. Their
details depend on your implementation. However, these actions are more common to checks. When you void or stop
a check, ClaimCenter also creates offsets that void the associated payments and reserves for you.
ClaimCenter generates offset transactions for all voids and stops and their payments. The description field of the
offset reads Offsetting transaction for voided check to Payee on Date.
Negative and Zero Dollar Transactions and Checks

There are times when you want to make zero-dollar or negative transactions. For example, you can receive an
invoice containing credit or no-cost items, and then create a payment to record that it was paid. Or, if you make an
Modifying Payments 335

overpayment to a claimant, the claimant’s next check can have a line item for that reserve line. The line item would
show a negative amount to offset the overpayment.
In ClaimCenter, you can create:
• A check with a negative amount.
If you want to create the check manually, the configuration parameter AllowNegativeManualChecks in the
config.xml file must be set to true.
• A check for $0.
• A check with a negative amount as one or more of its payments.
• A payment with a negative amount on one or more of its line items.
• A check with $0 entries on one or more of its payments.
• A payment with $0 entries on one or more of its line items.
• A recovery with a negative amount, but only if the recovery does not result in negative total recoveries on the
reserve line or the claim.
• A recovery with $0 entries on one or more of its line items.
• A recovery of $0.
• A reserve of $0.
Making Payments with Rules

For automatic payments or other payments made by using a Gosu rule, you must use the setAsNonEroding and
setAsEroding methods on Payment to change whether the payments erode reserves.
See also
• “Transaction Business Rules” on page 370
Payments and Zeroing Reserves

When an exposure or claim is closed, reserves on its reserve lines are set to zero. Payments can have an impact on
the zeroing of reserves as well, and this topic describes some of the scenarios in which zeroing transactions would
be created in ClaimCenter.
When a final payment is made that requires an offsetting reserve transaction, zeroing of various amounts is done in
that transaction. When payments, partial or final, do not result in offsetting reserve transactions, reserves are zeroed
only when the exposure or claim is closed.
The following topics are various scenarios in which reserves are zeroed.
• “Example of Zeroing Reserves in Single Currency Mode” on page 336
• “Example of Zeroing Reserves and Exchange Rate Fluctuation” on page 337
• “Example of Zeroing Reserves with a Final Payment with Offsetting Transaction” on page 337
Example of Zeroing Reserves in Single Currency Mode

In this first example, transactions are conducted in a single currency and a final payment triggers an offsetting
transaction and the zeroing of reserves.
ClaimCenter configuration:
• Multicurrency display is disabled.
• Multicurrency reserving is disabled.
Currency: USD

Financial Entity Transaction Amount Reserving Amount Claim Amount Reporting Amount
Available Reserves 200 USD 200 USD 200 USD 200 USD
Final Payment 120 USD 120 USD 120 USD 120 USD
When the final payment is made, the zeroing transaction is created.
Zeroing Transaction -80 USD -80 USD -80 USD -80 USD
In this example, a final payment of $120 is made, which prompts ClaimCenter to create the zeroing transaction to
zero the claim amount balance of -80 USD. If the final payment equals the existing open reserves, no such offsetting
transaction would be created.
Note: The Comments field typically contains a special description for zeroing transactions.
Example of Zeroing Reserves and Exchange Rate Fluctuation

In this example, a final payment is made that equals the total reserve amount, so no offsets are required. However,
by the time the payment is made, the exchange rate has changed.
• Multicurrency display is enabled.
• Multicurrency reserving is enabled.
Currencies:
• Transaction currency: United States Dollars (USD)
• Reserving currency: USD
• Claim currency: Canadian Dollars (CAD)
• Default currency: USD
Financial Entity Transaction Amount Reserving Amount Claim Amount Reporting Amount Exchange Rate
(USD:CAD)
Available Reserves 200 USD 200 USD 200 CAD 200 USD 1:1
Exchange Rate has now changed. 2:1
Final Payment 200 USD 200 USD 100 CAD 200 USD 2:1
When the exposure or claim is closed, the zeroing transaction is created.
Zeroing Transaction 0 USD 0 USD -100 CAD 0 USD
In this example, the exchange rate change prompts ClaimCenter to create the zeroing transaction when the claim or
exposure is closed to zero the claim amount balance of -100 CAD.
Example of Zeroing Reserves with a Final Payment with Offsetting Transaction

In this example, a final payment is made that is less than the total reserve amount, which results in an offsetting
transaction. This results in the zeroing of that transaction in all amount types.
Payments and Zeroing Reserves 337

• Multicurrency display is enabled.
• Multicurrency reserving is enabled.
Currencies:
• Transaction currency: United States Dollars (USD)
• Reserving currency: USD
• Claim currency: CAD
• Default currency: Euros (EUR)
Financial Entity Transaction Reserving Claim Amount Reporting Exchange Exchange

Amount Amount Amount Rate Rate
(USD:CAD) (CAD:EUR)
Available Reserves 200 USD 200 USD 200 CAD 100 EUR 1:1 1:0.5
Exchange Rate has now changed.
Final Payment 150 USD 150 USD 225 CAD 90 EUR 1:1.5 1:0.4
When the final payment is made, the zeroing transaction is created.
Zeroing Transaction -50 USD -50 USD 25 CAD -10 EUR
In the example illustrated in the preceding table, the final payment of 150 USD results in corresponding zeroing of
the reserving, claim, and reporting amounts.
When a final or partial payment is made that does not require an offsetting reserve transaction, the zeroing of
reserves is done only when the exposure or claim is closed.
See Also
• “Overview of Multicurrency” on page 373
• “Effect on Reserves of Closing a Claim or Exposure” on page 326
Checks
ClaimCenter uses checks to make payments. You create and edit payments in the check wizard.
Note: You can also use electronic fund transfers to make payments. See “Electronic Funds Transfer (EFT)” on
page 347 for details.
ClaimCenter must be integrated with an external financial application that prints and sends checks to make claim
payments. To make a claim-related disbursement, you create the necessary check descriptions in ClaimCenter to pay
the disbursement. After the check issue date occurs, ClaimCenter sends a request to your check writing application,
which in turn writes the actual check. Instead of issuing a check, your external system can send an electronic funds
transfer, wire transfer, or credit a credit card.
Payments and Checks

The terms check and payment in ClaimCenter refer to separate items:
• Payment – A payment is a transaction that you perform in ClaimCenter that is applied against a specific reserve
line. ClaimCenter uses payments to track the financial status of a claim. Fundamentally, payments track how
funds set in reserve are paid to settle a claim and pay its settlement expenses.
• Check – A check is a request that ClaimCenter creates and then sends to an external check writing or financial
management application. ClaimCenter records all the salient details of the check. These details include to whom

the check was made out and for how much, and against which reserve line the check is written. The application
then requests that the external system create and issue the physical check.
A single check, check group, or check set can comprise one or more payments of the same claim. Also, a single
payment can be made by more than one check, provided that all the checks are part of the same check group or
check set. However, a payment cannot be split among multiple check sets.
Types of Checks
You create checks in ClaimCenter by using the New Check wizard. After they are approved and when their issue date
is reached, ClaimCenter sends them to its check writing system to be issued. See “Transaction and Check Status” on
page 356 for a description of the statuses that describe a check’s lifecycle. ClaimCenter recognizes that checks
created in the same use of the New Check wizard are related, and manages them together.
In some cases, you can issue a check that is not directly related to any other check. A common example is a payment
to a body shop, which is typically a one-time payment to a single vendor. The vendor repairs the damage. You send
the vendor a check to cover the fee. In most cases, there is only a single payee, so the New Check wizard writes only
one check.
However, when a payment must be divided among several payees, a different check can be issued to each of them.
Multiple checks created at the same time are organized into check sets and check groups.
Some definitions:
• Check – A ClaimCenter request to generate a single physical check. Each check has a primary payee and can
also have one or more joint payees. A check can represent one or more payments.
• Check set – All the checks created by a single execution of the New Check wizard. The set includes checks that
will be issued at different times, such as a recurring check set. All the checks in a check set are submitted
together, and they must be approved or rejected as one. A single-payee, non-recurring check belongs to its own
check set.
• Check group – All the checks created by a single execution of the New Check wizard that are scheduled to be
issued at the same time. If a single payee check is written, it is in its own check group.
For a set of recurring checks, check groups organize the checks into groups to be issued at the same time. A
check group contains multiple checks when there are multiple payees.
A way to see the difference between a check and a check set is to compare them to joint payees and multiple payees.
• Joint payees – Two or more different payees that are listed in the same Pay To field of a single check. An
example of a check written to joint payees might be an auto claim, where the insurer pays a body shop for repairs
to the insured’s car. The insurer might write the check to both parties as joint payees. This is because both parties
are then required to sign the check before it can be deposited or cashed. This is one check, because the names of
the payees appear on a single physical check.
• Multiple payees – Unique payees, each of whom receives separate checks for one payment. For example. a
workers’ compensation claimant gets one check, while the claimant’s ex-spouse receives another for court-
mandated child support. The claimant is the primary payee, and the ex-spouse is a secondary payee.
The multiple payee example also illustrates check groups. In this case, both checks are in one check group. The
Grouped Checks section of a check detail screen lists them together. If these checks were to recur 12 times, there
would be 12 groups of two, and all 24 checks would be contained in one check set.
In the data model, checks are not a transaction subtype, but sets of checks are grouped into check sets, which are a
subtype of transaction sets.
Note: If a check is created in the Auto First and Final wizard and its associated exposure or claim is not at the
Ability to Pay validation level, it requires approval.
Recurring Check Sets

You can create a check set that includes a series of checks that ClaimCenter issues periodically. A typical use for
recurring checks is for a workers’ compensation claim. Damages for lost wages are paid on a monthly or weekly
Checks 339
basis. A single use of the New Check wizard can create a check set containing check groups, which in turn contain
single instances of the recurring checks.
The following table describes the recurrence types available in the Set check instructions step of the New Check wizard.
Recurrence Description
Type
Single Use to specify a single payment only, an occurrence of one. This type is the default in the base configuration.
Weekly Use to select the following:
• Weekly frequency—for example, every week, or every two weeks
• Day of week
• Number of days in advance to send the check
• Total number of checks to create
ClaimCenter shows the total recurrence amount after you specify the total number of checks.
Monthly Use to select the following:
• Monthly frequency—for example, every month or every third month
• Day of the month or the day of a week in a month to send the check
• Number of days in advance to send the check
• Total number of checks to create
ClaimCenter shows the total recurrence amount after you specify the total number of checks.
Notes
• After you initially create them, recurring checks must be written to the same payees and be for the same amount.
However, you can edit and clone check sets and make changes to either payees or amounts if necessary.
• If you have enabled multicurrency in ClaimCenter, you cannot change the exchange rate of multi-payee checks in
a recurrence. The exchange rate on the checks is locked in for the entire recurrence. Because the fixed amount on
a check portion can be shared across multiple checks in a recurrence, the exchange rate for all the checks in the
recurrence must be identical. To learn about check portions, see the definition for CheckPortion in the section
the Configuration Guide.
See also
Service Dates and Service Periods for Checks

A check can have a service date or a service period.
• A service date identifies the date on which a loss occurred that results in a payment.
• A service period identifies the period of time over which a payment represented in a check is earned.
Whether a payment applies to a service date or a service period depends on the nature of the exposure to which the
payment applies.
The most common example of a check’s service period is found in workers’ compensation claims. A primary type of
loss in this kind of claim is for the worker’s lost wages. In this case, the insured is entitled to all or part of the wages
they would have earned had they been physically able to work. For example, if that period of time was from August
1 – 14, the check’s service period would be August 1 – 14. The payment in the check identifies the time period over
which the damage—in this case, lost wages—occurred.
Another example of a service period is an auto policy that includes rental car benefits that apply if the insured’s
vehicle is not drivable. The insured rents a car for six days, and you send a check for reimbursement. The six days of
the rental are the service period for the check.

Manual Checks
In most cases, if you need to make a payment, you create a check in ClaimCenter, which records the payment and
sends a request to your check writing system. But you might need to quickly write out a check by hand and bypass
ClaimCenter. If ClaimCenter does not create the check, it does not know about it, and the check is not counted
against reserves. Thus, writing a check by hand can cause confusion in the application’s financial records.
You can account for checks written by hand by creating a manual check, a check record you create within
ClaimCenter to acknowledge a check that you write outside ClaimCenter. After a manual check reaches its issue
date, ClaimCenter changes its status to Notifying and sends a message, rather than a print request, to its external
check writing application.
ClaimCenter does not verify payment amount against available reserves when creating manual checks. Similarly,
when recoding payments on a manual check or transferring a manual check, available reserves are not verified.
Manual checks do not normally require approval and go directly to Notifying status. They cannot reach Pending
Approval, Awaiting Submission, or Rejected status unless you write custom approval rules. You can also transfer a
manual check in Notifying or later statuses, just as with a normal check.
Working with Checks

This topic describes at a high level how to modify checks.
If a check has the appropriate status, you can edit, delete, transfer, clone, reissue, void, or stop payment on it.
“Lifecycles of Checks” on page 359 defines the states for which these operations are available. To modify a check,
use the New Check wizard and select the check.
Deleting Checks
You can delete any check until its status becomes Requesting. You can also delete a check in Rejected status if its
reserve line is in a claim or exposure that is still open. If you have written recurring checks, you can delete any in the
series that have not been sent downstream to the external check writing application.
Editing Checks
You can edit a single check before its status becomes Requesting, but editing such a check after it is approved can
return its status to Pending Approval. You can also edit a Rejected check if its reserve line is part of a claim or
exposure that is still open.
After editing a check recurrence, you cannot change the amount after it is approved. Instead, you can indirectly edit
the total amount by changing the number of checks in the recurrence, which forces the underlying check set to be
resubmitted for approval. You can edit a check in a recurrence on the Check Details screen in two ways:
• If you click the Edit button, your changes apply only to that check.
• If you click the Edit Recurrence button, your changes apply to all remaining checks in the recurrence.
Note: You must have the resdelete permission to edit a final check. Otherwise, the check wizard cannot delete
and recreate the offsetting reserve.
Cloning Checks
Cloning is a time-saving device that enables you to use an existing check or check set as a template to create a new
check or check set. You can clone an existing check set that is either single or recurring and then use the New Check
wizard to make changes.
One typical use for cloning a single check is that you already have one or more checks written to joint payees. If you
want to create a new check for the same payees, clone an existing check and then modify the clone as necessary.
Cloning a recurring check set can save even more time. You might have set up a recurrence to pay through the end
of the year. Later, you could be informed that a cost of living increase (COLI) will apply for next year. You can
clone one of the checks in the existing recurrence, add an additional payment to provide for the COLI, and save the
new recurrence.
Checks 341
Notes on cloning checks

• Cloning creates a new check set for the same claim.
• Cloning creates a new check group. The check group and all checks in it are cloned and added to the new check
set.
• All payments are copied to the cloned checks, as are their line items.
• All payees are copied to the new checks.
• Deductions on the check being cloned are not copied to the new check.
• If the check is part of a recurrence, the recurrence is cloned as well. The first due date of the cloned recurrence is
the scheduled send date of the last check of the existing recurrence plus one service period.
• Cloned recurring checks retain the same service period as the original recurrence.
See also
• “Clone a Check” on page 342
Clone a Check
About this task

You can clone checks in ClaimCenter. See “Cloning Checks” on page 341.
Procedure
1. Open the claim the check is in and navigate to Financials→Checks.
2. Click the check number for the check you want to clone to open the Check Details screen.
3. Click the Clone button to open the New Check wizard.
4. Enter information for the Payee, Payments, and Instructions.
5. On the final screen of the wizard, click Finish to save the check.
Recoding Checks
You cannot recode a check. However, you can move a check’s payments and make a payment against a different
reserve line at any time. This process is called recoding a payment.
See also
• “Recoding a Payment to Another Reserve Line” on page 334
Reissuing Checks
You can reissue a check to correct a single check in a check group without having to eliminate all the checks in the
group. For example, you divide a payment into multiple checks, and one of them is incorrect. You can reissue the
incorrect check instead of voiding and recreating the entire check group.
Notes on reissuing checks

• You cannot change the amount of a reissued check.
• You must not void or stop the check before reissuing it. The reissue process first voids the existing check.
Voiding a check yourself prevents you from reissuing it.
• You cannot reissue a check if it is the only member of the check group. Since there are no other checks to void,
reissuing does not do anything useful.
• You cannot reissue a bulk check.

Transferring Checks from One Claim to Another

Sometimes a single person or entity is a payee on multiple claims. The single person or entity might receive a check
in the correct amount, but the wrong claim is charged.
For example, an attorney represents insured parties on behalf of the carrier in third-party litigation. The attorney can
represent quite a few insured parties. In the process of paying the attorney’s legal fees, it is possible to write a check
against the wrong claim. In this case, you can transfer a check from one claim to another, rather than voiding it, and
then recreate it in another claim.
Notes:
• Before transferring a check, ensure that the payee is linked to the contact management system in both claims, as
described later in this topic. If the contact is not linked and the payee already exists in the target claim,
ClaimCenter will create a duplicate contact in the target claim. See “Transfer a Check” on page 343.
• ContactManager, when integrated with ClaimCenter, provides centralized management of your claim contacts
and vendors. For more information, see the Guidewire Contact Management Guide.
You can transfer the check with the following limitations:
• The check must have already been sent to the check writing application and have a status at least of Requesting.
• The check cannot be a member of a check group that has multiple payees.
• The check cannot be recurring.
Transfer a Check
Before you begin

Under some circumstances, you can transfer a check. See “Transferring Checks from One Claim to Another” on
page 343.
Procedure
1. With the claim open, click Financials in the sidebar menu on the left to open the Financials screen.
2. Click Checks and click the Check Number for the check you want to transfer.
The Check Details screen opens.
3. Note the name in the Pay To The Order Of field.
This name is the check’s payee.
4. Ensure that this payee is linked to the Address Book in both the source claim and the target claim.
a. In the source claim, click Parties Involved in the sidebar menu on the left.
b. Select the check payee that you identified previously from the list of contacts.
ClaimCenter shows the payee’s contact information below the list of parties involved.
c. On the Basics tab, determine if the contact is linked, and, if not, click the Link button or the Relink button.
If the contact is not linked, there will be a Link button or a Relink button. There will also be a message
saying either that the contact is not linked or that the link is broken. A broken link means that the contact
was deleted in ContactManager. Relinking creates that contact again.
If the contact is already linked, there will be a message saying that the contact is linked to the Address
Book, and there will be an Unlink button. In this case, you do not need to link the contact.
d. Open the target claim and click Parties Involved in the sidebar menu on the left.
e. If there is a contact with the same name as the payee on the source claim and the contact is not linked as
described previously, click Link or Relink.
f. You might see a message saying that matches were found for the contact. If so, and there is a correct
match, pick it from the list.
Working with Checks 343

5. Open the source claim again.

6. Go back to the Check Details screen by navigating to Financials→Checks and clicking the Check Number.
7. Click the Transfer button.
8. To the right of the Claim field, click the Search icon and search for the claim to which to transfer the check.
9. In the list of claims returned by the search, click the Select button for the claim you want.
10. Click Transfer to transfer the check.
Transferring Checks from a Closed Claim

When a claim is closed, you can still transfer existing checks under certain conditions, as follows:
• You can transfer a supplemental payment from one closed claim to another.
• You can transfer a check from one closed claim to another, if there were payments made on the reserve line
before the target claim was closed. The payment is transferred as a supplemental payment.
Voiding or Stopping Checks

The integration with the external check writing system determines the exact definition of voiding versus stopping
payment on a check. ClaimCenter shows a void button or a stop button to tell you which is possible. Typically, the
primary distinction is that you stop payment on a check if the check itself is no longer in your physical possession.
Otherwise, you void it.
Note: When you stop or void one check in a check group, you stop or void all the checks in that group.
If you reissue a check, the reissue process first voids the check for you. If there are other checks in the group
containing the reissued check, they are unaffected.
Check statuses determine when you can void or stop payment on a check. In general, you can void or stop a check
after it reaches the status of Requesting. However, you can void, but not stop, a check with a status of Cleared. See
“Transaction and Check Status” on page 356 for more information about which check statuses allow voiding and
stopping. You must have a special permission to void or stop checks, and an additional permission to void a cleared
check.
Deducting from Checks

ClaimCenter provides support for backup withholding from checks. You might be required to deduct estimated taxes
from a check if the vendor has not provided you with full tax status information. You would then forward the
deducted amounts to the tax authority.
In the first step of the New Check wizard, settings for the Primary Payee Type and the Report As field determine if
ClaimCenter can deduct income tax from the check. If Type is Vendor and Report As is Reportable, ClaimCenter can
withhold income tax from the check.
If you select a contact in the Name field that is a vendor, the Type and Report As fields are set automatically to Vendor
and Reportable. You can change these fields in the wizard.
There are additional settings that determine if the amount is actually deducted from the check, as described in
“Deducting from Checks” on page 344. The base configuration parameter settings for deductions allow deductions
to be made from the check.
There are some things to note about how ClaimCenter handles checks with deductions:
• ClaimCenter calculates the net amount of a check as the gross amount minus the total deductions of the check.
• During check integration, the amount that is sent to the check printing system to be printed must be the net
amount of a check.
• The gross amount continues to be reflected in ClaimCenter financials because the deduction will eventually be
sent to a tax authority or other third party. The gross amount is the true cost on the claim.

Check Deductions
A Check can have one or more Deduction entities, each of which indicates an amount to be deducted from the
check's amount. These Deduction entities are created for each check by a plugin implementation of one of the
following plugin interfaces: either IBackupWithholdingPlugin or IDeductionAdapter.
You can write your own implementations of these plugin interfaces. The IBackupWithholdingPlugin plugin
interface is preferred for creating all kinds of Deduction entities, even those not related to backup withholding. It is
newer and easier to use than the IDeductionAdapter plugin interface.
See also
Backup Withholding Plugin

In the base configuration, ClaimCenter uses the plugin implementation
gw.plugin.taxframework.BackupWithholdingPlugin. This class implements IBackupWithholdingPlugin and
is registered with the IBackupWithholdingPlugin plugin registry. This plugin implementation provides support for
backup withholding from checks. It calls the backup withholding utility class
gw.util.BackupWithholdingCalculator to do the work. You can view and edit these Gosu classes if you want to
understand or modify the behavior.
ClaimCenter Backup Withholding Behavior

ClaimCenter and the BackupWithholdingPlugin plugin implementation behave as follows in the base
configuration.
1. The following settings on the first step of the New Check wizard determine if ClaimCenter can deduct income
tax from the check:
• A payee Type of Vendor, which is stored in the Check.Payee.PayeeType field
• A Report As value of Reportable, which is stored in the Check.Reportability field
2. After the user enters payment information on the second step of the New Check wizard and clicks Next,
ClaimCenter runs the BackupWithholdingPlugin plugin. It inspects the payees on the check and deducts
backup withholding if:
• The Check.Payee.PayeeType field is vendor.
• Check.Reportability field is reportable.
• Either of the following is true:
The vendor on the check has a Contact.WithholdingRate value. In this case, this custom withholding rate
is used to calculate the backup withholding amount, and there is no need to check the next condition.
The vendor on the check has a Contact.TaxStatus value that is not confirmed—it is either unconfirmed
or unknown. In this case the StandardWithholdingRate as defined in the config.xml file is used to
calculate the backup withholding amount.
There are three configuration parameters in the config.xml file that affect deductions:
• BackupWithholdingTypeCode – Default value is irs.
• CalculateBackupWithholdingDeduction – Default value is true.
• StandardWithholdingRate – Default value is a percentage, 28.0.
See also
• “Deducting from Checks” on page 344
Working with Checks 345

Check Deductions Versus Multiple Payee Checks

Deductions are one way to reduce the final amount of a check and collect money to send to a third party. Creating a
multiple payee check is another way to reduce the final amount of the primary check and send money to a third
party. You create a multiple payee check in the New Check wizard by clicking Add Payee, and thereby creating a
secondary check that is part of a check group.
Note: Neither of these approaches modifies the total of payments reflected in ClaimCenter financials. The
deducted amounts are going to a third party, and the payment amounts reflect the true cost on the claim.
Take the following into consideration when deciding how to reduce a check's amount:
• A secondary check creates a separate Check entity that can be escalated downstream and result in printing a
check or sending an EFT payment.
• Some functions of ClaimCenter cannot be performed on multiple payee checks, or are limited in their scope. For
example:
◦ You cannot transfer multiple payee checks to another claim.
◦ If you void or stop one check in a check group, you void or stop all checks in that group. However, you can
reissue a single check in a check group.
• The deduction plugin is called every time the check is edited in the New Check wizard. Any current deductions are
retired, and new Deduction entities returned by the plugin are added to the check.
• Deductions are usually used with deducted amounts where the Deduction.DeductionType field clearly indicates
the destination, such as the irs typekey for backup withholding. In this case a separate, secondary check is not
required to deliver the money. For example, a check is escalated that contains irs deductions, and integration
code notifies a downstream system that tracks backup withholding and sends a monthly payment to the tax
agency.
See also
• “Deducting from Checks” on page 344.
• For more on multiple payee checks and check groups, see “Types of Checks” on page 339.
• “Reissuing Checks” on page 342.
• “Transferring Checks from One Claim to Another” on page 343.
• “Voiding or Stopping Checks” on page 344.
Negative and Zero Dollar Checks and Payments

You can create negative and zero dollar checks and payments.
See also
Bulk Invoice Checks

Checks associated with bulk invoices cannot be edited, cloned, reissued, or deleted. Voiding or stopping a bulk
invoice check also voids or stops all the bulk invoice’s payments.
See also
• “Bulk Invoice Checks” on page 400
Effect on Checks of Closing a Claim or Exposure

Whenever ClaimCenter closes a claim or exposure, it automatically escalates any associated checks with a status of
AwaitingSubmission. ClaimCenter does not escalate supplemental checks, however.

Electronic Funds Transfer (EFT)

You can perform financial transactions electronically. These transactions are known as electronic funds transfers, or
EFTs. In ClaimCenter, you work with EFTs mainly in the context of a contact. The topics that follow describe areas
of ClaimCenter you can use to add bank data to a contact.
See also
• The topics included in this one refer to ContactManager, which, if integrated with ClaimCenter, provides
centralized management of your claim contacts and vendors. For more information, see the Guidewire Contact
Management Guide.
Add EFT Information in the New Claim Wizard

Procedure
1. Navigate to the New Claim wizard.
2. Under Basic Info, select either New Person or Edit Contact.
3. At the bottom of the screen you can add EFT information under the Bank Data section.
If integrated with ClaimCenter, ContactManager duplicates this EFT information in order to keep contact
information synchronized. Because the array is available at the Contact supertype, the EFT information is
available for all subtypes. However, it has not been exposed for the Place subtype.
Add EFT Information in the New Check Wizard

About this task
You can add EFT information in the New Check wizard. EFT is also available on FNOL Auto First and Final and
Quick Check, but it is not exposed on a manual check.
Procedure
1. In the New Check wizard, select EFT as a payment option.
2. Select from one of the registered EFT accounts for the payee.
ClaimCenter copies the selected account data to the check object to maintain an audit trail in case it
resynchronizes the contact with ContactManager and EFT information has changed.
Add EFT Information by Creating a New Person

About this task
If ClaimCenter is integrated with ContactManager, you can create a new contact with one or more EFT accounts,
one of which can be marked as primary.
Procedure
1. In ClaimCenter, navigate to AddressBook→Actions→New Person.
2. Add one or more EFT accounts to the new person.
EFT Data Model

The following diagram illustrates the relationship between the EFTData entity and other related entities. Only fields
that have impact on how the EFT data moves are listed in the diagram.
Electronic Funds Transfer (EFT) 347

EFT Data Model
EFTDataDelegate
AccountName
BankName Check
BankAccountType
BankAccountNumber
BankRoutingNumber
IsPrimary
EFTData Contact
EFTData is 1 to many Contact
Contact EFTRecords
Legend
A is one-to-
A B one B
A B A is one-to-
many B
A B A extends B
A B A implements B
A has foreign key

A B
to B
• The entities EFTData and Check implement the EFTDataDelegate entity.

• The delegate EFTDataDelegate is defined in the base data model with no columns in it. All the columns are
defined in extensions to make them configurable.
• EFTData has a non nullable Contact foreign key. Contact has an array called EFTRecords, which is an array of
EFTData.
Note: GWCheckEnhancement has the property EFTData with a Gosu setter and getter to copy EFT data from a
contact to a check. These properties must be extended synchronously with any changes to the EFTDataDelegate
entity.
Recoveries and Recovery Reserves

Recoveries and recovery reserves are analogous to payments and reserves, respectively, but refer to money received,
rather than paid out, in the course of settling a claim.

See also
• “Reserves” on page 325
Recoveries
A recovery is a transaction that accounts for money received by the carrier to help settle a claim. Recoveries can
come from a variety of sources. Among them are:
• Salvage – If a claimant receives payment for a completely destroyed vehicle, the carrier can get back some of its
cost by selling the vehicle for scrap.
• Subrogation – Money recovered by a carrier taking action against a liable party. For example, a carrier can pay
its insured for vehicle damages, and then collect from the at-fault driver.
• Deductibles – Money that the insured must pay to satisfy the policy terms and conditions.
ClaimCenter reports Total Recoveries that have been received.
Recoveries are tracked separately from reserves and payments. Recoveries are included in the financial calculation
TotalIncurredNet because they reduce total liability for the claim. The Total Incurred field at the top of the Financials
screen is the Total Incurred Net value, which subtracts recoveries.
Note: You can also create a negative recovery if it does not result in negative total recoveries on the reserve line or
the claim. For example, you might have received a check for a recovery that was written for too large an amount,
but was already deposited and entered in the system. Entering a negative recovery is one way you might handle
accounting for the refund.
See also
Recovery Reserves
Recovery reserves are estimates of how much money might be recovered from others in settling the claim. They are
analogous to reserves, but for recovery transactions instead of payments. They are estimates of the amounts likely to
be received that diminish the carrier’s liability on a claim. Similar to all transactions, they are categorized by their
unique reserve line.
Although permissions are needed to view, create, edit, or delete recoveries and recovery reserves, the permissions
are assigned to all roles in the base configuration.
Recovery reserves are related to one reserve line. Recoveries and recovery reserves have an additional attribute,
Recovery Category, similar to cost category but not part of the reserve line, that further defines them. The recovery
category is a required value and must be defined when creating recoveries and recovery reserves.
Assigning a Recovery Category

A recovery or recovery reserve transaction is assigned a recovery category, which further categorizes the transaction
beyond the standard ReserveLine components.
In the base configuration, the RecoveryCategory property can have one of the following values, defined in the
RecoveryCategory typelist:
• Credit to expense
• Credit to loss
• Deductible
• Salvage
• Subrogation
Recoveries and Recovery Reserves 349

On a single reserve line, you can add transactions with more than one recovery category. You can track financial
calculation amounts by the RecoveryCategory on the Financials Summary page.
See also
• “Financials Screens” on page 47
Recovery Reserve Offsets

After a recovery is received, it decreases the open recovery reserve associated with that reserve line. If a recovery
category is specified, the appropriate recovery reserve line with the corresponding recovery category is eroded. The
resulting calculation, Total Recovery Reserves minus Total Recoveries, is analogous to payments’ decreasing open
reserves.
If a recovery reserve does not exist or is not sufficient, a received recovery generates a matching recovery reserve to
keep Open Recovery Reserves from becoming negative. This offset recovery reserve transaction also increases the
Total Recovery Reserve.
This process is similar to the one in which a payment that exceeds reserves creates a reserve offset that keeps Open
Reserves positive and so increases the matching Total Reserves. There is no configuration parameter for recovery
reserves that is analogous to AllowPaymentsExceedReserves. You can always receive money to reduce a claim’s
cost.
If a received recovery is voided, the associated recovery reserve offset is also rolled back. The Total Recovery
Reserve decreases by the previous offset amount and the Open Recovery Reserves return to the values they had
before the recovery was created. Again, this process is analogous to what happens when payments exceed reserves.
The following table shows how these values can change for specific recoveries:
Claim is opened and no recoveries are expected

Total Recovery Reserves Open Recovery Reserves Recoveries Net Total Incurred
$0 $0 $0 $0
An unexpected recovery check is received
$500 $0 $500 $-500
Receive recovery check is voided
$0 $0 $0 $0
Configuring Recovery Reserves

You can configure ClaimCenter to suppress recovery reserves by setting the UseRecoveryReserves configuration
parameter in the config.xml file to false.
You can also create recovery reserve transactions to track the expected level of recoveries in the future. As described
previously, recovery transactions reduce the value of open recovery reserves. You can use and display the
calculation TotalIncurredNetRecoveryReserves if you have a high confidence that all recovery reserves will be
recovered. In this case, this calculation gives a more accurate and earlier indication of carrier liability.
See also
• For more information on configuring financial calculations, see the Configuration Guide.
Modifying Recovery Records

To make corrections to recovery records, you can either recode or transfer a recovery.

This section includes:

• “Transferring Recoveries” on page 351
• “Transfer a Recovery” on page 351
• “Multicurrency and Transferring a Recovery” on page 352
• “Recoding Recoveries” on page 352
• “Create and then Recode a Recovery” on page 352
Transferring Recoveries
You would need to transfer a recovery if someone entered a recovery amount on the wrong claim, and you need to
associate it with the correct, and different, claim. It does not matter if the claims are closed.
Transferring a recovery does the following:
• Creates an offset recovery on the same reserve line.
• Creates an onset recovery on the new claim and reserve line.
• Sets the original recovery's status to Pending Transfer.
Setting the configuration parameter UseRecoveryReserve in the config.xml file to true has the following effects
on recovery transfers:
• If a recovery has a zeroing offset recovery reserve, transferring this recovery creates a recovery reserve in the
negative amount of that zeroing offset.
• A zeroing recovery reserve is created on the onset recovery's reserve line, if necessary.
The recovery status changes from Pending Transfer to Transferred after it is acknowledged by the downstream
system.
See also
• “Transfer a Recovery” on page 351
Transfer a Recovery
Before you begin

For reasons of why you would want to transfer a recovery, review “Transferring Recoveries” on page 351.
Procedure
1. Navigate to a claim’s Financials screen and click the Transactions tab to open that screen.
2. Set the filter to Recoveries to help identify which recovery is to be transferred, and then click the amount in the
Amount column.
The Recovery Details screen opens.
3. Click Transfer to open the Transfer Recovery screen.
4. On the Transfer Recovery screen, find the targeted claim or enter the claim number if you know it.
If you search, you can select the claim from the active database or the archive, and you can enter a variety of
parameters to narrow your search. View the search results in the bottom section of the screen.
5. Select the targeted claim and click Select to return to the Transfer Recovery screen.
6. On the Transfer Recovery screen, choose the Reserve Line from the drop-down list or create a new one.
7. Enter the Exposure, Cost Type, and Cost Category.
If multicurrency is enabled, you can also select the ReservingCurrency.
8. Click Transfer.
Modifying Recovery Records 351

If the Transfer button is disabled, the following are typical causes:

• The recovery is an offset recovery, which cannot be transferred.
• The recovery has one of the following statuses: Transferred, Pending Transfer, Recoded, or Pending Recode.
• You do not have Edit recoveries permission.
The Financials→Transactions screen reflects your changes. The status of the recovery changes to PendingTransfer.
Multicurrency and Transferring a Recovery

You can use the following indicators to determine the exchange rate used when you transfer a recovery:
• If the claim selected for the transfer has the same claim currency as the original claim currency, no exchange rate
information displays. The same trans-to-claim exchange rate is used for the onset recovery.
• If the claim selected for the transfer has a different claim currency and the claim's currency is the same as the
recovery's currency, no exchange rate information shows.
• If the target claim has a different claim currency and the claim’s currency is different from the recovery's
currency, ClaimCenter displays exchange rate information. The entered information is applied as the transaction-
to-claim exchange rate for the onset recovery.
For more information, see “Multiple Currencies” on page 373.
Recoding Recoveries
Recoding a recovery is similar to transferring a recovery, but with a slight difference: You are assigning to the
correct reserve line on the same claim. Recoding enables you to correct clerical mistakes.
Recoding has the following effects:
• Creating an offset recovery on the same reserve line.
• Creating an onset recovery on the new reserve line.
• Setting the original recovery's status to Pending Recode.
Note: Offset recoveries cannot be recoded. Recoveries with the following statuses also cannot be recoded:
Transferred, Pending Transfer, Recoded, and Pending Recode.
If the configuration parameter UseRecoveryReserve in the config.xml file is set to true, a recovery has a zeroing
offset recovery reserve. The recoding process creates a recovery reserve in the negative amount of that zeroing
offset. There is also a zeroing recovery reserve created on the onset recovery's reserve line, if necessary.
The recovery status changes from Pending Recode to Recoded after it is acknowledged by the downstream system.
See also
• “Transferring Recoveries” on page 351
• “Create and then Recode a Recovery” on page 352
Create and then Recode a Recovery
Before you begin

You can recode recoveries as described at “Recoding Recoveries” on page 352.
Procedure
1. Open a claim and click the Financials menu item on the left to open the Financials: Summary screen.
2. Click the Actions menu and, in the New Transactions section, click Other→Recovery to open the Create Recovery
screen.
3. Select the Payer and the Reserve Line from those drop-down lists.
4. Enter an amount and click Update.

5. Click the recovery to open the Recovery Details screen.

6. Click Recode to open the Recode Recovery screen.
7. Change the Reserve Line by using the drop-down list, and then click Recode again.
The Financials→Transactions tab reflects your changes. The reserve line status is Pending Recode.
Working With Transactions and Checks

You can navigate in ClaimCenter to reach all screens that display existing transactions and checks, and all screens
where you have the correct permissions to edit.
View a Claim’s Existing Transactions

About this task
To view all transactions on a specific claim, do the following:
Procedure
1. Navigate to a claim and open it.
2. Click the Financials menu item and click the Transactions card.
You see a table showing all transactions of one type for the claim.
3. To define the transaction type shown in the table, choose one of the following types from the drop-down list:
• Payments
• Reserves
• Recoveries
• Recovery Reserves.
The drop-down list shows a Custom option that is not for your use. If you select a transaction from a table of
transactions, the view becomes Custom.
4. Sort each table of transactions by any column by clicking that column’s title.
5. To view the details of any transaction, select its amount.
View a Summary of a Claim’s Existing Transactions

Procedure
1. In ClaimCenter, navigate to a claim and open it.
2. Click the Financials menu item and click the Summary card.
You see a condensed version of all transactions and checks.
3. To further organize the contents of the Summary tab, choose one of the following items from the drop-down list
in the upper left:
• Claimant – Organize this tab to show all transactions for each claimant.
• Exposure – Show all transactions for each exposure together.
• Exposure Only – Show all transactions by exposure. Do not show claim-level transactions.
• Coverages – Show all transactions for each coverage on the policy.
• Claim Cost Only – Same as Exposure, but with no claim expenses, such as a car appraiser’s cost.
There is no option to view payments. They show next to the checks that make them.
Working With Transactions and Checks 353

View Existing Checks

About this task
To view all checks on a specific claim:
Procedure
2. Click the Financials menu item and click the Checks tab.
A screen showing all checks written on the claim opens. The checks are sorted by Check Number.
3. Review the Pay To, Gross Amount, Issue Date, Scheduled Send Date, Status, and Bulk Invoice number.
4. Sort each table of transactions by any column by clicking the column’s title.
5. To view the details of any transaction, click its Gross Amount.
Create a New Transaction or Check

Procedure
2. Select Actions.
3. Under the New Transaction section, select one of the following transaction types:
• Reserve
• Check
• Other→Manual Check
• Other→Recovery
• Other→Recovery Reserve.
You can also create a check through the quick check option.
Create Checks Against a Reserve You Have Selected

Procedure
2. Click the Financials menu item and select Transactions→Reserves.
3. Click a reserve Amount, and then click Create Check.
Create Recoveries Against a Particular Payment or Recovery Reserve

Procedure
2. Click the Financials menu item on the left.
3. Click the Transactions tab and choose Recovery Reserves from the drop-down list.
4. Select a transaction and click Create Recovery.

Modify a Transaction or Check

About this task
You can modify an existing check or transaction.
Procedure
1. In ClaimCenter, access the check or transaction.
2. Display the details.
Each screen has buttons only for modifications allowed for that check or transaction.
3. Select a modification:
• Edit
• Delete
• Recode
• Reissue
• Clone
• Transfer
• Stop
• Void
• Deduct
How Transactions Affect Financial Values

This example shows how transactions on the same reserve line change main financial values.
As eroding payments are made, reserves decrease, but non-eroding payments do not affect reserves. To see the sum
of all non-eroding payments, subtract Total Eroding Payments from Total Payments. You obtain Total Eroding
Payments by subtracting Open Reserves from Total Reserves. See “ClaimCenter Financial Calculations” on page
367.
ClaimCenter displays reserves in a manner that best conforms to your business practices. You generally see either
Remaining Reserves and Future Payments, or Open Reserves, their sum. You can optionally display Available
Reserves or Total Incurred.
Total Open Remaining Future Total Recoveries Net Total Available

Reserves Reserves Reserves Payments Payments Incurred Reserves
Initial reserve created for $500; requires approval
$0 $0 $0 $0 $0 $0 $0 $0
The reserve is approved
$500 $500 $500 $0 $0 $0 $500 $500
Eroding Payment is scheduled for $300 at the end of the month; requires approval
$500 $500 $500 $0 $0 $0 $500 $200
Eroding Payment is approved
$500 $500 $200 $300 $0 $0 $500 $200
End of the month arrives and $300 eroding payment is made
$500 $200 $200 $0 $300 $0 $500 $200
Working With Transactions and Checks 355

Total Open Remaining Future Total Recoveries Net Total Available

Reserves Reserves Reserves Payments Payments Incurred Reserves
Non-Eroding Payment of $50 is approved for payment today (has Awaiting Submission status)
$500 $200 $200 $0 $350 $0 $500 $200
Non-eroding Payment of $50 is made (has Submitting status)
$500 $200 $200 $0 $350 $0 $550 $200
Recovery of $100 is received
$500 $200 $200 $0 $350 $100 $450 $200
The Lifecycle of Financial Objects

ClaimCenter uses status values to identify and control the flow of transactions and checks, from creation and
approval to their subsequent submission to an external accounting system.
Transactions and checks pass through similar statuses as they pass through ClaimCenter. The following three
statuses define where checks and transactions are in their lifecycles:
• Approval Status – Defines when a requested check or transaction has been approved or rejected. See “Approval
Status” on page 356.
• Check Status – Defines when a check is written, approved, issued, cleared, or canceled. See “Lifecycles of
Checks” on page 359.
• Transaction Status – Defines when a transaction passes through statuses similar to those of a check. See
“Lifecycles of Transactions” on page 357.
These statuses also determine whether and how a transaction or check can be modified. Because ClaimCenter shares
financial information with one or more external accounting systems, these statuses also synchronize transactions and
checks with their statuses in those systems. A change in any of these statuses can trigger events in ClaimCenter. You
can write business rules that run when a specific status change occurs.
Approval Status
Both checks and transactions always carry one of the following approval statuses:
• Unapproved – Entered or being entered into ClaimCenter by someone who does not have approval authority.
• Approved – Given permission to remain in ClaimCenter.
• Rejected – Not given permission to remain in ClaimCenter.
All financial entities—transactions and checks—move from Unapproved to Approved when their transaction
statuses change from Pending Approval to Awaiting Submission.
Transaction and Check Status

Transaction status and check status are similar. They are visible in the user interface, and you can write Gosu code in
rules to use them. The main differences are:
• Submitting and Submitted transactions are equivalent to Requesting and Requested checks.
• Payments and checks can move—be transferred—between claims. However, only payments can move—be
recoded—to another reserve line.
Standard Lifecycle Events

During the early parts of their lifecycles, checks and all transactions have the same lifecycle. While being created,
they are in Draft status. After they are first saved, they get Pending Approval status. After the checks or transactions
are approved, the status changes to Awaiting Submission, or if the approver declines, Rejected status. During these

stages, these entities belong to ClaimCenter alone, so you can edit and delete them. Finally, the transaction is given
Submitting status and is sent to the external accounting system integrated with ClaimCenter, which returns the
Submitted acknowledgement.
A check goes through a similar lifecycle, substituting Requesting and Requested status for Submitting and
Submitted. After the downstream system returns the requested acknowledgment, it issues the check and sends Issued
and Cleared notifications back to ClaimCenter.
Recoveries can be recoded and transferred and have a slightly different lifecycle. See “Modifying Recovery
Records” on page 350 for details.
Unusual Lifecycle Events

Checks, payments, and reserves can deviate from their normal lifecycle if they are modified or canceled. Other
statuses describe these changes.
The unusual lifecycle events are:
• Recode – Move a payment or recovery, or check, if all its payments have been recoded, to another reserve line.
Bulk invoice checks cannot be recoded.
• Reissue – Correct a single check in a group of checks without having to void or stop all checks in the group.
• Transfer – Move a payment, a check, or a recovery to another claim.
• Void or Stop – Cancel a payment, reserve, check, or recovery already sent to a downstream system.
See also
• “Voiding Versus Stopping a Check” on page 357
• For details of these statuses and the allowed transitions between them, see the Integration Guide.
Voiding Versus Stopping a Check

Typically you void a check that you can physically rip up, and stop payment on it when it is no longer in your
possession. Except for manual checks, ClaimCenter cannot always determine whether to void or stop a check, and
so provides both options. You can also void recoveries.
If you stop or void a check that is part of a check group, you also stop or void all checks in that check's check group.
Any checks that are part of other check groups, even other check groups that are in the same check set, are not
affected by the stop or void.
If you request to stop or void a check in the user interface, you cannot know its actual status. The downstream
system might already have issued the check, and the check might even have been cashed. In all cases, ClaimCenter
assumes that your action was successful and creates an offsetting transaction, called an offset. This transaction
reverses the check amount. If the downstream system then notifies ClaimCenter that the check was indeed issued or
cashed, ClaimCenter responds by creating yet another transaction, an onset, that reverses the offset. Voiding or
stopping a final check returns the reserve to the original value it had before the final check made it zero.
If a check is transferred to another claim, ClaimCenter creates an offset and an onset at the same time. It does so by
subtracting the amount from the original claim and adding it to the new one. ClaimCenter is configured to display
the check transfer information in both the old and the new claims.
Lifecycles of Transactions
The following diagram and table summarize all transaction statuses and how they relate to approval status:
The Lifecycle of Financial Objects 357

Transaction Status Flow Chart
additional approvals
needed REJECTED
Reject
Create; Edit
PENDING
DRAFT (null) requires
approval APPROVAL
edit; no Manual
approval check Delete
needed approved
Create; Manual (deleted: status
no approval e
ov
check; no
doesn’t change)
pr
needed approval
Ap
te
Dele
it
Ed
Delete
Manual check; edit,

AWAITING Escalate approval not needed
SUBMITTING
SUBMISSION on its due date
Re-
reply: Recovery submit .
denied
try to reply:
Void/Stop request PENDING
PENDING DENIED
A check; received
(payment,
Try to recode TRANSFER or
VOID or STOP affects only its
recovery)
or transfer a
RECODE (payment
(payment, recovery) Payment(s) Payment
and recovery)
Pa ied c
den
reply: Recovery ym
reply: VOID/STOP denied ent heck reply: change
so
request received fa
request received
reply:
VOID/STOP
fails** SUBMITTED If a check is DENIED, its TRANSFERRED
VOIDED or payments become DENIED.
STOPPED The Edit, Delete and Resubmit
or RECODED
(payment and
(payment, recovery) arrows from DENIED are for
recovery)
(**a check was already Issued or Cleared) the check’s denied payments.
NOTE on automatically generated NOTE on payments of manual

transactions: These do not require checks: These go directly to
approval, so DRAFT always flows SUBMITTING - never to
to AWAITING SUBMISSION. AWAITING SUBMISSION
Approval status Transaction status Delete, Comment

Edit?
Unapproved null (Draft) yes When finished, moves to Pending Approval.
Unapproved Pending Approval—payments yes On approval, moves to Awaiting Submission.
and reserves only
Approved Awaiting Submission—payments yes In queue, unsent to downstream system because
and reserves only transaction date not reached, or a current date, to be sent
later.
Approved Submitting no Transaction date reached, sent downstream today.
Approved Submitted no Downstream reply, transaction received.
Approved Pending Void—payments and no The messaging plugin sends a request downstream to void
recoveries only the check. Not in the base configuration—you must set this
up.
Approved Voided—payments and no Downstream reply that the transaction is voided.
recoveries only
Approved Pending Stop—payments only no The messaging plugin sends a message downstream to stop
the check. Not in the base configuration—you must set this
up.

Approval status Transaction status Delete, Comment

Edit?
Approved Stopped—payments only no Downstream acknowledgement that a stop occurred.
Approved Pending Transfer—payments and no Notify downstream system to move it to another claim.
reserves only
Approved Transferred—payments and no Downstream reply—transfer notification received.
reserves only
Approved Pending Recode—payments and no Move to another reserve line, notification sent.
recoveries only
Approved Recoded—payments and no Downstream reply—recode notification received.
reserves only
Rejected Rejected yes Through Pending Approval—edit or delete only if claim
open.
Approved Denied—payments and no For recoveries only—a reply from downstream.
recoveries only
Lifecycles of Checks
The following high-level flow diagram and table summarize all check statuses and how they relate to approval
status. Bulk invoice checks are not included in the diagram or the table.
Lifecycles of Checks 359

Check Status Model
More approvals Statuses Before Escalation

needed
Edit
PENDING
Reject REJECTED
APPROVAL
Create;
val k,
needs approval
pro ec
ap l ch
Begin at Draft DRAFT Approve Edit Edit (no Delete
no nua
Create; approval)
a
it m
needs no approval
(no manual checks)
Ed
AWAITING Delete
SUBMISSION
*Check is
Due date reached deleted.
(manual check only)
No status
Create (manual check only)
Due date reached;

Try to VOID or STOP Escalate
Delete
Try to VOID (not STOP)
REQUESTING
PENDING API/reply:
CLEARED API/ (NOTIFYING if a denied DENIED
VOID or STOP
reply: manual check) Resubmit
failed
reply:
API/reply: request
Go to API/ VOID/STOP for check PENDING
Try to
PENDING reply: Try to Void/Stop received (not
request transfer TRANSFER
TRANSFERcheck received for a manual
cleared check)
reply: request
received
API/
reply:
VOIDED or
ISSUED failed REQUESTED TRANSFERRED
STOPPED
API/reply:denied
API/reply: Cleared
API
Notes
• To modify a Denied check you must clone it.
• Some statuses advance either by web service APIs or through the user interface, which the diagram does not
show explicitly. See:
◦ Integration Guide
Approval Check Status Edit? Delete Comment

Unapproved Draft yes, from cloned or reissued yes Saving the entity changes the status to
checks Unapproved.
Unapproved Pending Approval yes, including recurrence yes Waiting for approval.
settings
Approved Awaiting yes, except payments, yes Approved, in queue to go downstream.
Submission recurrences
Approved Requesting no, but can reissue after stop/ stop, void Issue date reached and check request sent.
void
Approved Requested no, but can reissue after stop/ stop, void Downstream acknowledgement of check
void request.

Approval Check Status Edit? Delete Comment

Approved Issued no, check is issued stop, void Notification to ClaimCenter—check issued.
Approved Cleared no, check cashed or EFT void only Notification to ClaimCenter—check cleared.
completed
Approved Notifying no, for manual checks only, stop, void Notification to ClaimCenter—check issued.
sent instead of Requesting
Approved Pending Void no no Void attempt sent downstream.
Approved Voided no no Notification to ClaimCenter—check voided.
Approved Pending Stop no no Stop attempt sent downstream.
Approved Stopped no no Notification to ClaimCenter—check stopped.
Approved Pending Transfer no, moving to another claim no Transfer notification sent downstream.
Approved Transferred no no Sent to ClaimCenter—downstream
acknowledgement of check request.
Approved Reissued no no From Stop/Void, Reissued, Pending Approval.
Rejected Rejected yes, all fields, if claim open yes From Pending Approval if Rejected.
former status Denied no yes Reply from downstream—affects Payments
Note: In the diagram, reply indicates that a transition changed from the downstream system. Methods of the
ClaimFinancialsAPI web service can also change the status of the check where the diagram refers to API.
Downstream Denials of Recoveries and Checks

A downstream system might refuse to issue a check or receive a recovery due to criteria it verifies against the
requested check or recovery. For example, your check writing or general ledger system might be required to
compare all check payee names against the Office of Foreign Assets Control (OFAC) watch list. This list has all
persons who are barred from receiving or sending monetary payments. In this case, the downstream system can tell
ClaimCenter to deny the check through a message reply or web service call. The check then moves from Requested
status to Denied status.
Note: Set up ClaimCenter so that denial of a check or recovery is a rare thing. As much as possible, incorporate all
criteria for preventing inappropriate transactions into your ClaimCenter configuration rules so that they are caught
and prevented as early as possible.
Recoveries and payments are the only type of transaction that can be denied. Payments are denied when the check
that pays them is denied. Reserve and recovery reserve transactions cannot be denied, so any potential limitations
from downstream systems on these transactions must also be enforced in ClaimCenter.
Denying a Check or Recovery

A Check or Recovery must be denied as soon as possible after being sent downstream. A check cannot be denied
after it has been issued or cleared.
Only recoveries in Submitted or Submitting status can be denied. Similarly, only checks in Requesting or Requested
status can be denied. Manual checks can also be denied when in Notifying status.
Downstream Denials of Recoveries and Checks 361

Denial occurs when the downstream system sends ClaimCenter a denial notification. This notification can occur in
several ways:
• The downstream system can use the denyRecovery and denyCheck methods in the ClaimFinancialsAPI web
service to asynchronously notify ClaimCenter after the downstream system has received the recovery or check
request.
• The Recovery.denyRecovery and Check.denyCheck methods can be called from a plugin-based message
handler. This approach supports the use case of having the downstream system set a flag on the
acknowledgement to the RecoverySubmitted or CheckRequested message. The message handler can then call
the appropriate domain method to perform the denial.
• Gosu rules can use the Recovery.denyRecovery and Check.denyCheck methods.
Denied Recoveries
After a recovery is denied, the following happens in ClaimCenter:
• The recovery’s status is set to Denied. On the Claim→Financials→Recovery Details→Transactions screen, the Status
field is set to Denied.
• A new activity using the recovery_denied activity pattern is assigned to the user who created the recovery.
• Any zeroing offset recovery reserve that had been created for the Recovery will be retired.
• ClaimCenter automatically generates an offset Recovery Reserve to keep recovery reserves to zero if the
following two conditions are true:
◦ The Recovery's claim or exposure is already closed.
◦ The Open Recovery Reserve value is zero for the Recovery's ReserveLine.
• Post-setup rules are executed for the recovery's RecoverySet and for the RecoveryReserveSet created to zero
Open Recovery Reserves, if any.
• ClaimCenter prevents importing or adding the denied recovery to a staging table.
Take one of the following actions to respond to a denied recovery:
• Resubmit the recovery by using the Claim→Financials→Transactions→Recovery Details→Resubmit button, which is
active only for denied recoveries. The new recovery then appears like any other recovery in this screen, with
Submitting status.
• Delete the recovery by using the Claim→Financials→Transactions→Recovery Details→Delete button. Once deleted,
you can create and edit another recovery.
• Do nothing. The recovery remains with its Denied status.
Denied Checks
To modify a denied check you must first clone the check and then edit the cloned check. The original denied check
cannot be modified.
You can deny any single payee check, both recurring and non-recurring. You can also deny manual checks. You
cannot deny a multiple-payee check. After you deny a check, the following things happen:
• The check’s status is set to Denied. On the Claim→Financials→Checks→Check Details screen under the Tracking
heading, the Status field becomes Denied.
• Each of the check’s contributing payments is denied. A contributing payment is one that contributes to the gross
check amount. Recoded and offsetting payments are not denied.
• ClaimCenter assigns a new activity using the check_denied pattern to the user who created the check.
• ClaimCenter executes post-setup rules for the check's CheckSet.
• You cannot import or add a denied check to a staging table.

ClaimCenter takes the following actions for all payments denied as a result of a check denial:
• Each payment's status becomes Denied.
• ClaimCenter retires any zeroing offset reserve that had been created for each payment.
Although you cannot edit a denied check directly, you can do the following.
• Resubmit the check by navigating to Claim→Financials→Checks→Check Details and clicking the Resubmit button.
This button is active only for Denied checks. The new check is added to the screen with Requesting status.
• Modify the check by cloning it. After cloning the check, you can edit the clone and submit it through the normal
processes. Cloning is configurable in the method GWCheckEnhancement.resetCloneFields.
• Delete the check by using navigating to Claim→Financials→Checks→Check Details and clicking the Delete button.
If you use the Deny Check feature, you must exercise care in allocating your check numbers. Resubmitting a denied
check uses the same check number. Cloning a denied check to edit, and then resubmitting, clears out the check
number. A new check number is allocated later. Cloning and resubmitting can also have a consequence, a missing
check number.
However, denial of a check is meant to occur between the time the check is escalated and sent downstream and
when it is issued by the check printing system. Allocating the check number and printing the check is normally an
atomic action. After allocating a check number and printing the check, you could void the check if needed, but not
deny it.
Denied Manual Checks

A manual check can be denied only if it is in Notifying status, which means it must be denied before its escalation
message is acknowledged. ClaimCenter changes a manual check status from Notifying directly to Issued status upon
message acknowledgement, when the acknowledgeSubmission method on the Check is called.
Closing a Claim or Exposure with a Denied Payment

After a check makes a final payment, ClaimCenter can close the associated exposure or claim if the configuration
parameters CloseClaimAfterFinalPayment and CloseExposureAfterFinalPayment in the config.xml file are
both true.
If a check with a final payment reaches Denied status:
• If the exposure was closed by the payment and the claim is still open, the exposure will be automatically
reopened if the payment is denied.
• If both the exposure and claim were closed by the payment, both will be reopened when the payment is denied,
first the claim and then the exposure.
• If the exposure or claim closed manually, or if the payment closed the exposure but the claim was closed
manually, neither is reopened by the denial of the payment.
• If the claim or exposure or both remain closed after the denial of each payment, the system creates any necessary
zeroing reserves to keep Open Reserves zeroed.
• If the claim or exposure or both are reopened due to the denial of a check, ClaimCenter adds a Reopened history
event to the claim History. The reason for reopening is Payment Denied, a typecode of either the
ClaimReopenedReason or ExposureReopenedReason typelist.
Financial Holds
ClaimCenter defines a financial hold as a way to mark a claim so that no indemnity payments can be made against
it. A financial hold is different from simply keeping the claim from getting to the Ability to Pay validation level. A
financial hold might be necessary to ensure that expense payments are made on the claim.
Denying a Check or Recovery 363

Applying Financial Holds to a Claim

In the base configuration of ClaimCenter, there are three ways that a claim can be marked for financial holds:
• The claim’s coverage is in question – This condition exists when the Coverage in Question? field on the
Summary→Claim Status screen is set to Yes. On the Claim entity, this field is CoverageInQuestion.
See “Coverage in Question and Financial Holds” on page 364
• The claim is an incident-only claim – This condition exists when the Incident Only? field on the Summary→Claim
Status screen is set to Yes. On the Claim entity, this field is IncidentReport.
See “Incident Only and Financial Holds” on page 364
• The claim policy is unverified – This condition exists when the Verified Policy field on the claim’s Policy screen is
set to No. On the Policy entity, this field is Verified.
See “Unverified Claim Policy and Financial Holds” on page 365
This behavior is configurable.
Note: Financial hold status is not stored in the database. The status is checked in rules as part of transaction
validation. The status is also checked before initial reserves are created.
Coverage in Question and Financial Holds

You can set the Coverage in Question field on the Summary→Claim Status screen either manually or automatically. Once
set, the field can be cleared only by a user who has the unsetcovinquestion permission, typically a supervisor. In
the base product, this permission is granted to the following roles:
• Claims Supervisor
• Manager
• New Loss Processing Supervisor
• Superuser
You can assign this permission as you like in your own configuration.
When the claim’s coverage in is question, an icon showing a document overlaid with a question mark appears in the
following locations:
• The Info bar
• The High-Risk Indicator section of the claim’s Summary screen
In the base configuration of ClaimCenter, the Coverage in Question field is automatically set in the following
circumstances:
• Loss date is before the policy’s effective date.
• Loss date is after the policy’s expiration date.
• Status on the claim’s Policy screen is something other than In force or Archived.
You can configure this functionality in Guidewire Studio in the ClaimPreupdate rule CPU20000 – Coverage in question
and its children. See the Configuration Guide.
Incident Only and Financial Holds

Sometimes the carrier receives information on claims that do not turn out to be claims. These claims are kept in case
they later become claims. They are also kept for reporting purposes.
It is not always clear that claims are Incident Only when the claim is first filed. Before this status can be determined,
some expenses might have been incurred, and it might be necessary to pay these expenses. Paying these expenses
requires the use of financial holds rather than keeping the validation level below Ability to Pay.
In the base ClaimCenter configuration, the Incident Only? field on the Summary→Claim Status screen can be set only
manually.

Unverified Claim Policy and Financial Holds

ClaimCenter automatically marks the claim policy as Unverified in one of the following cases:
• The claim policy is edited in ClaimCenter.
• The claim’s loss date is changed.
In these cases, the policy can no longer be deemed true to the policy snapshot that was taken from the policy system
when the claim was filed. The only way to verify the policy again is to refresh the policy. For more information, see
“Refreshing the Policy Snapshot on a Claim” on page 105.
ClaimCenter Handling of Financial Holds

When financial holds apply, ClaimCenter prevents any claimcost reserve or payment from being created or edited.
Expense transactions are allowed, although ClaimCenter will warn the user that the claim is under financial hold. In
the base ClaimCenter configuration, this functionality is enabled through transaction set validation rules.
Note: You can configure this functionality in Guidewire Studio in the transaction set validation rule TXV15000 –
Financial Holds and its children. See the Configuration Guide.
The base configuration of ClaimCenter also prevents any claimcost initial reserves from being created when
financial holds apply. This functionality is handled by checking for financial holds status before creating initial
reserves in rules in the InitialReserve rule set. These rules check the value of the Claim.applyFinancialHolds
method. For more information, see the Configuration Guide.
Integration with External Financial Systems

You typically integrate ClaimCenter with an external financial application that writes your physical checks. As you
make a claim-related disbursement, you create the check information inside ClaimCenter. If a check with Awaiting
Submission status reaches its issue date, or earlier if so configured, then ClaimCenter sends an escalation request to
your check writing application. The check writing application in turn writes the actual check.
Transaction statuses and check statuses synchronize the communications between ClaimCenter and external
accounting systems.
The following financials batch processes integrate ClaimCenter with external systems. Each has a specialized
function:
• Financials Escalation – Transmits checks that must be written to a check writing system, along with related
accounting information.
• T-accounts Escalation – Ensures that transactions inside ClaimCenter update all T-accounts and other internal
financial values, so that the calculated values used throughout ClaimCenter are correct.
• Bulk Invoice Escalation – Similar to financials escalation, but operates only on bulk invoice checks and their
related payments and reserves.
See also
• For information on scheduling these batch processes, see the Configuration Guide.
Financials Escalation Batch Process

The financialsescalation batch process moves checks whose send date has arrived to Requesting status. This
process generates the CheckStatusChanged event, which ClaimCenter listens for and, when received, sends a
request to the check writing system. After a check has Awaiting Submission status, if its issue date is today or
earlier, this batch process escalates the check and its associated payments and reserves.
Applying Financial Holds to a Claim 365

Specifically:
• T-accounts are updated.
• If needed, offsetting reserves are created. This change and any other associated reserve changes are given
Submitting status. For example, if an eroding payment exceeds its open reserves, it requires an offset to keep its
open reserves from becoming negative.
• If the payment is final and the exposure or claim can be closed, it will be.
• The check's status becomes Requesting, and a message to issue it can be sent to a check writing system.
• The check's payments' status become Submitting.
• Transaction post-setup rules run. If any result in a validation error or warning, ClaimCenter creates a reminder
activity showing the errors. It then tries to assign the activity to the user that created the payment. If that
assignment fails, ClaimCenter automatically assigns the activity. The activity's due date is today, its priority is
Normal, and no escalation date is set.
• If the check is recurring and it is the second-to-last check to be submitted in the recurrence, ClaimCenter creates
an activity. This activity alerts the user that the recurrence is ending soon.
The batch process financialsescalation by default runs daily at 6:05 a.m. and 6:05 p.m. If you want to escalate a
check immediately, you can create a rule to do so by using the Check.requestCheck method.
Note: When entering the date for escalation, enter a day only, but not a time. If a time is present, the batch process
delays escalation until the first time it runs on the next day.
Checks associated with a bulk invoice are escalated by the financialsescalation batch process only if their
PendEscalationForBulk fields are set to false. If a check’s PendEscalationForBulk field is true, the check is
instead escalated by the bulkinvoicesescalation batch process. This field allows some bulk invoice checks to be
processed normally. Others could be held, for example, so that other, newly arrived checks to the same vendor can
be bundled with them. See “Bulk Invoice Escalation Process” on page 367.
T-Account Escalation Batch Process

The taccountsescalation batch process transitions payments and their offsetting reserves from FutureDated state
to AwaitingSubmission state on the day that a future payment's ScheduledSendDate arrives. This process updates
certain financial calculations that include payments on checks scheduled to be sent today, financial calculations such
as total reserves, open reserves, total payments, and so forth,
As the batch process runs, offsetting reserves are created if needed. This change and any other associated reserve
changes are given Awaiting Submission status, which means that they can still be retired if their associated payments
are retired or changed. For example, an eroding payment—a future-dated payment scheduled to be sent today—
exceeds its available reserves. The eroding payment requires an offset to keep its available reserves from becoming
negative.
The taccountsescalation batch process updates T-accounts and summary financial values to reflect the fact that a
check is going to be issued on that date, without the check’s being issued. This update gives you time on the issue
date of a check to make adjustments, while keeping summary financial values correct.
You can change the time when the batch process runs in the scheduler-config.xml file. In the base configuration,
this process, TAccountEsc, is scheduled to run at 12:01 a.m.every day. If the server is down during this time, then
manually run the process as soon as possible. The batch process exists primarily for configurations where financials
escalation is configured to run only in the evening. In that way, on the day a check is scheduled to be sent, the
financials calculations get updated in the morning. However, the check would still be editable until it was escalated
in the evening.
Guidewire strongly recommends running this batch process as scheduled in the base configuration. Running the T-
account Escalation batch process, while technically optional, affects financial totals on the Financials Summary screen.
These totals might be wrong until the first run of the batch process, which successfully escalates any formerly
future-dated checks.

See also
• “Foreign Exchange Adjustments in Custom Financials Calculations” on page 384
Using Financials Batch Processes

As described previously, in the default configuration, the batch process financialsescalation runs twice a day at
6:05 a.m. and 6:05 p.m. However, if your configuration does not run financialsescalation at 6:05 p.m. and the
taccountescalation batch process runs at that time instead, there are likely to be inaccuracies. T-account entries
and summary financial transactions would be incorrect from 6:05 p.m until 6:05 a.m. Running these batch processes
at the default times makes the financial calculations correct for rules that reference them during the morning batch
processes, such as the Claim Exception rules.
Depending on your implementation, you can schedule these two batch processes differently:
• Schedule one of these two processes to run before the calculated values need to be up to date.
• To keep checks editable for as long as possible during the working day, run the taccountescalation process
soon after midnight. You can then schedule the financialsescalation process at your midday time or a few
hours after your close of business.
• If you do not care about not being able to edit future dated checks that have reached their send date before
financialsescalation runs, schedule financialsescalation to run just after midnight. You need not run
taccountescalation.
Bulk Invoice Escalation Process

A separate batch process, bulkinvoicesescalation, affects bulk invoices. It changes the status of a bulk invoice’s
items from Awaiting Submission status to Submitting, and their associated checks to Requesting, when the Invoice
reaches its send date. It also updates the checks and the check's payment. By default, this process runs daily at 6:35
a.m. and 6:35 p.m.
ClaimCenter Financial Calculations

ClaimCenter maintains a number of running totals of a claim’s financial transactions and updates them as transaction
statuses change. Guidewire refers to these running totals as financial calculations. You can use Gosu to manipulate
this information and add it anywhere in the user interface. ClaimCenter can also send this information to external
accounting systems. ClaimCenter pre-calculates—denormalizes—the calculations for quick retrieval from the
database.
See also
Financial Transactions Outside the User Interface

If you create financial transactions in the user interface, ClaimCenter does all the bookkeeping for you. It adjusts
aggregate limits, updates all T-accounts, changes all summary financial amounts, and so on. You can also use Gosu
to create financial transactions, or you can use the Transaction Presetup rule set.
For more information, see:
• Rules Guide
Financials Data Model

The following table lists the key financials entities in the data model that you see in the ClaimCenter base
configuration. Refer to the ClaimCenter Data Dictionary to see other financially related entities.
Integration with External Financial Systems 367
Entity or field Description

Check An entity that groups one or more payments made at the same time to a single payee or group of joint
payees. ClaimCenter sends it to an external system to be printed, unless it is a manual check not
created by the application.
CheckGroup An entity that groups together a multipayee check, with a primary check and one or more secondary
checks.
CheckSet The entity that collects all Checks resulting from a single usage of the New Check wizard. It includes all
issuances of a recurring Check and checks of a multipayee Check. It is a subtype of TransactionSet.
All Checks belong to a CheckSet.
CostCategory A Transaction field that categorizes a transaction. In the base configuration, the CostCategory typelist
includes values that you can use as filters to support the various Lines of Business (LOBs)
CostType A Transaction field that categorizes a transaction. In the base configuration, the CostType typelist
includes the following typecodes:
• aoexpense – Adjusting and other expense
• claimcost – Actual loss payments to claimants or repairers
• dccexpense – Defense and cost containment legal expense
• unspecified – Unspecified cost type
Deductible The entity that tracks the amount, the coverage, and the status of the deductible, such as whether it
has been paid or waived. One of the main fields on the Deductible entity is TransactionLineItem,
which is a foreign key to TransactionLineItem.
Line Category A field in a TransactionLineItem that categorizes the amount of that line item.
Payment A subtype of Transaction representing money paid out. A payment can be eroding or non-eroding,
depending on whether it draws down the reserves of its ReserveLine.
Recovery An entity that records money that reduces a claim’s liability, received from such sources as
subrogation, salvage, other insurance, co-payments or deductibles. A Recovery object is a subtype of
Transaction.
RecoveryReserve An entity that records the amount of future expected recoveries. It is a subtype of Transaction.
Reserve An entity that records a potential liability. It is a subtype of Transaction. A Reserve designates money
to be set aside for payments. Typically, a reserve is set soon after a claim is made.
ReserveLine An entity with a unique combination of Claim, Exposure, CostType, and CostCategory fields. Only E
xposure can be null. Reserves or recovery reserves are created, or payments are made, or recoveries
are applied against one ReserveLine.
Transaction An entity that represents a financial transaction for a particular claim or exposure. It also contains a
non-empty array of TransactionLineItem entities.
Transaction is an abstract supertype. The ClaimCenter interface uses its subtypes:
• Reserve
• Payment
• RecoveryReserve
• Recovery
These subtypes are final. Transaction must not be subtyped further. A new subtype will not function
correctly, may interfere with existing code and is not supported.
Every transaction is made against a single ReserveLine object.
TransactionLineIte An entity in every transaction that contains the amount of the transaction. Use the Category and
m Comments fields to describe a given Transaction Line Item’s contribution to the total transaction
amount.
TransactionOnset This join entity contains a foreign key to the Transaction entity and represents the relationship
between a transaction and its onset. It links a Transferred or Recoded transaction (Payment or
Recovery) to its new onset transaction.

Entity or field Description

TransactionOffset This join entity contains a foreign key to the Transaction entity and represents the relationship
between a transaction and its Offset. It links a Voided, Stopped, Recoded, or Transferred transaction
(Payment or Recovery) to its new onset transaction.
TransactionSet A collection of all transactions made at the same time and approved together. This collection can be,
for example, a check and all the payments it makes.
TransactionSet is an abstract supertype. The ClaimCenter interface uses the following subtypes of Tr
ansactionSet:
• ReserveSet
• CheckSet
• RecoveryReserveSet
• RecoverySet
CheckSet is a subtype of TransactionSet. A check is not a Transaction. The checks in the set, while
created at the same time, can be issued at different times and to different payees. You can also
associate documents with a TransactionSet.
All transactions (and checks) in a Transaction Set must be:
• Approved together
• Rejected together
• In Pending Approval status together
Transaction Line Items and Their Line Categories

Transactions are always made against a single ReserveLine, which is defined by a unique Exposure,
CostCategory, and CostType. These properties classify payments and not checks, which are not transactions.
Typically, CostType is the primary division between claim costs and claim expenses, while a CostCategory is a
subcategory of a CostType. LineCategory plays no role in defining a ReserveLine, but can be used to provide
additional information about the line item amount.
Reversing Transactions: Offsets and Onsets

Sometimes, transactions must be reversed. Examples include a payment that was applied on the wrong reserve line
and must be corrected or a check that needs to be voided or stopped. In each case, to maintain a complete trail, at
least one of the following new transactions is created that affects the original one:
• offset – ClaimCenter creates a new payment with an amount equal to the negative of the original transaction’s
amount. This payment serves to cancel the original transaction.
• onset – In a recode or transfer, a new payment is created as a copy of the original transaction, except that it is
associated with the new reserve line. An onset is not created for a payment that is successfully voided or stopped.
However, if the void or stop of a check is unsuccessful for any reason, a new onset payment is created on the
same reserve line to undo the offset.
Two entities, TransactionOffset and TransactionOnset, link the newly created offset and onset transactions.
Each is associated with the original transaction.
T-account Entities
ClaimCenter uses an internal subsystem of entities called T-accounts that support efficient calculation of totals for
the financial calculations API. They denormalize the amount totals of transactions on each ReserveLine according
to the transaction subtype, status, and other criteria. For example, the total of reserve transactions in Pending
Approval status on a particular reserve line are stored as the balance on a particular TAccount row.
T-accounts are updated when the status of a transaction changes. This process happens internally during the setup
phase, which occurs between the execution of the TransactionSetPresetup and TransactionSetPostsetup rule sets. The
process is also triggered when you call the prepareForCommit method on a TransactionSet or CheckCreator
object.
Financials Data Model 369
IMPORTANT After its TAccount objects are updated, you must not modify key properties of a transaction, such as
Amount, ScheduledSendDate, or ErodesReserves. These properties determine the TAccount object to which the
transaction contributes and how much it contributes. For more information on updating these properties, see the
Rules Guide.
You do not need to access TAccount objects or their values directly. The financial calculations use this data to
provide their answers.
Transaction Business Rules

ClaimCenter provides sets of rules that affect most of its financial events. You can develop rules that cause
ClaimCenter to model your company’s particular financial practices.
See also
• Rules Guide
Transaction Business Rule Sets

Rule sets are collections of similar rules. When an event triggers rule execution, the entire rule set executes, rather
than individual rules in them. Rules affecting transactions fall into one of these rule sets. For more information, see
the Rules Guide.
• Transaction Validation – Rule set that checks if transaction data is sufficient and valid for downstream processing.
See “Transaction Validation” on page 370.
• TransactionApproval – Rule set that checks whether a user has the authority to make the transaction. See
“Transaction Authority Approvals” on page 371.
• Approval Routing – Rule set that creates an activity to send a transaction to another user for approval. See
“Transaction Authority Approvals” on page 371 for an example.
• Initial Reserve – Rule set that sets a newly created reserve line’s reserve. See “Setting Initial Reserves” on page
371.
• Transaction Postsetup – Rule sets that run after a transaction set is approved, after a check is voided, stopped, or
escalated, and after other similar events. An example of a Transaction Post-Setup rule is a rule that looks at the
sum of initial reserves allocated. It compares it to the policy’s aggregate limit and issues a warning if reserves are
already within 10% of that limit.
• Transaction Preupdate – Rules that run before any object is updated in the database. They run prior to the
Transaction Validation rule set. See “Preupdate and Validation Rules” on page 140.
• Transaction Presetup – Rules that run just before any transaction set or check set is committed. See “Financial
Transactions Outside the User Interface” on page 367.
See also
• Rules Guide
Transaction Validation
One of the most common financial validations concerns evaluating if the limits of liability on a policy’s coverage
have been overstepped. The Transaction Validation rule set contains this type of rule.
For example, carriers commonly sell vehicle insurance with the following standard limits:
• 200/500/100 package to limit the maximum payout in one accident to $200,000 per person for bodily injury
• $500,000 for all bodily injury in one accident
• $100,000 for all third party property damage
Using the application’s transaction approval rules and library functions, you can track these limits and raise alerts
whenever a transaction exceeds the claim’s exposure limit or the policy’s per-occurrence limit.
ClaimCenter provides the following examples of business rules that pertain to coverage limits:
• Total Payments cannot exceed the exposure’s coverage.
• Reserves cannot exceed the exposure’s coverage.
• Total Payments cannot exceed the coverage’s per-occurrence limit.
• Total Reserves cannot exceed the coverage’s per-occurrence limit.
• A new check cannot increase Total Payments above a chosen limit, such as an aggregate, per-person, or lost
wages limit of a Personal Injury Policy coverage.
Transaction Authority Approvals

If you try to approve a transaction, Transaction Approval Rules can ensure that the transactions be marked as
Pending Approval. They also create an approval activity by using the Approval Routing rule set. These rules can
handle approvals of all kinds, not just those that involve authority limits. The Transaction Approval and Approval
Routing rule sets work together to verify if you have the required authority and if not, where to go to obtain
approval.
Setting Initial Reserves

The Initial Reserves rule set can create a initial reserve of a predetermined value to a new exposure. For example,
rules allocate a reserve for a vehicle damage exposure, and set the amount differently, depending on how the
exposure was segmented.
Financial Permissions and Authority Limits

There are security aspects for financial transactions.
See also
• For a complete discussion of ClaimCenter security, permissions, roles, ACLs (access control levels), and so on,
see “Security: Roles, Permissions, and Access Controls” on page 487.
User Permissions
Separate user permissions pertain to each transaction and to checks:
• View, create, edit, or delete a payment, reserve, recovery, or recovery reserve—16 separate permissions
• Create, edit, or delete a manual payment
• Void, stop, or transfer a check
• Void a check after the check cleared
• Exchange rate manual override
• Edit deductible
By default, the following roles have all these permissions except User Admin: Adjuster, Claims Supervisor,
Manager, Clerical, New Loss Processing Supervisor, Superuser, and User Admin. You can see the complete set of
user permissions either in the Administration section of the user interface or in the Security Dictionary.
Transaction Business Rules 371

Note: ClaimCenter does not actually use all these permissions. They are all defined for consistency. For example,
you cannot edit a recovery, the recedit permission. A recovery is a received check, and you cannot change its
information. Similarly, you do not edit a reserve or recovery reserve, the resedit and recresedit permissions.
You create a new reserve or recovery reserve by adding to the existing one.
Authority (Transaction Amount) Limits

By using the Authority Limit Profile, an administrator can set the maximum allowed transaction amount for any user
for the following:
• A claim’s and any exposure’s Total and Available Reserves
• A claim’s and any exposure’s payments to date
• Any single payment
• A payment that exceeds its reserve
• A change in reserve amount
For more information on authority limits, see “Managing Authority Limit Profiles” on page 519.
The CheckAuthorityLimits configuration parameter in the config.xml file is set to true in the default
configuration. This setting causes authority limits to be checked during approval of any transaction set. If you set
this parameter to false, these authority limit checks are not performed. Additionally, the configuration parameter
AllowPaymentsExceedReservesLimits is set by default to true, enabling users with appropriate permissions to
submit payments that exceed available reserves up to the authority limits. If you set this parameter to false, it
prevents all payments that exceed reserves, regardless of the user’s authority limit permissions.
Access Control Levels for Financial Objects

There are no special controls to restrict access to financial objects. To restrict access to sensitive financial
information, you must restrict access to the claim or exposure.

chapter 35
Multiple Currencies
ClaimCenter can be set up to use a single, base currency or different currencies for all its financial transactions,
based on your business needs. Enabling ClaimCenter to use multiple currencies, known as multicurrency, means that
you can create reserves and recovery reserves, write checks, and make payments in more than one currency.
This topic describes how multicurrency works, the role of exchange rates, and the various uses of multicurrency in
ClaimCenter.
See also
Overview of Multicurrency
You can configure ClaimCenter financials both to display and to use multiple currencies. If you enable
multicurrency display, you can write checks, create reserves and recovery reserves, and make payments in more than
one currency in a single claim. However, in all calculations, the secondary transaction currency is effectively
converted to the claim’s currency. Using multiple currencies, in this case, serves more as a convenience for users
who need to use different currencies on a short-term basis.
If you enable multicurrency reserving, you can create and manage reserves and recoveries, write checks, and make
payments in multiple currencies. You can track and erode reserves in the currency of choice, thus avoiding exchange
rate fluctuations and their potential impact on reserve amounts.
Multiple Currencies 373

Currency Modes
ClaimCenter can be configured in three different modes for currency – single currency, multicurrency display, or
multicurrency reserving, which can be described as follows:
• Single currency mode – All money amounts use one currency. All currency drop-down menus and exchange
rate information are hidden, since only one currency is allowed.
• Multicurrency display mode – Determines if ClaimCenter shows multiple currencies. With multicurrency
display enabled, you can:
◦ Create reserves or recovery reserves in the claim currency. Although these transactions can be created in a non-
claim currency, the totals are tracked in the claim currency only.
◦ Create payments and recoveries in any currency.
◦ Track these transactions as part of the financial calculations and summary. It must be noted that with this
configuration, creating reserves in a different transaction currency is a convenience. Reserves are always
converted and tracked in the claim currency. Payments and recoveries erode reserves in the claim currency.
◦ Reserves are converted and tracked in the claim's currency.
• Multicurrency reserving mode – Determines if you can track reserves and recovery reserves in multiple
currencies on a claim. With multicurrency reserving enabled, you can:
◦ Create and track reserves and recovery reserves in any currency.
◦ Create Payments and Recoveries in any currency. They erode reserves and recovery reserves respectively in the
currency the reserve was created.
◦ Track these transactions as part of the financial calculations and summary.
◦ As reserves are tracked in the currency they were created in, exchange rate fluctuations do not impact the
remaining amount on a reserve.
IMPORTANT In the base configuration, Guidewire disables multicurrency display and reserving. ClaimCenter
tracks all financial transactions in the default application currency.
Currency Types
ClaimCenter supports a single, main, or default currency, as well as currency types based on the policy, transaction,
and reserve line. They are defined as follows:
• Default currency – The main or base currency for the system, defined in the config.xml file. The terms server
currency, reporting currency, and main currency all refer to this default currency. This currency is used
application-wide mainly for reporting purposes. For example, an insurer based in London would have its reports
printed in their default currency, GBP. The ReportingAmount field is on the TransactionLineItem entity. It
returns the reporting amount of a transaction, which is the equivalent of the transaction amount in the reporting
currency.
• Claim currency – The currency associated with the claim. The claim inherits the currency from its policy, so it is
also known as the policy currency. The ClaimAmount field on the TransactionLineItem entity stores the claim
amount of a transaction, which is the equivalent of the transaction amount in the claim currency. See “Claim
Currency and Policy Currency” on page 375 for more information.
• Reserving currency – The designated currency of a reserve line. This currency type can be defined only when
multicurrency reserving is enabled, otherwise, it defaults to the claim currency. You can specify a reserving
currency if you need to create and track reserves in a non-claim currency. Payments erode reserves in this
currency. The ReservingAmount field is on the TransactionLineItem entity.
• Transaction currency – The currency of the transaction amount, which is the primary amount for a transaction,
from which other amounts are calculated. For payments, this is the currency in which the actual payment was
made. The TransactionAmount field is on the TransactionLineItem entity.
374 chapter 35 Multiple Currencies

Each multicurrency transaction can have up to four amounts in each of these currencies associated with it. In the
base configuration, for a single transaction, all four of these amounts will always be the same. If multicurrency
display is enabled, the transaction, claim, and reporting currency amounts can be different for a transaction. The
reserving currency, however, is the same as the claim currency. If multicurrency reserving is enabled, all four
currency amounts can be different for a transaction. See the Configuration Guide to understand the relationships.
Note: ClaimCenter has a list of all of the currencies in the system in the Currency typelist, along with their current
exchange rates. However, this typelist is configurable and you can specify the currencies you want to use in
ClaimCenter. For more information, see “Exchange Rates” on page 380.
Claim Currency and Policy Currency

When multicurrency display is enabled, ClaimCenter supports policies and claims that do not use the default
application currency. The Policy and Claim entities have a Currency field. The policy’s currency determines the
initial value for the Currency field in the Policy entity and is set up in the policy search adapter for verified
policies. For unverified policies, the currency is defined when the policy details are added in the New Claim wizard.
The claim currency is equal to the policy’s currency and is determined when the policy is retrieved to create the
claim. The Claim entity’s Currency field is equal to the same field in the Policy entity. Changes to the policy’s
currency field are always copied to the Claim.Currency field.
If there are transactions on a claim, you cannot change the claim currency, as this would impact the transactions and
financials calculations.
Configuring Multiple Currencies

Use the following parameters in the config.xml file to configure the multicurrency feature in ClaimCenter:
• DefaultApplicationCurrency – Specify the default currency to be used across the application. You are
required to set this value, regardless of the values of the other two parameters.
• MulticurrencyDisplayMode – Specify if you want ClaimCenter to support multiple currencies. Valid values are
SINGLE and MULTIPLE.
• EnableMultiCurrencyReserving – Specify if you want ClaimCenter to support multicurrency reserving. If you
enable this parameter, MulticurrencyDisplayMode must be set to MULTIPLE.
In the base configuration, ClaimCenter sets MulticurrencyDisplayMode to SINGLE and
EnableMultiCurrencyReserving to false.
IMPORTANT The MulticurrencyDisplayMode and EnableMultiCurrencyReserving configuration parameter

settings are semi-permanent. You can change the values of these parameters only once,
MulticurrencyDisplayMode from SINGLE to MULTIPLE and EnableMultiCurrencyReserving from false to
true. After you change the values and restart the server, you must not later change them back. If you do change the
value of MulticurrencyDisplayMode back to SINGLE or of EnableMultiCurrencyReserving back to false,
subsequent attempts to start the server fail. These configuration parameters are in config.xml.
ClaimCenter financial transactions are handled differently, based on whether multicurrency reserving is enabled or
disabled.
ClaimCenter Operation Multicurrency Reserving Disabled Multicurrency Reserving Enabled

Create checks and Use any currency. Payments are converted to Use any currency, preferably matching the Reservi
payments the claim currency and erode reserves in the ngCurrency on the ReserveLine. Payments erode
claim currency. reserves in the reserving currency.
Create reserves and Use the currency calculator to create and view Use any currency. Reserves are created and
recovery reserves reserves in an alternate currency. Amounts are managed in this reserving currency.
converted to the claim currency when reserves
are updated and managed.
Overview of Multicurrency 375

ClaimCenter Operation Multicurrency Reserving Disabled Multicurrency Reserving Enabled

Create bulk invoice Use any currency. Payments are converted to Use any currency. Payments are made in this
payments and write the claim currency and erode reserves in the currency and erode reserves in the reserving
associated checks claim currency. currency.
Integrate transactions Transactions are converted to the claim Transactions are tracked in reserving
into financial totals currency and incorporated into financial totals. currencies.
View financial View all financial summaries in the claim View summaries by reserving currency, in addition
summaries that include currency. to the usual summary views.
all transactions
Note: When you use more than one currency, ClaimCenter performs necessary conversions by using automatic or
manual exchange rates. See “Exchange Rates” on page 380.
Preferred Currency on Contacts

The Contact entity has a Preferred Currency field that indicates the currency in which that contact would prefer
to receive checks. You can assign a Preferred Currency to a contact when you create or edit it. After you specify the
payee while writing a check, ClaimCenter defaults the check’s currency to the preferred currency of the payee, if
one is specified.
The following points are all configurable.
• Single payee checks – ClaimCenter changes the check currency from the default to the Preferred Currency.
• Joint payee checks – ClaimCenter makes the same change based on the first joint payee.
• Multi-payee checks – ClaimCenter considers only the preferred currency of the primary payee, not secondary
payees. All the checks in a check group use the same currency.
Checks, Payments, and Recoveries and Multicurrency

If you enable multicurrency display in ClaimCenter, you can create checks and recoveries in any currency. The
system defines a default currency for the check or recovery according to the following conditions:
• If the payee for a check or a payer for a recovery has a preferred currency, the check or recovery defaults to this
currency.
• If there is no preferred currency specified, the check or recovery currency defaults to the currency of the reserve.
You have the option of overriding the default system currency. Payments and recoveries erode reserves in the
currency of the reserve.
Reserves and Recovery Reserves and Multicurrency

If multicurrency reserving is enabled, you can create and track reserves in multiple currencies. If multicurrency
reserving is disabled, you can still create reserves in different currencies, but only as a convenience. They are
essentially converted to and tracked in the claim currency.
Multicurrency Display and the ClaimCenter User Interface

If you enable multicurrency display in ClaimCenter configuration, then fields, buttons, and features that show
currencies and exchange rates are made visible.

If MulticurrencyDisplayMode is set to MULTIPLE in the config.xml file, you see the following in ClaimCenter:
• If a transaction uses any currency besides the reserving currency, the screen shows both currency amounts. The
amount in the reserving currency appears in smaller type below the amount in the transaction currency. Both
amounts are formatted according to their currency.
• In the Policy screen, you can select the policy currency by using a drop-down list of all of values defined in the
Currency typelist. As with any policy attribute, if you edit the currency of a verified policy, the policy becomes
unverified.
• If you are creating a reserve or a recovery reserve, you can use the multicurrency calculator icon to view the
SetReserveAmountinAnother Currency screen. In this screen, you can view and select an alternate transaction
currency for the reserve and set its TransactionAmount in that currency. You can view and change the amount
and exchange rate from the transaction to the claim currency.
• If writing a check, bulk invoice check, or recovery, you can select an alternate currency. You can view the market
exchange rate or set a custom exchange rate for the conversion from the check or recovery currency to the claim
currency.
• If you are searching for checks or recoveries in a monetary range, ClaimCenter presents From and To text fields
formatted in the currency chosen for the search.
See also
• For more information on setting a reserve amount in another currency, see “Market and Custom Exchange Rates”
on page 381.
• “Multicurrency Searches” on page 377.
• Using multiple currencies requires you to also correctly set the data types for those currencies. See the
Globalization Guide.
The New Check Wizard and Multicurrency

You can create all types of checks in any currency. The following steps of the New Check wizard use some parts of
the multicurrency feature:
• Step 1 – Shows the Preferred Currency of each primary and joint payee entered. Step 1 does not show the Preferred
Currency of secondary payees.
• Step 2 – Sets the check’s currency to a payee’s Preferred Currency, if specified. See “Preferred Currency on
Contacts” on page 376. Use the Currency drop-down menu to change the currency. You can also adjust the
exchange rate.
• Step 3 – Displays the Gross, Net, and Deduction amounts in both the check and claim currencies.
The Auto First and Final wizard also uses multicurrency display.
Multicurrency Searches
You can create checks and recoveries in any currency, and you can search for them regardless of currency, or in any
one currency. Enter currency parameters in the following screens to control these searches:
• Search→Recoveries in the Optional Parameters section
• Search→Checks in the Optional Parameters section
Single Currency Searches

Use the currency selector in the Optional Parameters sections to specify a currency for searches. This drop-down list
shows all the typecodes in the Currency typelist.
Multicurrency Display and the ClaimCenter User Interface 377

If you specify a currency, your search is restricted to items in that currency, and the From and To fields are used to
specify amounts in that currency. Single-currency searches return the sum of all items found. ClaimCenter shows the
following messages with the search results:
• Recovery Search – The results of this recovery search may be incomplete because a specific currency is being used to limit
the search.
• Check Search – The results of this search are limited to those checks in the specified check Total range and currency.
Using Multiple Currencies in Bulk Invoices

Bulk Invoices can be written in any currency. The Bulk Invoice, the physical check, and the invoice item checks use
this currency. See “Bulk Invoices and Multicurrency” on page 406 for details.
Multicurrency Reserving
You can configure ClaimCenter to use multicurrency reserving by setting the EnableMultiCurrencyReserving
parameter in config.xml.
With this parameter set, you can create reserves, checks, and make payments in varying currencies. Each reserve
line then has a designated reserving currency that defaults to the claim currency. You can specify the currency, along
with the cost type and cost category. Payments erode reserves in the corresponding reserving currency. As a result,
in subsequent transactions and adjustments, you can use the accurate reserve amount without being impacted by
moving exchange rates and currency fluctuations.
After you specify the reserving currency, ClaimCenter shows all amounts and calculations for the reserve line in this
currency. In the Financials Summary screen, you can view reserve line totals in the reserving currency, in addition to
the claim currency.
Whenever you create reserve lines in multiple currencies, the following conditions apply:
• Reserves for any one reserve line must be in the same reserving currency.
• All payments on a check must be from reserve lines with the same reserving currency.
• When you recode a payment or transfer a check, you can only select a target reserve line from reserve lines with
a reserving currency that matches the existing one.
IMPORTANT If you want to enable multicurrency reserving, multicurrency display must also be enabled. Also, you
must have exchange rate information loaded into ClaimCenter before you enable multicurrency reserving. See
“Exchange Rates” on page 380.
See also:
• “Reserves in Multiple Currencies” on page 329.
• “Working with Checks” on page 341.
Multicurrency Financial Summaries

In the base configuration, most ClaimCenter features, such as the Summary pages, financial calculations, and
aggregate limits, operate in the claim currency. The Financials Summary screen of each claim uses this currency.
ClaimCenter calculates these aggregate amounts in the claim currency.
When multicurrency reserving is enabled, the Financials Summary screen of each claim has the capability to show
reserve lines in the reserving currency as well as the claim currency. The summary screen also shows aggregates in
the reserving currency. Additionally, you can view amounts using fixed or market exchange rates.

Note: Exchange rate adjustments are always non-eroding, even if they adjust an eroding payment. They cannot be
made on recoveries, reserves, and recovery reserves, and therefore can create small errors in financial summaries.
With foreign exchange adjustments, you can change claim and reporting amounts. For example, you might increase
the claim amount of a check, which would increase the amount of Total Paid, but Total Reserves and Remaining
Reserves would not be affected. They do not take foreign exchange adjustments into account, so Remaining
Reserves would no longer equal the difference between Total Reserves and Total Payments.
See also
• “Foreign Exchange Adjustments and Financials Calculations” on page 384
Examples of Using Multicurrency

The following examples illustrate how you can use the multicurrency features in ClaimCenter to handle transactions
across geographical regions with potentially varying currencies.
Example: Canadian Insurer that Also Covers Losses in Other Currencies

A Canadian policyholder spends the weekend in the United States in the state of Florida. Separate currencies are
used by insurance companies that have snowbird policyholders, insured parties who spend a certain season of the
year in a different country. In this case, the insurance company writes all or most of its policies in Canada, but
covers losses in a few other countries on occasion.
ClaimCenter Configuration
• Multicurrency display – Enabled
• Multicurrency reserving – Disabled
Currencies
• Default currency – Canadian Dollars (CAD)
• Claim currency – CAD
• Reserving currency – CAD
• Transaction currency – United States Dollars (USD)
Create reserves and recoveries, create checks, and make payments in US dollars for claims associated with the
policyholder’s stay in Florida. Payments erode reserves in the claim currency. ClaimCenter calculates the amount of
a financial transaction in the claim currency by using the appropriate exchange rate. It then stores the amount both in
the transaction currency and the claim currency. Financial summaries are shown in the claim currency.
Example: British Insurer with Satellite Office in Paris

A London-based insurance company has a satellite office in Paris. Because the insurer is located in England,
ClaimCenter is configured with a default currency of British Pound Sterling (GBP). Policies that are written in
England are in GBP. However, the Paris office writes and handles policies and claims in Euros (EUR). Therefore,
ClaimCenter must handle claims in both GBP and EUR.
Additionally, insurance companies using ClaimCenter can create certain transactions in a third, different currency.
For example, a Parisian policyholder drives to the Czech Republic and has a car accident. The financial transactions
on the claim are paid in the Czech currency, Korunas (CZK).
Examples of Using Multicurrency 379

• Multicurrency reserving – Disabled
Currencies
• Default currency – GBP
• Claim currency – EUR
• Reserving currency – EUR
• Transaction currency – CZK
Although the policy was created in Paris, you can create reserves in Korunas for claims associated with the
policyholder’s trip to the Czech Republic. Payments erode reserves in the claim currency. ClaimCenter calculates
the amount of a financial transaction in the claim currency by using the appropriate exchange rate. Financial
summaries are shown in the claim currency.
See also
Example: Operating in a Marine Line of Business

Insurance companies operating in a marine line of business often need to insure fleets in multiple currencies. The
insured parties typically insure a single vessel in various currencies to hedge themselves against the risk of exchange
rates fluctuations. It is also common for an insurer to create reserves and make payments in a currency other than the
policy currency, when the expenses are in a different country.
For example, if a Japanese ship collides with an American ship, adjusters for the American ship may have to create
separate reserves in USD and JPY to cover the claim. Hull damage reserves are created for each ship in the
respective currencies. They may need to appoint lawyers in both the US and Japan and order parts from China.
• Multicurrency reserving – Enabled
Currencies
• Default currency – USD
• Claim currency – USD
• Reserving currency – JPY and USD
• Transaction currency – CNY
In this case, although the policy was created in the US, you can create reserves in Yen for claims associated with the
policyholder’s incident with the Japanese ship. Payments erode reserves in the reserving currency. A financial
transaction can be made in another currency, such as Yuan, and ClaimCenter calculates the amount of the transaction
in the reserving currency by using the appropriate exchange rate. Financial summaries are shown in the claim
currency and reserving currency.
Exchange Rates
You can make financial transactions in more than one currency in ClaimCenter. For any two currencies, there exists
a conversion factor, called an exchange rate, that converts one currency amount to the other.

ClaimCenter uses a table of exchange rates to calculate the claim amount from the transaction amount and perform
similar currency conversions. It uses the table in conjunction with a class that implements the
IExchangeRateSetPlugin plugin interface.
Market and Custom Exchange Rates

When you create transactions, you can determine the exchange rate in one of two modes, automatic or manual.
These modes are:
• Automatic mode – The system gets the rate based on data in the tables. It uses the exchange rate from the
application’s table of the most current market rates.
• Manual mode – When multicurrency display is enabled, if you select a currency other than the claim currency,
ClaimCenter displays the ExchangeRateMode field. Select Manual and enter a custom rate in the text field. The
default value in this field is the market rate. An insurer might try to avoid problems of currency fluctuations by
holding or hedging a currency. Therefore, it can be appropriate to manually enter exchange rates instead of
accepting the automatically selected market rate.
Obtaining Market Exchange Rates

Current market exchange rates are imported into ClaimCenter through a plugin that implements the
IExchangeRateSetPlugin interface. This plugin is run on a periodic basis by the Exchange Rate batch process to
refresh the latest market rates in the system.
To obtain real-world market exchange rates from outside ClaimCenter, you must implement the
IExchangeRateSetPlugin interface. How you implement the plugin interface and how often it runs to import an
exchange rate set are based on your business needs
For example, the plugin implementation could do the following:
• Communicate with a web service that provides current market exchange rates.
• Process and import a document with a list of rates. This list could be provided and periodically updated by an
internal currency management department.
In the base configuration, ClaimCenter includes a demonstration implementation called
SampleExchangeRateSetPlugin2. This implementation sets up unrealistic whole-number exchange rates between
currencies in the system that can make product demonstrations easier to understand. While its exchange rates are not
realistic, the code that creates the ExchangeRateSet and ExchangeRate entities can be used as an example for your
own implementation.
Exchange Rate Batch Process

The Exchange Rate batch process invokes the class that implements the IExchangeRateSetPlugin interface. In the
base configuration, the plugin implementation gw.plugin.exchangerate.impl.SampleExchangeRateSetPlugin2
adds a new set of sample market exchange rates in ClaimCenter. Running the batch process loads the updated
market rates.
In the base configuration, this batch process is specified in a commented-out section in the scheduler-config.xml
file, as follows:
<ProcessSchedule process="ExchangeRate">
<CronSchedule hours="2"/>
</ProcessSchedule>
Exchange Rates 381

The batch process might invoke the plugin in the following ways:
• Every day, for the latest market rates.
• Periodically, based on your business requirements.
Exchange Rate Plugin

An implementation of IExchangeRateSetPlugin is required to provide an ExchangeRateSet object containing at
least one ExchangeRate object from each currency in the Currency typelist. This ExchangeRate object specifies the
exchange rate between the currency and the system default currency.
The ExchangeRate object must have a BaseCurrency element in the chosen currency and a PriceCurrency
element that is the system default. If N represents a currency, then the minimum is N times one with a maximum of
N times N. You can also set up these exchange rate entities yourself for every currency X to every Y combination.
The sample plugin implementation class gw.plugin.exchangerate.impl.SampleExchangeRateSetPlugin2
implements this functionality by overriding the createExchangeRateSet method. The important features to
implement in your own plugin implementation are:
• Call CurrencyUtil.getDefaultCurrency to get the default currency.
• For each currency defined in the Currency typelist except the default currency, call
CurrencyUtil.createExchangeRate to create and initialize each ExchangeRate entity in an array.
• After all currencies have been added to the array, the method calls
CurrencyUtil.createMarketExchangeRateSet to create the ExchangeRateSet object that this method returns.
Exchange Rate Objects

ClaimCenter uses the set of ExchangeRate objects to construct an exchange rate between every currency pair, which
becomes the active market ExchangeRateSet.
The two main exchange rate objects are as follows:
• The ExchangeRate object represents an exchange rate between a pair of currencies.
◦ This rate can be a market rate, in which case it will exist in an ExchangeRateSet with rates between every
currency pair.
◦ This rate can be a manually entered custom rate, in which case it typically contains the amount entered by the
user and resides alone in an ExchangeRateSet.
• The ExchangeRateSet object represents a set of exchange rates, along with supplemental information about
those rates, including the effective and expiry dates for the set. The MarketRates field, when true, indicates that
the exchange rates are market rates. When this field is false, the set contains only one user-defined custom rate.
See also
• ExchangeRate and ExchangeRateSet table descriptions in the Configuration Guide.
Multicurrency and Active Market Rate Sets

If ClaimCenter has been configured for multicurrency display, ClaimCenter must always have an Active Market
Rate Set. ClaimCenter defines an Active Market Rate Set if the MarketRates field is set to true on the
ExchangeRateSet entity and the ExchangeRateSet has the current date. The current date must be between the
effective date, EffectiveDate, and the expired date, ExpireDate.
In this example, the ExchangeRateSet entity contains two currencies: US dollars and Euros. The entity also has
effective date, EffectiveDate, and expiration date, ExpireDate, fields.
To determine which ExchangeRateSet entity is the active market set, the system first searches for
ExchangeRateSet entities with MarketRates set to true. It then sorts on the most recent, unexpired effective date.
If the MarketRates field is set to false, the ExchangeRateSet entity indicates a custom rate.

IMPORTANT You must run the Exchange Rate batch process at least once to load the market rates. If you do not
run it, ClaimCenter displays an error if you try to create a multicurrency check. This error also occurs if the current
market rate set expires and no new set has been loaded. To avoid this issue, Guidewire recommends that you not
set the expiration date, enabling the system to always get the last known market rate set.
See also
• “Foreign Exchange Adjustments” on page 383
Importing Multiple Currency Transactions

Use the ClaimFinancialsAPI.addClaimFinancials method and the
ClaimFinancialsAPI.addClaimFinancialsWithValidation method to import financial transactions into
ClaimCenter. A call to either of these methods results in a new TransactionSet object containing transactions that
have the same currency and exchange rates.
See also
Foreign Exchange Adjustments

When multicurrency display is enabled, sometimes a check is written in a currency other than the claim currency
and no custom rate is entered. ClaimCenter typically uses that day’s exchange rates to convert the payment amount
to the claim and default currency. If a check clears, this exchange rate usually has changed, and the actual cleared
amounts in the claim and reporting currencies will differ from the previously-calculated amounts.
For example, the default, reporting, and claim currencies are US dollars, and you write a check for 100 Euros when
the Dollar–Euro exchange rate is 1.3. ClaimCenter calculates $130 as the claim and reporting amount for the
payment. If the recipient cashes the check one week later and the exchange rate has become 1.4, the insurer's US
bank account balance will actually be reduced by $140.
Note: Reserves are still only eroded by $130, because foreign exchange adjustments do not erode reserves.
ClaimCenter provides a way to adjust the payment's claim and reporting amounts. In the example, the adjustment
would be to $140. This adjustment changes some, but not all, summary calculations. It does not affect recoveries, for
example. See “Foreign Exchange Adjustments and Financials Calculations” on page 384 for details.
Note: You cannot make these adjustments on reserves, recoveries, or recovery reserves.
Making Foreign Exchange Adjustments

You can make exchange rate adjustments on a single payment or on an entire check. If the latter, then the adjustment
is distributed proportionally to all the check's payments except offsets, recoded, and canceled payments.
You can make adjustments only after the entity has certain transaction statuses. A check must have a status of
Notifying, Requesting, Requested, Issued, or Cleared. A payment must be Submitting or Submitted.
In the previous example, $140 minus $130 results in a $10 adjustment. If the payments of the check had claim
amounts of $39, or 30% of the total, and $91, or 70% of the total, the adjustment would be distributed between
them. $3 would be applied to the first payment and $7 to the second.
See also
• “Methods That Make Foreign Exchange Adjustments” on page 383
Methods That Make Foreign Exchange Adjustments

You can apply foreign exchange adjustments to checks and payments in the following ways:
Exchange Rates 383

Use the following methods in ClaimFinancialsAPI, making explicit calls to the SOAP API.
• applyForeignExchangeAdjustmentToPayment (paymentId, newClaimAmount)
• applyForeignExchangeAdjustmentToPayment (paymentId, newClaimAmount, newReportingAmount)
• applyForeignExchangeAdjustmentToCheck (checkId, newClaimAmount)
• applyForeignExchangeAdjustmentToCheck (checkId, newClaimAmount, newReportingAmount)
Use an equivalent scriptable method on a check or payment in Gosu code:
• applyForeignExchangeAdjustment (newClaimAmount)
• applyForeignExchangeAdjustment (newClaimAmount, newReportingAmount)
Generally, all the methods adjust a payment's claim or reporting amounts to specified values. These adjustments are
intended to be used when better values for the amounts are determined later, after a check is created and escalated.
To use these methods, ClaimCenter must be configured in multicurrency mode and the payment must meet the
following criteria:
• Be on an escalated check that has not been canceled or transferred.
• Not have been recoded.
• Not be an offset payment.
• Not be part of a multi-payee (grouped) check.
For additional details and examples of these methods, you can access the Gosu API documentation as described at
the Gosu Reference Guide.
Foreign Exchange Adjustments and Financials Calculations

ClaimCenter treats all foreign exchange adjustments as non-eroding. Therefore, most calculated values do not
change if you apply an adjustment, most importantly Open, Available, and Remaining Reserves. However, Net Total
Incurred, Gross Total Incurred, and Total Paid do change. To continue the example at the beginning of this topic,
total incurred and total paid values increase by $10, and the previously mentioned reserve calculations remain
unchanged.
See “ClaimCenter Financial Calculations” on page 367 for definitions of all calculated financial values.
Foreign Exchange Adjustments in Custom Financials Calculations

You can create your own custom financial calculations that include foreign exchange adjustments. For example, you
could define a calculation similar to Open Reserves that includes foreign exchange adjustments by subtracting the
sum of all exchange rate adjustments made on eroding payments.
Note: Exchange rate adjustments are always non-eroding, even if they adjust an eroding payment. Because of their
effect on financial calculations, applying foreign exchange adjustments can cause the values shown on the
Financials Summary screen to not add up.
See also
• “Methods That Use Foreign Exchange Adjustments” on page 384
Methods That Use Foreign Exchange Adjustments

The following methods in gw.api.financials.FinancialsCalculationUtil provide expressions that can be used
to define new calculations:
Method Description
getForeignExchangeAdjustmentsExpression Total foreign exchange adjustments for both eroding
and non-eroding payments.
getErodingPaymentsForeignExchangeAdjustmentsExpression Total foreign exchange adjustments only for payments
that erode reserves.

Method Description
getNonErodingPaymentsForeignExchangeAdjustmentsExpression Total foreign exchange adjustments only for payments
that do not erode reserves.
Example: Base Configuration of Foreign Exchange Adjustments

An American motorist hits another car in Europe and injures a passenger in the car. The following events take place
after this occurrence:
1. A claim is created with the American's insurer to pay the injured passenger. Anticipating that the claim will be
paid in euros, the adjuster creates an initial reserve of 80 euros. However, the claim currency is US dollars, as
the American’s policy is in the US. The claim amount for the reserve transaction is set to $100 based on the
current market exchange rate of 1.25.
2. The adjuster receives a bill for 1200 euros for medical treatment and increases reserves to 1280 euros, a claim
amount of $1600, based on the market exchange rate.
3. The adjuster writes a check for 1200 euros. The exchange rate has increased to 1.26, so the claim amount for
the payment is set to $1512.
4. By the time the check in step 3 clears the European bank, the Euro exchange rate has risen to 1.3, and the
insurance company's US bank account is charged $1560. The amount of the check, 1200 euros, did not
change, so the transaction amount for the payment need not be changed. However, the claim amount of the
payment, originally $1512, can be adjusted to reflect the amount for which the check actually cleared, $1560.
The integration makes this adjustment by calling ClaimCenter through one of the methods on the
ClaimFinancialsAPI SOAP API.
5. The claim adjuster finds that the other driver is partly at fault and opens a recovery reserve for 750 euros.
Based on the current Euro to US Dollar exchange rate of 2.0, the claim amount for the recovery reserve is
$1500. The adjuster sends a subrogation request for this amount to the British driver’s insurance company.
6. The American insurance company receives and deposits a subrogation check for 750 euros. They enter this
recovery by using the current exchange rate of 2.02, so the claim amount is set to $1515.
7. The recovery check clears the bank for $1530 at an exchange rate of 2.04. However, the claim amount of the
recovery transaction is not adjusted.
The following table shows the first six steps. In this table, entries in bold are changed by the action in the line above
them.
Exchange Open Total Total Eroding Open Recovery Gross Total Net Total Foreign
Rate Used Reserves Payments Payments* Recovery Incurred Incurred Exchange
Reserves Adjustment
1) Claim opened. Initial reserve created for 80 Euros.
--- $100 $100 $100
2) 1200 Euro bill received for medical treatment. Reserves set to 1280 Euros.
1.25 $/Euro $1600 $1600 $1600
3) 1200 Euro check sent for insured’s medical bills in Europe.
1.26 $/Euro $88 $1512 $1512 $1600 $1600
4) 1200 Euro check clears bank for $1560. Adjustment made.
5) Recovery attempt for 750 euros started. Recovery reserve opened for this amount.
2.0 $/Euro $88 $1512 $1512 $1500 $1600 $1600
6) 750 euro Subrogation check received and recovery of $1515 entered.
2.02 $/Euro $88 $1560 $1512 $10 $1515 $1600 $85
Foreign Exchange Adjustments 385

Notes
• * Total Eroding Payments is not a real calculation and is used in the table only for illustration.
• This example shows that foreign exchange adjustments are made on payments only, not on recoveries.
• Step 4, where the foreign exchange adjustment was applied, did not affect Open Reserves or Total Eroding
Payments.

chapter 36
Deductible Handling
A deductible is the amount the insured is required and obligated to pay by the insurance policy. The insured chooses
the deductible amount and it is usually applied to coverages such as comprehensive and collision. Generally, the
lower the deductible, the higher the insurance premium.
A typical scenario for using a deductible is an auto accident about which you notify your insurance company. Your
agent says that they will cover the entire cost of replacing the hood of your car after you contribute your insurance
deductible of $500.
In ClaimCenter, you can apply an insured’s deductible to a claim in the Personal Auto line of business. Other lines
of business can use deductible handling if you configure them to do so.
This topic introduces you to how ClaimCenter uses deductibles.
Overview of Deductible Handling

Deductibles are usually applied to the first claimcost payment on the check. The deductible amount is specified on
a coverage entity in the policy. After you select a policy in the New Claim wizard or in the Auto First and Final
wizard, ClaimCenter pulls that policy data from the policy administration system (PAS). For example, a typical auto
deductible for a collision coverage on an auto policy is $500 in the United States. An insured is in an auto accident.
There is $1000 of damage that is to be paid to the auto body shop. $1000 total damage minus the $500 deductible
equals $500, which is the amount the insured receives.
However, there are exceptions, and ClaimCenter is flexible in the handling of deductibles. Exceptions can include
the following:
• Some policies have a higher deductible based on the claim incident. For example, drivers in Great Britain can
pay a higher deductible if they are under a certain age.
• Deductible calculations are often made based on the fault rating of the insured, but only if the insured can prove
that the insured’s fault was a certain percentage. For example, if the insured could demonstrate a fault of 30%,
and that the other party’s fault was 70%, the insured would pay only 30% of the deductible.
• In some cases, the deductible can be negotiated with the claim adjuster where fault is hard to quantify or prove.
For these reasons, deductibles can not only be applied, but they can be waived or the amount can be edited.
Deductible Handling 387

Note: In the base configuration, ClaimCenter does not support paying a deductible across multiple payments.
Working with Deductibles

This section describes how to work with deductibles.
Viewing Deductibles
There are several places in the user interface in which you can see if a deductible has been applied to a claim.
• On the Summary screen, you can see this information in the Financials section.
• On the Subrogation screen, if there is a subrogation on the claim.
• On the Exposures screen, such as in an auto policy.
The following example is taken from the Exposures screen of the first vehicle on a policy.
In this example, the adjuster later determines that the accident was not the insured’s fault. On the Subrogation
Financials screen, the $500 deductible has been applied. The deductible will be returned to the insured as soon as the
carrier gets that amount from the party who was at fault. On the Subrogation screen, the deductible amount is shown
only if the insured incurred it.
Because the deductible is associated with a coverage in ClaimCenter, the deductible amounts apply only to reserve
lines created for an exposure. Therefore, claim-level reserve lines show no deductible amount.
Applying Deductibles
You can apply deductibles in the following Personal Auto wizards:
• New Check wizard, in step 2 of 3
• Quick Check wizard
• Auto First and Final wizard
You apply, or pay off, a deductible as payment is made against an exposure linked to a coverage with a deductible
amount. On the payments step of the check wizard, after choosing a reserve line with an exposure having an unpaid
deductible, you can optionally click Apply Deductible. If you decide to apply the deductible, ClaimCenter
automatically creates a transaction line item with a value equal to the negative of the deductible amount. The new
line item is then linked to the deductible, and the deductible is marked as paid.
In the base configuration, there is no support for paying off a deductible over multiple payments. You must apply the
entire deductible amount as a negative transaction line item on a payment. If the deductible amount is greater than
the amount of the check, ClaimCenter issues the following warning:
388 chapter 36 Deductible Handling

This payment cannot be added because it has a deductible line item whose amount exceeds the sum of the other line items'
amounts.
After the deductible on a coverage is paid or waived, the Apply Deductible button is not available for any payments
made against exposures linked to that coverage.
Edit a Deductible
About this task
A deductible can be overridden—changed to an amount different from that indicated on the policy—if it has not
been paid or waived. The field indicating an overridden deductible is called Modified, and you access it by clicking a
radio button. Clicking Yes causes the amount field to become editable, and you can edit the original amount to a
lower, nonnegative amount. If the Modify flag is ever reset to No, ClaimCenter recalculates the claim deductible
amount through the DeductibleCalculator, and it becomes uneditable again.
Procedure
1. With a claim open, navigate to the ClaimCenter Exposures screen and click an exposure name to open its
details screen.
2. Click Edit.
3. Select a coverage, if one has not already selected.
4. In the Deductible section, for Modify Deductible, click the Yes radio button.
5. Enter values for Deductible Amount and Edit Reason.
Waive a Deductible
About this task
It is possible to waive a deductible if it has not yet been applied to any payment. You waive a deductible in the
Details screen for an exposure. Use this screen to set the deductible’s Waive Deductible flag to Yes. This field is not
editable if the deductible has already been paid, unless something has caused it to become unpaid, in which case the
waived field is again editable. If you waive a deductible, the Apply Deductible button does not appear in the check
wizard after selecting related exposures. You must also have the permission of Edit Deductible.
Waiving a deductible is usually done by more experienced adjusters. Deductibles are often waived in no-fault states
if the insured is not at fault.
Procedure
1. With a claim open, navigate to the Exposures screen and click an exposure name to open its details screen.
2. Click Edit.
3. Select a coverage, if one has not already selected.
4. In the Deductibles section, for Waive Deductible, click the Yes radio button.
5. Enter an Edit Reason.
Working with Deductibles 389

Next steps
See also
Setting Up Deductibles
Deductible data comes from the policy. ClaimCenter creates the Deductible entity during exposure creation or after
updating to a coverage that has a deductible but does not already have a deductible linked to a claim. It is initially
marked as unpaid, unwaived, and unmodified—the Paid, Waived, and Overridden columns in the database are
false. If a new exposure is created without a coverage, or with a coverage that has no policy deductible, no
associated deductible is created. Updating a coverage's existing policy deductible amount updates the deductible's
amount if it exists and is unpaid.
In the base configuration, deductible handling is automatically set up. The following configuration parameters are
set to true in the config.xml file:
• UseDeductibleHandling – Enables deductibles to be applied in the system.
• AllowMultipleLineItems – Since deductibles are applied through TransactionLineItems, this parameter must
be also set to true for deductible handling to be enabled.
Setting the configuration parameter UseDeductibleHandling to false has the following results:
• The Deductible section of new claims does not show on the Exposures screen.
• For older claims that had an existing deductible, the Deductible section shows on the Exposures screen, but it is not
editable.
• The Apply Deductible button does not display on the check wizard screen for old claims that have a deductible
applicable.
• Transfer or recode of payments does not match the deductible from old payments to new payments.
IMPORTANT If you set the configuration parameter AllowMultipleLineItems to false, while leaving
UseDeductibleHandling set to true, you will encounter issues. You will not be able to create the first claim cost
payment because there is no way to apply the deductible.
390 chapter 36 Deductible Handling

chapter 37
Bulk Invoices
Use the ClaimCenter bulk invoice feature to record an invoice containing items for multiple claims and then pay it
with a single check.
Note: You must integrate ClaimCenter with ContactManager before you can use this feature. To enable you to set
the bulk invoice payee, ClaimCenter must obtain contact data from ContactManager first. For details on how to
integrate Guidewire ClaimCenter with Guidewire ContactManager, see the Guidewire Contact Management Guide.
See also the Integration Guide.
Bulk Invoice Overview

ClaimCenter provides the ability to enter multiple claims into a single record and then pay these claims with a single
check. In other words, you create an invoice with multiple, or bulk line items. The following examples illustrate this
concept.
Process cross-claim invoices electronically

A rental car company sends a single monthly invoice to a carrier. This invoice has hundreds of line items, each for a
loaner car rental charged to a different claim. You can use the bulk invoice feature to do the following:
• Electronically record the invoice.
• Assign each invoice line item to the correct claim.
• Create a single payment for all the line items on the invoice.
• Create a single check for the entire bulk invoice.
Enter cross-claim invoices manually

A police reports service provider sends a paper invoice every month with a list of police report bills for different
claims. Using the bulk invoice feature, you enter the payments for each claim into one screen to create one bulk
invoice and send one check.
Additional Information on Bulk Invoices

See the following topics for more information on bulk invoices.
Bulk Invoices 391

Topic See...
Bulk invoice activity patterns • Configuration Guide
Bulk invoice approval • “Bulk Invoice Approval” on page 398.
Bulk invoice configuration parameters • Configuration Guide
Bulk invoice data model • “Bulk Invoice Data Model” on page 408
Bulk Invoice escalation process • Configuration Guide
Bulk invoice integration: • “Bulk Invoice Validation” on page 398
• IBulkInvoiceValidationPlugin • Integration Guide
• BulkInvoiceAPI
• Validating a bulk invoice
• Stopping/voiding a bulk invoice
Bulk invoice payment configuration • Configuration Guide
Bulk invoice rules for bulk invoice approval and bulk invoice approval • Rules Guide
assignment
Bulk invoice screens • “Using the Bulk Invoice Screens” on page 393
Bulk Invoice Process Flow

The following diagram provides an overview of the bulk invoice process.
Update Overview of the Bulk Invoice Lifecycle

button
(save) all
approved
Validate Submit Items Create
approval
Create/ button button Validate are valid Item
granted
Edit Items Checks
Validate Approve
Draft, Rejected, Pending Item Pending Item
or Invalid Items In Review Validation, or
Draft status Validation, or
status status Invalid Items Invalid Items
fails validation
and all checks approved
Note: Bullk invoice
all Item checks written
statuses are shown

approver rejects Item(s) or Invoice in red italic.
Item(s) not valid
Item check can’t be created or is not approved
next status is Issued, then Cleared send date

Ext. Syst. writes bulk check
Send to reached
On Hold; may re-send to Ext. Syst . External
Ready to
Ext. Syst. holds up Invoice Submit
or ask to stop or void System
Pending Stop or Void, to Stop or Void if Requesting Awaiting
Ext. Syst. stops/voids Invoice
successful, or to Issued or Cleared if not to Requested Submission
ask to stop or void
Note: ClaimCenter uses a plugin implementation of the IBulkInvoiceValidationPlugin plugin interface to

perform bulk invoice validation. You can configure the plugin implementation to meet your business needs.
You can access the Bulk Invoices screen by selecting Bulk Invoices from the Desktop drop-down menu.
Additional Information on Bulk Invoices

For more details of the bulk invoice process flow, see the following topics:
392 chapter 37 Bulk Invoices
Topic See...
Bulk invoice creation or editing • “Using the Bulk Invoice Screens” on page 393
• “Working with Bulk Invoice Line Items” on page 397
Bulk invoice validation • “Bulk Invoice Validation” on page 398
Bulk invoice approval • “Bulk Invoice Approval” on page 398
Line item validation • “Invoice Line Item Validation” on page 399
Line item check creation • “Bulk Invoice Checks” on page 400
• “Bulk Invoices and Multicurrency” on page 406
Stopping or voiding a bulk invoice • “Stopping or Voiding a Bulk Invoice” on page 398
Using the Bulk Invoice Screens

About this task
To access the Bulk Invoices screen in ClaimCenter, navigate to the Desktop tab, then select Bulk Invoices from the menu
at the left-hand side of the screen. Within the Bulk Invoices screen, you can view and edit existing bulk invoices,
create new ones, or further process a bulk invoice.
You can use the function buttons on the Bulk Invoices screen to do the following:
• Create New – Create a new bulk invoice.
• Delete – Select the check box of a bulk invoice and then click this button.
• Submit, Stop, or Void – Further process a bulk invoice.
• Refresh – Refreshes the screen to show the latest invoice status.
The function buttons are available only if you have the correct permissions, and the operation is possible on the
selected bulk invoice.
Bulk Invoice Details Screen

To access the Bulk Invoice Details screen, do one of the following:
• Click Create New on the Bulk Invoices screen.
• Click one of the invoice numbers listed on the Bulk Invoices screen.
ClaimCenter divides the Bulk Invoice Details screen into multiple areas. The upper portion of the screen contains
sections pertaining to the bulk invoice as a whole. The middle portion of the screen contains information on the
validation status of the bulk invoice. The lower portion of the screen contains a list of line items. See the following
for details:
• “Upper Portion of Bulk Invoice Details” on page 393
• “Validation Status Area of Bulk Invoice Details” on page 396
• “Bulk Invoice Line Items Area of Bulk Invoice Details” on page 396
Upper Portion of Bulk Invoice Details

The upper portion of the Bulk Invoice Details screen contains information relating to the overall invoice. It also
contains a row of buttons that become active depending on the status of the bulk invoice. These buttons include the
following:
Field Description
Edit Opens a writable version of this screen. This button is only available under specific circumstances. For example, the
button is available if the bulk invoice is in Draft or Rejected status.
Using the Bulk Invoice Screens 393

Field Description
Submit Submits the bulk invoice for approval, if required, or for further processing if approval is not required.
Refresh Updates the bulk invoice status and shows if it has changed.
Update Save the bulk invoice to the database in its current state, even if incomplete. You see this button if you create a new
bulk invoice or edit an existing bulk invoice. After you click Update to save a bulk invoice, ClaimCenter shows the
invoice with Draft status in the list of bulk invoices on the Bulk Invoices screen. It is possible to re-edit a bulk invoice
after it has left Draft status, but not yet reached Requesting status. To do so, click the bulk invoice number in the list
and click Edit.
If you edit a bulk invoice and make any of the following changes, ClaimCenter returns the bulk invoice to Draft status:
• Edit Payee or Total Amount.
• Add or delete a line item.
• Edit the claim number for a line item.
• Edit the reserve line information for a line item, such as exposure, cost category, or cost type.
• Edit the payment type if a line item.
Note: During line item validation, you can edit only line items that have failed the validation.
Cancel Undo any changes since you last clicked Update. You see this button in Edit mode only.
Invoice Section of Bulk Invoice Details

The Invoice section of the Bulk Invoice Details screen contains the following fields:
Field Description
Invoice # An identifier assigned to the invoice being entered. Typically, this identifier comes directly from the
invoice received from the vendor. It is optional.
Date Received The date that the bulk invoice was received from the vendor. The default value is the current day's
date.
Distribution Select one of the following:
• Distribute amount evenly – ClaimCenter divides the total amount evenly among all the line items.
Distribute amount evenly is useful if your bill contains the same charge for many similar claims,
for example.
• Enter individual amounts – Enter individual amounts for each line item.
Amount to distribute If you select Distribute amount equally, this field must contain a value. This value is the total amount of
the invoice ClaimCenter will distribute equally among all the invoice items. If you do not select
Distribute amount equally, ClaimCenter hides this field.
If multicurrency display is enabled, the following field also appears:

Currency The currency that this bulk invoice uses. A bulk invoice has a single currency that ClaimCenter applies
to all bulk invoice items and their corresponding checks when created or updated. For more
information, see “Multiple Currencies” on page 373.
If multicurrency display is enabled, the following fields also appear if the currency you select is not the default currency:
Exchange Rate Mode If Automatic, the default, ClaimCenter uses the current market exchange rate. If Manual, you can enter
a specific rate in the Exchange Rate field. For more information on this set of fields, see “Exchange
Rates” on page 380.
Exchange Rate The rate that this bulk invoice uses for all its items' associated payments. This rate is from the bulk
invoice currency to the reporting currency, if ClaimCenter is in multicurrency mode.
Rate Set Description Description of the origin of the exchange rates being used for this bulk invoice.
Date of ExchangeRate Entry Date that the exchange rate being used for this invoice was entered.

Status Section of Bulk Invoice Details

The Status section of the Bulk Invoice Details screen contains the following fields:
Field Description
Status Status of the bulk invoice. See “Bulk Invoice Lifecycle Diagram” on page 402.
Date Approved If the bulk invoice was approved, the date when the reviewer approved the bulk invoice.
Total Approved The total of all approved items. ClaimCenter calculates and stores both the total amount for all line items,
Amount and the total approved amount, which is the amount of the bulk invoice check. ClaimCenter stores these
amounts internally with the following values:
• Its value in the default application currency
• Its value in the currency of the bulk invoice
Issue Date Date the bulk invoice was issued.
Invoice Item Details Section of Bulk Invoice Details

The Invoice Item Details section of the Bulk Invoice Details screen contains the following fields:
Field Description
Default Cost Type Use to filter the available reserve lines for each item. You can also use these fields as you enter a new
Default Cost Category reserve line.
Default Payment Type Assign Supplemental, Final, or Partial to the payment type of each line item.
Check Details Section of Bulk Invoice Details

The Check Details section of the Bulk Invoice Details screen contains the following fields:
Field Description
Payee Required. You can select the payee from contacts in the Address Book. ContactManager or an external
contact management system must be enabled so you can search the Address Book.
Payment Method Required. Select check or electronic funds transfer (EFT). Depending on your selection, additional fields are
shown.
Pay To the Order Required. This field is shown only if you opt to pay by check and defaults to Payee. You can select one or
of more payees from the address book.
Check # The number of the check that pays the bulk invoice. ClaimCenter propagates this number to the item checks.
This field is shown only if you opt to pay by check.
Delivery Method Select from Send, Hold for adjuster, or No check needed if a manual check was written.
This field is shown only if you opt to pay by check.
Recipient Required. The person to whom the check processing system sends the check. The recipient defaults to Paye
e. This field is shown only if you opt to pay by check.
Mailing Address The address where the check is sent. This defaults to the address of the Payee. This field is shown only if you
opt to pay by check.
Select EFT Record Select an existing EFT record attached to the current payee. This field is shown only if you opt to pay by EFT.
Name on the Required. Name of the person holding the account. This field is shown only if you opt to pay by EFT.
Account
Bank Name Name of the bank receiving the payment. This field is shown only if you opt to pay by EFT.
Account Type Required. Select Checking, Savings, or Other. This field is shown only if you opt to pay by EFT.
Bulk Invoice Details Screen 395

Field Description
Account Number Required. Enter the number of the account that is to receive the payment. This field is shown only if you opt
to pay by EFT.
Routing Number Required. Enter the ABA routing number of the receiving bank. This field is shown only if you opt to pay by
EFT.
Report As Whether the check amount is reportable to an income tax agency, such as the IRS.
Payment Instructions Section of Bulk Invoice Details

The Payment Instructions section of the Bulk Invoice Details screen contains the following fields:
Field Description
Send Date Required. The date to send the bulk invoice check to the downstream system.
Check Instructions Special instructions, which must be a valid value from the CheckHandlingInstructions typelist.
Memo Provides the ability to add free-form text to the check as you write it.
Validation Status Area of Bulk Invoice Details

ClaimCenter shows the validation status of the bulk invoice near the middle portion of the Bulk Invoice Details screen.
You must write your own validation by configuring a plugin implementation of the
IBulkInvoiceValidationPlugin plugin interface. In the base configuration, ClaimCenter provides the sample
plugin implementation gw.plugin.bulkinvoice.impl.SampleBulkInvoiceValidationPlugin. This class is
sample code only. You must configure the plugin code for your business needs. See “Bulk Invoice Validation” on
page 398 for more information.
Bulk Invoice Line Items Area of Bulk Invoice Details

The lower portion of the Bulk Invoice Details screen contains a table of line items. Each line item corresponds to an
invoice line item of the original bill. This table is initially empty after you create a new bulk invoice. Use the
following buttons in working with line items:
• Add – Use to add a new blank row in which you can enter the details of another line item.
• Remove – Use to delete all line items whose check boxes have been checked.
Use the following fields to create a line item:
Field Description
Claim Number The claim against which to make the payment shown on this line. After entering a number, ClaimCenter checks
to see that it is valid before allowing you to fill in the rest of the line item information.
Reserve Line The reserve line on the claim against which to make the payment. ClaimCenter displays all the reserve lines on
the claim in a drop-down list, after filtering them by Default Cost Type and Default Cost Category, if selected. If you
select New to create a new reserve line, ClaimCenter prompts you to reselect an exposure.
Exposure (Optional) If creating a new reserve line, select an exposure on the claim from this drop-down menu. See
“Working with Bulk Invoice Line Items” on page 397 for more information.
Note: A newly created reserve line uses the Cost Type and Cost Category from the Default Cost Type and Default
Cost Category fields.
Payment Type Choose one of the following:

• Final
• Partial
This value can be different for each line item.
Amount Enter this value unless you previously chose to Distribute amount evenly, in which case the split amount appears.

Field Description
Deductions Shows any deductions created on the check by a deduction plugin, such as the BackupWithholdingPlugin
plugin.
Service Date See “Service Dates and Service Periods for Checks” on page 340.
Description Optional field in which you can enter additional information.
Alerts A list of messages describing errors encountered while creating or editing a bulk invoice, such as Invalid Claim
Number or Payment for this line item exceeds reserves. The bulk invoice validation process produces other alerts.
Status The bulk invoice equivalent of a transaction status. For a list of these statuses, see “Bulk Invoice Lifecycle
Diagram” on page 402.
Working with Bulk Invoice Line Items

The lower portion of the Bulk Invoice Details screen contains information on the line items associated with the bulk
invoice.
Notes:
• A bulk invoice line item can only contain one payment. See “Placeholder Checks” on page 400.
• It is possible to create reserve lines with different Cost Types or Cost Categories or both. To do so, use one set of
defaults. Click Update, and then select a new set of defaults.
• It is important to understand that creating a new reserve line does not create a reserve for it. It is possible that this
action can cause the line item to fail its validation if the payment exceeds its reserves.
Create a New Bulk Invoice Line Item

Procedure
1. Open the Bulk Invoice Details screen.
2. If necessary, click Edit in the Bulk Invoice Details screen to access a writable version of the bulk invoice.
3. Click Add to create a new line item.
4. Enter the number of the claim against which ClaimCenter is to charge the invoice items on the bill.
• If the claim number that you enter is invalid, ClaimCenter colors the Claim # field yellow. You cannot
continue until you enter a valid claim number.
• If the claim number is valid, ClaimCenter displays a list of its reserve lines. The reserve lines are filtered by
the Default Cost Category and Default Cost Type values that you set previously for the bulk invoice.
5. Select an existing reserve line on the claim or select New... If you assign a line item to a reserve line that does
not yet exist on the claim, ClaimCenter creates the reserve line on the claim during line item validation.
6. Select the Exposure, unless you want the reserve line to be at the claim level.
7. Select a Cost Type or a Cost Category or both in the Default Cost Type or Default Cost Category drop-down lists, in
the Invoice Details portion of the screen.
8. Enter the remaining required fields:
• Payment Type
• Amount
• Deductions
The current values define the reserve line.
Working with Bulk Invoice Line Items 397

Stopping or Voiding a Bulk Invoice

The integration with an external check-writing system provides an opportunity to try to stop or void a bulk invoice.
Stopping or voiding moves the bulk invoice and its items into, respectively, Pending Stop or Pending Void status.
The external check-writing system calls the BulkInvoiceAPI web service after it completes the cancellation. At this
point, ClaimCenter transitions the bulk invoice into Stopped or Voided status.
Bulk Invoices that Are On Hold

The external system can also stop processing a bulk invoice and notify ClaimCenter through the BulkInvoiceAPI
web service that the invoice is on hold. In this case, you can void it, stop it, or resubmit it. You must first correct the
problem found by the downstream system before attempting to resubmit the bulk invoice.
Bulk Invoice Validation

ClaimCenter performs validation on the bulk invoice as part of the submission process, which occurs after you click
Submit. The purpose of this validation is to ensure that the bulk invoice conforms to your company’s business
practices. During bulk invoice validation, ClaimCenter performs the following checks using internal code:
• It checks the validity of the claim number.
• It checks the validation level of the exposures on the claim. All claim exposures must be at the Ability to Pay
validation level to pass validation.
You can configure bulk invoice validation by configuring a plugin implementation of the
IBulkInvoiceValidationPlugin plugin interface. In the base configuration, ClaimCenter provides the sample
plugin implementation gw.plugin.bulkinvoice.impl.SampleBulkInvoiceValidationPlugin.
To customize the validation code, set the following:
• The condition that triggers the validation alert.
• The type of the alert, as defined in the BIValidationAlertType typelist.
• The content of the alert message.
How ClaimCenter Validates a Bulk Invoice

The following sequence outlines the process that ClaimCenter follows in validating a bulk invoice in the base
configuration:
1. The user clicks Submit to submit the bulk invoice.
2. ClaimCenter executes the method validateBulkInvoice, for example, from the EditBulkInvoiceDetail
PCF file, passing it the current bulk invoice. This method is defined in the plugin class that implements the
IBulkInvoiceValidationPlugin plugin interface.
For an example of this method, see the plugin implementation
gw.plugin.bulkinvoice.impl.SampleBulkInvoiceValidationPlugin.
3. Base configuration code—and, in general, any bulk invoice validation code—checks for specific conditions
and generates error alerts if the bulk invoice meets those conditions.
Bulk Invoice Approval

There are two approval processes that a bulk invoice must pass before ClaimCenter can further process the bulk
invoice.
Approval Process Description

Bulk invoice approval Bulk invoice approval occurs after bulk invoice validation.

Approval Process Description

Check approval after line item ClaimCenter requires that every check created by the bulk invoice must pass thorough the
validation same approval process as all other checks. See “Bulk Invoice Checks” on page 400 for more
information.
Bulk invoices go through a first approval process similar to transactions in ClaimCenter, except that there are no
authority limits for bulk invoices. Clicking Submit starts this approval process. If no approval is required, the Submit
button starts line item validation, which otherwise starts after approval is granted.
After being approved, the bulk invoice’s status becomes Pending Bulk Invoice Item Validation. All its line items not
marked In Review or Rejected by the approver receive Item Approved status. All Rejected and In Review line items
remain in the bulk invoice with this status. See “Orphan Line Items” on page 400.
If a bulk invoice and a particular item are approved, but ClaimCenter subsequently rejects that item’s check, then the
bulk invoice item’s status becomes Not Valid. This status reflects the fact that ClaimCenter performs approval of the
bulk invoice item in bulk invoice approval rules and activities. You need to fix the item, remove it, or manually
reject it for the same reason the item's check was rejected.
Bulk Invoice Approval Rules

In the base configuration, ClaimCenter provides a single Bulk Invoice Approval rule. This rule requires an approval
for all bulk invoices. ClaimCenter disables this sample rule in the base configuration.
• If you have added additional approval and approval assignment rules, the approver sees an approval activity for
the bulk invoice after you click Submit. The approver can now reject or approve the entire bulk invoice.
• If you are the approver and you want to review the bulk invoice, first select it from your Activities screen. The
bulk invoice appears in the workspace at the bottom of the screen. Mark line items that you do not approve as
either Rejected or In Review. ClaimCenter ignores all line items so marked—see “Orphan Line Items” on page
400 for more information. You can optionally add a comment to the marked items explaining the reasons for
flagging them. You can also add comments to approved items.
After flagging line items, the approver can approve or reject the entire bulk invoice by using buttons of the same
name on the same screen. If the approver clicks Cancel at any point, ClaimCenter removes all flags from all line
items.
See also
• Rules Guide
Invoice Line Item Validation

ClaimCenter initiates line item validation as soon as the bulk invoice has been approved, or submitted, if approval is
not needed. This process proceeds asynchronously. To be validated, each approved line item:
• Must pass the Ability to Pay system validation level for its exposure or claim.
• Must not exceed available reserves, unless the configuration parameter AllowPaymentsExceedReservesLimits
is set in the config.xml file.
• Must have a valid Payment Type.
If any line items fail this validation, its status becomes Not Valid. Additionally, the bulk invoice itself is given the
status Invalid Bulk Invoice Items and cannot be processed further. You must first either edit or remove the line
items. Editing or removing a line item returns the bulk invoice to Draft status for reapproval and a repeat of this line
item validation.
Invoice Line Item Validation 399

Placeholder Checks
After a line item passes validation, ClaimCenter creates a check against the reserve line of the claim associated with
the line item. This check is a placeholder for the portion of the large bulk invoice check associated with that claim’s
reserve line. The claim financial screen displays this information and provides details of that reserve line. The
purpose of these checks is to indicate that a bulk invoice made a payment against that reserve line. Therefore, you
cannot edit or delete these checks from the Check Details screens.
As ClaimCenter creates each placeholder check, it also:
• Creates a claim contact for the check from the bulk invoice payee.
• Saves the contact with the claim.
• Marks the contact as linked with ContactManager.
ClaimCenter synchronizes these claim contacts with ContactManager. If the data changes for a contact in
ContactManager, ClaimCenter updates the contact data as it runs the contact automatic synchronization batch
process.
Note: A check created for a bulk invoice line item can only contain one payment with one transaction line item.
Transfer and Recode

It is possible to transfer a placeholder check from one claim to a different claim. This process creates a new invoice
item against the new claim. It is also possible to record the payment on a placeholder check on another reserve line,
which updates the invoice item’s reserve line. If you make that change after the bulk invoice has been sent to an
external accounting system, ClaimCenter notifies that system.
Repeated Line Item Validations

It is possible for line item validation to occur multiple times. As a consequence, it is possible for ClaimCenter to
have validated some line items already. If this is the case, one or more line items can already possess a placeholder
check. If a line item possesses a placeholder check already:
• ClaimCenter updates the existing check to reflect any editing changes.
• ClaimCenter retires the existing check if a line item becomes invalid after having been previously validated.
Note: During validation, if the check has already been approved, ClaimCenter does not require that the check be
re-approved.
Orphan Line Items

If the bulk invoice approver marks any line items Rejected or In Review, those line items do not participate in line
item validation. You can edit these items to remove these statuses until line item validation passes all the rest of the
line items and their checks are approved. The bulk invoice now receives Awaiting Submission status, and these line
items must now remain in the bulk invoice with their Rejected or In Review status. Their amounts do not become
part of the bulk invoice’s check.
For ClaimCenter to pay these amounts, you must either copy them to another bulk invoice, or write checks directly
from their claims. Alternatively, you can edit the bulk invoice. However, such an edit in most cases invalidates the
bulk invoice and moves it back to Draft status.
Bulk Invoice Checks

After ClaimCenter determines that the send date for the check associated with a bulk invoice has been reached, it
sends the check to an external check-writing system for issuance. You enter the values to be written on the check in
the Payment Instructions and Check Details sections of the Bulk Invoices→Bulk Invoice Details screen.

Note: You must write a message transport plugin implementation to listen for the BulkInvoiceStatusChange
event for ClaimCenter to be able to pass the check to an external system. See the Integration Guide for more
information.
Bulk Invoice Check Approval

Every check created by the bulk invoice must pass thorough the same approval process as all other checks. If it is
not possible to either create or approve a check, ClaimCenter cannot send the bulk invoice itself to the external
processing system. You must remove or edit the offending line item. If you edit the line item, ClaimCenter then
requires that it be re-approved.
Bulk Invoice Escalation Batch Processes

Escalating a bulk invoice is the last step in the creation and approval of a bulk invoice. It involves the following
batch processes:
Batch Process Description

Bulk Invoice Workflow The BulkInvoiceWF batch process transitions the bulk invoice to Awaiting Submission status after
Monitor its checks are approved. It can also transition the bulk invoice to Invalid Bulk Invoice Items status.
Which status a bulk invoice transitions to depends on whether all the pending-approval checks
were either approved or rejected.
Bulk Invoice Escalati After the bulk invoice reaches its Send date and is in Awaiting Submission status, the BulkInvoice
on sEscalation batch process gives the bulk invoice Requesting status. Integration code sends the
bulk invoice to the downstream accounting or check-writing system.
You can edit the bulk invoice until it receives Requesting status. Most edits that you make,
however, invalidate the bulk invoice and return it to Draft status.The only actions possible for the
bulk invoice after it has been escalated are:
• Stopping the bulk invoice
• Voiding the bulk invoice
• Placing the bulk invoice On Hold
The bulkinvoicesescalation batch process escalates the placeholder checks for the items,
causing the items to go to Submitting status. You can exclude an individual placeholder check from
this process by clearing its PendEScalationForBulk property. This exclusion causes ClaimCenter to
escalate the check as a standard check with the financialesc—Financials Escalation—batch
process.
See also
• For more information on these batch processes, see the System Administration Guide.
• For more information on bulk invoice processing, see “Bulk Invoice Process Flow” on page 392.
• For more information on creating or editing a bulk invoice, see “Using the Bulk Invoice Screens” on page 393.
Lifecycle of a Bulk Invoice and its Line Items

Each stage in the lifecycle of a bulk invoice has a specific status. The Bulk Invoice screen shows the status of each
bulk invoice. To update the ClaimCenter screen to reflect the latest status values, click Refresh.
Bulk Invoice Escalation Batch Processes 401

See also
• Individual line items also have their own, similar lifecycles and statuses. See “Lifecycle of Bulk Invoice Line
Items” on page 404 for details.
• Status changes cause events that you can use to trigger a custom rule or action. See “Bulk Invoice Events and
Acknowledgements” on page 406 for details.
Lifecycle of a Bulk Invoice

The lifecycle of a bulk invoice has the following general course:
• A user creates a bulk invoice. This process can take place over a period of time.
• The user clicks Update for the first time. This action saves the current bulk invoice information to the database,
complete or not. All bulk invoices at this point have a status of Draft.
• The user clicks Submit. ClaimCenter performs validation on the bulk invoice:
◦ If the bulk invoice passes validation, and it requires approval, ClaimCenter sends the bulk invoice to the
selected reviewer and changes the status to In Review. If approved, line item validation and processing starts
immediately. The status is Pending Bulk Invoice Item Validation.
◦ If the bulk invoice passes validation and it does not require approval, clicking Submit immediately starts line
item validation and processing. The status is Pending Bulk Invoice Item Validation.
• The BulkInvoiceSubmission distributed work queue processes each item by creating a placeholder check on the
item's associated claim. This check might require approval, like any other check. This approval is separate from
bulk invoice approval.
Note: If a bulk invoice gets stuck in Pending Bulk Invoice Item Validation status and all workers have finished,
an administrator must run the Bulk Invoice Submission batch process again. For more information, see the
System Administration Guide.
• If a line item fails its line item validation, or its check cannot be written or is rejected, ClaimCenter moves the
bulk invoice status to Invalid Bulk Invoice Items. At this point, it is possible to re-edit the line item to remove the
validation issue.
• After ClaimCenter validates all line items and the associated placeholder checks are approved, ClaimCenter
executes a batch process called Bulk Invoice Workflow Monitor (BulkInvoiceWF). This process transitions the
bulk invoice from Pending Bulk Invoice Item Validation status to either Awaiting Submission status or Invalid
Bulk Invoice Items status.
• If ClaimCenter moves the status to Awaiting Submission, the bulk invoice remains in that status until it reaches
its send date. At this point, any editing that you perform on the bulk invoice returns it back to Draft status.
• After the bulk invoice reaches its send date, ClaimCenter escalates the bulk invoice to Requesting status and
transmits it to an external check-writing system.
• After the external system acknowledges receipt of the request, ClaimCenter moves the bulk invoice to the
Requested status.
• After the external system produces the bulk check, it sends an Issued status, then a Cleared status back to
ClaimCenter.
• At any time after sending the bulk invoice to the external system, but before it reaches Cleared status, you can
attempt to stop or void its check. This attempt moves the bulk invoice status to either Pending Stop or Pending
Void. If the attempt to stop succeeds, the bulk invoice status then moves to Stopped. If the attempt to void
succeeds, the bulk invoice status then moves to Void.
• The external system can also attempt to stop a bulk invoice by giving it On Hold status.
Bulk Invoice Lifecycle Diagram

The following diagram illustrates the transitions from one bulk invoice status to another in the base configuration.

Note: Some statuses advance either by web service APIs or through the user interface, which the diagram does not
show explicitly. See the Integration Guide and the Integration Guide.
Bulk Invoice Statuses
item edit that

Null invalidates resubmit.
Invalid Bulk
(Start) the invoice Rejected no approval Invoice Items
now needed
first minor Line Item fails
edit,
update minor edit, no or its check
resubmit not
(save) edit, approval can’t be written
approved approval needed or is rejected
submitted for needed
approval Pending Bulk
Draft In Review approved Invoice Item
edit invalidates
Validation
submitted, no approval needed all Line Items validated,
Update (save) all checks written and
or validate approved
edit invalidates
escalation
sends to Awaiting
Requested Ext Requesting external Submission
system
try to try to
void/stop try again Note: “Ext” is a status change
void/stop
returned to ClaimCenter by the
external check writing system
On Hold Ext
try to
Ext
void/stop
Issued
void/stop
Pending Stop Voided fails
or Ext or Ext Ext
Pending Void Stopped void/stop
fails
Cleared
try to void (not stop) (End)
try to void/stop
Note: Dotted arrows indicate allowed Note: “Ext” is a status change returned to
digressions from a standard lifecycle. ClaimCenter by the external check writing system
The follow list describes each status:
Bulk invoice status Can delete Description

or edit
Awaiting submission yes Awaiting the date to be submitted to the downstream system.
Cleared no Downstream system notification that the bulk invoice check cleared.
Draft yes Bulk invoice is possibly committed to database, but is not yet ready for validation due to
one of the following:
• After being initially edited or re-edited after saving, or after being invalidated by edits
by the approver.
• After edits to correct line item validation errors, or after edits while awaiting
submission to the downstream system.
Lifecycle of a Bulk Invoice 403

Bulk invoice status Can delete Description

or edit
In review yes Submitted for approval and waiting for approval from the assigned approver.
Invalid bulk invoice yes At least one line Item failed processing, or its check could not be written or was rejected.
items
Issued no Downstream system notification that the bulk invoice check was issued.
null yes Creation started but never saved, meaning that the creator of the bulk invoice has never
used the Update button.
On hold no Downstream system found problems and notified ClaimCenter.
Pending bulk invoice no Approved, or not needing approval, ClaimCenter is currently processing—validating—all
item validation the line items.
Pending stop no The messaging plugin sent a message downstream to stop the bulk invoice. ClaimCenter
does not configure the message plugin in the base configuration. You must manually set
this up.
Pending void no The messaging plugin sends a message downstream to void the bulk invoice. ClaimCenter
does not configure the message plugin in the base configuration. You must manually set
this up.
Rejected yes Rejected by the assigned approver.
Requested no Downstream acknowledgement that bulk invoice was received.
Requesting no Queued for submission to the downstream system.
Stopped no Downstream system reported that the stop request succeeded.
Voided no Downstream system reported that the void request succeeded.
Lifecycle of Bulk Invoice Line Items

The following diagram illustrates the transitions from one line item status to another in the base configuration.

Statuses of Bulk Invoice Items

Line Item Validation
Null Not fails, or item’s check
(start) Valid can’t be written
or is not approved
first item edited,

save Update invalidating invoice
(save)
item approved, or
approval unneeded Item create requires Check
Draft (Draft) approval
item edited, now invoice Approved check Pending Approval
needs re-approval
create
check
invoice Invoice check
InReview, or item not approved
item marked approved automatic
for review approval
item edited,
edit of item
invalidating invoice Awaiting
invalidating
invoice Submission
Note: “Ext” is a status change

returned to ClaimCenter by the
external check writing system
In Review Rejected Submitted Ext Submitting
(Requested) (Requesting)
Note: Dotted arrows indicate
allowed digressions from a standard
try to try to lifecycle
try to void/stop void/stop
move try to
Item move
to Pending Stop Item
another
or to
claim Pending Void another
Ext; claim
void/stop Ext; void/ stop received
failed
Voided
or
Stopped
Pending
Transferred Ext; item Transfer
moved
The follow list describes each status of a bulk invoice line item:
Line item status Invoice status Can delete Comment

or edit
Awaiting awaitingsubmission yes Bulk invoice item and its check have passed approval and are
submission ready to be escalated, after the bulk invoice is ready to be
escalated
Check pending pendingitemvalidation yes Bulk invoice item has passed the bulk invoice approval process
approval and is waiting for its check to be approved
Draft draft yes Being initially edited, or reedited after being invalidated by edits
after line item validation rejects it or another line item
In review any yes Approver gives Item this status. It will not be processed further
unless reedited. See “Orphan Line Items” on page 400.
Item approved any yes Passed bulk invoice approval and passed line item validation.
Not valid any no Failed line item validation processing.
Null null yes Bulk invoice created but never saved—Update button not clicked.
Pending stop pendingstop no Message sent downstream to stop the invoice.
Pending transfer requested or later no Notify downstream system to transfer Item to another claim.
Lifecycle of a Bulk Invoice and its Line Items 405

Line item status Invoice status Can delete Comment

or edit
Pending void pendingvoid no Message sent downstream to void the invoice.
Rejected any yes Same as in review.
Stopped stopped no Downstream acknowledgement that stop request received.
Submitted requested no Downstream acknowledgement that submission received.
Submitting requested no Submitted (sent) to the downstream system.
Transferred requested or later no Downstream acknowledgement that transfer request received.
Voided voided no Downstream acknowledgement that void request received.
Bulk Invoice Events and Acknowledgements

ClaimCenter generates a specialized BulkInvoiceStatusChanged event every time it updates the bulk invoice
status, as well as when it first creates the bulk invoice. In addition to the BulkInvoiceStatusChanged event,
ClaimCenter generates the following events as well:
• BulkInvoiceAdded
• BulkInvoiceUpdated
• BulkInvoiceRemoved
These events are similar to the events that ClaimCenter generates for all financial transactions and checks.
IMPORTANT You must implement a version of the message transport plugin that can listen for the
BulkInvoiceStatusChanged event. This message transport plugin implementation is necessary for ClaimCenter to
be able to pass the check to an external system. See the Integration Guide for more information.
Bulk Invoices and Multicurrency

A bulk invoice uses a single currency. That currency becomes the transaction currency for each of its invoice items’
checks. The transaction currency does not have to be the same as the default application currency. Whatever
currency you choose, the entire bulk invoice and its associated checks use this currency, as do all the line items
associated with the bulk invoice.
The bulk invoice also has an exchange rate from its transaction currency to the reporting currency. It is possible to
attach the items for a bulk invoice to different claims, with different currencies.
It is also possible for the currency that a claim uses to differ from the default application currency and from the
currency of the bulk invoice. This means that the bulk invoice transaction-to-reporting exchange rate cannot be used
directly as the transaction-to-claim and claim-to-reporting exchange rates on the check.
ClaimCenter selects the two exchange rates for each check according to the following table:
Currencies: Transaction/BI, Claim, Transaction-to-Claim Exchange Rate Claim-to-Reporting

and Reporting Exchange Rate
All currencies are the same. Market identity rate. This is defined as a market exchange null
rate in which the base currency equals the price currency
and the numerical value is 1.
The reporting currency is different. Market identity rate. The bulk invoice’s
transaction-to-reporting
rate

Currencies: Transaction/BI, Claim, Transaction-to-Claim Exchange Rate Claim-to-Reporting

and Reporting Exchange Rate
The claim currency is different. ClaimCenter uses market rates and does not prompt you for ClaimCenter uses market
an exchange rate. rates
The Transaction/BI currency is The bulk invoice’s transaction-to-reporting exchange rate. null
different
All are different, automatic Market rate. Market rate
All are different, manual Custom rate created by dividing the bulk invoice’s Market rate
transaction-to-reporting rate by the claim-to-reporting rate.
After you select market rates, including identity rates, the following occurs.
• If the bulk invoice transaction-to-default rate is a market rate, it is possible to select it from that rate's market rate
set.
• If the bulk invoice uses a custom rate, it is possible to select it from a market rate set with a date near that of the
custom rate's effective date.
After ClaimCenter updates the checks, it repeats this process and recalculates the exchange rates and amounts.
Exchange Rate Adjustment of a Bulk Invoice

You can apply foreign exchange adjustment to the placeholder checks of a bulk invoice (the checks created for each
item), but not to the bulk invoice itself.
Bulk Invoice Financial Permissions and Authority Limits

This topic lists all the security aspects of bulk invoice transactions.
User Permissions
The following user permissions pertain to bulk invoices:
• bulkinvview – View bulk invoice
• bulkinvcreate – Create bulk invoice
• bulkinvedit – Edit bulk invoice
• bulkinvdelete – Delete bulk invoice
In the base configuration, the following roles have all the previously listed user permissions:
• Adjuster
• Claims Supervisor
• Clerical
• Customer Service Representative
• Manager
• New Loss Processing Supervisor
• Superuser
Bulk Invoice Financial Permissions and Authority Limits 407

Authority Limits
Bulk invoices have no special authority limits, but all transaction authority limits apply. These limits set the
following:
• The maximum for the claim and exposure total and available reserves
• The maximum for any single payment
• The maximum for a change in reserves amount
• The maximum for a payment that exceeds reserves
The CheckAuthorityLimits configuration parameter in the config.xml file controls whether ClaimCenter checks
authority limits for individual checks. The default value is true.
For more information on authority limits, see “Managing Authority Limit Profiles” on page 519.
Bulk invoice checks are subject to the same rules that apply to standard ClaimCenter checks. If you configure
ClaimCenter to not allow payments to exceed reserves, this setting also affects bulk invoices. In this case, be sure
that reserves are set high enough before creating the checks of a bulk invoice, or set configuration parameter
AllowPaymentsExceedReservesLimits in the config.xml file to true.
Bulk Invoice Web Service API

ClaimCenter includes a web service called BulkInvoiceAPI that enables an integrated system to submit and
manipulate bulk invoices directly from the external system. For example, it is possible for an associated rental car
company to directly submit bulk invoices to ClaimCenter from its systems by using this web service. In addition,
BulkInvoiceAPI methods can create and submit bulk invoices, as well as add, update, and delete bulk invoice
items.
See also
• See the Integration Guide for more information on the BulkInvoiceAPI web service methods.
Bulk Invoice Data Model

The data model uses the following entities to support bulk invoices.
Entity Description
BulkInvoice The top level BulkInvoice entity. It corresponds to the incoming invoice or bill to be paid. It has a
unique ID that can correspond to the invoice, some data fields, such as payee and a scheduled send
date, and a non-null array of BulkInvoiceItem objects.
BulkInvoiceItem Describes one line of the BulkInvoice. It corresponds to one line item of the original invoice. It contains
data fields describing the reserve line of the claim to which the item is to be charged, the amount, and
the payment type. It is associated with a single claim.
BIVvalidationAle Encapsulates one alert generated by a bulk invoice validation. Your implementation of the IBulkInvoice
rt ValidationPlugin plugin interface must return an array of these objects, or null if the validation is
successful. Each alert consists of a message and an alert type taken from the BIValidationAlertType
typelist.
See “Bulk Invoice Validation” on page 398 for more information on generating validation alerts.
ReserveLineWrapp Provides a level of indirection between a BulkInvoiceItem and its ReserveLine. This extra level is
er necessary if you create a BulkInvoiceItem for a non-existent reserve line, which prevents ClaimCenter
from committing the BulkInvoiceItem to the database.
The BulkInvoiceItem has a non-null foreign key to ReserveLineWrapper. There is a second foreign key
from the wrapper to the actual reserve line that is null if the reserve line does not yet exist.
ClaimCenter displays the wrapper’s reserve line, so you never see this.

The bulk invoice feature uses the following typelists.
Typelist Description
BulkInvoiceStatus The status of the bulk invoice. Its typecodes control which actions are possible for the invoice, such
as edit, submit, void, and so on.
BulkInvoiceItemStatus The status of a single BulkInvoiceItem. As with the BulkInvoiceStatus, this status controls which
actions are possible for a given invoice item.
BIValidationAlertType The alert type for an alert returned from the IBulkInvoiceValidationPlugin. In the base
configuration, this typelist has only the following typecodes:
• itemwitharchivedclaim
• unspecified
You can extend this list with alert types specific to the tests that you execute in your validation
plugin implementation.
The bulk invoice feature uses the following configuration parameters. See the Configuration Guide for details.
Configuration parameter Description

AllowPaymentsExceedReservesLimits If true, a user can submit payments that exceed available reserves up to the
amount limited by the paymentsexceedreserves authority limits. See the
BulkInvoiceApprovalPattern Name of the activity pattern to use if creating bulk invoice approval activities.
See the Configuration Guide.
BulkInvoiceItemValidationFailedPattern Name of the activity pattern to use in creating an activity to alert of a failure
during processing of a bulk invoice item. See the Configuration Guide.
BulkInvoiceUnableToStopPattern Name of the activity pattern to use if creating an activity to alert that
ClaimCenter was unable to stop a bulk invoice. See the Configuration Guide.
BulkInvoiceUnableToVoidPattern Name of the activity pattern to use in creating an activity to alert that
ClaimCenter was unable to void a bulk invoice. See the Configuration Guide.
MaxBulkInvoiceSearchResults Maximum number of bulk invoices that ClaimCenter returns in a search. See
Bulk Invoice Data Model 409


part 7
ClaimCenter Services
chapter 38
Services
The Services feature in ClaimCenter provides the adjuster with tools to create, track, and manage requests for
services to be provided by vendors. ClaimCenter works in conjunction with a contact management system such as
Guidewire ContactManager and optionally, a vendor portal, to streamline the communication between adjusters and
specialists offering services. Using this feature, you can identify the right vendors, create service requests, follow up
on the progress of the work, make payments, and track vendor performance.
Overview of Services
A service can be defined as any action that can be requested from a third-party vendor or internal provider. Some
examples are requesting a rental or courtesy vehicle, inspection and repair of damaged equipment, or commissioning
construction services. The services feature provides adjusters with the ability to send service requests to vendors
outside ClaimCenter and follow up on their progress. ClaimCenter uses a contact management system, such as
ContactManager, to access and select vendors capable of providing specific services and a vendor portal to facilitate
communication with vendors.
Note: In this topic and included examples, Guidewire ContactManager is the default contact management system,
and the Guidewire Vendor Portal is the default vendor communication portal. If you use components other than
these Guidewire components to manage contacts and vendors, ensure they are integrated appropriately with
Guidewire ClaimCenter before proceeding with adding and managing services.
You can create a service request in ClaimCenter in two ways—during claim creation in the New Claim wizard or at
any time by using the Actions menu. This topic covers the creation of service requests in the Actions menu. See “New
Claim Wizard Steps” on page 88 for more on adding services in the New Claim wizard.
After a service request is created, its status can be monitored and updated in both ClaimCenter and the integrated
Vendor Portal. You can add one or more quote and invoice documents to the service request and send messages to
the vendor. When work is complete, you can proceed from the service request to the payment process using the
built-in payment wizard.
You can also associate notes and activities with the service request, and ClaimCenter can be configured to notify
adjusters with a generated activity when a service request fulfills a condition. For example, the adjuster is notified
when a service request is declined.
Services 413
Setting Up Services
A basic set of services is provided in XML file format with sample data. You can customize services to match your
business requirements and import them into ClaimCenter and ContactManager. This approach is recommended.
Note: Once service data is imported, you cannot edit it or manage its synchronization with ContactManager in the
application user interface. You can make changes only by editing the corresponding XML file and importing it
back into the applications. Review your XML data files carefully before finalizing them for import into
ClaimCenter and ContactManager.
The services directory displays in a tree format when you add a service to a claim. At the topmost level of the tree,
the folder nodes represent service categories. Under these nodes, you can define service subcategories or service
types. The leaf nodes of the tree represent the specialized services grouped under each category.
In the services XML files, you can configure associated service request types—incident types—as well as the
categories, subcategories, and service types of the vendor service tree.
See also
Service Request Types

A service request can have various lifecycles, based on its request type. After you select the request type, the service
request goes through various predefined stages, which are indicated in the ClaimCenter user interface by status and
action update messages.
Service requests in ClaimCenter are classified into four types:
• Quote
• Quote and Perform Service
• Perform Service
• Unmanaged
Quote
Use the Quote request type if you require only a quote from vendors. You would use this option, for example, to
compare vendor quotes before making a final selection.
You can promote a quote-only service request to a quote-and-perform-service request by using the
RequestServicefromQuote menu option.
Quote and Perform Service

Use the QuoteandPerformService request type if you require the complete service request lifecycle—obtaining quotes,
requesting service, and making payments.
Perform Service
Use the PerformService request type if you require only a service, such as requesting a courtesy or rental car. You can
then proceed to make a payment, if necessary, after the service is complete.
Unmanaged
The Unmanaged request type is a specialized type used only for services created from the Auto First and Final wizard.
This request type is not available for other claims.
414 chapter 38 Services

See also
• “Lifecycle of a Service Request” on page 424
• “Promote Service Requests” on page 418
Creating a Service Request

In ClaimCenter, you can create a new service request either by using the Actions menu or in the New Claim wizard.
Create a New Service Request in the Actions Menu

Procedure
1. Navigate to Actions→New...Service.
ClaimCenter displays the CreateService Request screen, where you enter relevant information to be
communicated to the vendor on the specified services.
2. Enter the following information:
• Relates To – Specify if the service is requested for the entire claim or for a specific incident.
• Services to Perform – Add the services you would like the vendor to perform.
3. Click Add to view the services directory in the Select Services to Add screen.
The selected services are shown by category, subcategory, and service type.
4. Search for specific services in the directory by entering text in the text field and selecting Filter. Reset your
selections to start over.
The Filter option can perform partial name searches as well.
5. Select one or more related services, and then click Add again.
You can add one or more related services to one service request, and you can specify this in the Services data
files. If you attempt to add services that cannot be combined in the same service request, ClaimCenter displays
an error message. Request these services in separate service requests.
For example, in the base configuration, you cannot add a request for a car rental along with a request to repair
furniture.
6. Enter the following information for the service request:
• RequestType – Select the type of the service request. You can choose from Perform Service, Quote, and Quote
and Perform Service, depending on whether you are requesting only a quote, only a service, or both.
ClaimCenter only displays the request types associated with the services selected in the previous step. This
is configurable as well.
• Name – Select a vendor. You can create a new vendor contact, select an existing vendor on the claim, or you
can search and retrieve information for a vendor from ContactManager. If you choose the latter, the Search
Address Book For Vendors screen now displays with the selected services and an option of finding only
vendors offering these services.
• Additional Instructions – Enter any additional instructions you have for the vendor regarding this service. This
field is optional.
• Requested Quote/Service Completion Date – Enter the desired date of quote or service completion for the vendor.
The initial value is set to a week from the current date.
• Customer Contact – Add a customer contact for the service request. You can create a new contact, select an
existing contact on the claim, or you can search and retrieve information for an existing contact from
ContactManager.
• Service Address – Enter the address at which the service is to take place.
Creating a Service Request 415

7. If your service request is complete, click Submit. Alternately, you can choose to simply Save it in draft form
and return to complete it later.
The service request displays in the Services screen, associated with the claim, assigned a service number, and
sent to the selected vendor for processing. The vendor is notified through the Vendor Portal, and as the vendor
responds, you can manage and monitor the status and progress of the service request in ClaimCenter.
Creating Services Requests in the New Claim Wizard

You can create a service request during claim creation in the New Claim Wizard. The Services menu is included in Step
4 of the wizard for configured policy types. See “New Claim Wizard Steps” on page 88 for more information.
Viewing Service Requests

After a service request is added to a claim or incident, it is assigned a service number, and you can view details and
associated components in the main Services screen.
The Services screen provides a list of services and a detail view showing details on the currently selected service.
Services List
The Services screen displays all service requests associated with a claim, organized by Request Type, Status, and
service number (Service #).
The following icons indicate the service request type:
Icon Service Request Type

Perform Service
Quote
Quote and Perform Service
The following icons indicate the status of a service request:
Icon Service Request Status

Draft, Declined, Canceled, or Expired
These are Progress status messages.
Requested
Quoted
Completed
Alert. The service request needs your attention.

This icon can be used in conjunction with the other icons.
Each service request also displays the NextAction to be taken, the responsible ActionOwner, and whether the service
request relates to a claim or an incident. Vendor and service request details and quote amounts, if any, are also
shown. The Target column displays the estimated date for the Next Action to be completed.
Select a service to view details and associated components of the service request, which are described next.

Detail View of a Service

In ClaimCenter, a service request goes through a sequence of stages in its path to completion. You can view and edit
the status of a service request in the Details card, which includes the following:
• Service Number – Unique number generated by ClaimCenter and assigned to the service request. Like the claim
number, you can configure how this is generated, but it needs to be a globally-unique string. Refer to the
ClaimCenter Configuration Guide for more information.
• Reference Number – Number assigned by the vendor in the Vendor Portal.
• Progress – The status of the service request. See “Lifecycle of a Service Request” on page 424 for more
information on the possible values of the Progress status.
• Quote Status – The status of any attached quotes. See “Lifecycle of a Service Request” on page 424 for more
information on the possible values of the Quote Status.
• Next Action – The next step to be taken to complete the service request. This step is dependent on the Progress and
Quote Status fields.
• Action Owner – The party responsible for taking the next step, usually the adjuster or the vendor.
• Relates To – Specifies if the service request is associated with the entire claim or with a specific incident.
• Requested Quote/Service Completion Date – Requested date of completion.
• Expected Quote/Service Completion Date – Expected date of completion. The initial value of this date is the requested
date. It is updated, if necessary, by the vendor.
• Currency – Currency for the service request and associated invoices.
The Vendor section lists the contact information for the vendor performing the service and the communication
method used by ClaimCenter to connect to vendors. In the Services to Perform section, the category, subcategory, and
type of service are shown, along with the request type.
Customer and service contact information is also shown in this card.
Quotes
The Latest Quote/Prior Quote section displays details of the most recent quote attached to the service request. You can
view or edit the quote. You can also request a requote, revise the quote amount, or approve the quote in this section.
The Quote Documents table enables you to view and edit the quote document. See “Editing a Quote Document for a
Service Request” on page 421 for more information.
Invoices
The Invoices section displays the invoices attached to the service request. You can add another invoice or view the
existing invoices in the Invoices card.
See “Approve a Service Request Quote Invoice” on page 422 for more information on adding and approving
invoices.
Metrics
The Metrics section provides information on various metrics measured during the progress of this service request,
such as Quote Timeliness and Number of Delays.
See “Service Request Metrics” on page 425 for more information on service request metrics.
History Card for a Service

The History card displays a record of all changes made to the service request, including actions originating from the
vendor portal. Links to attached documents, if any, are also shown.
Viewing Service Requests 417

Activities Card for a Service

The Activities card lists activities, if any, generated by the service request. For example, when a vendor adds a quote,
ClaimCenter creates an activity to notify you that it needs to be reviewed.
Like the Workplan menu link, you can view, assign, skip, complete, approve, or reject activities. See “Activities” on
page 36.
Documents Card for a Service

In the Documents card, you can add and view documents, including quotes and invoices, associated with the service
request. Documents can be attachments to files in your system or links to other documents in ClaimCenter.
Note: You need appropriate permissions to access documents with special confidentiality and security levels.
See also
• “View Documents for a Service Request” on page 590
• “Link a Document to a Service Request” on page 598
• “Document Security” on page 602
Notes Card for a Service

In the Notes card, you can create, edit, and view notes associated with a selected service request.
Note: You need appropriate permissions to access notes with special confidentiality and security levels.
See also
• “Note Security” on page 267
Invoices Card for a Service

In the Invoices card, you can create, edit, and view invoices for the selected service request.
Messages Card for a Service

In the Messages card, you can create and send messages to vendors using the Vendor Portal. Messages can be in the
form of questions or requests for information.
When questions are received, ClaimCenter generates an activity to notify the adjuster that a response is required.
The following icons are used to indicate the type of service request messages:
Icon Service Request Message Type

Inbound Message
Outbound Message
Promote Service Requests

About this task
You can promote a Quote request type to a Quote and Perform Service request type after it is complete and a quote
has been enclosed.
Procedure
1. Open the claim and click Services in the sidebar.

2. Select a service request in the list of service requests.

3. Click Request Service from Quote.
4. In the Request Services from Quote screen, enter the required information, including the service completion date.
5. Add additional services, if necessary.
6. Click Update.
The Request Type is now updated to Quote and Perform Service, and you can proceed to edit and complete the
service request type accordingly.
Canceling or Declining Service Requests

A service request can be canceled or declined both in ClaimCenter and in the Vendor Portal.
Note: After a service request is canceled, its status cannot be reverted.
Cancel a Service Request in ClaimCenter

Procedure
3. Click Cancel Service.
4. Enter the reason for canceling the service request, and click Cancel Service.
The Progress status of the service request is now Canceled. If the request for cancellation comes from the
Vendor Portal, the status is updated to Canceled automatically.
Record a Service Request as Declined in ClaimCenter

About this task
You can decline a service request. After declining a service request, you cannot revert its status.
Procedure
3. Click Record Vendor Progress and then, click Vendor Declined.
4. In the Vendor Declined Work screen, enter the reason for canceling the service request, and click Update.
The Progress status of the service request is now Declined. If the request for declining the service request comes
from the Vendor Portal, the status is updated to Declined automatically.
Assign a Service Request

About this task
In ClaimCenter, assignable entities such as claims, exposures, and service requests can be assigned to a user. In the
base configuration, global and default assignment rules assign service requests to the claim owner. You can
configure these rules as needed.
See also “How ClaimCenter Assigns Work” on page 205.
Canceling or Declining Service Requests 419

Procedure
2. Select the service request in the list of service requests.
3. Click Assign.
4. Assign the service request by using one of the following options:
• Assign the service request to the claim or exposure owner, or to another user, or by using automatic
assignment.
• Assign the service request by using a picker. The picker helps you find a user by name, group name, or
proximity to a location.
Service Request Documents

Documents can be attached to a service request by the vendor or adjuster. A service request can be associated with
the following types of documents:
• Quote – A document from one or more vendors with an estimated payment amount for the service to be
performed.
• Invoice – A document from the selected vendor with the actual payment amount requested for the service
performed.
• Document (other) – Other documents, such as photographs, that the adjuster or vendor needs to share.
Add a Quote Document to a Service Request

About this task
When you receive a quote from a vendor, you can add it, along with accompanying documents, to a service request.
You can add quotes only to service requests that have none.
Quote documents can be added to the service request in two ways:
• By the vendor in the Vendor Portal – In this case, the quote documentation is attached to the response from the
Vendor Portal, and ClaimCenter automatically associates it with the service request. In the process, the quote
document is assigned a file name, and ClaimCenter also generates an activity to review the quote.
• By the claims adjuster in ClaimCenter – This process is described in this topic.
Procedure
1. In the Services screen, click the Details card and click Add Quote.
2. Enter a Reference Number, if necessary.
3. Enter the Total Amount included in the quote.
The currency for this field defaults to the claim currency.
4. Enter the number of days estimated in the quote to complete the service.
5. Enter a description.
6. Click Attach.
7. In the Attach Document screen, browse for and select a document.
You can attach multiple documents by using the Attach Document screen.
8. Enter document status and type, and click OK.
9. Click Update.
The document is now attached to your service request.

Next steps
See also
• “Working with Claim Documents” on page 589
Editing a Quote Document for a Service Request

You can edit a quote document in two ways:
• “Request Another Quote from the Vendor” on page 421
• “Revise an Existing Service Request Quote” on page 421
Request Another Quote from the Vendor
Procedure
1. In the Services screen, click the Details card, and then click Request Requote.
2. In the Request Requote screen, enter a reason for the request.
3. Enter a requested quote completion date, if different from the current one.
4. Click Update.
The vendor is now notified through the vendor portal that this quote needs revision.
Revise an Existing Service Request Quote
Procedure
1. In the Services screen, click the Details card and click Revise Quote.
2. In the Revise Quote screen, enter the following information.
a. A reference number, if necessary.
b. A new quote amount.
c. Requested number of days to complete the service.
d. An updated description, if necessary.
3. Click Link or Attach to add a new quote document, if there is one.
4. Click Update.
The quote is now updated in ClaimCenter.
Add an Invoice to a Service Request Quote

About this task
When you receive a quote from a vendor, you can add it, along with accompanying documents, to a service request.
Procedure
1. In the Services screen, click Add Invoice.
2. Enter a reference number.
3. Enter the total amount included in the quote.
The currency for this field defaults to the claim currency.
4. Enter the number of days estimated in the quote to complete the service.
Service Request Documents 421

Approve a Service Request Quote Invoice

About this task
After an invoice has been added to a service request, you can approve it.
Note: You can also set up invoices to be automatically approved and paid. See “Straight-through Invoice
Processing (STIP)” on page 423.
Procedure
1. Select the service request in the list of service requests, and then click ApproveInvoice in the same row.
The Invoices card opens.
2. Click Approve.
The invoice is now approved.
3. Click Pay to proceed to the services payment wizard.
Make Payments
About this task
When an invoice is approved, you can proceed directly from the service request to a customized payment wizard,
where relevant information from the service request is already recorded for you.
Alternatively, invoices that meet a set of predefined criteria can be automatically paid.
IMPORTANT Service request invoices do not support recurring or grouped (multi-payee) checks. Configuration to
enable this behavior is not recommended.
To make a payment
Procedure
1. Select the service request.
2. In the detail view, click the Invoices card.
3. Click Pay.
Step 1, Enter payee information, of the payment wizard, opens.
4. Edit the payee and recipient details, if needed in the following information preselected from the service
request:
• Payee name and type
• Recipient name and mailing address
• Service number
• Invoice reference number, if any.
• Invoice amount
5. Click Next.
Step 2, Enter payment information, opens.
6. Enter payment details.
The currency of the check must match the currency of the service request associated with the invoice.
7. Click Next.
Step 3, Set check instructions, opens.

8. Edit instruction details and add or remove documents, if necessary.

9. Click Finish to create your check.
Next steps
See also
• “Straight-through Invoice Processing (STIP)” on page 423
• “Checks” on page 338
Straight-through Invoice Processing (STIP)

ClaimCenter can be configured to automatically approve and pay invoices that meet a certain predefined set of
criteria, also known as Straight-through Invoice Processing (STIP). Some examples of STIP are:
• Automatic approval of invoices that are at or below a predefined monetary amount.
• Automatic payment to established vendors who have a long-standing relationship with an insurance company.
STIP payments can be made at the claim or exposure level. When invoices meet predefined criteria for approval or
payment, their progress through ClaimCenter is accelerated. For example, when an invoice is processed and
qualifies for automatic payment, the payment is completed without any user action required.
Invoice Auto-Approval Criteria

ClaimCenter includes a set of conditions for automatic approval of invoices in the base configuration. All the
conditions are checked, regardless of success or failure, and failure reasons are summarized on the invoice.
An invoice will not be automatically approved if one or more of the following conditions is true:
• If the associated claim is closed
• If the associated claim is under investigation
• If the associated claim is under a financial hold
• If the most recent quote on the service request the invoice is associated with is still waiting for approval
• If another invoice associated with the service request is still waiting for user approval
• If the specified amount on the invoice exceeds the amount on the quote
• If the specified amount on the invoice either exceeds a predefined small amount threshold for that currency or no
such threshold has been defined
Invoice Auto-Payment Criteria

ClaimCenter includes a set of conditions for automatic payment of invoices in the base configuration. All the
conditions are checked, regardless of success or failure, and failure reasons are summarized on the invoice.
An invoice will not be automatically paid if one or more of the following conditions is true:
• If the associated claim is not at ability to pay
• If the associated exposure is not at ability to pay
• If the invoice has ever previously been marked as unpaid
• If the associated incident has no exposures, or if an exposure could not be determined
• If a suitable reserve line could not be determined
• If the invoice amount exceeds the available reserves
• If the payee, typically the vendor, does not have a primary address
• If the invoice payment amount is negative
Straight-through Invoice Processing (STIP) 423

• If the compensability for this payment has not been determined. This condition only applies to workers
compensation claims
• If the associated claim is under a financial hold
See also
• “Selecting Reserve Lines for STIP” on page 424
Selecting Reserve Lines for STIP

When a service request invoice qualifies for automatic payment processing, the invoice amount is deducted from the
appropriate reserve line.
A reserve line is identified by STIP by using the following criteria:
• If the service request is associated with an exposure, the exposure’s reserve line is used.
• If the service request is associated with an incident, the incident’s reserve line is used.
• If the service request is associated with a claim, the claim’s reserve line is used.
If no reserve line is identified, the invoice cannot be automatically paid.
See also
Lifecycle of a Service Request

A service request is defined by its Progress status and Quote Status.
• Progress status – Indicates the state of the work done by the vendor for the service request.
• Quote Status – Describes the state of quotes, if any, linked to the service request.
An adjuster can manage the status of a service request entirely in ClaimCenter, or in ClaimCenter and a third-party
vendor portal, such as the Guidewire Vendor Portal. When a portal is used, the state of a service request is controlled
by the adjuster in ClaimCenter and by the vendor in the Vendor Portal. ClaimCenter manages the flow of
information between the two efficiently so that adjusters and vendors can monitor and update service requests
seamlessly.
You can configure how ClaimCenter transitions through the states of the three service request types.
See also
• “Service Request Types” on page 414
Example: Request Quotes for a Carpentry Service (Quote)

Before you begin
This example requires service information loaded into ClaimCenter as part of sample data.
About this task

You can request a vendor to provide only a quote for a selected service. The example in this topic illustrates the
stages of a quote-only service request.
Procedure
1. Navigate to Actions→New...Service.
2. In the Create Service Requests screen, enter the following information.
See “Creating a Service Request” on page 415 for more information on these fields.

a. Relates To – Select Claim.

b. Services to Perform – Click Add and select one or more services. For this example, select
Property→Construction services→Carpentry from the services directory. Click Add again.
c. Request Type – Select Quote.
d. Vendor Name – Select a vendor specializing in the requested service.
e. Additional Instructions – Enter special instructions, if any, for the vendor.
f. Requested Quote Completion Date – Select a date.
g. Customer Contact – Select the primary customer contact.
h. Service Address – Select the address for the service.
3. Click Save.
The service request is assigned a Service Number and saved in ClaimCenter, but it is not sent to the vendor
yet. The Progress Status is set to Draft, and the Quote Status is set to No Quote.
The Next Action is set to Submit request.
4. In the Services screen, where the service request is now shown, click Submit.
ClaimCenter sends the service request to the vendor through the Guidewire Vendor Portal. The Next Action is
set to Agree to provide quote.
5. The selected vendor responds to the service request in the vendor portal, which has instructions on how to
proceed with the next step.
6. After the vendor responds, ClaimCenter automatically updates the status of the service request accordingly.
For example, if the vendor responds by adding a quote, you are notified that a quote document is now
available for perusal and approval.
The following updates are made in ClaimCenter:
• Progress – Work Complete
• Quote Status – Quoted
• Next Action – None - quote submitted
7. You can view the quote and associated documents, if any.
Service Request Metrics

Adjusters can manage multiple service requests at any given time, and it might be useful to monitor these service
requests and focus on those that are delayed or problematic. ClaimCenter provides metrics—data embedded in the
Services feature that can provide a quick snapshot of the performance of service requests and vendors, especially in
comparison with company benchmarks.
Service request metrics automatically track the status and timeliness of each service request and show how a service
request performs against predefined target values. Using this information, you can identify crucial pieces of
information such as high-performing vendors and service requests that have been delayed past the target number of
days.
These configurable metrics enable you to:
• See information in a single consolidated view.
• Set targets.
• Identify vendors who are high or low performers.
• Adjust metrics over time to improve the service experience.
Service Request Metrics 425

Service Metrics Fields

If you open a claim and click Services, you can view the Metrics section in the lower, right portion of the main Services
screen.
In the base configuration, the following metrics are included:
• Response Time
• Quote Timeliness
• Service Timeliness
• Invoice Variance vs. Quote
• Number of Delays
• Cycle Time
These metrics are tracked at the service request level, that is, each service request is tracked individually. You can
compare a service request’s metrics to company-specific targets and gauge how well or poorly a vendor is
performing.
All the metrics, except Invoice Variance vs. Quote, are time-based. Over a period of time, you can review this data and
take appropriate action to improve customer satisfaction and reduce service request-related delays and expenses.
As with Claim Health Metrics, you can change the values that are measured and set new targets for them as well.
Service Metrics Calculations

In the Metrics table, the following columns are used for calculations:
• Value – The calculated value of this metric for the service request.
• Target/Service Level – The defined target value set for this metric, which is configurable.
• Status – The visual representation of how the service request performs against the target value.
Statuses include:
◦ Green circle with check mark, meaning on target
◦ Yellow circle with exclamation point, meaning at risk
◦ Red circle with X, meaning requires attention
◦ Gray circle, meaning not applicable or not set by the administrator
The following table describes how ClaimCenter calculates metrics for Services.
Metric Calculation Target

Response Time Time elapsed between submitting a service request to a vendor Defined in SampleMetricLimits.gs
and receiving a response.
Quote Timeliness Time elapsed between the Requested Quote Completion Date and the Defined in SampleMetricLimits.gs
actual quote Completion Date.
Service Timeliness Time elapsed between Requested Service Completion Date and the Defined in SampleMetricLimits.gs
actual Completion Date.
Invoice Variance vs. Value calculated as Total invoice-Latest quote/Latest quote. Defined in SampleMetricLimits.gs
Quote
Number of Delays Number of Expected Quote/Service Completion Date values that Defined in SampleMetricLimits.gs
needed to be updated.
Cycle Time Time elapsed between submitting a service request and Defined in SampleMetricLimits.gs
completing work (Completion Date).

See also
• For information on using Guidewire Studio to configure service request metrics, see the Configuration Guide.
Configuring Service Requests

ClaimCenter includes a configurable state handler for each of the service request types that defines the stages in
their progress to completion.
See also
Configuring Service Requests 427


part 8
ClaimCenter Management
chapter 39
Claim Performance Monitoring
Adjusters can have several hundred open claims at any given time, and their supervisors might manage an average
of twelve adjusters. Supervisors are therefore responsible for a book of claims that can number in the thousands, and
monitoring this many claims can be a problem. ClaimCenter provides Claim Performance Monitoring tools to help
supervisors and adjusters focus on claims that might be problematic and diagnose a claim’s status.
The Claim Performance Monitoring tools monitor the health of each claim and automatically track the status and
health metrics for each claim. Using this information, adjusters and supervisors can diagnose the health of the claim
file and can identify claims that need immediate or additional attention. This attention to the claim process enables
you to measure, track, and understand the metrics that strongly influence the customer experience, such as time to
first contact or first payment.
Claim Performance Monitoring tools include:
• Claim Health Metrics – Embedded in every claim to provide data, or metrics. You can see the overall health of
a claim and to compare it to your company’s specific benchmarks.
• Claim Reports – Aggregate important claim information and show the status of claims for groups and
organizations. Managers and supervisors can take appropriate action based on the information contained in the
reports.
• Claim Headline – The top section of the claim Summary screen, the claim headline presents a view of the most
important aspects of a claim.
• High-Risk Indicators – Visible in the claim Summary screen and persistent on the claim Info bar, high-risk
indicators provide a risk assessment of the claim. They are also available on the claim startup page.
You can use the metrics, coupled with high-risk indicators, icons, and flags, to understand certain aspects of a claim
quickly and possibly take immediate action.
The benefits of these configurable metrics include:
• Providing information, in a single consolidated view
• Setting thresholds
• Adjusting metrics over time to improve the customer service experience
Claim Performance Monitoring 431

See also
• For examples of how to configure metrics, the Configuration Guide.
• For information on ClaimCenter reports that use metric data, see the InfoCenter Reports Guide in the Guidewire
InfoCenter distribution.
Claim Health Metrics

The Claim Health Metrics screen shows how a claim and its exposures perform against target values for the insurer
defined metrics. It provides a fast way for you to quickly understand the claim’s health. You can then compare the
claim’s health to a defined target. By using this screen, you can determine information like:
• Why it has been so long since an adjuster reviewed this claim.
• Why the current reserve is so much higher than the initial reserve.
• Why the expense to loss cost ratio is so high.
In the base configuration, ClaimCenter provides a set of claim health metrics. These metrics include Days Open,
Initial Contact with Insured (Days), Number of Reserve Changes, and Incurred Loss Costs as % of Net Total
Incurred. These metrics can be tracked at the claim level, at the exposure level, or both. By comparing a claim’s
health metrics against company-specific targets and service levels, you can understand the status of a claim, and, if
necessary, you can take the appropriate action. These metrics can be further defined with tiers, which introduce a
finer level of granularity.
The metrics can differ depending on the line of business. For example, the Compensability Decision metric applies
only to workers’ compensation claims.
Uses of Claim Health Metrics

With claim health metrics, real-time information is delivered in the context of the claim that is immediately visible
to all claims handling personnel. This consistent guidance helps you to understand and improve claim management.
Because ClaimCenter tracks both open and closed claims for claim health metrics, the information is forward-
looking and actionable. Over time, adjusters can actively work to reduce their cycle times, lower claim related
expenses, and improve customer experience. You can change metrics and set new targets for these metrics.
Claim Health Metrics Fields

With a claim open, if you navigate to Summary→Health Metrics, you see the Claim Health Metrics screen. This screen lists
the metrics for this claim, each of which has the following information:
• Value – The calculated value of this metric for the claim.
• Target/Service Level – The defined target value set for this particular metric, which is configurable in the
Administration tab. See “Administering Metrics and Thresholds” on page 439.
• Status – The visual representation of how the claim performs against the target values set by the administrator.
Statuses include:
432 chapter 39 Claim Performance Monitoring

• Green circle with check mark, meaning on target
• Yellow circle with exclamation point, meaning at risk
• Red circle with X, meaning requires attention
• Gray circle, meaning not applicable or not set by the administrator

ClaimCenter re-evaluates the Claim Health Metric statuses at the end of the preupdate rules. As you view the Claim
Health Metrics screen, ClaimCenter also evaluates the time-based metrics. At the time ClaimCenter creates the claim
or exposure, it stores the metric target values as a temporal snapshot on the claim or exposure itself. Storing these
values as a snapshot means that later changes to the administrative data do not affect the metric targets for that claim
or exposure.
For efficiency of reporting, ClaimCenter also stores the current metric statuses of the claim or exposure, not the
calculated value of the metric, on the claim or exposure. ClaimCenter stores these values whenever metrics are re-
evaluated. For information on reports that use these values, see the InfoCenter Reports Guide in the Guidewire
InfoCenter distribution.
If a claim or exposure changes tiers, ClaimCenter uses the metric limit values defined in the Business
Settings→Metrics and Thresholds screen of the Administration tab. If the change in tiers is due to a change in
information, such as the addition of an injury incident, the metric targets and status are updated. This behavior is
based on the current administrative settings for the respective tier. See “Claim and Exposure Tiers” on page 435.
Claim Health Metrics Calculations

The following table describes how ClaimCenter calculates metrics that vary based on calculations.
Metric Closing Event Skipped Event Open Calculation Closed Calculation

Days Open Claim.Status is "Closed" Not applicable Days between Claim.Repor Days between Claim.Repor
tDate and today tDate and closing event
Initial contact Activity with ActivityPatter Activity with Ac Days between Claim.Repor Days between Claim.Repor
with Insured in n equal to Initial Contact with tivityPattern tDate and today tDate and closing event
Days the Insured activity with an having an
activity status of “Closed" Activity Status
of “Skipped”
Time to First First escalated payment with a Not applicable No payment made. Days between Claim.Repor
Loss Payment Cost Type equal to Claim Cost tDate and either the
in Days scheduled send date of the
claim cost payment that is
escalated or time of the
claim's closing if no such
payment was made
Days Since Last Claim.Status is "Closed" Not applicable Days between date last Not applicable
View - Adjuster viewed by Claim.Owner
and today
Days Since Last Claim.Status is "Closed" Not applicable Days between date last Not applicable
View - viewed by supervisor of the
Supervisor Claim.Owner's and today
Claim Health Metrics 433

Metrics with Other Calculations

In the base configuration, some metrics are valid for claims and others are valid for exposures. For example, the
number of reserve changes applies only to claims.
Metric Calculation
Activities Past Due Date Number of activities with a status of “Open” and a target date before today
Open Escalated Activities Number of activities with a status of “Open” that have been escalated
Number of Escalated Number of activities with an escalated property that is true
Activities
% of Escalated Activities Number of activities that have been escalated divided by the total number of activities
Number of Reserve Count starts at 0 after claim is created.
Changes List of Reserves to Count:
• Regular Positive Reserves Created. One or multiple ReserveSets are counted as one change.
• Negative Reserves Created.
List of Reserves not counted:
• Zeroing offset Reserves from closed exposure or claim
• Final Payment Created Reserves
• Offsetting Reserves from void/stop/transfer/recode payments
• Initial Reserves Created as claim is created
• Removed Reserves
Net Total incurred Total incurred net: Total Incurred Gross minus Total Recoveries
Total Paid Total Payments, the sum of all submitted and awaiting submission payments with a scheduled send
date of today or earlier.
Paid Loss Costs as % of Payments for Cost Type of claim cost divided by Total Payments.
Total Paid
Incurred Loss Costs as % Net Total Incurred for Cost Type of claim cost divided by Net Total Incurred.
of Net Total Incurred
% of Reserve Change Using the same criteria for inclusion as Number of Reserve Changes, the percentage is calculated
from initial reserve based on Reserve Amount changes. This percentage is the amount of the reserves that count in
Number of Reserve Changes divided by initial reserves.
Initial Reserves are defined as one of the following:
• Any reserves created during exposure creation
• After creating first approved reserve set on the claim, any reserves created within the InitialR
eserveAllowedPeriod
Uses the configuration parameter InitialReserveAllowedPeriod in the config.xml file. In the
base configuration, the value of this parameter, which defines the number of days after first initial
reserve, is 3 days. All reserve changes within that period count as initial reserves.
Deferred % of Reserve (Current Incurred net minus Initial user-set reserve) divided by Initial user-set reserve
Change from initial user
set reserve

See also
• For detailed information on the organization of metrics and how to administer them from the Administration tab,
see “Administering Metrics and Thresholds” on page 439.
• For information on the financial calculations and what each value means, see:
◦ “Definitions of Reserve Calculations” on page 327
◦ “Definitions of Total Incurred Calculations” on page 327
Claim and Exposure Tiers

To effectively evaluate a claim’s status, ClaimCenter provides a way to compare it against other claim targets. The
application groups similar claims and exposures by using the following hierarchy: policy type, claim metrics, and
then exposure metrics. Within each claim and exposure metric, there are multiple levels, or tiers, that you can
define. Define tiers to add further granularity within the type. If you do not define tier-specific target values, the tier
inherits the default targets for that metric.
• Policy Type – Every line of business contains its own claim and exposure metric tiers.
• ClaimTier.ttx Typelist – A typelist that groups similar claims. It shows the type, complexity, and size of the
claim, so that you can see this information while reviewing the metric values and the thresholds that might have
been triggered. Gosu defines the claim tiering logic in preupdate rules. You enter metric data on the Business
Settings→Metrics & Thresholds screen on the Administration tab. Guidewire recommends that the claim tier be
broadly defined so that it makes sense as a category for analysis. In other words, do not define many tiers that are
so specific that only a handful of claims fall into each tier.
• ExposureTier.ttx Typelist – A typelist that groups similar exposures. Similar to the ClaimTier.ttx typelist,
the ExposureTier.ttx typelist indicates the type, complexity, and priority of the exposures grouped into these
tiers.
Note: While claim and exposure tiers can span policy types, the system manages the targets by policy type for each
claim or exposure tier.
ClaimCenter evaluates initial and subsequent tiering for claims. A claim is assigned to a tier when first created.
Then, as claim information is added or changed, ClaimCenter can change the claim tier. After the claim tier changes,
ClaimCenter recalculates the metrics for the claim.
Example
In the New Claim wizard, an adjuster entered only partial information about the loss, and the claim tier was set as Low
Severity. At a later date, the adjuster determined that there were injuries, and the claim was reclassified to High
Severity. Because new information can change the tier, the evaluation for tiering happens at every update on the
claim. The preupdate rules evaluate the properties that make up the tiers and re-evaluate those values after the claim
changes to determine if the claim needs to be re-tiered.
See also
• For information on using the Metrics and Thresholds screen to enter tier values, see “Defining Claim Tiers” on page
441.
• For information on using Guidewire Studio to configure tiers, see the Configuration Guide.
Aggregated Metric Data

In the base configuration, ClaimCenter provides aggregated metrics information. You can see aggregated metrics on
the Team tab and the Dashboard. This data includes information like the number of claims and exposures assigned to
employees, aggregated by employee groups, as defined in the User and Group hierarchy. ClaimCenter aggregates
those metrics specifically by group hierarchy based on well-defined time frames. Because ClaimCenter calculates
these metrics and runs them separately from the non-aggregated metric calculations, those numbers might not be
consistent with the claim metric numbers. See “Team Management” on page 443.
Claim Health Metrics 435

Non-aggregated metrics are visible on the Claim Health Metrics screen, as described at “Claim Health Metrics” on page
432.
Claim Summary
View the claim Summary screen to see summarized information relating to the most important aspects of a claim’s
overall condition. To open this screen, with a claim open, click Summary in the sidebar. There are icons providing
visual cues that ClaimCenter updates on a regular basis. The claim Summary screen draws your attention to essential
information, such as the age of the claim, the level of funding available, and other high-risk indicators.
1. The Basics section indicates the age of the claim. The number of days combined with the graphic help you to
see if the claim is in critical condition. You can also see how long has it been in that condition and compare it
to your company targets to determine if you need to act quickly on it. If you have defined company targets, the
Target number shows what the average number might be for this type of claim. This number is based on your
business requirements and how the claim measures against that number. There is also a description that
originates from the Loss Details screen.
2. The Financials section indicates the a claim’s current cost—the total gross incurred and what monies have been
paid to date, if any. These numbers originate from the Financials screens. The Gross Incurred amount is
calculated as Open Reserves plus all payments made today or earlier. To see additional details relating to this
section, navigate to Summary→Health Metrics to open the Claim Health Metrics screen. These details are in the
Claim Financials section of that screen. Also, you can click Financials in the sidebar to see more detailed
information.
3. The High-Risk Indicators section shows attributes that make the claim a high risk. You can see details for these
indicators by navigating to Summary→Status to open the Claim Status screen, For information regarding flags,
see “Flags” on page 438.
High-risk indicator icons are also shown on the Info bar, which is always visible above the claim screens.
Other claim summary information is also available on the Summary screen, including Loss Details, Exposures, Services,
Parties Involved, Latest Notes, Planned Activities, Litigation, and Associated Claims.
On the Summary screen in the Exposures section, the first column has an icon that indicates whether an exposure is
open or closed. The icon can indicate open or closed . These same icons also indicate if the claim is open or
closed on the Info bar. See “Claim Status Screen” on page 436 for a figure that shows the Info bar.
Claim Status Screen

The Claim Status screen provides a deeper level of detail than the Summary screen. This screen is organized into
General Status and High-Risk Indicators sections. To open this screen, open a claim and then navigate to
Summary→Status.

Note: In addition to the Claim Status and Summary screens, indicators and flags are also present on the Info bar,
which is always visible at the top of a claim. The following figure shows the Info bar with the Open, Litigation,
and Flagged indicators outlined in red:

• “General Status Section” on page 437
• “High-Risk Indicators Section” on page 437
• “Flags” on page 438
General Status Section

This section of the Claim Status screen displays the status of a claim in several areas. These areas include fields
showing the line of business, claim status, claim creation date, primary adjuster, claim validation level, and so forth
—the pertinent claim data. For convenience, you can update some of these fields by clicking Edit.
High-Risk Indicators Section

In the default configuration, ClaimCenter considers the following areas to be potentially high-risk: litigation,
fatalities, large loss, coverage in question, SIU, and flags. High-risk indicators on the Claim Status screen help
identify claims that might require increased attention. Visible also at the top of the Claim Summary screen, icons and
statuses shown on this screen notify you of important events in a claim’s lifecycle.
Claim Status Screen 437

The base configuration provides the following high-risk indicators:

• Litigation – Claims that are in litigation. In edit mode, you can change the Litigation Status and First Notice Suit.
• Fatalities – Usually involve a fatality, but can also be configured to indicate a severe injury.
• Large Loss – Indicates whether there might be a large loss on the claim. The large loss number is set by clicking
the Administration tab and navigating to Business Settings→Metrics and Thresholds→Large Loss Threshold. It represents
the Net Total Incurred, which is the remaining reserves, plus total payments, minus any recoveries.
• Coverage in Question – In edit mode, you can select the Yes radio button to indicate situations in which the policy
coverage is in question.
• SIU – Special Investigation Unit (SIU) contains information about possible fraudulent claims, such as the SIU
status and score or if the claim was referred to the SIU team. This indicator is controlled by the SIU question set
accessible by navigating to Loss Details→Special Investigation Unit.
• Flag Details – Show if the claim has been flagged, when it was flagged, and the reasons. See “Flags” on page 438.
The default configuration provides functioning indicators, some of which can be configured in Studio. See the
Configuration Guide for details.
Flags
Flags are a type of indicator and are set through rules. A flag’s purpose is to notify you to act on the claim. In the
base configuration, ClaimCenter displays a flag on the Claim Status screen after one of the following occurs:
• A critical or high priority activity that has not been closed or skipped reaches the escalation date.
• In the personal auto line of business, a vehicle is marked as a total loss by the Total Loss Calculator. See “Vehicles,
People, and Property in the Add Claim Information Step” on page 92.
You cannot manually flag a claim, but a supervisor can remove a flag. Or, in the case of the vehicle, if the Total Loss
Calculator no longer indicates that the vehicle is a total loss, the application removes the flag. The claim has a

Flagged field to track the current status, which takes values from the FlaggedType typelist. In the default
configuration, the typecode names are Is Flagged, Was Flagged, and Never Flagged. A claim also has a
FlaggedDate and a FlaggedReason field. If a claim is flagged and the Claim.removeFlagReason method removes
the last reason from the FlaggedReason field, then value of the Flagged field changes to Was Flagged.
You can search for claims that have flags by using advanced search.
Remove a Claim Flag
About this task

The person who can remove a flag from a claim is the supervisor or manager of the group to which the claim is
assigned. This person can also be the supervisor of any parent group. A supervisor needs to first attend to the issue
as appropriate, and then remove the flag.
Procedure
1. Navigate to Summary→Status.
2. On the Claim Status screen, click Remove Flag.
3. Enter a reason in the Note field, and then click Remove Flag again.
You can see the reason that you entered in the Latest Notes section on the Summary screen of the claim.
Next steps
You can also remove flags by using the Team tab. See “Remove Claim Flags for a Team” on page 448.
Administering Metrics and Thresholds

If you have the administration permission metriclimitmanage, you can edit health claim metrics target values.
Click the Administration tab and navigate to Business Settings→Metrics & Thresholds to open the Metrics & Thresholds
screen. You can assign values to metrics in this screen. To create new metrics, you must use Guidewire Studio. This
topic describes how to assign values to metrics.
Note: To create new metrics, define them by using Gosu in Studio. See the Configuration Guide.
Metrics and thresholds are administered by claim, exposure, and policy type in the claim and exposure. You must
first select the policy type—the line of business—and then enter the values for either claim or exposure. All policy
types have the same metrics, but each policy type can have different target values associated with it.
The Metrics & Thresholds screen has the following cards:
• Claim Metric Limits
• Exposure Metric Limits
• Large Loss Threshold
Use the Claim Metric Limits Card

About this task
This card is on the Metrics & Thresholds screen. See “Administering Metrics and Thresholds” on page 439.
Procedure
1. Choose a policy type and click Edit.
2. Enter values for overall claim metrics, claim activity, and claim financials.
You can enter the value indicating if the metric is within target for service level, the value for At Risk , and
the value for Requires Attention .
Flags 439
Use the Exposure Metric Limits Card

About this task
Procedure
2. Enter values for exposures, which can differ based on the policy type.
You can enter the units for the measurement, the value for meeting the target/service level, the value for At
Risk , and the value for Requires Attention .
Use the Large Loss Threshold Card

About this task
Procedure
2. Enter an amount that indicates a large loss.
If you have integrated PolicyCenter with ClaimCenter, you can also enter a different threshold amount.
Claim Duration Indicator

The Claim Duration indicator is a bar graph representing the Days Open metric. You set this metric in the Metrics &
Thresholds screen on the Claim Metric Limits card, in the Overall Claim Metrics section. This screen is described in the
preceding topic. The indicator, which you can see on the claim Summary page, shows the percentage value of days
opened divided by the limit and compares it to your company’s benchmark.
The changes are based on the set targets and thresholds, and the color of the Claim Duration indicator can change
accordingly.
Note: The Claim Duration indicator does not display if targets have not been defined, if the claim is closed, or if the
limits are null.
The following table shows the range of colors if targets have been set. You can set the Target/Service Level, the
yellow warning level , and the red over-target level for the Days Open metric.

Did you set the target? Set Yellow? Set Red? Claim Duration Indicator Color
No Yes Yes Green until yellow warning level, yellow until red warning level, red at 100%
No No No No indicator shown
Yes No No Green only
Yes Yes Yes Green until yellow warning level, yellow until red warning level, red at 100%
Yes Yes No Green until yellow warning level, yellow at 100%
Yes No Yes Green until red warning level, red at 100%
Note: Guidewire recommends being consistent in how you set the targets.
See also
• “Administering Metrics and Thresholds” on page 439
Defining Claim Tiers

You have the option in ClaimCenter to have tiers—different target values for a particular metric within a specific
policy type. Tiers are a way to have further granularity within the policy type.
In the following figure showing Days Open settings for the personal auto policy type, values for the high severity tier
have been entered. No values have been set specifically for low severity and medium severity, so they do not show
unless you click the picker. If tier-specific target values are not set, the tier inherits the default targets for that metric.
In this example, low and medium severity claims inherit the Days Open values 5/4/6.
Health Metrics Permissions

Health metrics use the following permission: metriclimitmanage.
Administering Metrics and Thresholds 441


chapter 40
Team Management
ClaimCenter provides a management tool that helps supervisors and managers manage their groups. For each group,
you can see the number of claims, exposures, matters, activities, subrogations and how many items are open, closed,
flagged, new, overdue, or completed. You can also view weighted workload data for groups and users. This tool also
displays aging data, which categorizes claims, exposures, and subrogations by the number of days they have been
open.
You use this management tool to monitor and manage your teams’ workloads and activities. If you log in with a role
that has the View Team permission, you can access this tool from the Team tab. In order to monitor and manage a
group’s workload, you must be the group supervisor or marked as a manager in the group.
Note: There is no Team entity in ClaimCenter. Assigning work, supervising users, and managing users are all done
through groups, the Group entity.
Overview of Team Management

Supervisors and managers can manage their teams, obtain status information, monitor case loads, identify backlogs,
and reassign activities by using the team management functionality in ClaimCenter. In some respects, team
management is a reporting tool, where you can see data for all group workloads, all members of a group, or a single
group member.
When the Team tab is selected, the Actions button has the same menu selections for a manager or supervisor as it does
when the Desktop tab is selected:
• The first three choices, Statistics, Preferences, and Vacation Status, enable you to make personal settings. For a
description of these three settings, see “Personal Administration Settings and Views” on page 511.
• The fourth choice, Load and Vacation, shows the load factors, vacation statuses, and backup users for your team
members. You can see this item and the Load and Vacation screen if you have the group load factor permission
View. If you have the Admin permission, you can both view and edit this screen.
An administrator can set these permissions for a user. Click the Administration tab and navigate to
Users & Security→Users, and then find the user and edit the user’s Groups settings. The Load Factor Permissions
setting for a group determines if the user can only view or both view and edit the Load and Vacation screen for that
Team Management 443

group. The permissions on the groups are not inherited. Therefore, the administrator must set permissions on
each child group that the manager or supervisor needs to view or edit, not just the parent group.
On the Team tab, the top portion of the sidebar of shows an organization tree. If you expand the tree, you can see
subgroups and eventually, group members for groups that have no subgroups. You can select nodes of the tree to see
data for subgroups and for group members. In the bottom portion of the sidebar below the tree are reporting
categories that show different kinds of information about what the selected group or member is doing. The default
category for any group is Summary.
• When you first click the Team tab, ClaimCenter defaults to the My Groups selection in the tree view. The screen
shows high-level Summary data for all groups for which you are the supervisor or manager. You can also choose
to see Aging data for the group. The reporting categories for workloads of all groups are Summary and Aging. For
more information, see “My Groups on the Team Tab” on page 444.
• If you choose one of the groups from the tree in the sidebar, you see a set of Summary data for all subnodes of that
group.
◦ If the nodes are subgroups, you see data for subgroups and for the manager of those groups.
◦ If the nodes are users, you see data for users who are members of the group.
◦ As with the selection showing all your groups, you can select categories in the sidebar area below the
organization hierarchy to get different information. The information is shown in both a tabular format and,
under the table, as a bar graph. The reporting categories for workloads of groups are Summary, Aging, Claims,
Exposures, Activities, and Matters.
• You can also navigate under a group to a subgroup or group member and view and manage their workloads. The
reporting categories for workloads of group members are Claims, Exposures, Activities, and Matters.
See also
• “My Groups on the Team Tab” on page 444
• “Groups on the Team Tab” on page 445
• “Group Members on the Team Tab” on page 447
My Groups on the Team Tab

On the Team tab, when you choose the My Groups category in the left sidebar, you are at the highest level of the
groups that you supervise. This node enables you to see all high-level statistics for claims, exposures, matters,
activities, and subrogations for your groups. You can also see if there are flagged claims that need immediate
attention in the group. You can see Summary data and Aging data for all your groups.
• Summary – Shows a summary of claims, exposures, matters, activities, and subrogations owned by all groups
listed. For each group, you see summary data for:
◦ Open, flagged, new, and closed claims
◦ Open and closed exposures
◦ Open and closed matters
◦ Open and overdue activities and activities that were completed today
◦ Active and closed subrogations
◦ Total weighted workload values are also shown for each set of summary data and for each subgroup or group
member. Workload values are categorized by claims and exposures.
• Aging – Lists information about the number of days that claims, exposures, and subrogations assigned to each
group have been open and not yet been closed. The numbers in parentheses indicate claims under litigation. You
444 chapter 40 Team Management

see the time for which claims, exposures, and subrogations have been open for 0 – 30, 31 – 60, 61 – 120, and
over 120 days.
See also
• “Overview of Team Management” on page 443
• “Overview of Weighted Workload” on page 213
Groups on the Team Tab

On the Team tab, you can choose a group name under My Groups, in the left sidebar. You can see groups that you
directly supervise and any subgroups of those groups.
IMPORTANT The Team tab does not display system users—users with the SystemUserType value of sysservices.
Refer to the ClaimCenter Data Dictionary for more information on this user type.
If you drill down to a subgroup that has only members, and no subgroups, you can see statistics for individual team
members. You can see the team's current caseload and the statistics for each adjuster's claims, exposures, matters,
activities, and subrogations. For example, you can see which group member has flagged claims that need immediate
attention and if any members have a disproportionate caseload or weighted workload value. For a single group that
has members and not subgroups, you can see the following types of data:
• Summary – Shows a summary of claims, exposures, matters, activities, and subrogations owned by the members
of the group. There is a local total for this group. In parentheses there is also a global total in case the member is
also a member of other groups. If the member has claims, exposures, matters, activities, or subrogations from
other groups, the global total includes them as well.
For each member, you see summary data for:
◦ Open, flagged, new, and closed claims
◦ Open and closed exposures
◦ Open and closed maters
◦ Open and overdue activities and activities that were completed today
◦ Active and closed subrogations
◦ Aging – Lists information about the number of days that claim, exposures, and subrogations assigned to each
member of the group have been open and have not yet been closed. The numbers in parentheses indicate claims
under litigation. You see the time for which claims, exposures, and subrogations have been open for 0 – 30, 31
– 60, 61 – 120, and over 120 days.
◦ Claims – Shows a list of all claims owned by members of the group. You can see which claims are flagged ,
and you can select the check box for a claim to reassign it or clear its flag. To see how to clear a flag, see
“Remove Claim Flags for a Team” on page 448. Additionally, you can click a claim number to open the claim,
and you can click the name of the insured to see the insured’s data.
There is a drop-down filter at the top of this table that enables you to filter the list. You can filter by categories
like All open owned, New owned (this week), and Flagged. Data listed for each claim includes the adjuster that
owns the claim, the policy number, the insured, the claimants, net total incurred, and the date of the loss.
You can sort the claims by any column. Click the drop-down arrow on the right side of a column heading to
choose sort options.
Groups on the Team Tab 445

You can click the following linked data items to open the screens indicated:
▪ Claim – Opens the Claim at its Summary screen. This link takes you away from the Team tab.
▪ Insured – Opens the insured’s contact detail screen at the Basics card. This screen has a link that connects back
to the Team tab.
▪ Exposures – Shows a list of all exposures owned by members of the group. If you select the check box for an
exposure, you can reassign it by clicking Assign. There is a drop-down filter at the top of this table that
enables you to filter the list. You can choose categories like All open owned, New owned (this week), and
Closed in the last 90 days. Data listed for each exposure includes the claim number, the exposure number, the
exposure type, the coverage, the claimant, the adjuster, and net total incurred.
For any exposure, you can click the following linked data items to open the screens indicated:
▫ Claim – Opens the claim at the claim Summary screen. This link takes you away from the Team tab.
▫ # – Opens the claim at the detail screen for that exposure. This link takes you away from the Team tab.
▫ Type – Same as #. Opens the claim at the detail screen for that exposure. This link takes you away from the
Team tab.
▫ Claimant – Opens the claimant’s contact detail page at the Basics card. This screen has a link that connects
back to the Team tab.
▫ Activities – Shows a list of all activities belonging to the group. If you select the check box for an activity,
you can reassign it by clicking Assign. Activities that have been escalated have an escalated icon in the
first column, and those that are overdue have a due date that is red. There is a drop-down filter at the top of
this table that enables you to filter the list. You can choose filters like All open, Today’s activities, Overdue
only, and Escalated only. Data listed for each activity includes escalation status, due date, priority, subject,
claim number, insured party, assigned user or group, if external, line of business, and claim state.
You can sort the activities by any column. Click the drop-down arrow on the right side of a column
heading to choose sort options.
▣ Subject – Opens the claim at the Workplan screen, with the worksheet for the selected activity open below.
This link takes you away from the Team tab.
▣ Claim – Opens the claim at the Summary screen. This link takes you away from the Team tab.
▣ Insured – Opens the insured’s contact detail screen at the Basics card. This screen has a link that connects
▣ Matters – Shows a list of all legal matters belonging to the group. If you select the check box for a matter,
you can reassign it by clicking the Assign button. There is a drop-down filter at the top of this table that
enables you to filter the list. You can choose filters like All open, New open (this week), and Closed in
last 90 days. Data listed for each matter includes the name of the legal action, case number, claim
number, final settlement amount, trial date, and assigned user.
• Name – Opens the claim at the Detail screen for the matter, one level below the Litigation screen. This
link takes you away from the Team tab.
• Claim – Opens the claim at the Summary screen. This link takes you away from the Team tab.
See also
• “Group Members on the Team Tab” on page 447
• “Incidents, Exposures, and Claims” on page 248
• “Working with Activities” on page 225

• “Legal Matters” on page 253
Group Members on the Team Tab

On the Team tab in the organizational hierarchy section of the sidebar, you can drill down to groups that have
members. Members of a group can be either other groups or users who are members of that group. If you expand the
group node, you see all members of the group listed under it in the sidebar. In addition, there are three group
categories that are not member names.
Group Categories
In addition to member names, there are three categories in a group node that are not member names:
• Pending Assignment – Displays claims, exposures, activities, matters, and subrogations that have been assigned to
the group, but not to an individual user. You can select and assign any item you see listed, and you can filter
items as well by using the drop-down filter.
• Other – Displays claims, exposures, activities, matters, and subrogations assigned to the group under which the
node appears, but that were assigned to an invalid user. An invalid user is someone who is no longer a member of
the group. For example, the user might have switched groups or retired.
• In Queue – Displays activities that are in this group’s queue, but that have not been assigned yet. You can sort
these activities by using the filter. For example, selecting Overdue only from the drop-down filter displays overdue
activities that need to be attended to or assigned to someone who can address them.
Group Members Who Are Users

When you choose a group member who is a user, you can see the following data for the member, listed as menu
links in the sidebar below the organizational hierarchy:
• Claims – Shows a list of all claims owned by this member of the group. You can see which claims are flagged, and
you can click a claim number to open a claim. If you select a claim, you can reassign it by clicking the Assign
button. To see how to reset a flag, see “Remove Claim Flags for a Team” on page 448.
There is a drop-down filter at the top of this table that enables you to filter the list. You can filter by categories
like All open owned, New owned (this week), and Flagged. Data listed for each claim includes the adjuster that
owns the claim, the policy number, the insured, the claimants, net total incurred, and the date of the loss.
◦ Claim – Opens the claim at the Summary screen. This link takes you away from the Team tab.
◦ Insured – Opens the insured’s contact detail page at the Basics card. This screen has a link that connects back to
the Team tab.
◦ Exposures – Shows a list of all exposures owned by this member of the group. If you select the check box for an
exposure, you can reassign it by clicking Assign. There is a drop-down filter at the top of this table that enables
you to filter the list. You can choose categories like All open owned, New owned (this week), and Closed in the
last 90 days. Data listed for each exposure includes the claim number, the exposure number, the exposure type,
the coverage, the claimant, the adjuster, and net total incurred.
▪ Claim – Opens the claim at the claim Summary screen. This link takes you away from the Team tab.
▪ # – Opens the claim at the detail screen for that exposure. This link takes you away from the Team tab.
▪ Type – Same as #. Opens the claim at the detail screen for that exposure. This link takes you away from the
Team tab.
▪ Claimant – Opens the claimant’s contact detail page at the Basics card. This screen has a link that connects
▪ Activities – Shows a list of all activities belonging this member of the group. If you select the check box for an
activity, you can reassign it by clicking Assign. Activities that have been escalated have an escalated icon
Group Members on the Team Tab 447

in the first column, and those that are overdue have a due date that is red. There is a drop-down filter at the
top of this table that enables you to filter the list. You can choose filters like All open, Today’s activities,
Overdue only, and Escalated only. Data listed for each activity includes escalation status, due date, priority,
subject, claim number, insured party, assigned user or group, if external, line of business, and claim state.
▫ Subject – Opens the claim at the Workplan screen, with the worksheet for the selected activity open below.
This link takes you away from the Team tab.
▫ Claim – Opens the claim at the Summary screen. This link takes you away from the Team tab.
▫ Insured – Opens the insured’s contact detail screen at the Basics card. This screen has a link that connects
▫ Matters – Shows a list of all legal matters belonging to this member of the group. If you select the check
box for a matter, you can reassign it by clicking the Assign button. There is a drop-down filter at the top of
this table that enables you to filter the list. You can choose filters like All open, New open (this week), and
Closed in last 90 days. Data listed for each matter includes the name of the legal action, case number,
claim number, final settlement amount, trial date, and assigned user.
▣ Name – Opens the claim at the Detail screen for the matter, one level below the Litigation screen. This link
takes you away from the Team tab.
▣ Claim – Opens the claim at the Summary screen. This link takes you away from the Team tab.
See also
• “Incidents, Exposures, and Claims” on page 248
• “Working with Activities” on page 225
• “Legal Matters” on page 253
Remove Claim Flags for a Team

About this task
Only a supervisor or manager of the group to which the claim is assigned, or the supervisor of any parent group, can
remove a flag from a claim. Typically, a supervisor removes the flag after the task has been completed.
Procedure
1. Navigate to the Team tab and drill down to a group with a flagged claim or to a specific user.
2. Click Claims in the sidebar.
3. Select the check box for the claim whose flag you want to remove.
The Remove Flag button becomes enabled.
4. Click Remove Flag.
5. Provide a reason in the Note field, and then click Remove Flag.
The reason shows in the Latest Notes section on the Summary screen of the claim.

Administering the Team Tab

To make administrative changes to the Team tab, you can set configuration parameters in the config.xml file and
you can change the settings for the batch process and its workers.
Team Tab Configuration Parameters

You can set a number of configuration parameters that affect the Team tab. These configuration parameters, most of
which are in the Statistics, Team and Dashboard Parameters section of the config.xml file, include the
following:
• GroupSummaryShowUserGlobalWorkloadStats – If set to true, ClaimCenter shows global workload statistics
for individual users. See the Configuration Guide.
• UserStatisticsWindowSize – Sets the time window used to calculate user statistics. By default, this parameter
is set to 0, which means this week, defined as the start of the current business week up to and including today. See
• AgingStatsFirstDivision – Used in the Aging screen to determine the number of days in the lowest aging
group for claims, exposures, and subrogations, by default 0 – 30 days. The default value is 30 days. See the
Configuration Guide. See also the description of this screen at “Groups on the Team Tab” on page 445.
• AgingStatsSecondDivision – Used in the Aging screen to determine the number of days in the second aging
group for claims, exposures, and subrogations. This group ranges from AgingStatsFirstDivision + 1 to the
value of this parameter. The default value is 60 days. See the Configuration Guide. See also the description of
this screen at “Groups on the Team Tab” on page 445.
• AgingStatsThirdDivision – Used in the Aging screen to determine the number of days in the third aging group
for claims, exposures, and subrogations. This group ranges from AgingStatsSecondDivision + 1 to the value of
this parameter. This parameter also determines the final group of aging for claims, which is all claims over this
value. The default value is 120 days. See the Configuration Guide. See also the description of this screen at
“Groups on the Team Tab” on page 445.
• CalculateLitigatedClaimAgingStats – Whether to show the number of litigated claims on the Aging screen.
The default value is true. See the description of this screen at “Groups on the Team Tab” on page 445.
• MaxTeamSummaryChartUserBars – The maximum number of user’s bars to show in the chart on the Summary
screen. The default value is 10. Setting it to 0 to removes the chart entirely. Otherwise, there are chart bars for the
number of users indicated by this parameter with the highest values, and for the others there is one bar labeled All
Other Users. For a description of the Summary screen, see “Groups on the Team Tab” on page 445.
The following parameters also apply to the Team tab. They are settings for Oracle databases and are typically set by a
database administrator.
• DisableIndexFastFullScanForTeamGroupActivities – In the base configuration, ClaimCenter works around
query plan problems related to the index fast full scan when executing the team group activities page's main
query on Oracle. This parameter controls the work around and is true by default. If a future version of Oracle
fixes the defect this parameter might be removed. The parameter has no effect on databases other than Oracle.
• DisableHashJoinForTeamGroupActivities – In the base configuration, ClaimCenter works around query plan
problems related to hash joins when executing the team group activities page's main query on Oracle. This
parameter controls part of the work around and is true by default. The parameter has no effect on databases
other than Oracle.
• DisableSortMergeJoinForTeamGroupActivities – In the base configuration, ClaimCenter works around
query plan problems related to sort merge joins when executing the team group activities screen’s main query on
Oracle. This parameter, which is true by default, controls part of the workaround when
DisableHashJoinForClaimSearch is set to true. The parameter has no effect on databases other than Oracle.
Administering the Team Tab 449

See also
• For more information on configuration parameters and instructions on how to set the parameters, see the
Calculating Team Statistics

The ClaimCenter Team screen contains a left-hand navigation pane with links to a number of different types of data.
Different processes within ClaimCenter update the information on these screens. ClaimCenter updates the data on
the various Team pages as follows.
Team screen How updated?

Summary The Statistics batch process updates the data shown in these pages. Each of these pages shows the last time
Aging that ClaimCenter ran the batch process. In the base configuration, Guidewire schedules this process to run
every hour at 3 minutes after the hour.
Claims ClaimCenter calculates the data in these pages in real-time.
Exposures
Activities
Matters
See also
• For information on running batch processes, see the System Administration Guide.
• For information on configuring batch processes, see the System Administration Guide.
• For more about the Statistics batch process, see the System Administration Guide.

chapter 41
Dashboard
The Dashboard tab provides a high-level summary of ClaimCenter data. A manager can use it to gain an overview of
claims and related financial information during a standard time period. The information shown on the Dashboard
includes the number of open claims, recent claim activity, current financial data, and summary financial data.
For more information, see “ClaimCenter Dashboard Tab” on page 64.
Dashboard 451
452 chapter 41 Dashboard

part 9
Reinsurance Management
chapter 42
Reinsurance Management Concepts
Guidewire Reinsurance Management provides reinsurance for all lines of business.This topic provides a general
introduction to what reinsurance is and how insurance companies often set it up.
If you have Guidewire PolicyCenter 7.0 or later installed and have opted to use reinsurance, see the PolicyCenter
documentation for information on setting up reinsurance programs.
Overview of Reinsurance
Reinsurance is insurance risk transferred to another insurance company for all or part of an assumed liability. In
other words, reinsurance is insurance for insurance companies. When a company reinsures its liability with another
company, it cedes business to that company. The amount an insurer keeps for its own account is its retention. When
an insurance company or a reinsurance company accepts part of another company’s business, it assumes risk. It thus
becomes a reinsurer.
The insurance company directly selling the policy is also known in the industry as the insurer, the reinsured, or the
ceding company. The Guidewire term for this company that directly sells the policy is insurer. An insurance
company accepting ceded risks is known as the reinsurer.
An insurer might want to transfer their risk of loss for several reasons:
• To protect capital and maintain solvency
• To provide a more even flow of net income over time by flattening out claims losses
• To take on more business and across a larger set of risks than the insurer would normally retain
• To spread risk over the globe and take advantage of currency advantages
• To provide catastrophe relief
• To withdraw from a line of business
The insurer might find it advantageous to bundle various types of reinsurance in a way that maximizes its ability to
achieve these business goals.
Reinsurance Management Concepts 455

For instance:
• Insurers that want to increase capacity benefit from reinsurance that either takes a percent of the risk or takes a
loss above a certain point. If an insurer can be free of fear of multiple large losses, it can comfortably take on
more risk.
• Insurers that seek to stabilize their net income flow benefit from reinsurance that takes a percent of the loss above
a certain point.
• Insurers that want to withdraw from a line of business benefit from reinsurance that takes on a percentage of risk
under a certain loss point for that line of business.
Whether an insurer has one or more of these business goals in mind, common industry practice has established that
the insurer can achieve these goals through reinsurance. In setting up reinsurance programs, insurers take into
account factors such as:
• The insurer’s average policy claim losses and premium intake
• Likelihood of catastrophe
• Proximity of policies taken out in a geographic location
Insurers group reinsurance treaties into reinsurance programs to cover policy risks in a way that maximizes their
business goals. They also group treaties into programs to ensure that they have no gaps in coverage and to ensure
that they do not duplicate coverage.
Reinsurance Programs
Note: ClaimCenter is not designed to be the system of record for reinsurance agreements. ClaimCenter is designed
to integrate with such a system, which can be a reinsurance system or policy system like PolicyCenter.
A reinsurance program is a set of reinsurance treaties designed to insure policy risks for all policies held by the
carrier that fall:
• Within one type of line of business or peril.
• Under a certain monetary cap.
The line of business or peril covered by the reinsurance program is also known as the reinsurance coverage group.
Insurance companies typically assemble one reinsurance program per reinsurance coverage group.
There are two types of reinsurance agreements. Carriers procure reinsurance in the form of facultative agreements
for specific risks and treaties that provide coverage for all risks of a certain type.
An insurance company typically operates several reinsurance programs. Each reinsurance program is structured to
cover a class of risks in a monetary range. Risks that are large and rare are not usually covered by treaties in a
reinsurance program. These risks are handled by facultative agreements.
To build a reinsurance program, the insurance company assembles one or more reinsurance treaties with the same
reinsurance coverage type. Each treaty provides a different type of risk or loss coverage and provides it for a
monetary layer or range that is different from the other treaties. These various treaties are arranged in the program to
yield a measurable business advantage.
456 chapter 42 Reinsurance Management Concepts

Each individual treaty can be drawn up with a different reinsurer from the other treaties. In addition, each individual
treaty covers one and only one of the following:
• A different layer of monetary risk against all policies that have coverables in that reinsurance coverage group
• A different monetary range of loss for qualifying risks above a certain attachment point and below a cap
Reinsurance Agreements
There are two kinds of reinsurance agreements, treaties and facultative agreements.
• Treaty – An agreement between the insurer and the reinsurer to provide coverage for all risks of a certain type.
• Facultative agreement – An agreement for a specific risk that is negotiated on an individual case basis.
Each of these agreement types can be drawn up as either a proportional or a non-proportional agreement.
Proportional and non-proportional agreements share the risk, premium, and payment for loss with the reinsurer in
different ways:
• Proportional Reinsurance – Transfers a percentage of the risk to the reinsurer. The reinsurer receives that
percentage of the premium and is responsible for that percentage of each loss. Proportional reinsurance is always
per risk coverage—it covers one risk.
• Non-proportional Reinsurance – There is no proportional ceding of the risk and no proportional sharing of the
premium or the losses. The insurer pays the entire loss up to an agreed amount called the attachment point. The
reinsurer pays all or part of the loss that exceeds the attachment point up to a limit previously agreed on by the
insurer and reinsurer.
Treaties
A treaty is an agreement between the insurer and the reinsurer that provides reinsurance without the insurer having
to submit every risk to the reinsurer. The treaty is a contract, usually arranged on a yearly basis, that covers a class of
risks for a monetary range of total insured value. The insurer cedes to the reinsurer a portion of each risk that the
treaty covers.
For example, the insurer has a treaty with a reinsurance company. The reinsurance company agrees to pay 40% of
property damage claims when the claim amount is between $1 million and $5 million.
See also
• “Proportional Treaties” on page 458
• “Non-proportional Treaties” on page 462
Reinsurance Coverage Groups for Treaties

You can group individual coverages into a reinsurance coverage group. Treaties are written to cover losses against a
broad category of coverages. For example, a reinsurance group might contain coverages for building, contents, and
business interruption. A treaty provides coverage for one or more of these reinsurance coverage groups.
Facultative Agreements
Facultative agreements are always for per risk insurance. They are used to reinsure risks that do not fall within the
reinsurance coverages provided by the treaties in a program.
For a specific risk, the insurer and the reinsurer each have free choice in arranging the reinsurance. The insurer is
free to decide whether or not to reinsure a particular risk and can offer the reinsurance to any reinsurer it chooses. By
the same token, it is at the reinsurer’s discretion whether to accept any risk offered, decline it, or negotiate different
terms.
A facultative agreement provides reinsurance for claims that fall within a specified range. The facultative agreement
reinsures a specific amount.
Reinsurance Agreements 457

For example, a policy provides insurance up to $4 million. A number of treaties provide coverage for claims up to
$2 million. For a specific risk on the policy, the insurer negotiates two proportional facultative agreements to
provide coverage for claims valued at $2 million to $4 million. One facultative agreement provides reinsurance
coverage for $500,000. The second facultative agreement provides reinsurance coverage for $1.5 million. If the risk
suffers a loss of $4 million, the treaties provide reinsurance for the first $2 million. The two facultative agreements
provide reinsurance for the remaining $2 million.
See also
• “Facultative Agreements” on page 457
• “Non-proportional Facultative Agreements” on page 464
Proportional Agreements
Reinsurance Management provides proportional reinsurance for both treaties and facultative agreements.
Proportional reinsurance transfers a percentage of the risk to the reinsurer. The reinsurer receives that percentage of
the premium and is responsible for that percentage of each loss. Proportional reinsurance is always per risk coverage
— it covers one risk.
Proportional Treaties
Reinsurance Management provides two types of proportional treaties:
• Quota share – The reinsurer assumes an agreed-upon percentage of each relevant risk and shares all premiums
and losses accordingly with the reinsured. For example, an insurer has a 40% quota share on all homeowners
policies. For every policy, 40% of the premium is ceded to the reinsurer. The reinsurer is responsible to pay for
40% of all losses. A quota share treaty provides reinsurance coverage starting at $0 up to a coverage limit.
• Surplus – The surplus treaty provides reinsurance coverage from a starting value up to the coverage limit. The
way in which the percentage of premium is ceded and losses are paid is similar to quota share.
Example of Ceding Risk to Proportional Treaties

In a reinsurance program, quota share and surplus treaties provide layers of reinsurance coverage. In the following
example, three proportional treaties provide reinsurance coverage up to $10 million:
Treaty Layers of reinsurance Monetary risk ceded Proportional share of risk

to reinsurer
Surplus 2 From $5 million to $10 million $5 million $5 million of $10 million = 50%
Quota share From $0 to $1 million ceding 40% of the risk to the $400,000 $400,000 of $10 million = 4%
reinsurer
Insurer’s share From $0 to $1 million 60% of the risk retained by the $600,000 $600,000 of $10 million = 6%
insurer
The treaties share a $10 million risk proportionally as shown in the following illustration:

Example of ceding risk to proportional treaties
Legend
40% Proportional
treaties
Surplus 1
$0 to $10 million
Proportional
share of risk
6% QS
4% Quota
4% Share
50%
Surplus 2 6% Carrier
When there is a loss of $10 million or less on a risk with a total insured value of $10 million, the proportional
treaties share the loss proportionally. The amount of each treaty’s share is shown in the last two columns of the
following table:
Treaty Proportional share of loss $10 million loss $5 million loss

Surplus 2 50% of loss amount $5 million $2.5 million
Surplus 1 40% of loss amount $4 million $2 million
Quota share 4% of loss amount $400,000 $200,000
Insurer’s share 6% of loss amount $600,000 $300,000
When there is a loss of $2 million on a risk with total insured value of $3.7 million, Surplus Treaty 2 does not apply.
This treaty does not apply because the risk does not exceed $5 million. Only the Quota Share Treaty and Surplus
Treaty 1 apply. The proportional treaties share the loss proportionally as shown in the last two columns of the
following table:
Treaty $4 million risk proportional share calculation Proportional share of Actual monies tendered on
formula loss the $2 million loss
Surplus 2 N/A since the total risk < $5 million 0% $0.00
Surplus 1 100% x 2.7 million/3.7 million 73% $1.46 million
Quota share (40% x $1 million)/3.7 million 11% $220,000
Insurer’s share (60% x $1 million)/3.7 million 16% $320,000
Proportional Facultative Agreements

Proportional facultative agreements differ in several ways from proportional treaties.
Proportional treaties define how much risk within the coverage group is ceded to the reinsurer in terms of either:
• A percentage share—the quota share
• Layers to be ceded—the surplus
A treaty applies to all risks within the scope of the treaty. New risks within the coverage group signed by insurer are
automatically covered by existing treaty.
Proportional Agreements 459

Facultative agreements, on the other hand, reinsure a specific risk. The agreement can simply cede a monetary value,
such as $2 million of the risk, or a percentage, such as 15% of the risk. If the agreement cedes a monetary value, the
system determines a percentage share for determining ceded loss. In practice, you might think of the agreement as
representing the layer above the highest surplus treaty.
A proportional facultative agreement, like a proportional treaty, shares premiums and losses from the first dollar.
Example of Ceding Amount of Risk to Proportional Facultative Agreements

This example shows how risk is ceded in a proportional facultative agreement with a monetary amount entered in
the Amount of Risk Ceded field on the Facultative screen. This example builds upon Example of Ceding Risk to
Proportional Treaties which provided reinsurance from $0 to 10 million on a specific risk. However, in this example
the risk is valued at $20 million. The insurer negotiates two proportional facultative agreements to provide coverage
for claims up to $20 million. One facultative agreement cedes $2 million in risk. A second facultative agreement
cedes $8 million of risk.
In a reinsurance program, quota share and surplus treaties often provide reinsurance coverage as in the following
example. In this example, the risk is equal to the total risk covered by the treaties and facultative agreements put
together. If the risk had been smaller, some of the treaties might drop out of the coverage. Also, if the risk were
smaller, the smaller risk would replace the $20 million in the proportional share of risk calculation in the last
column.
Treaty Layers of reinsurance Amount of risk Proportional share of risk

ceded
Proportional Facultative Agreements
Proportional Facultative 2 $8 million $8 million of $20 million = 40%
Proportional Facultative 1 $2 million $2 million of $20 million = 10%

Proportional treaties
Quota share From $0 to $1 million ceding 40% of the $400,000 $400,000 of $20 million = 2%
risk to the reinsurer
Insurer’s share From $0 to $1 million 60% of the risk $600,000 $600,000 of $20 million = 3%
retained by the insurer
The following illustration shows the coverage provided by the reinsurance program:

Example of ceding risk to proportional facultative agreements
40%
Prop Fac 2
Legend
10%
$0 to $20 million
Proportional
Prop Fac 1 agreements
2% Quota Share
3%
3% Carrier Facultative
25% 2% share of risk
20%
Surplus 2 Surplus 1
Treaty share of
risk
Carrier share of
risk
When there is a loss of $20 million or less, the proportional agreements share the loss proportionally, as shown in
the last two columns of the following table. In this example, the risk equals the risk limit of the combined treaties:
Agreement Proportional share of loss $20 million loss $5 million loss

Proportional facultative agreements
Proportional facultative 2 40% of loss amount $8 million $2 million
Proportional facultative 1 10% of loss amount $2 million $500,000
Proportional treaties
Surplus 2 25% of loss amount $5 million $1.25 million
Surplus 1 20% of loss amount $4 million $1 million
Quota share 2% of loss amount $400,000 $100,000
Insurer’s share 3% of loss amount $600,000 $150,000
Example of Ceding a Share Percentage to Proportional Facultative Agreements

The previous example shows how risk is ceded to proportional facultative agreements by entering a monetary
amount in the Amount of Risk Ceded field on the Facultative screen. Instead of entering a monetary amount, you can
specify a Ceded Share (%) field on the Facultative screen. For example, the ceding is the same if the two proportional
facultative agreements specify 40% and 10% instead of $8 million and $2 million, respectively.
Non-proportional Agreements
Reinsurance Management provides non-proportional reinsurance for both treaties and facultative agreements.
In non-proportional reinsurance there is no proportional ceding of the risk and no proportional sharing of the
premium or the losses. The insurer is responsible for the entire loss up to an agreed amount called the attachment
point. The reinsurer then pays all or part of the loss that exceeds the attachment point up to a limit previously agreed
upon by the insurer and reinsurer. The reinsurance premium charged by the reinsurer does not have a direct
proportional relationship to the amount of loss that the reinsurer is responsible for.

Note: In the base configuration, ClaimCenter does not automatically create reinsurance transactions for non-
proportional agreements. A reinsurance manager can manually enter transactions for this type of agreement. You
can configure ClaimCenter and add automatic creation of reinsurance recoverables for non-proportional facultative
agreements. This configuration is not trivial, and is likely to require some time and effort to accomplish.
Non-proportional Treaties
Reinsurance Management provides the following types of non-proportional treaties:
• Excess of Loss – The reinsurer pays a percentage of the amount of a loss in excess of a specified retention for
each risk coverage. An excess of loss treaty has an attachment point and coverage limit, and coverage applies to
one risk.
For example, if a storm destroys 10 covered locations, the limit is applied 10 times, once for each location.
• Net Excess of Loss – Similar to an excess of loss agreement. However, net excess of loss covers losses net of any
recoveries from excess of loss or proportional agreements. A net excess of loss treaty has an attachment point and
coverage limit.
• Per Event – Cover aggregate losses from an event with multiple risks. A per event agreement is similar to a net
excess of loss agreement. The insurer determines its net loss after deducting any amounts recoverable from per
risk proportional or non-proportional agreements. Then the per event agreement provides coverage if those net
losses are above the attachment point of the per event agreement.
Per event treaties are typically catastrophe, for property, or clash cover, for liability.
• Annual Aggregate – Similar to a per event treaty, but based on a time period rather than an event. An annual
aggregate treaty provides aggregate coverage, net of any per risk coverage or more specific aggregate coverage,
such as per event coverage. The annual aggregate treaty covers total losses for an entire book of business for a
defined period of time. The period of time is usually one program year. Annual aggregate treaties are defined to
start at a specified attachment point or for losses above a specified loss ratio. In either case, the treaty defines a
coverage limit. The coverage limit is the maximum amount the reinsurer pays under the treaty, not the top of a
layer as in other non-proportional treaties.
For example, an aggregate agreement provides reinsurance for net losses to all covered buildings after recovering
per risk reinsurance for each building.
See “Non-proportional Treaties” on page 462.
Example of Ceding Risk to a Single Excess of Loss Treaty

An excess of loss treaty has an attachment point of $1 million, and a coverage limit of $3 million with 0% insurer
share. The reinsurer does not cover the first $1 million of any loss, but does cover 100% of the loss above $1 million
up to the limit of $3 million. The reinsurer provides $2 million in excess coverage, the Coverage Limit minus the
Attachment Point, often referred to as $2 million in excess of $1 million.
Treaties Layers of reinsurance

From $3 million and up, the insurer provides 100% coverage.
Excess of Loss Attachment point $1 million
Coverage limit $3 million
From $0 to $1 million, the insurer provides 100% coverage.
Losses would be covered by this agreement as follows:

• $900,000 loss – The reinsurer pays nothing because it is under the $1 million attachment point.
• $2,500,000 loss – The insurer pays the first $1 million, and the reinsurer pays the next $1,500,000.
• $4,500,000 loss – The insurer pays the first $1 million. The reinsurer pays the next $2 million up to the
reinsurance limit of $3 million. The insurer pays the last $1.5 million, unless the insurer has another reinsurance
agreement that covers a higher band of losses, which would typically be the case.

Example of Ceding Risk to Multiple Excess of Loss Treaties

The insurer has a program that contains two treaties. A quota share treaty covers 50% up to $1 million. An excess of
loss treaty covers $4 million in excess of $1 million.
Treaty Layers of reinsurance

Excess of loss Attachment point: $1 million
Coverage limit: $5 million
Quota share treaty 50% up to $1 million
If there is a $3 million loss, the insurer pays a 50% share of the first $1 million. The excess of loss agreement pays
the $2 million above the $1 million attachment point. The insurer’s gross retention is $1 million, where the excess of
loss attaches, and total net retention for any loss under $5 million is $500,000.
Example of ceding risk to excess of loss treaty
Treaties
Ceding in a $3M loss

$1M to $5M
XOL
Legend
$2M
$1M to $3M
XOL
Non-proportional
treaties
Proportional
$500K treaties
QS
The quota share treaty cedes 50% Carrier
$0 to $1M
$0 to $1M

$500K Proportional
QS share of risk
Example of Ceding Risk to a Net Excess of Loss Treaty

The insurer has a program that contains three treaties:
• A quota share treaty covers 50% up to $1 million.
• An excess of loss treaty covers $3 million in excess of $2 million.
• A net excess of loss treaty covers $1 million in excess of $500,000.
Layers of reinsurance
Treaties
Excess of loss Attachment point: $2 million
Quota share treaty Attachment point: $500,000
Non-proportional Agreements 463

Layers of reinsurance
Net treaties
Net excess of loss 50% up to $1 million
If there is a $3 million loss, the insurer pays a 50% share of the first $1 million and 100% of the next $1 million. The
excess of loss pays the $1 million above $2 million. The insurer’s net loss is $1.5 million, but the insurer collects
$1 million from the net excess of loss agreement for the amount of net loss above $500,000. The insurer's gross
retention is $2 million, where the excess of loss attaches, and total net retention for any loss under $5 million is
$500,000.
Example of ceding risk to net excess of loss treaty
Treaties Legend
Non-proportional
treaties
Proportional Proportional
treaties share of risk
$2 to $5M
XOL
Ceding in a $3M loss Ceding in a $3M loss
before NXOL after NXOL
$1M $1M
$2 to $3M
XOL XOL
$2 to $3M
$1M $1M
$1 to $2M
$1 to $2M
Carrier NXOL
NXOL
QS $500K $500K
Carrier Carrier
$0 to $1M
$0 to $1M
$0 to $1M
$500K $500K
QS QS
The quota share treaty cedes 50%
Example of Ceding Risk to Per Event and Annual Aggregate Treaties

An insurer might be willing to hold a $1 million net retention for any one risk to property. However, if there are
widespread losses from a single catastrophic event such as a tornado or flood, 100 separate losses could add up to
$100 million in retained risk. To protect against a loss of this magnitude, the insurer can have a per event agreement
to provide coverage for $100 million in excess of $20 million. The insurer retains $20 million in aggregate net risk.
The insurer collects $80 million from the per event agreement in the case of a $100 million net loss (after per risk
insurance) from a single event.
Annual aggregate treaties provide reinsurance coverage for multiple catastrophic events in a single year. For
example, the insurer had planned for 2,000 slip and fall liability losses in a year, but there are claims for 10,000. The
insurer’s risk retention is unacceptably high. To protect against this eventuality, the insurer negotiates an annual
aggregate treaty to cover yearly net losses for $500 million in excess of $200 million. The annual aggregate treaty
cedes 75% of the risk to the reinsurer.
Non-proportional Facultative Agreements

Non-proportional facultative agreements can be excess of loss or net excess of loss agreements.

Excess of Loss
Non-proportional facultative agreements are usually excess of loss agreements.
If a facultative excess of loss agreement insures amounts above other excess of loss agreements, it provides another
layer of coverage when no standard treaty is in place. There is no difference from a standard excess of loss situation.
However, if a facultative excess of loss agreement insures amounts above a set of proportional agreements, the
behavior is different. When a set of proportional treaties are in place, the idea is to share risks up to the limit of the
highest surplus, such as $2 million. For larger risks, a facultative excess of loss agreement can remove the potential
for losses larger than $2 million. The risk still looks like a $2 million risk to all the proportional participants.
The insurer charges a premium to cover the cost of the facultative excess of loss agreement plus other costs such as
commissions to agents. Since all proportional participants benefit from the facultative excess of loss agreement, the
premium is shared proportionally after deducting the cost of the facultative excess of loss agreement.
Net Excess of Loss

The other type of non-proportional facultative agreement is a net excess of loss agreement. This agreement provides
reinsurance after proportional reinsurance and protects only the insurer’s share of the risk.
The net excess of loss premium is not deducted in advance of determining what is shared among the proportional
participants.
Summary of Agreement Types

Reinsurance agreements are categorized into different types based on how the risk is shared. The agreement records
the parameters to use in the calculation of how to divide the risk and how to distribute the premiums.
The following table shows the types of agreements in the default configuration. The marked cells indicate that the
item applies to that agreement type. The final column, Transaction Generation, shows how ClaimCenter handles
reinsurance transactions for the type of agreement. For more information, see “Handling of Transactions for
Reinsurance Agreements” on page 468.
Policy Loss Date Transaction

Agreement Type Treaty Facultative Per Risk Aggregate Attachment Attachment Generation
Non-proportional
Annual Aggregate • • • reporting
Per Event • • • reporting
Excess of Loss • • • • configurable
Net Excess of Loss • • • • configurable
Facultative Excess of Loss • • • configurable
Facultative Net Excess of • • • configurable

Loss
Proportional
Quota Share • • • automated
Surplus • • • automated
Facultative Proportional • • • automated
The Policy Attachment column shows the types of agreements that apply to all losses against the policy for the
entire term. Excess of Loss and Net Excess of Loss treaties can be specified as either policy attachment or loss date
attachment.


chapter 43
Reinsurance Management in
ClaimCenter
This topic describes how to work with Guidewire Reinsurance Management in ClaimCenter.
For a general overview of reinsurance, see “Reinsurance Management Concepts” on page 455.
Reinsurance in ClaimCenter
Insurance companies must correctly identify claims that qualify for reinsurance. Otherwise, leakage occurs.
ClaimCenter helps the insurer reduce this leakage by providing features that support tracking reinsurance
agreements that apply to specific claims and retrieving recoverable amounts from the reinsurers.
ClaimCenter sets up this information in two steps:
• ClaimCenter retrieves reinsurance agreements – ClaimCenter retrieves information about how the insurer’s
reinsurance applies to individual policy risks when an exposure is created against that risk in a claim.
ClaimCenter pulls over the reinsurance agreements that apply to the exposures on a claim and groups them
according to the policy risk.
• ClaimCenter provides a way to create reinsurance transactions – ClaimCenter uses the information retrieved
to create reinsurance transactions. These transactions can then be sent to a billing system to collect the money
that the reinsurer owes the insurer.
Reinsurance Agreements Retrieval

ClaimCenter retrieves all reinsurance agreements associated with a particular risk from the external reinsurance
system of record when exposures are added to the claim. ClaimCenter refers to this set of agreements as an
agreement group.
Reinsurance Management in ClaimCenter 467

Note: ClaimCenter does not retrieve reinsurance agreements for unverified policies or for exposures that do not
have a coverage. Because the identity of the risk is required, reinsurance agreements are retrieved only when
exposures are created by coverage, and not by coverage type.
Reinsurance agreement information for a claim is on the Reinsurance→Reinsurance Financials Summary screen. In the
base product, this screen is available to a user with the Reinsurance Manager role. It is also available to a user who
has been granted the View RI Transactions and Agreements permission riview. Agreements can be edited by a user
with the Reinsurance Manager role or by a user who has been granted the Edit RI Transactions and Agreements
permission riedit.
See also
• To enable reinsurance retrieval, see the Integration Guide.
Reinsurance Transactions
In some circumstances, the base configuration of ClaimCenter automatically creates reinsurance transactions when
the corresponding regular claim financial transactions are created. These transactions include reserves and payments.
A user with the Reinsurance Manager role or with the permissions to view and edit reinsurance transactions and
agreements, riview and riedit, can also create and edit reinsurance transactions. Users with riview permission
can view these transactions in read-only mode.
Reinsurance Transaction Types

There are two kinds of reinsurance transactions. The following reinsurance transactions are fundamental to the
ClaimCenter reinsurance management process:
• Ceded reserve – A reserve created for the portion of reserves that the reinsurer must cover.
• Reinsurance (RI) recoverable – A transaction to track the amount to be billed to the reinsurer. An RI
recoverable is the portion of the payment that the reinsurer must cover.
Note: RI recoverables are different from normal claim recoveries, in that RI recoverables are created when the
reinsurer is to be billed. Normal claim recoveries are entered when the recovery is received by the insurer.
All reinsurance transactions are created based on the regular financial transactions created for the claim.
ClaimCenter identifies potential reinsurance ceded reserves and recoverables for a claim in the
Reinsurance→Reinsurance Financials Summary screen. To see this screen, you need either the Reinsurance Manager role
or the riview and riedit permissions described previously under “Reinsurance Agreements Retrieval” on page
467.
Automatically Creating Reinsurance Transactions

ClaimCenter automatically creates reinsurance transactions under the following conditions:
• There must be at least one reinsurance agreement associated with the exposure.
• The agreement is a proportional agreement.
• The claim financial transactions have reached Submitting status.
It is also possible to configure ClaimCenter to automatically create transactions for non-proportional agreements.
Handling of Transactions for Reinsurance Agreements

The table in “Summary of Agreement Types” on page 465 summarizes reinsurance agreements and shows how
reinsurance transactions are handled in ClaimCenter. The final column of that table shows that reinsurance
transaction calculation is automated in ClaimCenter for proportional agreements and can be configured for non-
proportional per risk agreements. For per-event and aggregate agreements, you can use reporting to calculate
reinsurance recoveries.
Reinsurance recoveries are calculated correctly by the system only if all agreements that apply to a risk are
proportional. When both proportional and excess of loss agreements apply to a risk, the recoveries are calculated by
ignoring the reinsurance recoverable from the excess of loss agreement.
468 chapter 43 Reinsurance Management in ClaimCenter
Setting up Reinsurance Users and Groups

Reinsurance processing is a separate process from claims adjudication. In the base configuration of ClaimCenter,
reinsurance processing is handled by a separate type of Reinsurance Manager user in a special Reinsurance Unit.
The Reinsurance Manager user can see and edit all data in ClaimCenter that is associated with reinsurance.
The adjuster can see if a claim has been marked for reinsurance and, if so, the Reinsurance Manager who has been
assigned. The insured has no knowledge of reinsurance.
Reinsurance Manager Role

The base configuration of ClaimCenter provides a Reinsurance Manager role that has the permissions required for a
user to work with reinsurance. A user who has this role can:
• View and perform edits on the Reinsurance→Reinsurance Financials Summary screen of a claim.
• View and edit the reinsurance reportable information on a the Claim Status screen of a claim, at Summary→Status.
• View and edit the Reinsurance Thresholds screen. Click the Administration tab and navigate to Business Settings
→Reinsurance Thresholds. See “Managing Reinsurance Thresholds” on page 545.
• View and edit other claim information, including sensitive data, without ACL-based restrictions.
The Reinsurance Manager, just like anyone else who can view a claim, can also:
• See all reinsurance notes in the Summary screen of a claim, at Summary→Overview.
• See if a Reinsurance Manager has been assigned to a claim on the Parties Involved→Users screen of a claim.
See also
• For a list of Reinsurance Permissions, see “Reinsurance Permissions” on page 469.
Reinsurance Permissions
The following permissions are specific to reinsurance and can be seen in the Reinsurance Manager role. Click the
Administration tab and navigate to Users & Security→Roles to see the complete list of permissions for the Reinsurance
Manager in the base configuration.
Permission Name Code Description

Edit reinsurance reportable reinsuranceedit Can edit the reinsurance reportable status on a claim
Edit reinsurance reportable thresholds reinsthresholdedit Can edit the reinsurance reportable thresholds
Edit RI transactions & agreements riedit Can edit reinsurance transactions and agreements
View reinsurance reportable thresholds reinsthresholdview Can view the reinsurance reportable thresholds
View RI transactions & agreements riview Can view reinsurance transactions and agreements
Ignore ACLs ignoreacl Can view claim information without restrictions
Other user roles can be set to use one or more of these permissions. These permissions can also be used to set
visibility of certain regions of the user interface.
Setting up Reinsurance Users and Groups 469

Note: The Edit reinsurance reportable thresholds permission is included for compatibility with previous versions of
ClaimCenter. The reinsurance thresholds on the Reinsurance Thresholds screen are not used in the base configuration
of ClaimCenter. To access this screen, click the Administration tab and navigate to Business Settings→Reinsurance
Thresholds.
Reinsurance Unit Group Type

Typically, a user in the Reinsurance Manager role is in a group with a group type of Reinsurance Unit. Besides
serving as a grouping mechanism, the Reinsurance Unit group type is used as the basis for assigning reinsurance
activities.
Reinsurance Unit Group Activity and Claim Assignment

Users with the Reinsurance Manager role, or users who have a role with added reinsurance permissions, can have
activities and claims assigned to them. For this assignment to happen, they must be part of a user group with the
group type Reinsurance Unit. In the base configuration, ClaimCenter assigns a reinsurance manager to a claim and
creates a Review Claim for Reinsurance activity based on the group type.
Every reinsurance agreement has a notification threshold, defined as the point at which the reinsurer needs to be
contacted. The notification threshold is a monetary amount. When the gross total incurred on an exposure is greater
than the notification threshold of any agreement in the exposure’s associated agreement group, ClaimCenter does the
following two things:
• Assigns a reinsurance manager to the claim, if one has not been already assigned.
• Creates a Review Claim for Reinsurance activity and assigns it to the reinsurance manager.
In the DefaultGroupActivityAssignmentRules ruleset, the rule DGA04000 - Assign reinsurance review activity to reins user
accomplishes this task. The rule uses one of the following activity patterns:
◦ claim_reinsurance_review
◦ reinsurance_review
◦ reinsurance_needs_synchronization
These same two actions are taken when a claim has been marked as Reinsurance Reportable on the Claim Status
screen at Summary→Status.
You can create the Review Claim for Reinsurance activity on a claim manually. With the claim open, navigate to
Actions→New Activity→Reminder→Review Claim for Reinsurance. This activity is also assigned to a member of a group
with group type Reinsurance Unit.
Identifying the Reinsurance Manager Assigned to a Claim

After a reinsurance manager has been assigned to a claim, you can see the user listed on the claim’s Parties
Involved→Users screen.
Working with Reinsurance Agreements and Transactions

ClaimCenter provides visibility into reinsurance agreements and financials to users in the Reinsurance Manager role
or with riview permissions. To access the Reinsurance Financials Summary screen, open a claim and click Reinsurance
in the sidebar.
The Reinsurance Financials Summary screen helps identify agreements applied to a claim, their ceded reserves, and their
reinsurance recoverables by showing four types of information:
• The reinsurance agreements that apply to the loss on the claim.
• The percentage that an agreement shares in the loss, if the agreement is a proportional agreement.
• The ceded reserve line for each reinsurance agreement. For proportional agreements, this reserve is automatically
calculated by multiplying the reserve line by the proportional share.

• The reinsurance recoverable amount for each agreement. For proportional agreements, this amount is
automatically calculated each time a payment is made on the claim by multiplying the payment amount by the
proportional share.
You can edit the calculated reserve and recoverable amounts by manually entering amounts related to the non-
proportional agreements, such as excess of loss treaties and facultative agreements.
The information that appears on the Reinsurance→Reinsurance Financials Summary screen can be sent to a financial
system. For example, the information could be used to send notifications of reinsurance recoverables and invoice the
reinsurers.
Viewing Reinsurance Financials

The main reinsurance screen in ClaimCenter, Reinsurance Financials Summary, has information about reinsurance
financials. To access this screen, open a claim and click Reinsurance in the sidebar.
The top of the screen shows the Reinsurance Financials Summary. This summary has three columns:
• Submitted Claim Financials – Summaries of the claim financials without reinsurance.
• Reinsurance Financials – Reinsurance financials by themselves.
• Claim Financials with Reinsurance – Claim financials when reinsurance financials are included.
The section below the summaries shows a list view of all the reinsurance agreements that are associated with
exposures on this claim. For each agreement, ClaimCenter shows the associated exposure and the agreement name
in the Agreement column and other relevant information, such as:
• Start – For example, the attachment point of an Excess of Loss agreement.
• End – For example, the recovery limit of an Excess of Loss agreement.
• Proportional Share – Applicable if this agreement is a proportional agreement.
• Exceeds Not. Threshold – Whether or not the exposure has passed this agreement’s notification threshold.
• RI Recoverable – The amount to be billed to the reinsurer—the portion of the payment that the reinsurer must
cover.
• Ceded Reserves – The amount of the reserve that the reinsurer must cover.
Clicking the name of any agreement in this list view opens the Agreement Details screen. The top of the Agreement
Details screen has all the details of the individual agreements as they were supplied to ClaimCenter. The bottom of
this screen has the details of how each reserve line on every exposure associated with this agreement mapped its
financials to the reinsurance financials.
Manually Edit Reinsurance Transactions

About this task
The reinsurance manager can manually edit or add reinsurance transactions.
Procedure
1. Click the Edit link on the line for each agreement in the Reinsurance Financials Summary list view.
This action takes you to the Adjust Recoverables screen.
2. Modify the Ceded Reserves and RI Recoverable.
3. Enter a reason for the adjustment.
Managing Reinsurance Agreements and Agreement Groups

On rare occasions, it might be necessary for the reinsurance manager to add or edit reinsurance agreements or
agreement groups in ClaimCenter. You can edit only the agreements and agreement groups that were added in
ClaimCenter.
Working with Reinsurance Agreements and Transactions 471

In the base configuration, you cannot edit or delete agreements and agreement groups that were retrieved from an
external system. You also cannot add an agreement created in ClaimCenter to an agreement group that was retrieved
from an external system. Additionally, you cannot add exposures to or remove exposures from externally retrieved
agreement groups.
The reinsurance manager can add, edit, move, and delete eligible reinsurance agreements.
Add New Reinsurance Agreements
Procedure
1. Open the Reinsurance Financials Summary screen by opening a claim and clicking Reinsurance in the sidebar.
2. Click Add Agreement and choose the agreement type.
3. Add an agreement group if needed.
All new agreements must be associated with an agreement group
Edit New Reinsurance Agreements
Procedure
2. Click the name of a reinsurance agreement to open the Agreement Details screen.
3. Edit the details of the agreement.
Move Exposures to Another Agreement Group
Procedure
2. Click Manage Exposures to open the Exposures and Reinsurance screen.
3. Move the exposures to a different agreement group.
Delete Reinsurance Agreements
Procedure
2. Click the name of a reinsurance agreement to open the Agreement Details screen.
3. Click the Delete button to delete the reinsurance agreement.
When you delete a reinsurance agreement, the RI ceded reserves and RI recoverable calculated automatically
by the system are zeroed. If there are manually entered RI transactions on the reinsurance agreement being
deleted, you must manually zero out the adjustments to be able to delete the reinsurance agreement.
Manually Retrieve Reinsurance Agreements

About this task
Manual retrieval can be useful in some cases. For example:
• If an exposure that was not associated with a risk was added to the claim, the reinsurance agreements for that
exposure would not have been retrieved when it was created. For example, you create the exposure by using the

create exposure by coverage type method. After the exposure has been associated with a risk, the reinsurance
manager can retrieve the proper agreements manually.
• If the reinsurance agreements have been changed in the source system since the initial retrieval in ClaimCenter,
manual retrieval updates ClaimCenter with the proper information.
Procedure
1. Access and open a claim.
2. Navigate to the Reinsurance→Reinsurance Financials Summary screen.
3. Click Manage Exposures to open the Exposures and Reinsurance screen.
4. Click the Retrieve Reinsurance button to force a retrieval from the reinsurance system of record.
Mark a Claim as Reinsurance Reportable

About this task
When an exposure is set up on a claim, the claim is also automatically marked to show whether reinsurance is
applied to it. This indicator is set in the Reinsurance Reportable? field on the Claim Status screen. An activity is also sent
to the reinsurance manager to review the reinsurance information for this claim.
You can manually mark a claim to be reported for reinsurance. You might manually mark a claim if you think
reinsurance applies to the claim, but no reinsurance agreements have been pulled over from the reinsurance system.
Note: Marking a claim as reported for reinsurance does not retrieve reinsurance agreements from the external
reinsurance system of record or automatically create reinsurance transactions.
Procedure
1. Open the claim and navigate to Summary→Status to open the Claim Status screen.
2. Click Edit and, in the General Status section, select Yes for the Reinsurance Reportable? field.
3. Provide a reason in the Reinsurance Edit Reason field.
Result
This action creates:
• A note you can see on the Summary screen in the Latest Notes section.
• A Review Claim for Reinsurance activity.
Associate Claims for Reinsurance

About this task
You can associate claims with one another. Associating claims enables the reinsurance manager to run reports to find
examples of reinsurance-related associated claims and analyze them for reinsurance reportability.
Procedure
1. Open the claim and navigate to Loss Details→Associations.
2. Click New Association.
3. Enter a title for this association.
4. Click Add and enter the claim number to associate with this one.
5. Click Update.
Mark a Claim as Reinsurance Reportable 473


part 10
PolicyCenter Administration
chapter 44
Users, Groups, and Regions
ClaimCenter organizes people into Users, Groups, and Regions. A user is someone, such as an employee of an
insurer, with permission to use ClaimCenter. Users then form work-related groups, which you can further aggregate
into regions. The Administration tab models this structure and presents it in the Sidebar in a tree view.
See also
• “Security: Roles, Permissions, and Access Controls” on page 487 for additional details about how ClaimCenter
uses this structure to enforce security
• “Work Assignment” on page 203 for a description of how ClaimCenter assigns work to groups and users
• “Managing Users and Groups” on page 514 and “Search for Regions” on page 524
• “Create New Users and Groups” on page 515
• “Manage Users” on page 515
• “Manage Attributes” on page 517 and “Managing Authority Limit Profiles” on page 519
• “Manage Groups” on page 516
• “Managing Regions” on page 524
Understanding Groups
The basic way ClaimCenter organizes a carrier’s employees, the people available to handle claims, is the group. A
group’s members can either be other groups—teams or subgroups—or users, people who work on claims. Groups
are often defined to mirror the carrier’s organizational structure—a main office has departments that contain
divisional offices that control local offices, and so on. But groups can also be defined virtually. A virtual group is a
set of people who are not part of the same team or department, but who are related in some other way. For example,
a virtual group could contain all adjusters in a large region with expertise in commercial arson. The members do
normal work in different local offices and are members of their own office groups as well.
All the carrier’s groups must form a regular hierarchy, a tree structure, in which each subgroup has a single parent
and zero or more child groups. There is no limit to the number of levels in this tree. Such a group hierarchy can
model any organization. The parent can be the home office, which has regional offices as its children, which in turn
could have children corresponding to different lines of business. These lines of business in turn could have local
offices as their children. Virtual groups can also be part of this hierarchy.
Users, Groups, and Regions 477
Groups have the following additional properties:

• There can be only one group with no parent. This group is the top level, root group.
• There is no limit to the number of members and child groups—subgroups—a group can have.
• A group always has one supervisor. Guidewire recommends that the supervisor be a member of the group. While
a supervisor is not required to be a member of the group, making the supervisor a group member is often useful.
For example, it is likely that you will want group work like pending claim assignments to be assigned to the
group supervisor.
• A group can be associated with one or more regions, which can be specified in assignment rules.
• Groups control data security. Each group is a member of a single security zone.
• A default rule set governs how work is assigned to a group. Each group can have its own default rule sets that can
assign activities, claims, exposures, and matters to it.
• A group is described further by its group type, used in rules to determine if work is to be assigned to the group.
• Similar to users’ having individual load factors that indicate the ideal distribution of work in a group, a group
itself can have a load factor, which assignment rules can consider.
Administrators add, edit, and delete groups, and can do the same with their members. Editing a group includes
choosing its parent group and supervisor, and setting its region, group type, security zone, and permissions to change
load factors. You can delete a group only if it is empty and has no child groups. Otherwise, you break the tree
structure and create orphan users.
Understanding Users
Users are people who are permitted to log into ClaimCenter. They are involved with the process of settling claims.
The goal of assignment is to assign work to users, which makes them owners of that work. After assigning work to
the correct group, you or a rule pick a user from that group. Therefore, each user must belong to at least one group.
Each user is characterized by:
• Credential – Defines a user name and password for logging into ClaimCenter.
• Roles – Restrict what the user can view and work on. For more information, see “Role-Based Security” on page
488.
• Authority Limits – Cap the monetary amount of financial transactions the user can authorize. See “Managing
Authority Limit Profiles” on page 519.
The following additional user characteristics help in the assignment process:
• Location information – Includes name, address, email, and phone and fax numbers. The address can be used to
assign based on proximity.
• Custom user attributes – Examples are languages spoken or a special expertise, like familiarity with fraud
investigation.
• User experience rating – Helps in steering complex claims away from new adjusters.
• User role – Examples are doctor, lawyer, vehicle inspector, police, or fraud investigator, called Special
Investigator in ClaimCenter.
• Load factor – Gives the correct proportion of work to a part-time or apprentice adjuster. ClaimCenter uses load
factors to balance the number of work assignments among all the users in a group. Other load factors allow
balancing work across groups.
• Vacation status – Can be used to prevent new work from being automatically assigned to someone who is out of
the office.
Administrators define users, giving them membership in groups as well as the characteristics listed previously. Both
the Team tab and the Administration tab have User Profile screens that enable administrators to define and edit these
characteristics. Users can also be imported into ClaimCenter.
478 chapter 44 Users, Groups, and Regions

It can be useful to make users members of several groups. An experienced fraud investigator can be a member of:
• A region’s Special Investigation (SI) team, a special group.
• The local office group. This group mirrors the user’s position in the company and reporting relationship.
Multiple memberships make it easier for assignment rules to find the user because the rules take different paths
down the group hierarchy.
Understanding Roles
Users have one or more roles, which are a collection of permissions. Permissions enable users to create, view, edit,
and delete various ClaimCenter objects. For example, assigning a claim to a user who is an adjuster guarantees that
the user has the necessary permissions to complete the work.
Custom User Attributes

ClaimCenter provides a general way to describe user attributes that is helpful in deciding how to assign work. There
is also a rule that assigns work based on these attributes. The rule selects the user with the attribute who has waited
longer for this type of work than any other user with the same attribute.
These attributes are found in the UserAttributeType.ttx typelist, accessible through Guidewire Studio. In the
base configuration, this typelist contains the typecodes default, Account, Expertise, and Language. You can
extend this typelist.
Custom user attributes themselves have optional attributes that increase their usefulness.
• Type – A way to group custom user attributes. For example you can give French and Spanish the type Language.
• State – Defines where the attribute is valid. An expert in workers’ compensation claims usually has expertise in
just one state.
• Value – Defines an integer value for an attribute. Language fluency might be rated on a 1-5 scale.
Custom user attributes are listed in the Administration tab on the Users & Security→Attributes screen. An administrator
can create user attributes in the Attributes screen and apply them to users.
Create User Attributes

Before you begin
To be able to create custom user attributes, you must be logged in to ClaimCenter as an administrator.
Procedure
1. Select the Administration tab and click Users & Security→Users in the Sidebar menu.
2. Search for a user.
3. Click the Attributes card and click Edit to add an attribute for that user.
4. Specify Type, State, and Value settings for that user.
User Roles
Users can also possess one or more user roles, which are distinct from regular roles. User roles are granted to a user
for a specific claim. User roles include doctor, attorney, nursing care manager, and so on. You can define or remove
user roles in Guidewire Studio in the UserRole.ttx typelist.
Use Gosu in rules to assign work to a user with a specific user role. The method
claim.assignToClaimUserWithRole assigns work to a user with a specific user role, who is also a member of the
group that owns the claim. The claim must already be assigned to a group before this method is useful.
An example of user role assignment is a workers’ compensation claim that requires a nursing case manager.
ClaimCenter, through assignment, makes the user with the role of adjuster the owner of the claim. However
Understanding Roles 479
ClaimCenter might assign activities or even an exposure to a user with the user role of nursing case manager. As a
user, the case manager can also have assigned roles, which give access to the claim screens related to the case
manager’s work. However, the case manager is prevented from viewing other claim information. If this case
manager were assigned to an exposure, the exposure could be reassigned to the claim owner after the activities were
completed.
Users granted a user role on a claim or exposure have the same permissions as the claim or exposure owner on that
entity. The same is true for contacts granted a contact role. Constraints on user roles can restrict these permissions.
Also, administrators can grant ACL permissions to users with specific user roles.
Grant a User a User Role
About this task

Assigning a user role already in the UserRole.ttx typelist is subject to conditions, or constraints, defined in the
UserRoleConstraint typelist.
Procedure
1. Open a a claim.
2. Navigate to Parties Involved→Users.
3. Select the user to open the User Details screen for that user.
4. In the User Details screen, click Edit.
5. In the Roles section, click Add.
6. Click the Role field in the new row and choose a role from the drop-down list.
Grant a Contact a Contact Role
About this task

You can grant contact roles to contacts. Some contact roles are constrained from being given to certain classes of
contacts. For example, a person, but not a vendor, can be given the role of supervisor. In Guidewire Studio, the
ContactRole.ttx typelist contains all defined contact roles. The typecodes in the ContactRoleCategory.ttx
typelist define the constraints governing to whom the contact roles can be given.
Procedure
1. Open a a claim.
2. Navigate to Parties Involved→Contacts.
3. Select the contact to open the contact’s detail view below the list of contacts.
4. On the Basics tab, and click Edit.
5. In the Roles section, click Add.
6. Click the Role field in the new row and choose a role from the drop-down list.
Constraints on User and Contact Roles

Granting a user a user role gives that user access to the claim. However, you can restrict users with a specific user
role from working on a claim unless they have the correct system permissions. You can also limit the number of
users with a specific role. Apply these restrictions by using the following user role constraints:

User Role Constraint Definition

ObjectOwner The user given a user role on an object must have the same permissions needed to own the object.
Default value is true.
ClaimExclusive Each claim can have at most one user given this user role. Default value is true.
ExposureExclusive Each exposure can have at most one user assigned to this role. Default value is true.
The entityroleconstraints-config.xml file defines how role constraints are used.

See also
Assign a User an Experience Rating
About this task

All users can be granted an experience attribute by an administrator from the choices in the
UserExperienceType.ttx typelist. In the base configuration, this typelist contains typecodes describing level of
experience: low, medium, and high. Assignment rules can use this characteristic to keep complicated work from
inexperienced users.
Procedure
1. Click the Administration tab and navigate to Users & Security→Users and find a user.
2. On that user’s User Details screen, click Edit and then click the Profile card.
3. In the Extended Profile section, chose a level from the Experience Level drop-down list.
Load Factors
Not all members of a group are equal. Supervisors, new hires, members who belong to other groups, and those
working on special projects can have a reduced workload when work is distributed. To balance workloads,
administrators assign each user a number from 0 to 100 to reflect the percentage of the group’s normal workload
each user must have.
This number, called a load factor, appears in manual assignment screens to help in manual assignment.
Round-robin automatic assignment rules take these load factors into account. These rules assign only half the work
to a user with a load factor of 50 that they assign to others in the same group. The algorithm assigns equal amounts
of items because it cannot know how difficult each item is.
See also
• “Team Management” on page 443 for information on setting a user’s load factor.
Workload Counts
After becoming a member of multiple work teams, a user can be assigned a full workload as a member of each team.
This assignment does not take into account the workload the user is assigned as a member of other groups. Besides
using load factors, ClaimCenter manages this potential problem by providing a summary of the total of all the work
assigned to each user.
Supervisors see total workloads by using the Team tab. Each member of a supervisor’s group is listed. The table
shows all activities, claims, exposures, matters, and subrogations assigned to that member. Information is broken
down by whether each item is new, open, flagged, closed, or overdue, or completed today, depending on the work
category. Not all these types are shown for each work category. In each category, the table shows the total count of
items assigned to the user as a team member as well as the entire total. Weighted workload values are also shown for
each team and team members. Supervisors can use this information to reduce overworked subordinates’ load factors.
User Roles 481

Gosu functions can also return this information. For example, auto-assignment rules can exclude overworked users
from round-robin assignment or to reduce their load factors.
ClaimCenter updates these global numbers hourly when running the Statistics batch process.
See also
• “How ClaimCenter Assigns Work” on page 205
• “Calculating Team Statistics” on page 450
Assign a User Inactive or Active Status
About this task

A user always has the status of active or inactive. After becoming inactive, a user cannot log into ClaimCenter and
cannot be assigned anything. Only an administrator can change this status.
Procedure
1. Click the Administration tab and navigate to Users & Security→Users and find a user.
2. In the detail view for the user, click Edit and then click the Basics card.
3. Set Active to Yes or No.
Related Users
Related users are users or contacts who either:
• Have a user role on the claim.
• Own the claim, or one or more of its exposures, activities, or matters.
By contrast, a claim user is a person meeting the second criteria of having been assigned work on the claim.
See also
• “User Roles” on page 479
View all Related Users on a Claim
About this task

To see all related users on a claim, as well as all the claim’s other users, do the following.
Procedure
1. Open a claim.
2. Navigate to Parties Involved→Users.
Result
This screen lists all users on the claim and shows the relationship of ClaimCenter users to the claim. It describes
both the work assigned and the users’ user role on the claim, if any. You can edit this screen to grant or remove user
roles, but not assignments. After a user has no work to complete and has no user role on the claim, ClaimCenter
removes the user from the claim or exposure and from this list.

View All Claims on which You Are a Related User
Procedure
1. Click the Desktop tab and then click Claims.
2. On the Claims screen in the filter drop-down list choose either of the following filters:
• All opened related
• New related (this week)
If you own an exposure, this filter lists you as a related user on the claim.
3. View all claims on which you are a related user.
View All Exposures on which You Are a Related User
Procedure
1. Click the Desktop tab and then click Exposures.
2. On the Exposures screen in the filter drop-down list choose either of the following filters:
• All opened related
• New related (this week)
Both these filters return claims or exposures owned by the user, but not claims and exposures for activities or
matters owned by the user.
3. View all exposures on which you are a related user.
View All Claims on which You Are Assigned Work
Procedure
1. Click the Desktop tab and then click Exposures.
2. In the filter drop-down list choose All open owned or New opened (this week).
3. Click the Desktop tab and then click Activities to view all your activities.
View All Matters Related to a Specific Claim

There is no screen that shows all matters that you have been assigned. However, you can view all matters related to
a claim.
1. Open a claim.
2. Click Litigation in the Sidebar menu.
3. All matters assigned to anyone for that claim are listed in the Matters screen.
Understanding Assignment Queues

ClaimCenter creates, maintains, and displays queues of activities for each group.
In the Assignment rules visible in Guidewire Studio, a call to activity.assignActivityToQueue assigns the
current activity to the current group. It also generates the necessary queue if it does not already exist.
Only activities can be assigned to a queue. Claims, exposures, and matters cannot be assigned to a queue. However,
there is a way to use queues to indirectly assign claims, exposures, and matters.
Related Users 483

Using a Queue to Assign Claims

Although only activities can be assigned to queues, they can be used to indirectly assign claims, exposures, or
matters. The following example describes how to use a queue to assign first notice of loss (FNOL) claims. After
importing an FNOL, ClaimCenter triggers the rule sets in the following table. These rule sets generate review
activities and put them in a queue. A group member then takes an activity from the queue and completes it by
manually assigning the FNOL to a final user and group. The following table summarizes these tasks:
Task performed by a rule Rule set Action performed by rule

Assign FNOL claim to an intake Global Claim Assignment Select the current group that makes the final claim
group. Rules assignment.
Assign claim to the group Default Group Claim Assign the claim to a temporary owner until it can be
supervisor. Assignment Rules properly assigned.
Create FNOL review activity. Claim Workplan Use a pre-defined activity pattern to make a new activity.
Assign FNOL review activity to Global Activity Assignment Both the claim and the activity have the same current
same group. Rules group.
Assign FNOL review activity to Default Group Activity A current group’s user takes the activity from the queue and
queue. Assignment Rules manually assigns the claim to another group and user.
Using the Pending Assignment Queue

After assignment selects a group, the confirmManually method puts an activity for manually assigning the work in
that group supervisor’s Pending Assignment queue. By completing this activity, the supervisor assigns the related
work. For example:
activity.CurrentAssignment.confirmManually(activity.CurrentAssignment.AssignedGroup.Supervisor)
Until supervisors are comfortable with automatic assignment, rules can put most work into their pending assignment
queues. The Pending Assignment queue is part of the Desktop, but visible only by administrators and supervisors.
Understanding Regions
A region is a named area that contains one or more states, postal codes, or counties. For example, you can define a
Western US region that includes the states California, Nevada, and Washington. You can also configure the
application to use other address elements, such as Canadian provinces, to define regions.
Define as many regions as you want. The regions can overlap. State-level regions can describe the office to which a
claim is sent. A postal code or county-level region might govern which person is assigned to inspect a damaged
vehicle.
You can assign users and groups to cover one or more regions, and ClaimCenter can associate its business rules to
provide location-based assignment. For example, a claim has a loss location of California. ClaimCenter can
determine that the responsibility falls in the Western region and then assign that claim to a group that covers that
region.
A group can also cover multiple regions. For example, you define one region to be Arizona and New Mexico, and
another region to be all counties in Southern California. You can then assign both these regions to your Southwest
Regional Office.
How Regions Compare to Security Zones

Use regions for assignment. Administrators can define the regions and assign them to groups by using Assignment
by Location rules. In the base configuration, a region is a defined collection of states, ZIP codes, and counties, and
one region can overlap another. A group can belong to multiple regions.

Security zones, however, are only names. They are not defined as collections of geographical areas such as states. A
group can belong to just one security zone. An administrator performs add, edit, and delete operations in the Security
Zones menu item of the Administration tab. See “Managing Security Zones” on page 536.
Working with Regions

You can create and edit regions, associate them with groups, and assign work to groups based on the region they are
in. In the base configuration, a user with the role User Admin has the permissions required to perform these tasks.
The following graphic shows the screen you use to create a region:
Create a Region
Procedure
1. Click the Administration tab and navigate to Users & Security→Regions→Add Region.
2. Enter a name and pick a type: state, ZIP code, or county.
3. Choose the items appropriate to the type and click Update.
If picking a group of items that are ZIP codes or counties, they can come from many states.
Edit a Region
About this task

In addition to editing an existing region, you can also rename a region. However, because renaming effectively
deletes the original region, Guidewire recommends avoiding renaming. Instead, create a new region with the new
name.
Procedure
1. Click the Administration tab and navigate to Users & Security→Regions and select a region.
2. Click Edit and choose the type.
3. Add or remove states, ZIPs, or counties.
Understanding Regions 485

Delete a Region
About this task

Guidewire recommends that you avoid deleting regions because deleting a region can result in leaving users without
a region. Instead, create and use new regions. See “Create a Region” on page 485.
Procedure
1. Click the Administration tab and navigate to Users & Security→Regions and select the check box for a region.
2. Click Delete.
Associate a Group or User with a Region
About this task

You assign users to a region by adding the region to a group they belong to.
Procedure
1. Click the Administration tab and navigate to Users & Security→Groups, and then find and select a group.
2. Click the Regions card.
3. Click Edit.
4. Click Add and then search for regions.
5. Select one or more regions in the list by clicking their check boxes, and then click Select.
Next steps
See also
• “Remove a Region from a Group” on page 486
Remove a Region from a Group
Procedure
1. Click the Administration tab and navigate to Users & Security→Groups, and then find and select a group.
2. Click Edit.
3. Click the Regions card.
4. Click the check box next to each region you want to remove from the group.
5. Click Remove.
Next steps
See also
• “Associate a Group or User with a Region” on page 486

chapter 45
Security: Roles, Permissions, and

Access Controls
Security is critically important for both general data and financial information. For example, an insurer does not
want the details of a famous client’s claim to appear in the tabloids. The insurer also does not want an adjuster to
have sole control over claim payments made to the spouse. Therefore, ClaimCenter implements the following types
of security methods:
• Role-based security – Defines the actions you are allowed to perform. This type of security includes defining
permissions, bundling groups of related permissions into roles, and assigning these roles to users based on the
ClaimCenter work they must perform. Role-based security applies to all entities. For example, if you can access
one claim, you can access all claims.
Following are examples of role-based security:
◦ Give legal staff access to a very limited view of any claim file, mostly to matters.
◦ Give nursing care managers access to injury exposures, but not property exposures, on all claims.
◦ Data-based security – Defines what data you have access to. ClaimCenter can segregate the claims and other
entities it provides into different subsets, or security levels, and restrict access to sensitive data by using claim
access control. Data-based security can also be implemented for notes, documents, and exposures. This type of
security provides you access to some categories of claims, but not to others.
Data-based security can also grant different levels of authority to users in different groups or security zones.
For example, certain claim summaries might be visible to all adjusters in the same security zone. However,
only the adjusters in the same office handling the claim could edit them. For more information, see “Security
Zones” on page 504.
Following are examples of data-based security:
▪ Restrict owners of bodily injury and vehicle damage exposures to accessing only the documents, notes, and
activities related to these respective exposures.
▪ Control access to claims filed by your employees or access to other types of sensitive claims.
▪ Give users access to a claim only if they have an assigned activity or exposure on that claim.
▪ Grant users the ability to edit a claim if they are in the same group as users who own that claim.
Security: Roles, Permissions, and Access Controls 487

▪ Grant users the ability to view a claim if they are in the same region as the user who owns that claim.
Role-Based Security
Use role-based security to define the actions a user of ClaimCenter is allowed to perform. Working with this type of
security includes defining permissions, adding related permissions to roles, and assigning these roles to users based
on the work they perform. Role-based security applies to all entities.
Permissions
The fundamental units of security in ClaimCenter are permissions. With proper authority, you can create
permissions. After they exist, you can group permissions into roles and assign one or more of these roles to each
user.
Note: You can also bundle permissions into claim security types and use access control to restrict user access to
certain claims. See “Claim Security Types” on page 492.
Permissions cover all data of the same type. For example, permission to view a claim is permission to view all
claims. No claim can be excluded from this permission.
Permissions are always in force. You can never override or ignore them. However, it is possible to override use of
access control, as described in “Configuration Parameters That Affect Access Control” on page 491.
There are two subcategories of permissions. These permissions can either affect which screens of the user interface
you can access or restrict the entities you can view or manipulate:
• Screen permissions – Control access to a particular screen. With proper permission, an administrator can create
new screen permissions, collect them into groups by using roles, and assign the roles to users.
• Domain permissions – Relate to a specific ClaimCenter entity, like a claim or a bulk invoice. The most
important entities have domain permissions associated with them. Only ClaimCenter can define these permission.
An administrator can add these permission to roles and then grant these roles to users.
Narrowly Defined Permissions

Typically, individual permissions restrict access in very narrow and specific ways. For example, over two dozen
permissions relate to viewing and editing claims. A similar number affect exposures, such as viewing claim contacts
or editing loss details.
Some permissions can be even more narrowly defined. For example, the permission to edit claim storage
information, StorageUpdate, restricts access to a screen that is part of the Loss Details screen. The screen contains
information that tracks paper documents associated with the claim. People who store boxes of files need permission
to edit this page so they can record where the paper files have moved. But they are not adjusters. Therefore, they
cannot have the broader permissions required to edit loss details, which govern access to the entire loss details
screen, including the page they need permission to edit.
Roles
A role is a collection of permissions. By grouping permissions into roles, a user’s authority can be precisely defined
by a few assigned roles, rather than by a much larger list of permissions. A user must have at least one role and can
have any number of additional roles.
Working with Permissions and Roles

You use Guidewire Studio to add or remove permissions themselves. To create roles, add permissions to roles,
remove permissions from roles, modify roles, and assign roles to users, you use ClaimCenter administration screens.
488 chapter 45 Security: Roles, Permissions, and Access Controls

Note: You must be logged in as an administrator to be able to access the Administration tab. Additionally, you must
have a role with the Manage Roles and View Roles permissions to be able to view and edit the Roles screen.
Create a Permission and Apply It to a Screen
About this task

You can create a new permission and apply it to a screen.
Procedure
1. Start Guidewire Studio.
At a command prompt, navigate to the ClaimCenter installation directory and enter gwb studio.
2. Press Ctrl+Shift+N and enter SystemPermissionType, and then double-click SystemPermissionType.ttx
in the search results.
3. Add the permission name and typecode to the SystemPermissionType.ttx file in the editor.
4. Add code to the PCF file that looks for the new permission before displaying the screen.
For example, you can set the editable attribute of the file or of a widget in the file to a permission typecode.
Adding a permission typecode is the same as testing if the permission is true—if the current user has that
permission—before allowing the user to edit in the screen.
The following code shows a permission typecode setting for the editable attribute:
editable="perm.System.editSensSIUdetails"
5. Restart the ClaimCenter server to pick up these changes.

6. Optionally regenerate the Security Dictionary as well.
Next steps
You can delete permissions by removing them from the same typelist. However, if you do so, you must also remove
all references to them in every PCF file in the application. The Security Dictionary helps in locating these
references. See “Data-based Security and Claim Access Control” on page 491.
See also
Add Permissions to a User Role
Procedure
1. Click the Administration tab and navigate to Users & Security→Roles.
2. Click a role, and then click Edit.
3. Click Add above the list of roles.
4. Click the Permission field for the new permission and choose a permission from the drop-down list.
5. To add more permissions, click Add for each one and select it from the drop-down list.
6. Click Update to finish.
Remove Permissions from an Existing User Role
About this task

Deleting permissions from an existing role is not recommended because any users who need the deleted permissions
are adversely affected. Instead, create a new role without that permission and assign the new role to users.
Working with Permissions and Roles 489

Procedure
2. Click a role.
3. Click Edit.
4. Select the check boxes next to the permissions you want to remove, and then click Remove
5. Click Update.
Create a New User Role
Procedure
1. Click the Administration tab and navigate to Users & Security→Roles→Add Role.
2. Enter a name and description.
3. Add permissions as described in “Add Permissions to a User Role” on page 489.
4. Optionally click the Users card and add users to the role, as described in the next topic.
5. When finished adding permissions, click Update.
Assign a Role to One or More Users
Procedure
2. Click a role.
3. Click Edit.
4. Click the Users card.
5. Click Add.
6. Search for users you want to add.
7. Select check boxes next to the users you want to add, and then click Select.
8. Click Update.
Remove a Role
About this task

Removing a role is not recommended, because you can cause users to lose permissions they need to perform their
jobs.
Procedure
2. Select the check box for each role you want to delete.
3. Click Delete, then confirm the delete.

Applying Permissions to Search Results

Normally, you never see either an entity’s name or details if you lack the view permission for that type of entity. But,
if you search for that entity, the search results can include entities that you cannot view. You then know that they
exist. You can set two configuration parameters in the config.xml file that, by default, prevent this behavior.
• RestrictSearchesToPermittedItems – If true, the default value, search results include only the items for
which you have view permission.
• RestrictContactPotentialMatchToPermittedItems – If true, the default value, searching or using
autocomplete for a Contact entity restricts search results to items that you have permission to view.
Data-based Security and Claim Access Control

Role-based security provides users of ClaimCenter access to all claims and can be used to restrict access to specific
screens in ClaimCenter. See “Role-Based Security” on page 488.
ClaimCenter provides a second security mechanism, Access Control, to restrict access to defined subsets of claims
and to a lesser degree, subsets of exposures and documents.
Note: Access Control is also known as Access Control Lists (ACLs).
See also
• “Exposure Level Security” on page 500
How Access Control Works

A user creating or editing a claim decides whether to restrict access to the claim by applying a special category of a
restricted claim security type to the claim. There can be several to choose from. The claim owner can later put the
claim in another subset, the unrestricted subset.
Users trusted to have access to a restricted claim have either special permissions or a role that contains these
permissions.
An access profile is defined for each restricted claim type. The access profile grants users with the special
permissions in the profile the ability to:
• Become a restricted claim or exposure owner.
• Have a special user role on the claim or exposure.
The access profile grants an access level to these users in addition to their groups and security zones. Typically, an
access profile grants only two kinds of access, view and edit, unless more levels have been defined.
See also
• “Claim Security Types” on page 492
• “Access Profile Creation and Editing” on page 494
• “Claim Access Levels” on page 493
• “Access Profiles” on page 493
Configuration Parameters That Affect Access Control

You can configure the following aspects of access control by setting configuration parameters in the config.xml
file.
Turning Off Access Control

The UseACLPermissions system parameter must be true for claim access control to be functional. The default
value is true. Document and Exposure access control cannot be disabled with this parameter. Even if you turn
Working with Permissions and Roles 491

access control off, its related system permissions still apply. If access control is in use, a user’s effective permissions
on a claim are the intersection of their role permissions and access control permissions.
Even if access control is on in ClaimCenter, it can still be turned off for users with specific user roles. See “Access
Profile Creation and Editing” on page 494.
Access Control and Searches That Find Restricted Claims

The RestrictSearchesToPermittedItems system parameter in config.xml determines the items a user can view
in search results. If this parameter is set to false, search results can include claims that the user cannot view or edit.
Inheriting Access Control Permissions

ClaimCenter supports downline access for supervisors, which gives supervisors the same access as any user, group,
or security zone that they administer. In other words, if a user has access to a claim, the user’s supervisor also has
access. The supervisor must also have a role that grants the proper claim permissions as well.
Normally, a user’s supervisor inherits all access control permissions from all those supervised. But if the system
parameter EnableDownLinePermissions in config.xml is set to false, supervisors must be explicitly added to
access control.
Note: Access controls for documents and exposures do not have similar configuration parameters. They cannot be
turned off, cannot restrict search results, and do not support downline inheritance. They can be deleted.
Elements of Access Control

The components of claim access control are covered in the following topics:
• “Claim Security Types” on page 492 – Claim subsets, like fraudulent, sensitive or litigated, to be affected by
access control.
• “Claim Access Types” on page 492 – Groupings of permissions like roles. They define what access means,
typically View or Edit.
• “Claim Access Levels” on page 493 – How access control affects claim owners, users with specific user roles,
and their groups and security zone.
• “Access Profiles” on page 493 – Using the previous concepts, how to restrict claim access by using access
control.
Claim Security Types

Claim security types are subsets of claims that can be given extra security restrictions by access control. You can
create these subsets in the ClaimSecurityType.ttx typelist. A claim can belong to only one of these security types.
These subsets appear in the Special Claim Permission drop-down list of the claim Claim Status screen. With a claim
open, navigate to Summary→Status to see this screen. After clicking Edit, you can assign a claim one of these claim
security types.
Claims not assigned any of these types are given the type UnsecuredClaim. Each claim security type has a matching
access profile. ClaimCenter provides the following claim security types:
• Employee Claim– A claim covering one of your coworkers.
• Fraud Risk
• Sensitive – A claim you would like to keep out of the public eye.
• Under Litigation
• UnsecuredClaim – None of the previous types. Used if none of the previous types have been assigned.
Claim Access Types

A claim access type is a collection of system permissions, similar to a role, that access control grants to users,
groups, and security zones. Defined in the typelist ClaimAccessType.ttx, they are another way of grouping claim-
specific system permissions, and then granting groups of permissions.
ClaimCenter defines the following claim access types:

• Edit – Cannot view, but can change and operate on claims by closing them or making payments on them.
• View – Can search for and see all claim information, including its exposures, activities, and financial data.
To create more claim access types, and group permissions into them, see:
• “Creating a New Claim Access Type” on page 494
• “Mapping Permissions to a Claim Access Type” on page 494
Claim Access Levels

The following access levels can be defined as required for getting on access control for a claim. They have slightly
different meanings, depending on usage. In general, they define the relationship one must have with the claim’s
owner.
Level Access permission

user User with a specific user role defined in the access profile.
group Users who belong to the same group as the user with that role.
securityzone Users who belong to the same security zone as the user with that role.
anyone All users.
See also
Access Profiles
Access profiles define whether a user, group, or security zone joins access control for a claim of a particular claim
security type. They also define what access types users, groups, or security zones have for that claim. Each claim
security type has one access profile. Access profiles also define what access types are permitted for the claim’s
exposures and activities.
An access profile specifies:
• Special permissions, if any, that a user must have to have access to that claim security type. See “Access Profile
Creation and Editing” on page 494.
• Access types to grant to all allowed users.
• Access types to grant to allowed users with specific user roles.
• Access types to grant to groups and security zones to which the user belongs.
• Access types to grant for claim-related exposures and activities.
See “Access Profile Creation and Editing” on page 494 for an example of an Access Profile and how it uses these
special permissions and grants Access Types.
Configuring Access Control

You can configure access control.
Create a New Claim Security Type
Procedure
1. Open ClaimCenter Studio.
2. Add a new typecode to the ClaimSecurityType.ttx typelist.
Elements of Access Control 493

Add Access Control to a Claim
Procedure
1. After creating a claim, navigate to Summary→Status.
2. Click Edit on the Claim Status screen.
3. Click the Special Claim Permission drop-down list.
4. Select the claim security type: Employee claim, Fraud risk, Under litigation, Sensitive, or UnsecuredClaim.
If you do not select any of these types or you select <none>, the claim is assigned the UnsecuredClaim claim
security type. The claim owner can later change this assignment.
If you select a security type for which you do not have access permission, after you exit the claim, you are
unable to subsequently access that claim.
Creating a New Claim Access Type

In the base configuration, View and Edit are the only claim access types available with ClaimCenter. You can define
others. Claim access types are typecodes of the ClaimAccessType.ttx typelist, which you can access in Guidewire
Studio. You can make as many claim access types as there are claim-related system permissions, just as you can
create many roles. However, large numbers of claim access types can degrade performance.
Although the View and Edit claim access types grant broad permissions, access control restricts them to few users.
Mapping Permissions to a Claim Access Type

You can open Guidewire Studio and map permissions to claim access types. Every claim-related system permission
can be added to a single claim access type. You can similarly map any new claim-related permissions you create.
The security-config.xml file holds these mappings. The following are examples:
...
<AccessMapping claimAccessType="view" systemPermission="claimview"/>
<AccessMapping claimAccessType="view" systemPermission="plcyview"/>
<AccessMapping claimAccessType="view" systemPermission="claimviewres"/>
...
In mapping, be sure to:

• Map only permissions that are related to claims. For example, mapping ruleadmin to View or Edit creates a
configuration error.
• Map each system permission to only one claim access type. For example, mapping paycreate to View is
allowed unless it is already mapped to Edit, which is the more likely mapping.
Access Profile Creation and Editing

Access profiles are located in security-config.xml. Following is the access profile for the employeeclaim
security type:
<AccessProfile securitylevel="employeeclaim">
<ClaimOwnPermission permission="ownsensclaim"/>
<SubObjectOwnPermission permission="ownsensclaimsub"/>
<ClaimAccessLevels>
<AccessLevel level="group" permission="view"/>
<AccessLevel level="group" permission="edit"/>
<DraftClaimAccessLevel level="group"/>
</ClaimAccessLevels>
<ActivityAccessLevels>
<AccessLevel level="user" permission="view"/>
<AccessLevel level="user" permission="edit"/>
</ActivityAccessLevels>
<ExposureAccessLevels>
<AccessLevel level="user" permission="view"/>
<AccessLevel level="user" permission="edit"/>

</ExposureAccessLevels>
</AccessProfile>
This example specifies the access to all claims that have the employeeclaim claim security type. The elements
perform the following actions:
ClaimOwnPermission and SubObjectOwnPermission Elements

If an access profile defines the ClaimOwnPermission or the SubObjectOwnPermission element, you must give the
user the Trusted For Sensitive Claims role. This role contains these two permissions. Otherwise, access control
restricts that user from the claim:
<ClaimOwnPermission permission="ownsensclaim" />

<SubObjectOwnPermission permission="ownsensclaimsub" />
You can also create your own permissions (for example, ownEmployeeClaim), grant them to trusted users, and add
similar lines to the appropriate access profile to restrict access to those users.
ClaimAccessLevels Element
The ClaimAccessLevels element must contain at least one of the defined subelements. The previous example
shows the default subelements.
• AccessLevel – Restricts and defines access to those users with a specific relationship to the claim owner, in the
same group or security zone, or even any user, anyone.
<AccessLevel level="group" permission="view" /> 

user All users who own the claim, one of its exposures, or claim activities.
group All users who belong to the group to which the claim, exposure, or activity is assigned.
securityzone All users who belong to the security zone of the group owning the claim, exposure, or activity.
anyone All users.
• DraftClaimAccessLevel – Same as AccessLevel, but applies only after a claim is in draft status.
• ClaimUserAccessLevel – This subelement grants access to users with a specific user role, or related to another
user with such a user role level as defined in the next table. User roles, defined in the UserRole.ttx typelist, are
assigned by the claim owner while adding another user to the Parties Involved→Users screen of a claim. For
example, the user handling subrogation for the claim can be assigned the Subrogation Owner user role, which for
an Unsecured Claim is defined as follows:
<ClaimUserAccessLevel role="subrogationowner" level="user" permission="view"/>

<ClaimUserAccessLevel role="subrogationowner" level="user" permission="edit"/>

user All users with this user role.
group All users in the same group as any user with this user role.
securityzone All users in the same security zone as any user with this user role.
anyone All users.
Configuring Access Control 495

IMPORTANT Be careful after adding a ClaimUserAccessLevel element, a user role, to an access profile. Later
assignment of this user role to one user can grant access to large groups and security zones.
ExposureAccessLevels and ActivityAccessLevels Elements

The ExposureAccessLevels and ActivityAccessLevels elements grant claim access to users owning a claim
exposure or activity. The previous access profile example shows how this access is granted. It also grants View
access to those in the same group as an exposure owner, but not to members of an activity owner’s group.
See also:
Applying Access Control Retroactively

To force access control to apply to an existing claim, assign it to the security access type you want and save it. If you
have changed a claim’s access profile, assign the claim to another access type, save it, and then restore its original
access type and save it again.
Joining Access Control

You join access control at the user access level after you have the special permissions required by the access profile
and:
• You are assigned to the claim or one of its exposures or activities.
• The claim’s access profile grants access to a specific user role, as defined in the UserRole typelist, and your
administrator has granted you that role.
You join access control at the group or security zone access level after you have the special permissions required by
the access profile and:
• You are related to—in the same group or security zone as—a user assigned to the claim or one of its exposures or
activities.
• You are related to—in the same group or security zone as—a user with a user role on the claim allowed by its
access profile.
Although ClaimCenter defines an access level of All, no access profile permits access at this level, even for the
UnsecuredClaim claim security type.
Rebuilding Access Control Lists

After you have access to an entity through an ACL, that access is permanent. But if you join another group or
region, it might not be appropriate to retain that access. The only way to remove access is to redo, or rebuild, the
ACL that allows access. Removing access can be a manual operation, and finding and editing the correct ACL can
be time-consuming and can introduce errors. Another possibility is to use the rebuildClaimACL method to write
rules that can remove reassigned users.
See also
Access Control for Documents and Notes

In addition to the standard document and note-related system permissions, you can control access to documents and
notes by configuring access permissions. To do so, a document must have its document security type set. To see
documents of a particular type, you must have both permission to view documents in general and permissions to

access to the document security type. A document access profile grants this access. Access control for notes is the
same as for documents.
Note and document access control requires:
• Document Security Types or Note Security Types – Security types determine document and note access
control. Typical security types for documents are Unrestricted and Sensitive. The supported types are defined in
the DocumentSecurityType typelist. They appear in the Security Type drop-down list of the Documents→Document
Details and New Document screens. A document can be assigned a maximum of one security type. Security types
for notes are defined in a similar manner by the NoteSecurityType typelist. Typical security types for notes are
Medical, Private, Public, and Sensitive.
• System Permissions – Users must be assigned roles containing permissions to access documents and notes in
general. The roles must also have permissions which match those in the access profile of the security type.
Different permissions affect notes and documents.
• Document and Note Access Profiles – Using the previous two concepts, these profiles relate permissions and
security types to restrict access to a subtype of documents.
Document and note access control:
• Cannot be modified by configuration parameters.
• Cannot be disabled.
• Always finds restricted documents and notes in searches.
• Does not support downline access.
Working with Access Control for Documents and Notes

The following topics describe how to define and use document and note access control.
Documents and Notes Example

A carrier has three groups that access claims and attach documents to them: Adjusters, Subrogation, and Special
Investigations. The subrogation and special investigation documents and sensitive notes are confidential and are
only seen by members of their respective groups. Consider a single claim with six documents:
• Three documents added by the adjuster
• One document added by the Special Investigations Unit
• Two documents added by the subrogation specialist
Create your configuration so that:
• A Subrogation user viewing the claim sees five (three plus two) documents.
• Special Investigations see four (one plus three).
• Adjusters see only three.
• Further, you want a member of the Managers group to see all six documents.
See also
• “Create Document and Note Security Types” on page 497
• “Assign a Document or Note to a Security Type” on page 498
• “Creating Document Access Profiles and Note Access Profiles” on page 498
Create Document and Note Security Types

A document type is set by using the Security Type field in the user interface or through Gosu. The security types
supported in the base configuration are defined by the DocumentSecurityType typelist. You can add your own
security types. Documents that are not assigned a security type are given the unrestricted security type.
Access Control for Documents and Notes 497

For example, add these lines to DocumentSecurityType to create subrogation and special investigation security
types:
<typecode code="subrogation" name="Subrogation Doc" desc="subrogation document"/>

<typecode code="specialinv" name="Special Inv Doc" desc="special investigations document"/>
For notes, add this line to NoteSecurityType to create the sensitive note security type:
<typecode code="sensitive" name="Sensitive Note" desc="sensitive note"/>
Assign a Document or Note to a Security Type

After creating a new document by selecting Actions→New Document, choose the security type to assign the document
from the Security Type drop-down list.
You cannot assign a document to a security type unless you possess the permissions defined in the corresponding
document access profile.
Creating Document Access Profiles and Note Access Profiles

Access to document types is controlled by adding a document access profile section to security-config.xml. You
must have a document access profile for each document security type you want to place under document access
control. The same is true for notes.
Each document access profile has the following syntax, where type specifies a document or note security type, and
perm is a system permission:
<DocumentPermissions>
<DocumentAccessProfile securitylevel="type"> 
<DocumentViewPermission permission="perm"/> 
<DocumentEditPermission permission="perm"/> 
<DocumentDeletePermission permission="perm"/> 
</DocumentAccessProfile>
</DocumentPermissions>
...
<NotePermissions>
<NoteAccessProfile securitylevel="type"> 
<NoteViewPermission permission="perm"/> 
<NoteEditPermission permission="perm"/> 
<NotetDeletePermission permission="perm"/> 
</NoteAccessProfile>
</NotePermissions>
ClaimCenter provides three permissions for sensitive documents: viewsensdoc, editsensdoc, and deletesensdoc.
In addition, for sensitive notes, ClaimCenter provides the permissions viewsensnote, editsensnote, and
deletesensnote. ClaimCenter provides a similar set of three permissions for private note types. These permissions
restrict access to documents and notes of each defined security type to users with a role that contains these
permissions.
Continuing the example, the document access profiles for unrestricted, subrogation, and SIU document types,
bringing together the security type and permissions, are:
<DocumentPermissions>
<DocumentAccessProfile securitylevel="unrestricted"/>
...
<DocumentAccessProfile securitylevel="subrogation">
<DocumentViewPermission permission="viewsubdoc" />
<DocumentEditPermission permission="editsubdoc"/>
<DocumentDeletePermission permission="delsubdoc"/>
...
<DocumentAccessProfile securitylevel="specialinv">
<DocumentViewPermission permission="viewspecinvdoc" />
<DocumentEditPermission permission="editspecinvdoc"/>
<DocumentDeletePermission permission="delspecinvdoc"/>

</DocumentPermissions>
For notes, the XML is analogous. Set permissions for public (unrestricted), private, and sensitive note types in
security-config.xml relating to viewprivnote, editprivnote, and delprivnote system permissions. There is a
similar set of relationships for notes of sensitive type.
<NotePermissions>
<NoteAccessProfile securitylevel="public"/>
<NoteAccessProfile securitylevel="private">
<NoteViewPermission permission="viewprivnote"/>
<NoteEditPermission permission="editprivnote"/>
<NoteDeletePermission permission="delprivnote"/>
<NoteAccessProfile securitylevel="sensitive">
<NoteViewPermission permission="viewsensnote"/>
<NoteEditPermission permission="editsensnote"/>
<NoteDeletePermission permission="delsensnote"/>
</NotePermissions>
Create and Assign New Permissions
Before you begin

You must create and assign new system permissions that match the permissions used in the document or note access
profile.
Procedure
1. In Studio, navigate to configuration config→Extensions→Typelist.
2. Select DocumentSecurityType to edit or view permissions for document. Select NoteSecurityType to edit or
view permissions for notes.
For this example showing document permissions, add the following typecodes to the SystemPermisionType
typelist. Adding typecodes to this typelist is the normal way of creating permissions.
<typecode code="viewsubdoc" name="View subro documents" desc="Permission to view a subro document"/>

<typecode code="editsubdoc" name="Edit subro documents" desc="Permission to edit a subro document"/>
<typecode code="delsubdoc" name="Delete subro documents" desc="Permission to delete a subro document"/>
<typecode code="viewspecinvdoc" name="View SIU documents" desc="Permission to view a SIU document"/>
<typecode code="editspecinvdoc" name="Edit SIU documents" desc="Permission to edit a SIU document"/>
<typecode code="delspecinvdoc" name="Delete SIU documents" desc="Permission to delete a SIU document"/>
...
<typecode code="viewssensnote" name="View sensitive notes" desc="Permission to view sensitive notes"/>
<typecode code="editsensnote" name="Edit sensitive notes" desc="Permission to edit sensitive notes"/>
<typecode code="delsensnote" name="Delete sensitive notes" desc="Permision to delete sensitive notes"/>
3. In ClaimCenter, log in as an administrator.

4. Click the Administration tab.
5. Click Users & Security→Roles in the sidebar.
6. Select a role to view the Basics tab for that role so that you can add or remove permissions.
7. Click the Users tab. If necessary, assign user to the role. These users will be able to access these document and
note subsets according to their role permissions.
Next steps
In this example, based on the previously defined access profile:
• Add the three new subrogation permissions to the Subrogation role.
• Add the three new special investigations permissions to the SIU role.
• Add the note permissions to the Trusted Adjuster role.
Working with Access Control for Documents and Notes 499

• Add all six permissions to the Manager role.

All subrogators, SIU experts, trusted adjusters and managers have already been assigned these roles, so they have
the correct permissions. Adjusters have none of them. To finish this example, manages are able to access all
documents, SIU inspectors have access to their documents and those added by adjusters, and so on.
Access Control for Exposures

Some jurisdictions require that certain kinds of claim data be protected. These requirements are typically necessary
for personal injury, accident injury, and workers’ compensation data. This data is almost always available at the
exposure level rather than claim level. For example, many Canadian insurers must insulate auto body adjusters’
information from that of personal injury adjusters. Exposure level security provides this data protection.
Exposure Level Security

Exposure access control restricts access to exposures in a claim. With this kind of access control in place, an adjuster
on a claim could have access to some, but not all, exposures on a claim. Users granted access through exposure
security see:
• The exposure screen.
• The existence and contents of all notes related to that exposure.
• The existence and contents of all documents tied to that exposure.
• The contents of activities related to that exposure.
• The contents of matters related to that exposure.
Exposure access control does not prevent users from viewing:
• The existence of exposures that they are not allowed to see—all exposures are listed on the claim.
• The existence of matters and activities that they are not allowed to see—the exposure lists them.
• Financial transactions related to an exposure that they are not allowed to see.
A user who attempts to view an object to which they do not have access receives a permissions error.
The exposure-level security feature can secure variously the content, existence, and search results of various entities
related to an exposure, as shown in the following table:
Entity Hide existence Hide contents Hide in searches

Exposures no yes no
Notes yes yes yes
Documents yes yes yes
Activities no yes no
Financials no no no
Matters no yes no
History no no no
All others no no no

Static and Claim-based Exposure Security

You can implement either static or claim-based exposure security.
• Static exposure security – Gives every user with the correct system permissions access to all their associated
exposure security types. The exposure access profile alone defines this association.
• Claim-based exposure security – Combines claim access control with exposure security. A user must have
permissions both for access control of the claim and for static exposure security.
Working with Exposure Security

To implement exposure level security on a subset of all exposures, use the following multi-step procedure:
1. Create subsets of exposures. See “Create Exposure Security Types” on page 501.
2. Assign exposures to these subsets. See “Assign a Security Type to an Exposure” on page 501.
3. Give a new permission to trusted users. See “Create and Assign New Permissions” on page 499.
4. Associate this permission with the security type. See “Create Exposure Access Profiles” on page 503.
• If you want static access control, independent of claim access control, you are finished.
• If you want claim-based access control, see the additional step “Implement Claim-based Exposure Access”
on page 503.
See also
• “System Permissions for Access to Exposures” on page 502
• “Static Exposure Access” on page 503
Create Exposure Security Types

About this task
You can create exposure security types in Guidewire Studio by adding typecodes to the ExposureSecurityType
typelist. In the base configuration, this typelist is empty and contains no internal codes, so you have full control in
defining types. Exposures not given a security type have the default type of null. These types differ from claim and
document security types, which have the type unsecured unless given a security type.
For an example of how to add security types to a typelist, see “Create Document and Note Security Types” on page
497.
Procedure
1. Open Guidewire Studio and navigate to configuration→config→Extensions→Typelist.
2. Double-click ExposureSecurityType.ttx.
Next steps
The next step is “Assign a Security Type to an Exposure” on page 501.
Assign a Security Type to an Exposure

Before you begin
Complete the step “Create Exposure Security Types” on page 501 before you perform this step.
About this task

ClaimCenter does not provide screens that an administrator can use to assign security types to exposures as it does
for claims. For example, see “Add Access Control to a Claim” on page 494. However, you can do the following:
Access Control for Exposures 501

Procedure
1. Modify an exposure page to show a Security Type drop-down list.
This step is similar to the implementation for claims or documents. See “Assign a Document or Note to a
Security Type” on page 498.
2. If you have segmented exposures, create a preupdate rule to assign a security type to all exposures given the
same segment.
For example, a rule could implement the business rule, “If an exposure segment is Personal Injury, set its
security type to injury.”
Next steps
The next step is “Create and Grant New Permissions for Exposures” on page 502.
Create and Grant New Permissions for Exposures

Before you begin
Complete the step “Assign a Security Type to an Exposure” on page 501 before you perform this step.
About this task

You can create permissions for exposures in addition to the permissions described at “System Permissions for
Access to Exposures” on page 502.
Procedure
1. Add the new permissions as described at “Create and Assign New Permissions” on page 499.
2. Add these permissions to the appropriate roles or create new roles and assign the roles to users in the usual
way.
3. Map these new permissions to claim access types.
See “Mapping Permissions to a Claim Access Type” on page 494. These permissions also grant the user
permission to view the claim containing the exposure.
Next steps
The next step is “Create Exposure Access Profiles” on page 503.
System Permissions for Access to Exposures

The following system permissions, defined in the SystemPermissionType.ttx typelist, are available in the base
configuration to control access to exposures:
• expclose – Permission to close an exposure.
• expcreate – Permission to create a new exposure.
• expedit – Permission to edit an exposure on a claim.
• expeditclsd – Permission to edit a closed exposure.
• expown – Permission to own an exposure and to see the Exposures screen on the Desktop tab.
• expraown – Permission to reassign your own exposures.
• expraunown – Permission to reassign exposures owned by others.
• expreopen – Permission to reopen an exposure.
• expvalidate – Permission to run validation rules on exposures.
• expview – Permission to view exposures on a claim.

Create Exposure Access Profiles

Complete the step “Create and Grant New Permissions for Exposures” on page 502 before you perform this step.
Additionally, see “System Permissions for Access to Exposures” on page 502.
In this example, the user must have the expeditsec permission to access an exposure of the secured exposure
security type and the content of its related notes, documents, and activities. The user must also have the
unsecexpedit permission to access all exposures without a security type. If you omit this line, users without any
special permissions can access all such exposures.
After you complete this step of the example, you will have implemented static exposure access.
1. To create exposure access profiles, create a block in security-config.xml called ExposurePermission.
2. Verify that this block, if used, is the last block in security-config.xml. For example:
<ExposurePermissions>
<ExposurePermission securitylevel="secured" permission="expeditsec"/>
<ExposurePermission permission="unsecexpedit"/>
</ExposurePermissions>
The next step is “Implement Claim-based Exposure Access” on page 503.

See also
• “Static Exposure Access” on page 503
• “Creating Document Access Profiles and Note Access Profiles” on page 498
Static Exposure Access

Static security applies to all exposures and is solely based on the ExposurePermissions element in security-
config.xml. For example, any user with the expeditsec permission and the relevant system permissions can
access all exposures that have the secured security type.
See also
• “Create Exposure Access Profiles” on page 503
Implement Claim-based Exposure Access

Before you begin
Complete the step “Create Exposure Access Profiles” on page 503 before you perform this step.
About this task
IMPORTANT Having many custom claim access types can put a performance load on your system. Use this
security implementation with care. Additionally Guidewire recommends that you implement claim-based access
control only with custom claim access types. To implement this kind of access control, you need one custom claim
access type for each exposure security type.
Implement the static form of exposure security and then implement claim-based security. You cannot use the default
claim access types for claim-based exposure security. For example, mapping the claim View access type to both the
abexposures and the expview permissions would eliminate the distinction between all claim exposures and
abexposure exposures.
Procedure
1. Add a new abexposure exposure security type, as described at “Create Document and Note Security Types”
on page 497.
2. Add a new abexposures system permission, as described at “Create and Assign New Permissions” on page
499.
Working with Exposure Security 503

3. Create an ExposurePermissions element in the security-config.xml file that associates the security type
and the system permission:
<ExposurePermissions>
<ExposurePermission securitylevel="abexposure" permission="abexposures"/>
</ExposurePermissions>
4. Add the abexposure typecode to the ClaimAccessType.ttx typelist. Right-click an existing typecode and
click Add new→typecode.
5. Enter the following values:
Name Value
Code abexposure
Name Auto body
Description Auto body exposure
See “Creating a New Claim Access Type” on page 494.

6. Create a mapping element in the security-config.xml file to map your new permission to your new claim
access type. The code is:
<AccessMapping claimAccessType="abexposure" systemPermission="abexposures"/>
See “Mapping Permissions to a Claim Access Type” on page 494.

7. Add this new claim access type to the access profile in the security-config.xml file. For example:
<AccessProfile securitylevel="sensitiveclaim">
...
<ExposureAccessLevels>
<AccessLevel level="user" permission="abexposure"/>
</ExposureAccessLevels>
</AccessProfile>
See “Access Profile Creation and Editing” on page 494.
Result
After this access control is in place, users that attempt to access an exposure must have both the abexposures
permission for exposure security and access to sensitive claims. This access control is claim access control
defined by the claim’s access profile.
Security Zones
Security zones provide a means of describing a section of your organization larger than a group, within which
information is shared more freely than with those outside the section. For example, an insurer allows all claims to be
seen, but allows edit access only to people within that claim’s handling office. To implement this scenario, you can
create security zones corresponding to offices so that people outside an office cannot edit another office’s claims.
Claim access control is the part of ClaimCenter that uses security zones. See “Access Profile Creation and Editing”
on page 494.
Security zones are just names. They are not defined as collections of geographical areas like regions, described at
“Understanding Regions” on page 484. Every claim, exposure, and activity is owned by both a user and a group.
Each group belongs to a single security zone. Users are part of a security zone if they are a member of a group
within that security zone. Thus, users in multiple groups can belong to more than one security zone.

You might want to create security zones that are related to something besides geography. For example, you could
define workers’ compensation, auto, and property as separate security zones, thus restricting information flow
between them.
Create or Edit Security Zones
About this task

You can create and edit security zones. If you edit a security zone, you can change its name. The effect is to delete
the old zone and assign the zone with the new name to all groups that had used the old name.
If you have defined only one security zone, there is no difference between the anyone and security zone security
levels of access profiles used by access control.
Procedure
1. In ClaimCenter, click the Administration tab and navigate to Users & Security→Security Zones.
2. Add or edit a security zone as follows:
• To add a new security zone, click Add Security Zone.
• To edit a security zone, click the zone name and then click Edit.
3. Enter data and then click Update.
Change a Group’s Security Zone
Procedure
1. Click the Administration tab and navigate to Users & Security→Groups.
2. Search for groups.
3. In the search results list, click a group name to open its Profile screen.
4. Click Edit.
5. Pick a zone from the Security Zone drop-down list and click Update.
Result
If permission is granted to a user on a claim that the user is related to, ClaimCenter evaluates if the user has the
correct security zone. See “Related Users” on page 482.
User Login and Passwords

About this task
ClaimCenter is password protected. An administrator must give each new user a user name and password. Both are
required to log in to ClaimCenter. After you are logged in, ClaimCenter has other features to control access to
information.
Anyone with a valid user name and password can log in to ClaimCenter. The password does not control any aspect
of what a logged-in user can see or do. Other than requiring that a password have a minimum and maximum length,
ClaimCenter does not require that passwords have any specific format, or that they be changed regularly.
Users can be locked out of ClaimCenter if they enter incorrect passwords several times during a login attempt.
Configuration parameters specify the number of login attempts before lockout and how long the user must wait after
an unsuccessful login attempt before being allowed to try again. Alternatively, ClaimCenter can be set up to require
that an administrator get involved before the user is allowed to retry. For details, see “Configuration Parameters for
Password Behavior” on page 507.
Security Zones 505

After a browser connects to ClaimCenter, a session is created for that browser connection. The session has a time-
out parameter.
The following considerations apply to logging in, logins, and passwords:
• You must always log in to ClaimCenter.
• You can change your password.
• Administrators can change a user’s password.
• You can lock yourself out of ClaimCenter.
If you provide several incorrect passwords or user names while attempting to log in, you will be locked out. This
lockout can continue for a certain period of time or until an administrator unlocks your user name.
• Administrators can unlock and lock users.
• Administrators create passwords and user names after creating new users.
Next steps
See also
• For information configuring password entry behavior, see “Configuration Parameters for Password Behavior” on
page 507.
Log in to ClaimCenter
Procedure
1. Enter a valid user name and password.
2. Click Log In or press Enter.
Change your Password

Procedure
1. Log in to ClaimCenter and click the Desktop tab.
2. Click Actions→Preferences to open the Preferences worksheet at the bottom of the screen.
3. Enter passwords in the Old Password, New Password, and Confirm New Password fields.
If you do not remember the old password, an administrator must reset you password for you.
4. Click Update.
Administrator Change a User’s Password

About this task
This procedure does not enable the administrator to view the original password.
Procedure
1. Log in as a user that has the User Admin role.
3. Search for a user and, in the list of search results, click the user’s name.
4. On the details screen for the user, in the Basics card, click Edit.
5. Enter a new password in both the New Password and Confirm Password boxes.
6. Click Update.

Administrator Unlock or Lock Users

Procedure
3. Search for a user and, in the list of search results, click the user’s name.
4. On the details screen for the user, with the Basics card selected, click Edit.
5. For the Locked field, click No to unlock a user or Yes to lock a user.
6. Click Update to save your work
Administrator Create New User, Password, and User Name

Procedure
2. On the Administration tab, click Actions→New User.
3. Enter information such as first and last name, user name, initial password, roles, and group assignments.
Before you begin
About this task
Procedure
1.
2.
3.
4. a.
b.
c.
d.
5.
6.
7.
Configuration Parameters for Password Behavior

The following configuration parameters in the Security section of the config.xml file, control login passwords.
The Default column is the value of the parameter in the base configuration.
Configuration parameter Description Default

SessionTimeoutSecs How long in seconds a user’s session remains active since the end of its last use. 10800
MinPasswordLength Minimum length of a user's password. 2
MaxPasswordLength Maximum length of a user's password. 16
FailedAttemptsBeforeLockout How many login failures are allowed before user is locked out. A setting of -1 3
disables this account lockout feature.
User Login and Passwords 507

Configuration parameter Description Default

LoginRetryDelay The number of milliseconds of delay before a user can retry after being locked out. 0
LockoutPeriod How many seconds a user's account will stay locked after being locked out. A value -1
of -1 means that the account must be manually unlocked by an administrator.
Security Dictionary
The ClaimCenter Security Dictionary is web-based documentation that you can generate from the command line by
entering the following command:
gwb genDataDictionary
Whenever you change the ClaimCenter data model, regenerate the Security Dictionary to view the changes.
Use the Security Dictionary to view:
• Application Permission Keys – View them individually, or click the Summary link to view the grouped
individual functions that you are allowed to perform on that entity if given that particular permission.
• Pages – Select a file to see the permissions used on that page.
• System Permissions – Select a permission to see any associated roles, related application permission keys,
related pages, and related elements.
For example, click catmanage, the permission to manage catastrophes, to see which roles use this permission—
Catastrophe Admin and Superuser. A user with a role that has this permission can also create, delete, and edit
catastrophes. Knowing which PCF files and widgets use this permission is also useful for troubleshooting
purposes when configuring these files.
• Roles – You can see the role information by clicking the Administration tab and navigating to Users &
Security→Roles. Additionally, you can use the Security Dictionary to see other roles that share permissions.
For example, if you click Adjuster, you see the list of permissions that an adjuster has. If you select a permission
such as sendemail, the permission to send email, you also see the roles that share that permission. For
sendemail, you see the additional roles Claims Supervisor, Clerical, Customer Service Representative, Manager,
New Loss Processing Supervisor, Reinsurance Manager, and Superuser.
See also
• For information on the genDataDict command, see the Configuration Guide
• For information on exporting the Security Dictionary from the Administration tab, see “Exporting the Security
Dictionary” on page 536
Configuration Files for Access Control Profiles

The following files configure claim access controls.
Configuration File Description

config.xml See “Configuration Parameters That Affect Access Control” on page 491.
security-config.xml Defines access profiles and the mapping of system permissions to claim access types.
ClaimAccessType.ttx Type of access that access control provides to a claim - view or edit. Can be extended.
ClaimSecurityType.ttx Subsets of claims - sensitive, employee, litigated, fraud, or other - typelist. Can be extended.
The following file configures exposure access control.

Configuration File Description

ExposureSecurityType.ttx This typelist is similar to ClaimSecurityType.ttx.
Security for Contacts

You might need more granular control over who gets to view, edit, create, and delete contacts, rather than using the
simple view and edit permissions.
For example, you might have specific contact managers that manage certain subtypes of contacts and, therefore,
want the system to enforce permissions at the contact subtype level. Enforcing permissions at this level is especially
important for the Service Provider Management feature, where the list of contact subtypes, service providers, is an
integral part. Only specific contact managers can manage the lists of these contact subtypes.
See also
• For information on security for contacts, see the Guidewire Contact Management Guide.
Security for Contacts 509


chapter 46
Administration Tasks
This topic describes how to perform administrative tasks in Guidewire ClaimCenter.
Personal Administration Settings and Views

There are a number of personal administration actions any user can perform, such as viewing statistics, changing
preferences, and changing vacation status.
Click the Desktop tab and then, click Actions to perform the following tasks.
• View statistics on claims and activities
• Specify administrative preferences, including password and regional preferences
• Specify vacation status
See also
• “Statistics” on page 511
• “Preferences” on page 512
• “Vacation Status” on page 277
Statistics
Select Statistics to see an overview of how many claims and activities you have. The number of claims reflects all
claims, including those that are incidents only. If you are a supervisor, this screen also shows statistics for your team.
Administration Tasks 511

Preferences
Select Preferences to change your password or your Startup View, the first set of screens, tabs, and menus you see after
you log into ClaimCenter. You can also set your default country, your default phone region, and how many entries
you see in your recent claims list when you click the Claim tab.
• Password – Reset your password.
• Startup View – You can change the default screen to open the New Claim wizard or show a list of your current
claims or exposures, or a claim search screen. If you are an administrator, you have other options, such as
showing the Team screens or starting on the Administration tab.
• Entries in recent claims list – Determines how many claims are listed when you click the Claim tab.
• Regional Formats – Set the regional formats that ClaimCenter uses to enter and display dates, times, numbers,
monetary amounts, and names.
• Default Country – Determines the settings for names and addresses.
• Default Phone Region – Determines how phone number entries are handled, especially the country code setting.
See also
• “Setting ClaimCenter Preferences” on page 56
• “Selecting language and regional formats in ClaimCenter” on page 58
• “User Login and Passwords” on page 505
Vacation Status
Change your vacation status from At Work to On Vacation or On Vacation (Inactive). You can also specify a backup to
accept new work assigned to you. If you are an administrator or supervisor, you can also see and edit group load and
vacation details. See “Vacation Status” on page 277.
Administration Tab
If you are logged in as a user with administrator privileges, you can use the Administration tab to view and maintain
many business elements that define how ClaimCenter is used. You can define your organization’s group structure
and manage the users that belong to those groups. You can also specify permissions and roles, such as adjuster,
manager, supervisor, and so on, for your users to control who is allowed to perform certain ClaimCenter actions.
Groups and users in ClaimCenter primarily correspond to adjusters who processing claims and using the system.
Supervisors manage groups. They can view their team members' work status and quickly identify problems. Anyone
with administrative privileges can view basic group and user information, set permissions for workload
management, and define assignment rules.
In the Administration tab, clicking menu links in the sidebar menu on the left takes you to screens for managing the
following areas:
Menu choice Administrative task

Users & Security Groups menu links for Users, Groups, Roles, Regions, Security Zones, Authority Limit
Profile, and Attributes.
Users Search for users and manage them. See “Managing Users and Groups” on
page 514.
Groups Manage groups. See “Managing Users and Groups” on page 514.
Roles Add permissions to and delete permissions from roles, and add roles to or
remove roles from users. See “Managing Roles” on page 522.
Regions Define and edit regions. See “Managing Regions” on page 524.
512 chapter 46 Administration Tasks


Security Zones Edit the coverage verification reference tables. See “Coverage Verification
Reference Tables” on page 538. See also “Managing Security Zones” on page
536.
Authority Limit Profile Add or edit authority limit profiles to a role. See “Managing Authority Limit
Profiles” on page 519.
Attributes Define user attributes that can help in assigning work. See “Manage
Attributes” on page 517.
Special Handling Groups menu links for Accounts and Service Tiers.
Accounts Manage accounts for people or organizations that have policies with your
company. See “Managing Accounts” on page 514.
Service Tiers Manage service tiers for people or organizations that have policies with your
company. A service tier represents a level of customer service associated with
a claim and categorizes policies by their level of importance. See “Service
Tiers” on page 122.
Business Settings Groups menu links for Activity Patterns, Business Week, Catastrophes, Coverage
Verification, Holidays, ICD Codes, Metrics & Thresholds, Reinsurance Thresholds, and WC
Parameters.
Activity Patterns Edit or delete activity patterns or create new ones. See “Managing Activity
Patterns” on page 517.
Business Week Define your business week. See “Managing Business Weeks” on page 551.
Catastrophes Add, deactivate, and edit catastrophes as well as bulk associate claims to a
catastrophe. See “Managing Catastrophes” on page 518.
Coverage Verification View information on which exposures are valid, or not valid, for the policy.
• Invalid Coverage for Cause Choose the menu link for the type of coverage or exposure verification you
want to work with. ClaimCenter uses the policy of the claim and its coverages
• Incompatible New Exposure
to verify that related exposures are valid. See “Managing Coverage
• Possible Invalid Coverage Due to Fault Rating Verification” on page 538.
Holidays Add holidays that can be zone specific. See “Managing Holidays” on page
526.
ICD Codes Administer the International Statistical Classification of Diseases and Related
Health Problems (ICD) medical diagnosis codes that classify diseases. See
“Managing ICD Codes” on page 546.
Metrics & Thresholds Define and manage metrics and large loss thresholds, such as claim metrics,
exposure metrics, and large loss limit. See “Managing Metrics and Thresholds”
on page 547.
Reinsurance Thresholds Edit the reinsurance tables based on treaty type, policy, threshold value,
reporting value, and dates. See “Managing Reinsurance Thresholds” on page
545.
WC Parameters Edit workers’ compensation parameters to define benefit times and amounts.
• Benefit Parameters Choose the menu link for the screen you want to work with. See “Managing
WC Parameters” on page 539.
• PPD Min / Max
• PPD Weeks
• Denial Period
Monitoring Groups menu links for Message Queues, Workflows, and Workflow Statistics.
Message Queues Control the message queues.See “Managing Messages Queues” on page
526.
Administration Tab 513


Workflows Troubleshoot workflows that are in the application. See “Managing
Workflows” on page 529.
Workflow Statistics Troubleshoot workflows that are in the application. See “Managing
Workflows” on page 529.
Utilities Groups menu links for Import Data, Export Data, and Script Parameters.
Import Data Import and export certain types of data through the ClaimCenter interface.
See “Managing Importing and Exporting Data” on page 531.
Export Data Import and export certain types of data through the ClaimCenter interface.
See “Managing Importing and Exporting Data” on page 531.
Script Parameters Edit script parameters without restarting the application. See “Managing
Script Parameters” on page 529.
Managing Accounts
An account represents an organization or person that has one or more policies. The settings in this screen enable you
to add and edit accounts. You can set up automated notifications, automated activities, or notes to be shown to
adjusters working on claims connected to the policies with these account numbers.
When you click Administration→Special Handling→Accounts, you see a list of accounts. You can:
• Click Add Account to add a new account to the list.
• Click an account number to see its details page and edit the existing account.
• Select the check box for an account and then click Delete to remove it from ClaimCenter.
You see a prompt warning you that removing an account can affect existing policies that reference the account.
◦ If you are sure that removing the account will not affect existing policies used in ClaimCenter, you can click
OK to remove the account. Otherwise, click Cancel.
See also
• For general information, see “Accounts and Service Tiers” on page 119.
• For specific information on working with the account management screens, see “Account-related Tasks” on page
120.
• “Administration Tab” on page 512
Managing Users and Groups

To manage existing groups or users, you must find them either in the organization tree or by searching for them.
Find Users and Groups in the Organization Tree

About this task
Find users and groups in ClaimCenter using the organization tree as follows:
Procedure
1. Expand the organization tree, which appears in the upper left when you click the Administration tab, to see all
groups and users in your organization.
2. Navigate through the tree and select the user or group.

Search for a User or Group

About this task
In ClaimCenter, you can search for existing users and groups as follows:
Procedure
1. Navigate to the Users & Security→Users screen or the Users & Security→Groups screen to locate a user or group.
2. Select the user or group from the search results.
Next steps
See also
• “Users, Groups, and Regions” on page 477
Create New Users and Groups

About this task
You can define a user or group.
Choose New User or New Group from the Actions link of the Administration tab.
Manage Users
About this task
You can edit the properties of users.
Procedure
2. Search for and select a user.
3. Click the Edit button.
4. Change the following user data as needed:
• Name, user name, password – Set these values on the Basics card.
• Profile – Click the Profile card to enter data like job title, department, address, phone numbers, email, and
employee number.
• Active – On the Basics card, setting Active status to No means that the user is inactive. An inactive user
cannot be assigned work and cannot log in. The user remains inactive until an administrator changes the
Active status to Yes.
• Locked – On the Basics card, setting Locked status to Yes means that the user is locked and is unable to login
because of too many login attempts. A setting in the config.xml file determines how locked-out users are
handled. Locked-out users can be allowed to log in again at a later time, or an administrator can be required
to unlock them.
• Vacation Status – On the Basics card, set a vacation status and designate a backup user to receive work
assignments during vacation periods.
• User roles – On the Basics card, add roles for a user or remove them. See “Understanding Roles” on page
479.
• Group memberships – On the Basics card, set characteristics, such as whether or not the user is a member
or a manager, load factor, and weighted workload.
Managing Users and Groups 515

– Set the value of Member to Yes if the user is a working member of the group. This is required for work
assignment.
– Specify if the user is a Manager of the group.
– Setting the Load Factor Permissions to Admin for a user enables the user to both view and edit the Load and
Vacation screen for the group. Setting this permission to View enables the user just to see the screen.
– See “Load Factors” on page 481.
– See “Weighted Workload” on page 213
• Authority Limits – For information on settings in this card, see “Managing Authority Limit Profiles” on
page 519.
• Attributes – For information on settings in this card, see “Manage Attributes” on page 517.
• Regions – For information on settings in this card, see “Managing Regions” on page 524.
• Details – Show information on activities, claims, exposures, and matters that have various relationships to
this user, such as All open owned and All open related.
Deleting Users
If you have the permissions to do so, you can click Delete User on the user screen and delete a user. However, the
system checks if that user:
• Is the Super User.
• Is the default owner, the assignee of last resort used by the assignment system.
• Supervises any groups.
• Has any items assigned, including claims, exposures, and transactions.
If any of the previous conditions are met, ClaimCenter prevents you from deleting that user by not showing the
Delete User button. You can see some of the conditions preventing deletion in the data dictionary. The User entity’s
virtual property SafeToDelete lists the conditions.
Manage Groups
About this task
You can use the Groups screen both to search for groups and to edit the properties of a group.
Procedure
1. Use the Users & Security→Groups menu link on the Administration tab to open the Groups screen.
2. Select a group and click Edit.
3. Change the following group settings as needed:
• Name and Type
• Parent – The group to which this group belongs, which determines its location in the Organization tree.
• Supervisor – User who is the supervisor of the group.
• Security Zone – See “Managing Security Zones” on page 536.
• Users – Members of the group.
• Load factor – A percentage of the normal workload for the group. Assignment rules can consider this load
factor in assigning work to the group. See “Load Factors” on page 481.
• Queues – The queues of activities for the group to which work can be assigned. Assigning an activity to a
queue is an alternative to assigning the activity to individual members of a group. Activities in a queue wait
for a group member to take ownership of them. See “Queues” on page 210.
• Regions – See “Managing Regions” on page 524.

4. You can also delete a group by clicking the Delete button.
Next steps
See also
• To create a new group, see “Create New Users and Groups” on page 515.
Managing Activity Patterns

You can access the Activity Patterns screen to manage all activity patterns in your installation. To open this screen,
click the Administration tab and navigate to Business Settings→Activity Patterns. On this screen, you can:
• View all activity patterns or select a subset by category.
• Use the Add Activity Pattern button to add a new activity pattern.
• Select an activity pattern and use the Edit button to modify it.
Note: If you have multiple languages defined for your installation, when you click Edit, you can edit the Subject of
the activity for each language. Use the table at the bottom of the screen.
IMPORTANT Guidewire recommends that you not delete an activity pattern because it might be used in more than
one area. See “Understanding Activity Patterns” on page 234 for details of how activity patterns work and what
their fields do.
See also
Manage Attributes
About this task
ClaimCenter provides a general way to describe any user attributes that you need to use in assigning work.
ClaimCenter also has rules that assign work based on these attributes, such as selecting a user with a specified
attribute by round-robin.
Procedure
1. To manage user attributes, click the Administration tab and navigate to Users & Security→Attributes.
2. Use the Add Attribute button to create a new attribute by specifying its Name, Type, and Description. You can also
delete an existing attribute by selecting it and clicking Delete.
Result
Attributes are grouped by Type, defined in the UserAttributeType typelist, which you can access from ClaimCenter
Studio. In the base configuration, this typelist contains Default, Expertise, Language, and Named account types. This
typelist can be extended. The type is a way to group custom user attributes. For example, you can give the French
attribute the type Language.
Managing Activity Patterns 517

Next steps
See also
• “Custom User Attributes” on page 479
Managing Catastrophes
A catastrophe is a single incident or series of closely related incidents that cause a significant number of losses. The
system provides a way to associate a claim with a CAT number. ClaimCenter maintains a list of catastrophes that
affect the carrier’s business. ClaimCenter can associate one catastrophe from this list with a claim. After creating a
new claim, the New Claim wizard displays a list of active catastrophes, and you can associate the claim with one of
them.
When you navigate to Administration→Business Settings→Catastrophes, you can do the following:
• Add a catastrophe. See “Add a new catastrophe” on page 518.
• Activate or deactivate catastrophes. See “Activate or deactivate a catastrophe” on page 518.
• Select a catastrophe and find claims to associate with it. See “Associate a catastrophe with a claim” on page
518.
Add a new catastrophe

Procedure
2. Click Add Catastrophe.
3. Enter the required fields such as name, description, CAT number, type, dates covered and click Update.
The status of the catastrophe is active.
Activate or deactivate a catastrophe

Procedure
1. Click the Administration tab and navigate to Business Settings→Catastrophes to see the list of catastrophes.
2. Check the check box for a catastrophe and click either Activate or Deactivate.
If you deactivate a catastrophe, you cannot see it in the user interface and you cannot associate a claim with it.
Associate a catastrophe with a claim

About this task
If you create a new catastrophe, you can find claims to associate with it.
Procedure
1. Click the name of the catastrophe to open the Catastrophe Details screen.
2. Click Find Unmatched Claims.
The list of unmatched claims is built by using only active catastrophes. ClaimCenter runs a batch process that
performs a search to find all claims with the following criteria:
• Claim loss date is within the catastrophe's effective dates.
• Claim loss location matches one of the catastrophe's affected zones.
• Claim loss cause is one of the catastrophe's coverage perils.
• The claim does not already have an activity on it for potential catastrophe match.
• Claim.Catastrophe is null.
The system shows the number of matching claims and creates an activity on the found claims. The count
includes all claims that have a Review for Catastrophe activity open.
3. After the batch process runs, find the claim and navigate to its Loss Details screen. Generally, the quickest way
is to click Desktop→Activities and set the filter on the Activities screen to All open. The activity subject is Review
for Catastrophe.
4. If you select the claim number, you can navigate to the editable Loss Details screen to link the claim to the
catastrophe.
Result
This process results in running the batch process one time. You can also schedule the batch process to run
periodically to find claims that match but have not yet been associated with active catastrophes.
Next steps
See also
• “Catastrophes and Disasters” on page 157 to learn about catastrophes.
Managing Authority Limit Profiles

Authority limits are used in ClaimCenter to determine if a financial transaction can be automatically approved when
it is created, or if it requires further manual approval by a supervisor. An Authority Limit Profile is a named
collection of authority limits. Together, these authority limits determine the type of transactions a user can create and
whether those new transactions require approval. The authority limits to which a user is subject are defined by the
user’s assigned Authority Limit Profile. A user assigned the Custom profile has a customized set of authority limits.
You manage authority limit profiles by navigating to Administration→Users & Security→Authority Limit Profile.
See also
Authority Limits
An authority limit is composed of an authority limit type and a limit amount. If no limit is specified for a particular
authority limit type, typically the user cannot create transactions of the given type. If a user performs an action that
exceeds the user’s limit, the action requires approval by a user with higher limits who is selected by the approval
routing rules.
The AuthorityLimitType typelist, accessed from ClaimCenter Studio, contains the following types of limits. You
cannot add others.
Authority Limit Name Description

Claim available reserves The available reserves for all exposures on a claim
Claim payments to date The total amount of payments to date for the claim. Use this
authority limit type to enforce total payments. If your
authority limit profile does not have this limit type, you see an
error message when trying to create a check. The system
alerts you with the following message: You do not have the
authority to create this payment.
Claim total reserves The total reserves for all exposures on a claim. If the user's
authority limit profile does not have this limit type, the user
will not see the menu option to create reserves.
Managing Authority Limit Profiles 519
Authority Limit Name Description

This authority limit type covers the sum of reserve
transactions. If a claim has any supplemental payments, the
Total Incurred on the financial summary screen will always be
greater than the Claim Total Reserves for authority limit
checking. Therefore, a user can exceed the claim total
reserves limit by the amount of the sum of supplemental
payments.
Exposure available reserves The available reserves for a single exposure.
Exposure payments to date The total amount of payments to date for a single exposure.
Exposure total reserves The total reserves for a single exposure.
Payment amount The amount of a single payment.
Payments exceed reserves The amount by which payments are allowed to exceed
reserves on a claim.
Reserve change size The size of a single reserve change.
Configuration Parameters that Affect Authority Limits

The following parameters in the config.xml file, which you can access in ClaimCenter Studio, affect authority
limits.
Parameter Default Description

CheckAuthorityLimits true This parameter determines if authority limits are checked when approving a
transaction set. If set to false, it disables authority limit checking.
If set to false, it disables authority limit checking. ClaimCenter will not perform any
validation for the creation or approval of financial transactions. You will need to
implement your own validation for transactions.
If set to true and no limits are added in the Authority Limit Profile for a user, the user
is permitted to have maximum authority. See “Working with Authority Limit Profiles”
on page 521.
AllowPaymentsExceedReser false While this parameter does not affect authority limit behavior, it is related to it. The
vesLimits Payments Exceed Reserves authority limit makes sense only if this parameter is set to
true.
If set to true, you can submit payments that exceed available reserves up to the
amount specified by the Payments Exceed Reserves authority limits. Otherwise, no
partial or final payments that exceed reserves are allowed, other than first and final
payments.
MulticurrencyDisplayMode SINGLE This parameter does not directly affect authority limit behavior. However, it must be
set to MULTIPLE for ClaimCenter to show the currency selector.
WARNING: The MultiCurrencyDisplayMode parameter setting is semi-permanent.
After you enable MultiCurrencyDisplayMode by setting the value to MULTIPLE and
then start the server, you cannot change the value again.
EnableMultiCurrencyReser false This parameter does not directly affect authority limit behavior. However, if you set Mu
ving lticurrencyDisplayMode to MULTIPLE, you must also set this parameter to true.
IMPORTANT: The EnableMultiCurrencyReserving parameter setting is semi-
permanent. After you set the value of EnableMultiCurrencyReserving to true and
then start the server, you cannot change the value again.

Authority Limit Profiles in Another Currency

You can define an authority limit profile in a currency that is different from the base currency. Using a different
currency is useful for carriers that write policies in more than one country, or in countries with different currencies.
They can manage their claims for all these countries in one instance of ClaimCenter.
For example, a United Kingdom (UK) based carrier writes policies in both the UK and Ireland. The UK’s currency
is GBP and Ireland’s currency is the Euro. The carrier wants all their claims for their British policies to be managed
and tracked in GBP. The carrier also wants all of their claims for their Irish policies to be managed in the Euro. The
base currency is GBP because the carrier is based in the UK. However, the carrier wants to create certain
transactions in a different currency. The carrier administers authority limit profiles in different currencies for their
users.
A user can be assigned only one Authority Limit Profile, which has all its limits defined in one currency. For a
particular user, you would assign them an Authority Limit Profile with a currency that matches the claim currency of
the claims they will typically handle. For example, an adjuster in Ireland would be assigned an Authority Limit
Profile with a currency of Euro. A UK adjuster would have an Authority Limit Profile with limits defined in GBP.
No matter what the currency of the user's assigned Authority Limit Profile is, the user can still administer claims of
any currency. If the currency of the user’s profile does not match that of the claim for which the user is creating
transactions, the user’s Authority Limit Profile currency is converted. This conversion to the claim currency happens
on-the-fly using current exchange rates, and it is then compared with the ClaimAmount value of the relevant
transactions.
Working with Authority Limit Profiles

To manage complex sets of authority limits, ClaimCenter groups them into authority limit profiles, which you can
assign to users. You can define additional profiles or edit the following profiles that are in the base configuration:
• Adjuster profile
• Claims Supervisor profile
• Regional Supervisor profile
Working with Authority Limits

For each of the authority limit types, you can define a limit amount that applies to the whole claim or only to
transactions with a given coverage or cost type. For example, you can create different amounts for the payment
amount, depending on the cost type and coverage selected. Therefore, you can design a complex set of authority
limits. Also, the currency you select in the Currency drop-down list applies to all the limit types.
When applying authority limits, the coverage of the limit type determines what coverage type transactions the limit
checks. If you leave it unspecified—null—the limit applies to all transactions, regardless of coverage. The
PolicyType further narrows the limit to the specified line of business.
To enforce limits on the claim's Total Incurred Gross financial calculation, create two limits with the same limit
amount. One limit must be of type Claim Total Reserves and the other of type Claim Payments to Date.
See also
• “Manage Authority Limit Profiles” on page 521
Manage Authority Limit Profiles
About this task

You can manage authority limit profiles.
Procedure
1. Click the Administration tab and then navigate to Users & Security→Authority Limits Profile.
Managing Authority Limit Profiles 521

2. In this screen, you can:

• Create a new profile – Click the Add Authority Limit Profile button.
• Delete a profile – Select the profile’s check box and then click Delete.
• Edit an existing profile – Click the name of the profile to open its detail view, and then click Edit.
• Change a limit – Edit a profile and then enter the limit type, policy type, coverage type, cost type, and
amount. All but the amount are available from drop-down lists.
• Create a new limit – Edit a profile and click the Add button, and then set the values.
Assign Authority Limits to a User
About this task

You can edit a user and assign authority limit profiles.
Procedure
1. Click the Administration tab and then navigate to Users & Security→Users.
2. Search for a user, and select the user in the search results.
3. To assign authority limit profiles for the user, on the user’s screen, click the Authority Limits card.
4. Click Edit and select a profile from the Authority Limit Profile drop-down list.
Assign a Customized Authority Limit Profile to a User
About this task

You can customize and assign an authority limit profile to a user. To define generally available authority limit
profiles, see “Working with Authority Limits” on page 521.
Procedure
2. Search for a user, and select the user in the search results.
3. On the user’s screen, click the Authority Limits card.
4. Select the profile closest to the one you want the user to have from the Authority Limit Profile drop-down list.
5. Select Custom from this same drop-down list. The screen contains a table of the authority limits of the Authority
Limit Profile you first selected.
6. Modify the profile’s existing limits, or add new ones, or both.
Your changes affect only this user.
Managing Roles
Roles are named collections of system permissions that you assign to users. Both roles and permissions are listed
and fully described in “Role-Based Security” on page 488.
Use the Roles screen, available at Administration→Users & Security→Roles, to manage the roles themselves. You can
create new roles, add or remove permissions from existing roles, and assign roles to users.

See also
• “Security: Roles, Permissions, and Access Controls” on page 487
Assign Roles to Users

About this task
You can edit a user and assign roles.
Procedure
2. Search for a user, and then select the user in the search results.
3. Click Edit.
• To add a role to this user, on the Basics card in the Roles section, click Add. Then select a new role from the
drop-down list, and click Update to save your changes.
• To remove a role from this user, on the Basics card in the Roles section, select the check box next to the role
you want to delete and click Remove. Then click Update to save your changes.
Changing Roles and Their Permissions

You can work with roles and set permissions assigned to each role in the Roles screen.
Add a New Role
Procedure
1. Click the Administration tab and then navigate to Users & Security→Roles.
2. Click Add Role.
3. Give the role a name and a description. The name you choose appears in the table of roles.
4. You can also add permissions to the role in this screen below the Description field.
5. Click Update to add the new role to the list of roles.
Delete a Role
Procedure
2. Select the check box next to the role you want to delete.
3. Click Delete.
Add Permissions for a Role
Procedure
Managing Roles 523

2. Edit the role using one of two methods.

• Click the role name in the main Roles screen and then click Edit.
• Click Add Role.
You can add system permissions from either screen.
3. Click Add below the Description field to add a line to the table of permissions.
4. Click in the Permission field and choose a permission from the drop-down list.
Delete Permissions for a Role
Procedure
1. Edit the role by using one of two methods:
• Click the role name in the main Roles screen and then click Edit.
• Click Add Role.
You can delete system permissions from either screen.
2. To delete a permission, select its check box and click Delete.
Managing Regions
Regions are geographical areas that are used to define areas of responsibility for groups. Assignment rules use
regions.
You define and name regions in the Regions screen. Click the Administration tab and then navigate to Users &
Security→Regions to open this screen.
You assign regions to groups when you edit a group’s attributes, as described at “Manage Groups” on page 516.
Regions can be defined as collections of states, counties, or ZIP codes, and can use another address element, such as
postal codes, if so configured.
You can assign more than one region to a group, and more than one group can be given the same region. For
example, you might want a group to be responsible for a region including both states and counties. You can create
one region for the states, another region for the counties, and assign both regions to the same group.
See also
• “Understanding Regions” on page 484
Search for Regions

Procedure
1. Click the Administration tab and then navigate to Users & Security→Regions to open the Regions screen.
On the Regions screen, you can find all regions defined in your installation.
2. You can search either by using a filter or by listing all regions for a search.
a. To list all regions, simply leave the Region Name blank and set the Zone Type to All.
b. To search by using a filter, filter the search by Zone Type and Code.
You typically use this search feature when managing regions.

Creating, Editing, and Deleting Regions

To create, edit, and delete regions, click the Administration tab and then navigate to Users & Security→Regions to open
the Regions screen.
If the region you want to work with is not visible, you can use the Search button item to find it. For more
information, see “Search for Regions” on page 524.
Create a New Region
About this task

To create a new region in ClaimCenter:
Procedure
1. Click the Administration tab and then navigate to Users & Security→Regions.
2. On the Regions screen, click Add Region.
3. In the Add Region screen, give the region a Name and select its Type, which by default is County, State, or Zip
code.
• If you choose County, you must then choose a state. After choosing a state, you see two boxes separated by
Add--> and <--Remove buttons that you use to build the set of counties.
• If you choose State, you see two boxes separated by Add--> and <--Remove buttons. Use them to build the set
of states.
• If you choose Zip code, you can click Add and enter the value for each ZIP code you want to have in the
region.
4. Click Update to save the new region.
Edit an Existing Region
Procedure
2. On the Regions screen, click the region name to open its edit screen, and then click Edit.
3. In the Add Region screen, give the region a Name and select its Type, which by default is County, State, or Zip
code.
• If you choose County, you must then choose a state. After choosing a state, you see two boxes separated by
Add--> and <--Remove buttons that you use to build the set of counties.
• If you choose State, you see two boxes separated by Add--> and <--Remove buttons. Use them to build the set
of states.
• If you choose Zip code, you can click Add and enter the value for each ZIP code you want to have in the
region.
4. Click Update to save the changes to the region.
Delete a Region
About this task

To delete an existing region in ClaimCenter:
Procedure
2. On the Regions screen, select the check box for the region in the list.
Managing Regions 525

3. Click Delete.
Assign a Region to a Group
Procedure
2. Select the group, either from the Organization tree or by searching for and selecting the group on the Groups
screen.
To open the Groups screen so you can search, navigate to Users & Security→Groups.
3. Click Regions to see the list of regions associated with this group.
4. Click Edit and then click Add.
5. In the Browse Group Regions screen that opens, search for regions. You can filter by Zone Type or Code.
See “Search for Regions” on page 524.
6. Select the check box next to the region or regions you want to add.
7. Click Select to add your selections to the list.
8. Click Update.
Disassociate a Region from a Group
Procedure
2. Select the group, either from the Organization tree or by searching for the group on the Groups screen.
Navigate to Users & Security→Groups to open the Groups screen.
3. Click Edit.
4. Click Regions and select the check box for the region.
5. Click Remove.
Managing Holidays
You can administer holidays by clicking the Administration tab and then navigating to Business Settings→Holidays.
Holidays and weekends define the business days for the business calendar. Holidays can vary according to city,
state, county, or country. In turn, ClaimCenter uses a business calendar to calculate many important dates. Given that
holidays differ in different areas, ClaimCenter defines holidays associated with different regions.
Since many holiday dates change annually, it is a good practice to edit these holidays at the beginning of each new
year.
Information on setting holidays, weekends, and business weeks is available in the following topics:
• “Specifying Holiday Dates” on page 271
• “Working with Holidays, Weekends, and Business Weeks” on page 272
• “Managing Business Weeks” on page 551
See also
Managing Messages Queues

This topic provides a brief overview of ClaimCenter messaging. For detailed descriptions, see:

After certain events occur, ClaimCenter can send a message to an external system to notify it of the event. Every
message is related to a specific claim and has a particular external destination. Event messages could be sent to an
email server, to the Metro Bureau, to a payment system, or to ContactManager to synchronize a contact. For
example, when a payment is ready to be made on a claim, ClaimCenter sends a message to your accounts payable
system to have it issue a check.
After ClaimCenter sends a message, the message is said to be pending or in flight until the external system
acknowledges receipt of the message. Only one message for a given claim and destination can be in flight at one
time. Messages are ordered as first-in-first-out because one message can depend on reception of another message.
This ordering is called safe-ordered messaging. Messages that relate to more than one claim are called non-safe-
ordered messages. They can be sent at any time and can enter the FIFO queue in any position. The distinction
between safe- and non-safe-ordered messages is important when you try to re-send a message that has failed because
of an error.
To monitor and manage the message queues that ClaimCenter uses to send messages to these systems, click the
Administration tab and then navigate to Monitoring→Message Queues. You can manage resending failed messages and
suspending, resuming, and restarting the messaging system.
See also
Monitoring Message Queues

To monitor message queues, click the Administration tab and then navigate to Monitoring→Message Queues. The
Message Queues screen can show several summary tables of messages:
• The summary table lists all external destinations for ClaimCenter messages and the ID and status of each
message queue. It also shows the traffic statistics—the number of failed, retryable error, in flight, unsent
(queued), and batched messages, and messages awaiting retry.
• You can click a destination name to open the Destination screen and see similar statistics for a single destination.
This screen shows statistics for messages relating to each claim, as well as all non-ordered messages to that
destination.
◦ Use the filter to search for claims with failed messages, unfinished messages, or messages needing retry.
◦ If the non-safe-ordered messages link is listed, you can click it to view the list of non-safe-ordered messages by
claim. The Non-safe-ordered messages screen does not show any safe-ordered messages.
Suspending and Resuming Messaging

If you know that a message destination is not available, you can temporarily suspend sending messages to that
destination. Messages are put in a queue during the time that their destination is suspended. You can later resume
sending messages to the destination, and the queued messages are sent in the proper order. You can do the following:
• Suspend messaging to a specific destination. See “Suspend Messaging to a Specific Destination” on page 527.
• Resume messaging to a single destination. See “Resume Messaging to a Single Destination” on page 528.
• Restart messaging to all destinations. “Restart Messaging to all Destinations” on page 528.
• Skip a message. See “Skip a Message” on page 528.
• Skip all messages. See “Skip all Messages” on page 528.
Suspend Messaging to a Specific Destination
Procedure
1. Click the Administration tab and then navigate to Monitoring→Message Queues.
Managing Messages Queues 527

2. Select the check box for the destination in the Message Queues screen.
3. Click Suspend.
The Status for that destination changes to Suspended.
Resume Messaging to a Single Destination
Procedure
2. Select the check box for the destination in the Message Queues screen.
3. Click Resume.
The Status for that destination changes to Started.
Restart Messaging to all Destinations
Procedure
2. Click the Restart Messaging Engine button to resume sending messages to all destinations.
Skip a Message
Procedure
2. Click the destination name for the message in the Message Queues screen to open the Destination screen.
3. If you know that a message cannot reach its destination or is no longer relevant, you can skip it by selecting it
and clicking Skip first.
ClaimCenter stops trying to send it to the destination.
Once you skip a message, you cannot retry it.
Skip all Messages
Procedure
2. Click the destination name for the messages in the Message Queues screen to open the Destination screen.
3. Choose all messages by selecting the check box in the table header.
4. Click Skip.
Retrying Messages
In any message destination screen, clicking the check box to select a message from a single destination activates the
Retry button. Click it to resend the message. To resend all retryable messages to a single destination, select them all
before clicking Retry.
ClaimCenter distinguishes between retryable and failed messages. The Retry button is not available for a failed
message.

Synchronizing Contacts with ContactManager

Note: This feature works only if you have integrated ContactManager with ClaimCenter. See the Guidewire
Contact Management Guide.
If you choose the Contact Auto Sync Failure destination and select one contact, a Sync button appears. Use it to copy all
changes and additions made on that ClaimCenter contact to ContactManager. If you select the check box above all
the new or changed ClaimCenter contacts, clicking the Sync button updates all contacts in ContactManager.
See also
Managing Script Parameters

A script parameter is an application-wide global parameter that has a value that tends to change over time. For
instance, script parameters can be used to set initial reserve values for auto glass damage, full body damage, or
minor body damage. These initial reserve values can change from year to year.
See also
• For information on how to configure the list of script parameters, see the Configuration Guide.
Modify Existing Script Parameters

About this task
You can modify values of existing script parameters in ClaimCenter.
Procedure
1. Click the Administration tab and navigate to Utilities→Script Parameters.
On the Script Parameters screen, you see the list of script parameters and the Value and Type of each parameter,
such as java.lang.boolean, java.lang.integer, and so on.
2. Select a script parameter in the list.
3. Click Edit.
4. Change the script parameter Value.
Create, Edit, and Delete Script Parameters

About this task
You can edit and delete existing script parameters and create new ones in Guidewire Studio.
Procedure
1. Navigate in the Project window to configuration→config→resources and double-click ScriptParameters.xml.
2. Restart the ClaimCenter server to pick up the changes.
Managing Workflows
A workflow is a multistep process that manages a complex business practice that rules cannot define by themselves.
You define a workflow in Studio and execute instances of it from buttons you add to PCF pages.
Managing Messages Queues 529

Once invoked, a workflow handler executes the instance of the workflow, performs its steps, and controls its status.
You can edit a workflow even when instances of it are running. Editing a workflow creates another version of the
workflow with an incremented Process Version. New instances use the latest Process Version.
If you click the Administration tab, you can navigate to Monitoring and choose Workflows or Workflow Statistics.
• On the Workflows screen, you can search for workflows, see a list of workflow instances and their statuses, and
manage them.
See the following topics that describe working with this screen:
◦ “Find Workflows” on page 530
◦ “Start and Stop Workflows” on page 530
◦ On the Workflow Statistics screen, you can search for a workflow type and period during which its steps
executed. You then see data about the workflow steps that executed during that period.
See “View Workflow Statistics” on page 530.
See also
Find Workflows
Procedure
1. Click the Administration tab and navigate to Monitoring→Workflows.
2. The upper part of the Workflows screen enables you to search either for all workflow instances, or for all
instances of one Workflow Type, which is one workflow name.
3. Filter your search by a version, a start date range, an update date range, a specific step it is executing, the
handler type it uses, or its current status.
The results reflect, for each workflow instance found, its Workflow Type, Ver (version), Start Time, Update Time,
Parent, Children, Handler, current Step, Status, Active State, Work Item, and Timeout. The last item indicates if the
workflow has timed out instead of completing.
Start and Stop Workflows

Workflows proceed according to their internal schedules. They stop either on an error or if you suspend them in the
Workflow screen. You can restart workflows on the Workflows screen.
1. Click the Administration tab and navigate to Monitoring→Workflows.
2. Search in the upper part of the Workflows screen for all workflow instances, or for all instances of one Workflow
Type, which is one workflow name. See “Find Workflows” on page 530.
• You can suspend only the instances that have Active status. To suspend an instance, select it and click the
Suspend button.
• To restart an instance with suspended status, click Resume. The Resume-All button resumes all instances in the
current list.
View Workflow Statistics

About this task
Workflow statistics are collected periodically. You define the period you want to see. The statistics capture
information on the workflow steps that have completed during the interval you specify. For each step that
completed, the elapsed time and execution time is analyzed by extracting the min, max, mean, and std deviation. To
see workflow statistics:

Procedure
2. Navigate to Monitoring→Workflow Statistics.
Managing Importing and Exporting Data

While users enter much of the administrative data directly into ClaimCenter, there are times when it is necessary or
convenient to transfer this information in bulk. The Administration tab provides a convenient way of moving
administrative data, question sets, role definitions, and so on as XML or zipped XML files.
You can also import or export other types of data, in either XML or CSV format, by using the API. Also, there is a
command to import files in either format, but not to export them.
Method Import / File Names File Formats

Export
user yes / yes admin.xml, questions.xml, roles.xml, vendorservicetree.xml, vendorserv XML, zipped
interface icedetails.xml XML
APIs yes / yes any XML, CSV
See also
Importing Administrative and Other Data in the Administration Tab

About this task
To import administrative and other data in ClaimCenter:
Procedure
1. Click the Administration tab and then navigate to Utilities→Import Data.
2. Select a file of administrative data to import.
The Browse button can assist you in finding the file.
For example, if you have created a file of modified question sets, called newquestionset.xml, select this file.
This file must be either in XML or zipped XML format, with an XSD compatible with the XML files you can
import. However, you need not import all administrative data. You can instead import any subset, such as
users, regions, or security zones.
3. Click Next, and follow the commands on the screen to resolve differences between the data in the imported file
and data already in the database.
Data not yet in the database is imported without question. If the imported data differs from what is already in
the database, these commands enable you either to accept the imported data or to keep what is in the database.
4. Click Finish to complete the import.
Next steps
See also
• “Export Data in the Administration Tab” on page 532
Managing Importing and Exporting Data 531

Export Data in the Administration Tab

About this task
To export administrative data in ClaimCenter administration, use the following steps.
Note: There is no method in the user interface to export a CSV file or other file format.
Procedure
1. Click the Administration tab and then navigate to Utilities→Export Data to export administrative data or the
security dictionary.
See also “Exporting the Security Dictionary” on page 536.
2. Select the data to export from the Data to Export text drop-down list. You can choose from one of the export
types listed in “Export Categories” on page 532.
3. Click Export.
Export Categories
Exporting administrative data creates XML files. Each file contains all the data of a certain type in your installation.
These export categories are:
• Activity Patterns – Exports all activity pattern data to activitypattern.xml, data of type ActivityPattern. If
you choose Admin as the export type, the same activity patterns are exported with the other administrative data.
For more information, see “Managing Activity Patterns” on page 517.
• Admin – Exports all administrative data to admin.xml, including data of the following types:
◦ Attribute
◦ AssignableQueue
◦ AuthorityLimit
◦ Catastrophe
◦ Contact objects, plus their associated Address and ContactIndividual objects
◦ Credential
◦ Group, and GroupRegion, GroupRuleSet, and GroupUser
◦ GroupAssignmentState and GroupUserAssignmentState
◦ InvalidCoverageForCause
◦ IncompatibleNewExposure
◦ IntegerClaimMetricLimit
◦ IntegerExposureMetricLimit
◦ LargeLossThreshold
◦ MoneyClaimMetricLimit
◦ Organization
◦ QuestionSet and Question, QuestionChoice, and QuestionFilter
◦ PolicyTypeMetricLimits
◦ Region
◦ ReinsuranceThreshold, and ReinsuranceCoverage and ReinsuranceLossCause
◦ Reviewtype and ReviewCategoryQuestionSet
◦ Role, Privileges, RolePrivilege, and Permission
◦ SecurityZone

◦ User, including AttributeUser, UserRole, and UserSettings

◦ UserPreference
◦ WCBenefitParameterSet and WCBenefitFactors and WCDenialPeriod
• Authority Limit Profiles – Exports all data on authority limit profiles to authoritylimitprofiles.xml, data of type
AuthorityLimitProfile. If you choose Admin as the export type, the same authority limit profiles are exported
with the other administrative data.
For more information, see “Managing Authority Limit Profiles” on page 519.
• Business Weeks – Exports all data you have defined on business weeks to businessweeks.xml. If you have not
defined business weeks, no data is exported.
For more information, see “Managing Business Weeks” on page 551.
• Catastrophes – Exports all data you have defined on catastrophes to catastrophes.xml, data of type
Catastrophe. If you choose Admin as the export type, the same catastrophe data is exported with the other
administrative data.
For more information, see “Managing Catastrophes” on page 518.
• Coverage Verifications – Exports all data on coverage verification to coverageverification.xml. If you choose
Admin as the export type, the same coverage verification data is exported with the other administrative data. The
exported file has the following types of data:
◦ InvalidCoverageForCause
◦ IncompatibleNewExposure
◦ InvalidCoverageForFault
For more information, see “Verifying Coverage” on page 111.
• Exchange Rates – Exports all data on exchange rates to exchangerates.xml. You must choose this export type to
export exchange rate data because it is not exported with the Admin data. The file contains the following types of
data:
◦ ExhangeRate
◦ ExhangeRateSet
For more information, see “Exchange Rates” on page 380.
• Holidays – Exports all data you have defined on holidays to holidays.xml. If you have not defined holidays, no
data is exported.
For more information, see “Managing Business Weeks” on page 551.
• ICD Codes – Exports all data on version 10 of the International Statistical Classification of Diseases and Related
Health Problems (ICD), medical diagnosis codes that classify diseases, to icd.xml. You must choose this export
type to export ICD data, because it is not exported with the Admin data. The file contains data of type ICDCode.
For more information, see “Managing ICD Codes” on page 546.
• Large Loss Thresholds – Exports all data on large loss thresholds to largelossthresholds.xml. The file contains
data of type LargeLossThreshold. If you choose Admin as the export type, the same large loss threshold data is
exported with the other administrative data.
For more information, see “Managing Metrics and Thresholds” on page 547.
• Metric Limits – Exports all data on metric limits to metriclimits.xml. If you choose Admin as the export type, the
same metric limit data is exported with the other administrative data. The file has data of the following types:
◦ IntegerClaimMetricLimit
◦ IntegerExposureMetricLimit
◦ MoneyClaimMetricLimit
◦ PolicyTypeMetricLimits
Export Data in the Administration Tab 533

• Questions – Exports all data on question sets to questions.xml. By default, contains both the SIU (fraud) and
Service Provider Management question sets. You can export question sets to modify them and create your own
custom question sets. If you choose Admin as the export type, the same question set data is exported with the other
administrative data. The file has data of the following types:
◦ QuestionSet
◦ Question
◦ QuestionChoice
◦ QuestionFilter
◦ Reviewtype
◦ ReviewCategoryQuestionSet
For more information, see “Question Sets” on page 281.
• Regions – Exports all data on regions to regions.xml. If you choose Admin as the export type, the same region
data is exported with the other administrative data. The file has data of the following types:
◦ Region
◦ RegionZones
◦ RegionZone
For more information, see “Managing Regions” on page 524.
• Reinsurance Thresholds – Exports all data on reinsurance thresholds to reinsurancethresholds.xml. If you
choose Admin as the export type, the same reinsurance threshold data is exported with the other administrative
data. The file has data of the following types:
◦ ReinsuranceThreshold
◦ ReinsuranceCoverage
◦ ReinsuranceLossCause
For more information, see “Managing Reinsurance Thresholds” on page 545.
• Roles – Exports all data that maps system permissions to roles to the file roles.xml. If you choose Admin as the
export type, the same role data is exported with the other administrative data. The file has data of the following
types:
◦ Role
◦ Privileges
◦ RolePrivilege
◦ Permission
For more information, see “Managing Roles” on page 522.
• Service Metric Limits – Exports all limit data for service request metrics to servicerequestmetriclimits.xml. If
you choose Admin as the export type, the same metric limit data is exported with the other administrative data.
The export data set includes all instances of ServiceRequestMetricLimit.
Each instance includes:
• ServiceRequestMetricType – Type of metric.
• CustomerServiceTier
• SpecialistService – Service request type.
• Currency
• LimitType – Calculation method for the limit.
• DecimalTargetValue, DecimalYellowValue, and DecimalRedValue – Target, yellow, and red limit values.
• MetricUnit – The units for the limit values (currency, hours, days, and so on).
• Special Handling – Exports data for accounts and special handling of those accounts to
accountsandspecialhandling.xml. You must choose this type to export this data because it is not exported
with the Admin data. The data includes the following types:
◦ Account
◦ AccountSpecialHandling
◦ Company
For more information, see “Accounts and Service Tiers” on page 119.
• Users and Groups – Exports all data on users and groups to the file usergroup.xml. If you choose Admin as the
export type, the same user and group data is exported with the other administrative data. The file has data of the
following types:
◦ User
◦ Users
◦ UserContact
◦ UserSettings
◦ Credential
◦ Organization
◦ Group
◦ SecurityZone
◦ AuthorityLimitProfile
◦ Address
◦ Role
For more information, see “Managing Users and Groups” on page 514.
For more information, see “Managing Roles” on page 522.
• Vendor Service Details – Exports all data on vendor service details to the file vendorservicedetails.xml. Vendor
service details associate each service with a compatible incident type and service request type.
• Vendor Service Tree – Exports the tree of vendor services to the file vendorservicetree.xml. Vendor services
describe services performed by vendors. The file has data of the following types:
◦ SpecialistService
• Workload Classifications – Exports data on workload classifications to the file workloadclassifications.xml.
Workload classifications support weighted workload balancing.
See “Weighted Workload Classifications” on page 215.
After you choose to export one of these types of data, ClaimCenter provides it with all relevant data formatted in
XML. For example, the questions.xml file contains all the default question sets and all the question sets
subsequently added.
See also
• “Question Sets” on page 281
• “Claim Fraud” on page 143
• The Guidewire Contact Management Guide for details of the supplied question sets and how to modify them.
Export Data in the Administration Tab 535

Exporting the Security Dictionary
About this task

You can export the ClaimCenter Security Dictionary from the Export Data screen. The Security Dictionary provides
information on application permission keys, page configuration files, system permissions, and roles. You can export
this data as HTML or XML.
To export the Security Dictionary:
Procedure
1. Click the Administration tab and then navigate to Utilities→Export Data.
2. Under Export Security Dictionary, select the output format, HTML or XML.
3. Click Export.
Next steps
See also
• “Security Dictionary” on page 508
Importing and Exporting with APIs and from the Command Line
You might want to import or export other types of data than is available in the ClaimCenter Administration tab, or
you might want to use file formats other than XML. For example, if you receive new information from an external
system, you might want to import this new data into ClaimCenter in a single step. APIs and the command-line
functions are your two alternatives to the user interface described previously. APIs enable you both to import and to
export, but the command-line commands support only import.
Importing and Exporting with APIs

Use the ImportToolsAPI to create batch processes that move data in and out of ClaimCenter. These batch processes
might be used to add current FNOL information periodically to ClaimCenter. These files can have either XML or
CSV format.
Importing from the Command Line

There are command-line commands for importing, but not exporting, XML and CSV files containing any kind of
data, not just the types of data supported by the Administration tab.
See also
Managing Security Zones

Security zones are a way for ClaimCenter to provide security for a defined area larger than a group in your
organization.
Every group must belong to a security zone. It is a good idea to have a strategy for how to use security zones. One
strategy is to use zones that describe your lines of business (LOBs). Another is to describe zones that reflect your
local or regional offices.
If you define just one security zone, there is no difference between global and related permission scopes. With just
one security zone, both the owner of any claim and all users are members of the same security zone.
Security zones are just names. They are not defined as collections of geographical areas and are not regions. Claim
center provides two default security zones, Workers’ Compensation and Auto and Property.

See also
• “Understanding Regions” on page 484
• “Security Zones” on page 504
• “Data-based Security and Claim Access Control” on page 491
Add and Edit Security Zones

About this task
You can perform add, edit, and delete operations on security zones.
Note: Changing the name of a security zone effectively deletes the old zone and assigns the zone with the new
name to all groups that had used the old name.
Procedure
1. On the Administration tab, click Users & Security→Security Zones in the sidebar.
2. Choose to create a new security zone or to edit an existing security zone.
3. To create a new security zone:
a. Click the Add Security Zone button.
b. Enter a name and description.
c. Click Update.
4. To edit an existing security zone:
a. In the list of zones, click the zone you want to edit and then click Edit.
b. Edit the name or description or both.
c. Click Update.
Choose or Change a Group’s Security Zone

Procedure
2. Select the group, either from the Organization tree or by searching for and selecting the group on the Groups
screen.
To open the Groups screen, navigate to Users & Security→Groups.
3. On the screen for the group you selected, click Edit.
4. In the Security Zone field, select a security zone from the drop-down list.
Creating and Managing Reference Tables

Reference tables are tables not connected to specific claims. Most entities in ClaimCenter are claim related. Main
entities that are not related to specific claims and are used across claims are bulk invoices, aggregate limits, and
reference tables.
Managing Security Zones 537

ClaimCenter implements two varieties of reference tables: reference tables that define the Verifying Coverage
feature and workers’ compensation reference tables that enable rules to calculate benefits. You can view these
reference tables by selecting one of the following sidebar menu links in the Administration tab:
• Business Settings→Coverage Verification – See “Managing Coverage Verification” on page 538.
• Business Settings→WC Parameters – See “Managing WC Parameters” on page 539.
You can also create your own sets of reference tables.
See also
• “Verifying Coverage” on page 111
Coverage Verification Reference Tables

The coverage verification feature uses the following tables to define allowed coverages for specific losses, users,
and exposures.See “Verifying Coverage” on page 111 for more information.
• Invalid Coverage For Cause – A list of invalid loss cause and coverage pairs. ClaimCenter uses these pairs to warn if
you are about to create an exposure with such an invalid combination, such as a personal auto comprehensive
exposure due to a collision. The PCF files are InvalidCoverageForCause.pcf and
InvalidCoverageForCauseLV.pcf. They use the entity InvalidCoverageForCause.eti to populate the table in
the user interface and store changes.
• Incompatible New Exposure – A list of new exposures you try to create that are incompatible with other exposures
that are already part of the claim. For example, it warns you if you try to create a comprehensive exposure when
the claim already contains a collision exposure. The PCF files are IncompatibleNewExposure.pcf and
IncompatibleNewExposureLV.pcf. They use the entity IncompatibleNewExposure.eti to populate the table in
• Possible Invalid Coverage due to Fault Rating – A list of invalid coverage and fault rating pairs. ClaimCenter uses
these pairs to warn if you are about to create an exposure with an invalid combination. An example is a personal
auto liability exposure when the other party is at fault. The PCF files are InvalidCoverageForCause.pcf and
InvalidCoverageForCauseLV.pcf. They use the entity InvalidCoverageForCause.eti to populate the table in
Configuring Reference Tables

You can create new reference entities and the PCF files for them and add them either to the Coverage Verification or WC
Parameters menu items in the Administration tab. Or you can create a new menu item for your new tables. Click Edit in
the screens that show each table to edit values and remove table rows.
Once you have a correctly defined and populated reference table, you can write rules that read and use it. You can
use Gosu functions in the rules to access the reference table.
ClaimCenter uses the Coverage Verification tables to help users avoid creating unreasonable exposures.
Managing Coverage Verification

Whenever you create a new exposure, ClaimCenter looks for inconsistencies between a policy’s coverages and the
loss party, loss cause, other existing exposures, and claimant’s liability. The tables on each screen associate loss
causes with appropriate exposures, loss party with appropriate exposures, and exposures on a claim incompatible
with other existing exposures. In addition, you can edit and extend these tables.

On the Administration tab, click Business Settings→Coverage Verification in the sidebar. You see the following menu
links:
• Invalid Coverage for Cause – You can edit or add the loss type, line of business code, policy type, loss cause, and
invalid coverage for new exposure.
• Incompatible New Exposure – You can edit or add policy type, invalid coverage for a new exposure, and the
coverage of existing exposure.
• Possible Invalid Coverage due to Fault Rating – You can edit or add the policy type, invalid coverage for a new
exposure, and fault rating.
See also
• “Verifying Coverage” on page 111
Managing WC Parameters
ClaimCenter provides menu links on the Administration tab under Business Settings→WC Parameters that you can use to
administer and manage parameters associated with Workers’ Comp calculations. The screens that open from these
menu links work in conjunction with business logic defined in Guidewire Studio. ClaimCenter bases this framework
of business logic on conventions in use in the United States. However, it is possible for you to adapt the logic for use
in other countries as well.
Note: See “Jurisdictional Benefit Calculation Management” on page 196 for an explanation of the various types of
compensation.
Using this functionality, it is possible to calculate multiple types of compensation, based on jurisdiction:
TPD Temporary Partial Disability

TTD Temporary Total Disability
PPD Permanent Partial Disability
PTD Permanent Total Disability
An important aspect of handling workers’ compensation claims is calculating workers’ compensation payments for
lost time. For example, the following calculation is an example of a possible TPD calculation using AWW (Amount
Weekly Wage):
WeeklyCompRate= JurisdictionRate x (Pre-injuryAWW - Post-injuryAWW)
It is possible for an individual state to calculate this value differently for each year. In the base configuration,
ClaimCenter provides sample calculations for a few example states and more detailed sample PPD calculations for
the state of California. The goal of these examples is to show you how you can calculate these amounts.
You enter, manage, and edit various workers’ compensation-related parameters through the ClaimCenter interface.
ClaimCenter then uses these parameters to perform the actual calculations in Gosu code, which you can configure
through ClaimCenter Studio.
An adjuster can always override workers’ comp amounts by entering a manual amount.
Click the Administration tab and navigate to Business Settings→WC Parameters to see the menu links for screens in
which you can manage workers’ compensation parameters. The menu links and screens are:
Managing WC Parameters 539

Screen Description Topic

“Using the Benefit Provides a list of jurisdictions. Clicking a jurisdiction opens the “Using the Benefit Parameters
Parameters Detail Screen” Benefit Parameters Detail screen showing the set of benefit Detail Screen” on page 540
on page 540 parameters for that jurisdiction. You can view and edit these
parameters.
“Enter Information in the Provides data similar to the PPD area of the Benefit Parameter “Enter Information in the PPD
PPD Min/Max Screen” on Detail screen, but with more detail. Min/Max Screen” on page
page 541 541
“Enter Information in the Entry screen in which you can define the limits of how long the “Enter Information in the PPD
PPD Weeks Screen” on page injured worker can receive the workers’ compensation benefits, Weeks Screen” on page 541
541 based on the disability.
Compensability Parameters Shows a list of jurisdictions and the maximum time for each “Entering Denial Period
that the carrier has to make compensability decision, the denial Information” on page 542
period. Click a jurisdiction to open its Compensability Parameter
Detail page, where you can edit the settings.
Using the Benefit Parameters Detail Screen

Use this screen to define a benefit parameters record, with a different jurisdictional state, start date, and end date for
each record. For example, you can create several entries for a single state, with each entry based on a specific time
period.
You access the Benefit Parameter Detail screen by clicking the Administration tab and navigating to Business Settings→WC
Parameters→Benefit Parameters and then doing one of the following:
• Clicking Add in the Benefit Parameters screen. ClaimCenter opens the Benefit Parameter Detail screen in which you
can create a new set of defined benefit parameters based on a new jurisdiction.
• Clicking a jurisdiction in the Benefit Parameters screen. ClaimCenter opens an existing set of benefit parameters,
which you can then edit.
Use the Benefit Parameter Detail screen to define information on the following:
Area Description
General You must set the following for each defined set of benefit parameters:
• Jurisdiction
• Start date
• End date
These parameters make this set of benefit parameters unique.
Temporary Total ClaimCenter can calculate benefits, for example, as Average Weekly Wage (AWW) times Percent of Wages. If
Disability (TTD) the result falls within the maximum and minimum, this calculated benefit amount becomes the benefit.
Temporary Partial Otherwise the value of the benefit is one of the following:
Disability (TPD) • The maximum if the result was more than the maximum weekly benefit.
Permanent Total • The minimum if the result was less than the minimum weekly benefit.
Disability (PTD) If you set Minimum adjusted by Weekly Wage to Yes and the employee's AWW is less than the Minimum
Permanent Partial Weekly Benefit, the calculation changes. The minimum amount that the worker can receive becomes the
Disability (PPD) AWW rather than the Minimum Weekly Benefit.
Waiting Period In the Waiting Period section, you set the following:
• Number of days – Number of lost work days before the workers' compensation benefits will begin to be
paid. For example, if the waiting period is three days, the worker is eligible to be paid on the fourth day
of lost wages.
• Retroactive Period – Number of lost work days at which point the worker is paid retroactively for the
original waiting period days. For example, the waiting period is three days and the retroactive period is

Area Description
14 days. In this case, the worker is eligible to be paid for the initial three days of lost wages on the 14th
day of lost wages.
Other You can add additional factors for ClaimCenter to use in calculating workers’ compensation benefits. The
Jurisdictional Other Jurisdictional Factors list view at the bottom of the screen can track information about special rules that
Factors apply to claims in this jurisdiction. Click Add under Other Jurisdictional Factors to define additional factors. Click
the field for Category to add a category, and do the same for Detailed Factor. You can specify the units for the
category and indicate if it applies to any combination of TTD, TPD, PTD, and PPD.
In the default configuration, this list view informs adjusters working on claims of special conditions for
various types of disabilities. The information could be leveraged in rules. The information is presented on
the time loss exposures for claims in the appropriate jurisdictions. The expectation is that the adjuster can
take this information into account and modify the benefits and manage the claim as appropriate.
ClaimCenter renders the Benefit Parameter Detail screen by using the WCBenefitParameterSetDV PCF file.
ClaimCenter embeds WCBenefitFactorsLV in WCBenefitParameterSetDV. The WCBenefitFactorsLV PCF file
defines the information to show in the Other Jurisdictional Factors section of the Benefit Parameter Detail screen. The
entity WCBenefitParameterSet is used to retrieve and store the data used in these screens.
Enter Information in the PPD Min/Max Screen

About this task
Use the PPD Min / Max screen to define the extent to which an injured worker is disabled. ClaimCenter renders the PPD
Min / Max screen by using the WCPDBenefits and the WCPDBenefitsLV PCF files. The entity ref_WC_PD_Benefits is
used to retrieve and store the data used in these screens.
Procedure
1. Access the PPD Min / Max screen by clicking the Administration tab and navigating to Business Settings→WC
Parameters→PPD Min / Max.
2. Click Edit to edit the screen.
The disability percentage minimum and maximum values on this screen refer to the degree to which the
injured worker is disabled. The PPD Min / Max values are based on jurisdiction, with start and end dates, such as
dates defining a calendar year.
3. Enter a jurisdiction, the start and end dates, a minimum and maximum disability percentage, and a minimum
and maximum benefit dollar amount.
If the data on the Benefit Parameters screen conflicts with the data on the PPD Min / Max screen, use the detailed
data on the PPD Min / Max screen.
Enter Information in the PPD Weeks Screen

About this task
Use this screen to define the length of time the injured worker can receive workers’ compensation benefits, based on
the disability. ClaimCenter renders the PPD Weeks screen by using the WCPDWeeksAndLimits and the
WCPDWeeksAndLimitsLV PCF files. The entity ref_WC_PD_WeeksAndLimits is used to retrieve and store the data
used in these screens.
Procedure
1. Access the PPD Weeks screen by clicking the Administration tab and navigating to Business Settings→WC
Parameters→PPD Weeks.
2. Click Edit to edit the screen.

The PPD Weeks settings are based on jurisdiction, with start and end dates, such as dates defining a calendar
year.
3. Enter a jurisdiction, the start and end dates, the disability percent, and the number of weeks that apply.
Entering Denial Period Information

About this task
The denial period defines the maximum time the carrier has to make the compensability decision.
Procedure
1. Access the Denial Period Detail screen by clicking the Administration tab and navigating to Business Settings→WC
Parameters→Denial Period Detail.
2. Do one of the following:
• Click Add in the Denial Period screen. ClaimCenter opens the Denial Period Detail screen.
Create a new denial period based on a new jurisdiction.
• Click a jurisdiction in the Denial Period screen. ClaimCenter opens an existing set of parameters in the Denial
Period Detail screen.
Click Edit to edit them.
Deciding Compensability and the Denial Period

If the compensability decision is not made by the time the denial period expires, the claim is automatically
determined to be compensable. ClaimCenter uses the denial period data to determine due dates of the Determine
Compensability activity. If ClaimCenter does not find a jurisdiction in the reference table, the system uses the
Determine Compensability activity pattern. ClaimCenter creates the activity and sets the activity due date to five
business days after the notice date.
The denial period is based on jurisdiction with effective and expiration dates. ClaimCenter also requires you to enter
a due date formula that is based on either the loss or notice date. For example:
• Greater of x days after the loss date or y days after the notice date
• x days after the loss date
• y days after the notice date
Depending on your selected formula, you further define what Target Days from Loss (x) or Target Days from Notice (y) is.
You must also select Target Include Days that can be based on calendar or business days.
You can optionally indicate documents to be used when accepting or denying compensability.
ClaimCenter renders the Denial Period screen by using the DenialPeriods and the DenialPeriodsLV PCF files. The
entity WCDenialPeriod is used to retrieve and store the data used in these screens.
Creating Benefits Calculations in Gosu

ClaimCenter uses the benefit amounts and other information that you enter on the WC Benefit Parameters screens to
calculate workers’ compensation benefits programmatically. Guidewire calls the entire process the Workers’ Comp
Benefits Calculator. ClaimCenter stores the formulas used in these calculations in Gosu code that you can access and
configure in Studio.
In Guidewire Studio, navigate in the Project window to Configuration→gsrc and then open the node gw.api.benefits
to see the classes.
Guidewire provides the following classes to illustrate how to construct benefit calculations:

Gosu class Description

PPDBenefitsCalculator Benefits calculator for permanent partial disability (PPD). This example implementation
illustrates how to vary the minimum compensation rate by state and also how a particular
state, California, can use a separate calculator from the other states.
PPDBenefitsCalculatorForCA Benefits calculator for permanent partial disability (PPD) in California. Guidewire has
provided detailed information for the US state of California to serve as an example of the
implementation.
PTDBenefitsCalculator Benefits calculator for permanent total disability (PTD). The sample code includes a
custom calculator for the U.S. state of Pennsylvania (PA), taking into account
Pennsylvania's special minimum compensation rate.
TPDBenefitsCalculator Benefits calculator for temporary partial disability (TPD). The sample code includes
customized calculators for the U.S. states of Florida (FL), Pennsylvania (PA), and New
Jersey (NJ).
TTDBenefitsCalculator Benefits calculator for temporary total disability (TTD). The sample code includes
customized calculators for the U.S. states of Illinois (IL) and Pennsylvania (PA).
WorkersCompBenefitsExceptions Static utilities for workers’ compensation benefit calculators. Utilities for a particular type
of benefit, such as TTD or PPD, must go in the appropriate calculator class. However,
utilities that will be shared across multiple benefit types do go in this class.
For each of the four benefit types (TTD, TPD, PPD, and PTD), the Gosu class for each type contains common getter
properties that each class then overrides:
BaseRate Typically, the weekly rate of pay for the worker before the injury occurred, except for Temporary Partial
Disability (TPD).
For Temporary Partial Disability, the base rate is typically the difference between:
• The weekly rate of pay for the worker pre-injury
• The weekly rate of pay for the worker post-injury
The calculation typically enforces the condition that the worker is earning less due to the disability.
PercentOfWages The percentage of the BaseRate that is paid to injured workers as their benefit
MaxCompRate The jurisdictional Maximum to pay the injured worked each week.
MinCompRate The jurisdictional Minimum to pay the injured worked each week.
MinAwwAdjustment A common exception to lower the Jurisdictional Minimum Comp Rate. If the BaseRate is lower than the
mandated Minimum, states with this exception will lower the jurisdictional minimum to the BaseRate.
ClaimCenter uses these values to calculate the following:
CompRate The weekly benefit for the injured worker based upon their BaseRate and the applicable jurisdictional
parameters
MaxWeeksToPay The maximum number of weeks to pay this benefit. ClaimCenter implements this calculation only in the
sample code for PPD calculations. The other calculations return null in the ClaimCenter base configuration.
In addition to the previous properties, ClaimCenter uses an array of WCBenefitFactorDetail objects to track other
notes, conditions, and exceptions related to the Jurisdictions benefit calculations. Some of the important fields on
WCBenefitFactorDetail are:
AppliesToPPD A flag that indicates to which of the four benefit types this entry belongs.
AppliesToPTD
AppliesToTPD

AppliesToTTD
FactorCategory Typekey to the WCBenefitFactorCategory typelist.
DetailedFactor Typekey to the WCBenefitFactorType typelist, filtered by FactorCategory, the WCBenefitFactorCategory

typelist.
FactorValue Tracks a related value. For example, if DetailedFactor is set to age, the field indicates that a benefit is
possibly reduced at a certain age. This value tracks the specific age, such as 70, at which the change in
benefits occurs.
FactorComment Available only if WCBenefitFactorDetail.DetailedFactor == "other".
Viewing the Resultant Calculations

ClaimCenter displays the results of these calculations as benefits amounts in the Time Loss→Benefits card of a
workers’ compensation claim. This screen provides a view of any calculated values for each of the four benefit
types. The screen shows any benefit factors relevant to the claim as well. It is possible to edit this screen and enter a
weekly compensation rate manually.
In this screen:
• If there is no entry in WCBenefitCalculations appropriate for the claim, ClaimCenter sets the value of Reference
Data for that benefit type to Not available.
• If ClaimCenter cannot calculate the Compensation Rate, meaning that CompRate == null, then ClaimCenter
generates a Not available message.
Benefits Calculator and Multicurrency

The WorkersCompBenefitCalculator uses the WCBenefitParameterSet values to do the calculations. It does not
contain information about the claim currency. ClaimCenter calculates everything based on the default currency of
the system, configuration parameter DefaultApplicationCurrency.
If an adjuster is working on a workers’ compensation claim and it is in Euros, but the default currency is in U.S.
dollars, ClaimCenter shows both currencies. The benefits screens of the workers’ compensation claim will be in
Euros for claim-specific benefit amounts—the weekly wage, the weekly wage amount, and benefit periods.
However, all the calculator-based benefit amounts will be in U.S. dollars.
For example, if there is a a parameter of PPD maximum value of USD $2000, you could set 1500 in Euros for a
compensation rate. The calculator class interprets the 1500 Euros as $1500 USD because you must do the currency
conversion inside the calculator implementation.
Note: For benefit definitions refer to “Jurisdictional Benefit Calculation Management” on page 196.
Workers’ Compensation Reference Tables

ClaimCenter uses the following administration entities to store reference data for workers’ comp calculations. The
tables, as seen in the Benefit Parameters screens, are:
ClaimCenter screen Entity

Benefit Parameters WCBenefitParameterSet
PPD Min / Max ref_WC_PD_benefits
PPD Weeks ref_WC_PD_WeeksAndLimits
Denial Period WCDenialPeriod

Note: The administration tables WCBenefitParameterSet, ref_WC_PD_benefits, and

ref_WC_PD_WeeksAndLimits do not contain any information about the currency of a claim.‘
Workers’ Compensation Permissions

In the base configuration, ClaimCenter provides the following permissions for use with workers’ compensation:

View WC disability rates wcrefview Permission to create, edit, and delete values on Workers’ Comp disability rate
tables.
Manage WC disability rates wcrefmanage Permission to view the values on Workers’ Comp disability rate tables.
Managing Reinsurance Thresholds

Reinsurance is insurance risk transferred to another insurance company for all or part of an assumed liability. In
other words, reinsurance is insurance for insurance companies. When a company reinsures its liability with another
company, it cedes business to that company. The amount an insurer keeps for its own account is its retention. When
an insurance company or a reinsurance company accepts part of another company’s business, it assumes risk. It thus
becomes a reinsurer.
The insurance company directly selling the policy is also known in the industry as the insurer, the reinsured, or the
ceding company. The Guidewire term for this company that directly sells the policy is insurer. An insurance
company accepting ceded risks is known as the reinsurer.
Agreements between insurers and reinsurers, called reinsurance treaties, are based on losses to insurers exceeding
certain threshold amounts. Generally, insurers identify claims for possible reinsurance if the total incurred on a claim
approaches the thresholds set out in the reinsurance treaty. ClaimCenter enables administrators and authorized
reinsurance handlers set reinsurance thresholds. Setting these thresholds helps ClaimCenter automatically identify
claims for reinsurance and assign review tasks to reinsurance managers.
For each policy type, ClaimCenter stores the following threshold information:
• Threshold value for gross total incurred, over which the reinsurance is triggered.
• Reporting threshold percentage, at which point the reinsurer is to be notified.
• Start and end dates, which set the life spans of thresholds.
• List of loss causes and coverages included in threshold calculations. An empty list is considered to include all
loss causes and coverages.
See also
• “Reinsurance Management Concepts” on page 455
• “Reinsurance Management in ClaimCenter” on page 467
Administer Reinsurance Thresholds

About this task
The base configuration contains default threshold values that you must change to match the terms of your own
reinsurance treaties.
Procedure
1. Click the Administration tab and navigate to Business Settings→Reinsurance Threshold and click Edit.
The treaty types are mapped to policy types with a threshold value and reporting threshold percentage and
optionally a start date and end date.

2. Make any changes and click Update when you are finished.
Managing ICD Codes

The International Statistical Classification of Diseases and Related Health Problems (ICD) are medical diagnosis
codes that classify diseases. The ICD also classifies a wide variety of signs, symptoms, abnormal findings,
complaints, social circumstances, and external causes of injury or disease. Every health condition can be assigned to
a unique category. Published by the World Health Organization, ICD is used for morbidity and mortality statistics,
reimbursement systems, and automated decision support in medicine. Given a diagnosis code from a physician, the
treatment codes for that injury or illness can be compared to the diagnosis code to ensure the treatments are valid
and appropriate. Additionally, use these codes to adjust the claim as benchmarks of the claim characteristics. An
example might be the amount of time off from work for the type of job for that diagnosis.
You manage ICD codes from the Administration tab, and you apply them in the Medical Diagnosis section of a claim in
ClaimCenter. For information on permissions required to manage ICD codes, see “ICD Permissions” on page 547.
Note: Medical Diagnosis is located in different areas of the user interface depending on the line of business. For
example, you would edit a Medical Diagnosis in a workers’ compensation claim by navigating to Medical Details screen
and clicking Edit. You would then click the Medical Case Mgmt card and make your edits on the Medical Diagnosis
section. In a personal auto claim, you would navigate to Loss Details screen and click the name of a person in the
Injuries section. Then, on the Injury Incident screen, you would click Edit and make your edits on the Medical Diagnosis
section.
Guidewire provides ICD-10 codes as reference data, which can be imported through either the command line or the
user interface. In the user interface, use the Utilities→Import Data tool in the Administration tab. ClaimCenter stores each
code in an ICDCode entity. Once stored, you can use it immediately without doing additional configuration. Each
year the administrator must either add or expire codes.
ClaimCenter additionally stores classifications of ICD codes used for categorization in the typelist ICDBodySystem.
Note: Guidewire does not provide ICD-9 codes in the base configuration, and the link to the external web site does
not work for ICD-9.
See also
• “Working with Medical Details for Workers’ Compensations Claims” on page 191
Working with ICD Codes

You can view, edit, or add new codes.
View ICD Codes
Procedure
1. To see a code in ClaimCenter, click the Administration tab and navigate to Business Settings→ICD Codes.
2. Optionally, enter a code or select a body system from the drop-down list, and then click Search.
3. Select a code by clicking its link in the ICD Code column.
4. In the ICD Code Details screen, you can obtain additional information about that code. Click the code identifier
in the ICD Code field to see the code on the external ICD web site.
Edit ICD Codes
Procedure
1. Click the Administration tab and navigate to Business Settings→ICD Codes.
2. Enter a code or select a body system from the drop-down list and click Search.

3. Select a code by clicking its link in the ICD Code column.

4. Click Edit. You can:
• Edit the code number.
• Edit the description.
• Edit the body system.
• Mark it as chronic, or clear the check box to remove the chronic setting.
• Enter availability and expiration dates.
Typically, you might edit the dates to activate or retire a code, because you cannot delete them.
5. When you are finished, to save your edits, click Update.
Add New ICD Codes
Procedure
1. Click the Administration tab and navigate to Business Settings→ICD Codes.
2. Click Add new code. The New ICD Code screen opens.
3. Enter the code and description, and associate it with a body system.
4. Optionally mark the code as chronic.
5. Optionally add the available date or the expiration date or both.
6. Click Update.
You can also import codes by clicking the Administration tab and navigating to Utilities→Import Data or by using the
command line. See “Managing Importing and Exporting Data” on page 531.
ICD Permissions
You need the following permissions to work with administration reference data:
• viewrefdata – Enables you to view administration reference data.
• editrefdata – Enables you to edit administration reference data.
Managing Metrics and Thresholds

You can define metric targets by policy type in ClaimCenter by clicking Administration tab and navigating to Business
Settings →Metrics & Thresholds. You can define metric targets for different tiers. When a tier is not defined, you are
setting up the metric targets for the default tier.
Selecting a policy type displays all the metric limits that apply to that policy type. Every metric subtype has default
limits. For money based metric targets, there are multiple defaults, one for each currency in the Currency typelist.
Because these default limits are added automatically by the system, you cannot delete them, but you can edit them.
You add new metric limits by using the menu items on the default limits. You can add new limits for each claim tier
that applies to the policy type. The claim tier typelist is filtered by the policy type typelist. You can add only one
limit per tier.
See also
Editing Metric Limits

You need the Manage Metric Limits permission metriclimitmanage to edit claim health metric target values. Click
the Administration tab and navigate to Business Settings→Metrics & Thresholds. There are separate cards for
Working with ICD Codes 547
ClaimMetricLimits, ExposureMetricLimits, and Large Loss Thresholds, which is visible on the high-risk indicators section of
the claim summary.
To edit, you must first select the policy type. In the following example, the policy type is Personal Auto.
Metric values can be assigned for the target service green level, yellow status, and red status. The red level is used
for highlighting claims that need immediate attention. The yellow level is for warnings and indicates that supervisors
or adjusters need to take action before the claim becomes problematic. You can have yellow values be either above
or below the target values, either warning that you are slightly above the target, or warning that you are approaching
the target.
You first assign metric target values by policy type. While all policy types have the same metrics, there can be
different target values associated with them. For example, you decide that the Days Open target value for the red level
can be at a higher threshold number for one policy type than for the others.
Using Tiers to Add Granularity

You can use tiers to provide different target values for a particular metric with a specific policy type. Tiers are a way
to add further granularity within the policy type and help in identifying type, complexity, and size of the claim.
For example, the Days Open metric on the Personal Auto policy type has default values of 30/25/60. For Low
Severity claims the values are 10/8/20. For the High Severity claims, the values are 150/140/180. In this example,
the Medium Severity tier is not defined. The screen showing these settings is in “Using Tiers to Add Granularity” on
page 548.
Add a Tier
Procedure
1. Click the Administration tab and navigate to Business Settings→Metrics & Thresholds.
3. In the Attribute column, click the down arrow next to the claim metric to which you want to add a tier.
4. ClaimCenter shows the available tiers. Click one to add it to the metric.
When you add a tier, the initial values are the same as the base values for the metric.
5. Enter values for the tier and click Update to save.
Remove a Tier
About this task

You cannot remove a metric on the Administration tab, but you can remove a tier from a metric.
Procedure
3. Click the check box for the tier you want to remove.
The Remove button is now enabled.
4. Click Remove to delete the tier.
Claim Metric Limits

In the base configuration, you can administer the targets for the following claim metrics. To see these limits, click
the Administration tab and navigate to Business Settings→Metrics & Thresholds.
Metric Name Description

Overall Claim Metrics
• Days Open Average days open.
• Initial Contact with Insured (Days) Average time to initial contact.
Claim Activity
• Days Since Last View - Adjuster Number of days since the adjuster last viewed the claim.
• Days Since Last View - Supervisor Number of days since the supervisor last viewed the claim.
• Activities Past Due Date Indicates that activities are past their due date.
• Open Escalated Activities Number of how many escalated activities are still open.
• Number of Escalated Activities Number of escalated activities associated with the claim.
• % of Escalated Activities Number of escalated activities divided by total activities.
Claim Financials
• Net Total Incurred Total Incurred Net financial calculation, the Open Reserves plus Total Payments
minus Total Recoveries. This metric can be in more than one currency.
• Total Paid The amount that has been paid on the claim. This metric can be in more than
one currency. The Total Payments financial calculation is the sum of all
submitted and awaiting submission payments whose scheduled send date is
today or earlier.
• Incurred Loss Costs as % of Net Total Net Total Incurred for Cost Type of claim cost divided by Net Total Incurred.
Incurred
• Paid Loss Costs as % of Total Paid Payments for Cost Type of claim cost divided by Total Payments.
• Time to First Loss Payment (Days) The number of days until the first loss payment occurs.
• Number of Reserve Changes The number of reserve changes.
• % Reserve Change from Initial Reserve Change in Total Reserve Amount from Initial Reserve Amount divided by Initial
Reserve Amount calculation.
Using Tiers to Add Granularity 549

Claim Metric Limits and Currency

If ClaimCenter is configured to use a single currency, all money based metrics use the default currency type.
However, if multicurrency is configured, all money based metrics such as Net Total Incurred or Total Paid, have an
entry for every currency defined. In the base configuration, USD and CAD currencies are included in the
metriclimit type filter.
To change the type of currency that you see in the user interface, see the Globalization Guide.
Exposure Metric Limits

In the base configuration, you can administer the exposure metrics listed in the following table. To see these limits,
click the Administration tab and navigate to Business Settings→Metrics & Thresholds and click Exposure Metric Limits.
Tiering is based on the policy type. For example, for the Personal Auto policy type, available exposure tiers include
rental, towing, first party medical, first party physical damage, third party medical, and so forth.
Metric Name Description

Exposures
• Days Open Average days open.
• Initial Contact with Claimant Average time to initial contact.
(Days)
• Net Total Incurred Total Incurred Net financial calculation, the Open Reserves plus Total Payments minus
Total Recoveries. This metric can be in more than one currency.
• Total Paid The amount that has been paid on the claim. This metric can be in more than one
currency. The Total Payments financial calculation is the sum of all submitted and
awaiting submission payments whose scheduled send date is today or earlier.
• % of Escalated Activities Number of escalated activities divided by total activities.
• Paid Loss Costs as % of Total Paid Payments for Cost Type of claim cost divided by Total Payments.
• Time to First Loss Payment (Days) The number of days until the first loss payment occurs.
Set a Large Loss Threshold

About this task
You can set large loss thresholds in the Metrics & Thresholds screen, based on policy type. To see these limits:
Procedure
2. Select a Policy Type and click Large Loss Thresholds.
3. Click Edit to set the Large Loss Indicator amount.
Claim amounts that are over your defined limit trigger the large loss indicator.
4. If PolicyCenter has been integrated with ClaimCenter, you can also define the large loss threshold for
PolicyCenter, the Policy System Notification.
When that number is reached, then PolicyCenter is notified. This number does not need to match the large loss
indicator number in ClaimCenter.
Claim Metrics Batch Processes

To run your existing claims against newly set claim health metrics, you must run the Claim Health Calculations
batch process. Press Alt+Shift+T to open the Server Tools screen, and then click Batch Processes in the sidebar menu.

You must be logged in as a user with a role that has the toolsBatchProcessview permission to be able to see this
screen.
ClaimCenter provides the following batch processes to calculate claim metrics:
• Claim Health Calculations – Calculates health indicators and metrics for all claims that do not have any metrics
calculated.
• Recalculate Claim Metrics – Recalculates claim metrics for claims whose metric update time has passed. For
example, this batch process is used for overdue activities.
See also
• The Configuration Guide
Managing Business Weeks

To define one or more business weeks, click the Administration tab and navigate to Business Settings→Business Week.
For information on this feature, see:
• “Working with Holidays, Weekends, and Business Weeks” on page 272
• “Business Weeks and Business Hours” on page 274
See also
Managing Business Weeks 551


chapter 47
Business Rules Overview
ClaimCenter enables you to create, edit, and manage business rules using the Business Rules screens in the
Administration tab.
ClaimCenter includes two types of rules:
• Business rules – Business rules are created and managed by using the Administration→Business Settings→Business
Rules menu. You can create, edit, and manage activities using business rules. Business rules are targeted towards
administrators and can be configured without any system downtime.
• Gosu rules – Gosu rules are created and managed entirely in Guidewire Studio. They are written and edited in
Gosu and require in-depth domain knowledge and technical expertise. When you make changes to Gosu rules,
you will typically need to restart the application server.
See also:
the Rules Guide.
Business Rules for Activities

ClaimCenter provides a management tool that enables business analysts and administrators to create and manage
activities in business rules. Business rules for activities are executed at different stages of the application to generate
and manage activities.
Various aspects of business rules are configurable, either through the user interface or in Guidewire Studio. For
example, you can dynamically create new rules for activity generation or change existing rule triggers and entities
using the ClaimCenter menus. You can deploy these changes immediately without server downtime. You can also
make more complex changes such as adding new rule triggers or enhancing rule execution using Gosu in Studio.
See also
Accessing Business Rules

You access and manage business rules for activities in the Administration tab using the Business Settings→Business
Rules menu link. The configuration parameter, BizRulesEnabled, in config.xml needs to be set to true in order for
these screens to be activated.
Business Rules Overview 553
The Activity Rules screen displays a list of existing activity rules, if any.
Roles and Permissions

You need appropriate permissions and roles to access the Business Rules screens and manage rules. A set of five
permissions is available to enable users to create, edit, deploy, and manage business rules for activities. In the base
configuration, these permissions are included in the Super User account. Additionally, three roles can be assigned to
users for business rules. These include Activity Rules Admin, Activity Rules Editor, and Activity Rules Viewer.
See the System Administration Guide for more information.
Managing Business Rule Export and Import

You transfer rules between different server environments by exporting the rules from one server and importing the
rules into the other server. Typically, dedicated Rule Administrators manage the export and import of business rules
between different ClaimCenter servers.
During the rule import process, it is possible for rule conflicts to occur. This can happen, for example, if you import
a different version of a rule that already exists on the importing server. ClaimCenter detects and highlights these
types of issues. The Rule Administrator manages these rule conflicts manually, in the Business Rules import screens.
To access the main Business Rules import and export screen, navigate to the following location in Guidewire
ClaimCenter:
Administration→Business Settings→Business Rules→Activity Rules→Import/Export Status
See also
Configuring Business Rules

In the base configuration, you can configure some aspects of business rules for activities. For example, you can
configure ClaimCenter to add new trigger entities and generate activities on additional entities. However, you cannot
modify applicability criteria or the Set Field rule action.
For more information on configuration of business rules for activities, see the Configuration Guide.
Business Rule States

At initial creation, all business rules are in the Draft state. As you begin the process of reviewing, evaluating, and
updating a business rules, its state can vary and progress.
In ClaimCenter, business rules have the following states:
• Draft – This is the first state a rule is assigned when it is created and saved. A rule reverts to Draft status any
time it is edited. Draft rules can be executed in a development environment.
• Staged – Draft rules are moved up or promoted to the Staged status in a development environment when editing
is complete and they are ready to be executed and tested.
• Approved – Staged rules are promoted to the Approved status once the evaluation phase is complete and they
are ready to be exported to production. Only Approved rules must be exported from the development server.
• Deployed – Approved business rules are imported into production, where they can then be promoted to
Deployed. Only rules in Deployed status can be executed in production.
Note: In order to deploy business rules, the BizRulesDeploymentEnabled configuration parameter must be set to
true in config.xml.
The following diagram describes the various states associated with a business rule, as it is created, edited, and
deployed in development and production environments.
554 chapter 47 Business Rules Overview

Business Rules States
Development Testing Production
Test, Reject Rule

Staged Approved
Draft
Create/Edit Rule
Test, Import Rule Deploy

Import
Promote to
Rule
Test, Approved
Promote to Edit
Business Staged
Analyst
Approved Deployed
Export Back to
Implementation Staged Development
Specialist Export Rule and
Testing*
Staged Approved
Export Business Rule Business Rule
Rule
* Export deployed rules from Production and import back to Development and Testing to keep all environments in sync.
See also
Working with Business Rules

You typically create new rules in a development environment. This is a collaborative process involving company
personnel such as the business analyst and the implementation specialist.
A business rule has the following components:
• Basic information – Specify basic rule details such as the rule name, description, and the object or entity that
triggers the rule.
• Applicability criteria – Specify whether the rule applies to one or more loss types, policy types, or jurisdictions.
• Rule conditions – Specify the conditions that need to be met for the business rule to be executed.
• Actions – Specify the actions that will be taken, such as activity generation, when the rule is executed.
Create a New Activity Rule

About this task
Create a new activity rule in ClaimCenter as follows:
Working with Business Rules 555

Procedure
1. Click Administration→Business Settings→Business Rules.
2. Select Activity Rules.
The Activity Rules screen is shown with a list of existing activity rules, if any.
3. Click Add to create a new activity rule.
4. In the topmost section of the screen, enter the following information:
• Name – Enter a name.
• Description – Enter a description of the rule.
• TriggerEntity – Specify the object that acts as the trigger for the rule. For example, a Claim or Exposure.
Performing an action on this object, such as creating or updating it, will activate the rule. Additionally, an
entity, such as a Claim, can be associated with a collection of objects, such as Exposures. The activity rule is
also triggered every time any associated collection object is updated.
If you select Claim: Repeat for each Exposure as the Trigger Entity, the rule is executed for each item in the
collection, that is, for each associated exposure.
These selections determine the subsequent menu options available in the bottom portions of the screen.
• TriggerAction – Select the action that activates the rule. In the base configuration, you can choose from
Creation, Update, or Exception.
• Enabled – Specify if the rule will be executed in the current environment. For example, you could choose to
disable certain activity rules in development.
5. In the AppliesTo section, select the applicability criteria for the rule.
For example, you can choose to apply the rule to a specific loss type, such as Property, or to all loss types.
6. In the RuleCondition section, specify the conditions that must be fulfilled for this rule to run. A rule condition is
composed of one or more rows of expressions combined with operations. You can specify multiple criteria for
rule conditions.
7. In the Actions section, specify the action that needs to be performed when the rule conditions are met and the
rule is executed.
In the base configuration, ClaimCenter offers three choices for rule Actions:
• Generate Activity
• Generate History Event
• Set Field
8. Click Save and the new rule is saved in Draft state.
Validation errors, if any, are highlighted once the rule is saved.
9. Edit the rule to go back and fix validation errors.
Next steps
See also
• “Specifying Business Rule Conditions” on page 557
• “Specifying Rule Actions” on page 561
Promote Business Rules

About this task
Once a draft rule is complete and has been validated, it is ready to be moved to a staging area for evaluation. This is
typically done in the development environment.

Procedure
1. Open the rule in ClaimCenter by selecting Administration→Business Settings→Business Rules→Activity Rules.
Existing activity rules are listed by name.
2. Click the rule name to open it.
3. In the rule details screen, select Promote to Staged.
The rule status in the Version field is now changed to Staged. In a typical workflow, a developer would create a
rule, edit it, run it, and when it is ready, promote it to the Staged status for review.
Next steps
See also
• “Business Rule States” on page 554.
Clone Business Rules

About this task
You can using cloning to copy an existing rule and use it as the basis for a new rule.
Procedure
1. Open the rule in ClaimCenter by selecting Administration→Business Settings→Business Rules→Activity Rules.
ClaimCenter displays list of existing activity rules by name.
2. Select the rule in the list by using the check box in the column to the left.
3. Click Clone.
A new rule is created and is available in the Rule screen to edit.
Specifying Business Rule Conditions

On the Rule screen in Rule Condition, you specify additional conditions that must be met for this rule to create an
activity. In new rules, the default rule condition is AND, which means the rule fires if all the applicability criteria are
met. You can replace this condition with your own.
The rule condition type can be one of the following types:
• None – Always fires when the rule is executed.
• All of the following criteria must be true (AND) – All rows evaluate to true.
• At least one of the following must be true (OR) – At least one row evaluates to true.
• The following combination of criteria must evaluate to true (AND/OR) – Multiple rows can be combined by using AND,
OR, and parentheses for grouping. The rows evaluate to true.
Each row requires a Left Expression followed by an Operation. The Right Expression is required except when the
Operation is Is True, Is False, Has Value, or Has No Value.
So that you can more easily comprehend the rule condition, ClaimCenter displays a formatted view of the rule
condition below the rule condition table.
Note: Avoid commas when using numerical values in business rules expressions. Use commas only in lists.
The following are examples of rule conditions:
• Example of AND:

claim.FirstAndFinal Is False
AND
(claim.LossType = "Property"
• Example of AND/OR:
claim.AccidentType = "Collision or sideswipe with another vehicle"

AND
claim.LossType = "Auto"
OR
claim.Policy.PolicyType = "Personal Auto"
Entering Expressions in Business Rules

In the Rule Condition, expressions appear on the left and right of a condition row.
Expressions can be in one of the following modes:
Mode Description
Formula Write an expression using literals, comparison operators, and object properties.
Last saved value Retrieve the last value of a field or property saved to the database.
Count In a list, count the number of items matching a given condition.

Sum In a list, sum up the expression for every item matching a given condition.
Select the mode by clicking to the immediate right of an expression.
Formula Expressions in Business Rules

In formula expressions, you enter literals, context objects, arithmetic operators, and utility functions directly in the
text field. The arithmetic operators are +, -, *, /, and %. For information about these operators, see the Gosu
Reference Guide. Utility functions are defined globally and are always available.
When you start typing, autocomplete shows you available objects, properties, and methods based on the selected
context and filtered by the text you enter.
To select from available objects, press Spacebar. Type one or two letters to display first-level objects containing
letters in that order. Type a period after the object to select its subobjects, properties, and methods. Type three or
more letters to display objects containing letters in that order. The letters can match objects at multiple levels of
nesting. The number of levels is defined in the BizRulesLeafSearchNumOfHops parameter in config.xml. The
default value is 3.
To access utility functions, type Util followed by a period.
The following formula expressions use literals and comparison operators:
• 50
• 50 + 50
• "some" + "thing"
Enter Formula Expressions in Business Rules
About this task
The following formula expression uses objects and comparison operators:

• claim.AssignmentDate < claim.Policy.ExpirationDate
To enter this formula expression:

Procedure
1. In Administration→Business Rules→Activity Rules, open the rule and click Edit.
2. In Rule Condition, click Add.
3. Set the mode to Formula by clicking to the immediate right of an expression.

4. In the Left Expression, press Spacebar to view available objects, and then select claim.
5. Type a period to view objects and properties on the object.
6. Select AssignmentDate.
7. In the Operation column, type < for the comparison operator.
8. In the Right Expression, select claim.Policy.ExpirationDate.
Use Last Saved Values in Expressions
About this task

In the left expression, select from available objects whose last saved value is to be used. When you start typing, the
autocomplete feature shows you all available objects, properties, and methods based on the rule trigger entity and
filtered by the text you enter.
The following is an example of an expression using the last saved value:
The last saved value of claim.SIEscalateSIU
To enter an expression using previously saved values:
Procedure
2. To the right of the expression, click and select Last saved value.
3. Click Set field to display the The last saved value of... screen.
4. Select the field. For this example, select claim.SIEscalateSIU and click OK.
Count and Sum Expressions in Business Rules

You enter both count and sum expression types in the same way. These expressions can include a Boolean condition
to filter the list.
The following are examples of count and sum expressions:
• Count the number of vehicles with outstanding loans covering a specified time period:
The count of
each vehicle in the claim.Vehicles list where
vehicle.LoanMonthsRemaining >= 60
• Sum the gross amounts for checks that are on hold:
The sum of check.GrossAmount for each check in the claim.Checks list
where check.DeliveryMethod = "Hold for adjuster"
Enter Count and Sum Expressions in Business Rules
About this task

To enter a count or sum expression:
Procedure
Entering Expressions in Business Rules 559
2. To the right of the expression, click and select Count or Sum.

For this example, select Count.
3. Click Set fields and condition to display the Count or Sum popup screen.
4. For this example, select the list claim.Vehicles.
5. Select the type of count, and specify conditions of items to count.
For this example, set the count condition to:
Count each "vehicle" where
Add the following expression to complete the count condition:
vehicle.LoanMonthsRemaining >= 60
Below the condition table, the formatted view displays the complete rule condition with the count or sum that
you are editing highlighted in yellow.
Operations in Business Rule Conditions

Operations appear between the left and right expressions. In rule conditions, operations specify how the left
expression is compared against the right expression. Each rule condition row requires an operation. There are three
types of operations:
• Comparison
• Unary
• Functional
Comparison Operations
Comparison operations require both left and right expressions. Both expressions must evaluate to the same type. The
comparison operations are:
Operation Description
= Left expression is equal to the right expression.
Is Not Equal To Left expression is not equal to the right expression.
< Left expression is less than the right expression.

<= Left expression is less than or equal to the right expression.
> Left expression is greater than the right expression.
>= Left expression is greater than or equal to the right expression.
Monetary Expressions
When using monetary amount properties in operations in the rule condition builder, drill down to the appropriate
Amount property to avoid validation errors.
For example:
• exposure.AverageWeeklyWages.Amount < 1000.00
Unary Operations
Unary operations require only a left expression. For Is True and Is False, the expression must evaluate to a Boolean.
Is True Left expression is true.

Is False Left expression is false.
Has a Value Left expression has a value. The expression does not evaluate to null.
Has No Value Left expression evaluates to null.
Functional Operations
Functional operations require both left and right expressions.
Is In Item in the left expression is contained in the list in the right expression.
Is Not In Item in the left expression is not contained in the list in the right expression.
Contains List in the left expression contains at least one item matching the condition in the right expression.
Does Not Contain List in the left expression does not contain any item matching the condition in the right expression.
For Is In and Is Not In, the right expression must evaluate to a list, and the left expression must evaluate to a type
matching an item in the list.
For Contains and Does Not Contain, the left expression must evaluate to a list, and the right expression specifies a
condition that items in the left expression are compared against.
The following conditions use functional operations:
• claim.JurisdictionState Is In "California", "Oregon", "Washington"
• claim.Activities Does Not Contain an activity where activity.Status = "Open" AND
activity.AssignedUser = claim.AssignedUser
Specifying Rule Actions

On the Rule screen, in Actions, you specify the action that is to be taken in rule conditions are true.
ClaimCenter provides the following action choices for activity rules:
• Generate Activity
• Generate History Event
• Set Field
The following topics provide more details about these actions:
• “Generate Activities” on page 561
• “Generate History Events” on page 562
• “Set Fields” on page 563
Generate Activities
About this task

In an activity rule, the most common action selected upon rule execution is activity generation.
To generate an activity:
Procedure
1. In the Actions section of an activity rule, click Add Action.

2. In the Parameters tab, select Generate Activity in the Action drop-down menu.
3. In the Activity Pattern drop-down menu, select an activity pattern.
The Activity fields are populated based on the activity pattern choice. In addition, this screen also includes the
following additional fields for business rules:
• AssignedTo – Select how the activity is to be assigned. Choices include AutoAssign, ClaimOwner, Group, Queue,
and Users by Role. If you choose to assign the activity to a group or queue, you must enter a group or queue
in the associated text field. If you select UsersbyRole, a list of roles associated with the claim is shown. You
can then make a selection from the UserRole drop-down list.
• RelatedTo – Select the entity the activity is associated with. The list of available values shown depends on the
trigger entities selected for the business rule.
• AdditionalRestriction – Select restrictions to avoid duplication of activities, if needed. You can check for
duplicate activities on the claim or with the same assignee and also specify if duplicates are open.
4. Enter relevant details for the activity pattern. In each field, you can enter text, select from a drop-down menu
or use a formula. In formula fields, (∫x) appears after the field name.
To include a formula, embed the expression between ${}. After typing ${, autocomplete shows you available
objects, properties, and methods based on the rule trigger entity and filtered by the text you enter.
For example, the following formula sets the value of the field to the current date:
5. Click Save or Update to save your changes.
Result
When the rule is executed, the specified activity is generated and a corresponding entry is added to the claim
workplan.
Next steps
See also
• “Working with Activities” on page 225.
• “How ClaimCenter Assigns Work” on page 205.
• “Queues” on page 210.
Generate History Events
About this task

When an activity rule is executed, you can choose to create an event to be added to the claim history in the Actions
section.
To generate a history event:
Procedure
2. In the Parameters tab, select Generate History Event in the Action drop-down menu.
3. Enter the event type in the Type drop-down menu.
4. In the Related To field, specify if the history event is related to the claim. The list of available values shown
depends on the trigger entities selected for the business rule.
Result
When the rule is executed, the specified event is added to the claim history.

Next steps
See also
• “Claim History” on page 133.
Set Fields
About this task

When an activity rule is executed, you can choose to specify the value of a field in the Actions section.
To set a specific field:
Procedure
2. In the Parameters tab, select Set Field in the Action drop-down menu.
3. Specify if you want to set the field only if it is currently empty.
4. Enter the name of the field. You can also click Set Field and enter the field name in the Set Field screen. When
you start typing, the autocomplete feature shows you all available fields filtered by the text you enter.
5. Enter a value. You can enter literal values or functions ({fx}) in this field.
Validation errors, if any, are indicated in the corresponding fields of this screen.
Result
When the rule is executed, the specified event is added to the claim history.
Next steps
See also
• “Claim History” on page 133.
View Rule History

About this task
Changes to business rules are recorded in the rule History.
Procedure
1. Open the rule in ClaimCenter by navigating to Administration→Business Settings→Business Rules→Activity Rules.
A list of existing activity rules displays, ordered by name.
2. Click the rule in the list to open the Rule screen.
3. Click View History.
The History screen displays a list of changes with associated details including the date and time of the change,
the name of the responsible user, and the system name. It also provides details on import status, if any.
Deleting a Business Rule Version

ClaimCenter associates a version number and a status (state) with each individual business rule. Whether it is
possible to delete any given version of a rule depends on the state of the business rule. The following table lists the
rules for deleting a rule version.
Rule version state Rule deletion action

Deployed It is not possible delete a rule version after its deployment
Specifying Rule Actions 563

Rule version state Rule deletion action

Approved or Staged Clicking Delete deletes all rule versions down to the last deployed rule version.
Draft – Direct parent deployed Clicking Delete Draft deletes all rule versions down to the last deployed rule version.
Draft – Rule previously staged or Clicking Delete Draft deletes the immediate draft version of the rule. After deleting the draft
approved version of the rule, it then becomes possible to delete the staged and approved versions of
the rule.
Business Rule Execution Flow

In general, ClaimCenter business rules have the following execution flow:
• ClaimCenter application logic triggers the evaluation of business rules at certain points in the application flow,
based on rule implementation. Only those rules that match a triggering action and a triggering entity are
candidates for evaluation.
• Business rule logic uses applicability criteria, defined in the Applies To area of the Business Rules editor, to filter
rules for evaluation based on the current state of the data. For example, if Jurisdiction = California, ClaimCenter
evaluates only those rules with a jurisdiction of California.
• After ClaimCenter determines the list of rules eligible for execution, it evaluates the rule conditions for each rule.
ClaimCenter then creates the set of rules for which the rule conditions evaluate to true and executes the actions
for this set of rules.
• Rule logic caches the rules for execution at every triggering point. ClaimCenter flushes this rule cache at every
rule edit, rule import, and application restart.
See also
Business Rule Summary

ClaimCenter provides a set of business rules in the base configuration that generate activities for claims, exposures,
check sets, recovery sets, and subrogations. Check sets and recovery sets are both transaction sets. The entity trigger
action, depending on the entity, can be on creation, update, or exception. You work with these rules in the
ClaimCenter Business Rules editor.
The following list describes the activity business rules that Guidewire provides in the base ClaimCenter
configuration.
Rule Description
CER02000 - At least This business rule runs after the Claim Exception Gosu rules complete. It is triggered on a claim
one activity for exception. The rule ensures that the user who owns the claim has at least one activity assigned for the
claim owner claim.
CER03000 - At least This business rule runs after the Claim Exception Gosu rules complete. It is triggered on a claim
one activity for exception. The rule evaluates each exposure for the claim and ensures that each user who owns each
exposure owner claim exposure has at least one activity assigned.
CLW01000 - Contact This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
insured claim. If the claim is not first and final and it is not a worker’s compensation claim, the rule creates an
activity to interview the insured party on the claim.
CLW02000 - Thirty This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
day review claim. If the claim is not first and final, the rule creates an activity to perform a 30-day review of the
claim.

Rule Description
CLW03100 - Verify This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
coverage claim. If the claim is not first and final and the experience level of the assigned user is low, this rule
creates an activity to verify the coverage on the claim.
CLW04100 - Scene This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
inspection claim. The rule first determines if the claim loss type is AUTO and the strategy indicates that the claim
needs further investigation. If so, this rule creates an activity to perform an inspection of the scene of
the auto claim.
CLW04210 - Police This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
report claim. The rule first determines if:
• The claim is not first and final.
• The claim loss type is AUTO.
• The strategy indicates that the claim needs further investigation.
• The user experience level is low.
If all these conditions are true, this rule creates an activity to obtain a police report for the auto claim.
CLW05100 - This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
Property inspection claim. The rule first determines if:
• The claim loss type is property (PR).
If all these conditions are true, this rule creates an activity to set up a property inspection. For example,
in the base configuration, the line of business for this loss type can be Commercial Property,
Homeowners, or Inland Marine.
CLW05210 - Police This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
report claim. The rule creates an activity to obtain a police report if the following is true:
• The user experience level is low.
• The claim loss type is property (PR). For example, in the base configuration, the line of business for
this loss type can be Commercial Property, Homeowners, or Inland Marine.
• The loss cause is fire.
CLW05300 - Verify This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
coverage claim. This rule creates an activity to verify the coverage on the claim if the following is true:
• The claim loss type is property (PR).
• The policy for this claim is a Homeowners policy.
CLW07310 - Get This business rule runs after the Claim Workplan Gosu rules complete. It is triggered on creation of a
Employee Injury claim. If the claim is for Workers’ Comp and the user experience level is low, this rule creates an activity
Notice to get the employee’s notice of injury.
CPU05000 - SI - This business rule runs after the Claim Preupdate Gosu rules complete. It is triggered on update of a
Create Supervisor claim. If the SIU score is higher than a threshold value, this rule creates a supervisor review activity.
Review Activity The rule compares the SIU total score for the claim to the script parameter SpecialInvestigation_Cre
ateActivityForSupervisorThreshold, which in the base configuration is set to a value of 5.
CPU06000 - SI - This business rule runs after the Claim Preupdate Gosu rules complete. It is triggered on update of a
Create SIU claim. If the claim was changed to escalate it for SIU review, this rule creates an SIU escalation review
Escalation Activity activity.
In addition, the rule:
• Sets fields on the claim indicating the date the special investigation was escalated and the fact that
the SIU status is under investigation.
• Creates a history event for this change.
Business Rule Summary 565

Rule Description
CPU09000 - Related This business rule runs after the Claim Preupdate Gosu rules complete. It is triggered on update of a
to Catastrophe claim. The rule checks whether a claim matches a named catastrophe that is already in the system. If
there is a match, the rule creates an activity for the claim owner to look into this issue.
CPU31100 - Class This business rule runs after the Claim Preupdate Gosu rules complete. It is triggered on update of a
Code Selection claim. The rule creates an activity to review the employment class code for a workers’ compensation
claim to ensure that the code is correct for the policy location. The rule applies if:
• The claim loss type is Workers’ Compensation
• There is workers’ compensation information in the claim.ClaimWorkComp field.
• There is an employment class code for the claim.
• There is no location for the employment class code.
• One of the following conditions is true:
◦ The claim is still in Draft state and is open.
◦ The claim is not in Draft state and the field ClaimWorkComp.ClassCodeByLocation just changed.
After evaluating these conditions, if the rule still applies and an employment class code review activity is
not already open, this rule creates one.
EPU02000 - Salvage This business rule runs after the Exposure Preupdate Gosu rules complete. It is triggered by update of an
exposure of a claim. The rule first determines:
• If the exposure is a vehicle incident with a total loss.
• If the exposure does not already have an activity for salvage review.
If so, then the rule creates two activities and sets the date the salvage activity was assigned if it is not
already set. The activities it creates are to review the claim exposure both for potential salvage value
and for possible vehicle recovery.
EXW01000 - This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
Contact claimant an exposure. The rule creates an activity to make initial contact with the claimant if the following
conditions are true:
• The claim is not a workers’ compensation claim.
• The claimant is not the insured party on the policy.
EXW02100 - Vehicle This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
inspection an exposure. This rule creates an activity to schedule an inspection on the damaged vehicle if the
following conditions are true:
• The exposure type is Vehicle.
Medical report an exposure. If the exposure type is Bodily Injury, this rule creates an activity to get the claimant’s
medical report.
EXW04200 - IME This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
an exposure. This rule creates an activity to get an independent medical evaluation by an expert if the
following conditions are true:
• The exposure type is Bodily Injury.
• The injury is a normal injury that requires investigation. For example, the injury is not a Workers’
Comp injury.
Medical report an exposure. This rule creates an activity to get the initial medical report for a Workers’ Comp injury.
EXW06100 - Wage This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
Statement an exposure. If the exposure type is Workers’ Comp lost wages, this rule creates an activity to get the
wage statement from the injured employee’s employer.

Rule Description
EXW07100 - Get list This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
of damaged items an exposure. This rule creates an activity to get a list of the items that were damaged if the following
conditions are true:
• The policy type is Homeowners.
• The exposure type is Content.
• The coverage subtype is Homeowners personal property.
Contact insured an exposure. This rule creates an activity to contract the insured to determine if additional living
about living expenses are required if the following conditions are true:
expenses • The policy type is Homeowners.
• The exposure type is Living Expenses.
EXW07300 - Get This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
property inspected an exposure. This rule creates an activity to schedule an inspection of the damaged property under the
following conditions:
• The policy type is Homeowners.
• The exposure type is one of the following:
◦ Dwelling
◦ Other Structure
◦ Property Damage with a coverage subtype of Homeowners personal liability property damage
EXW07400 - Get This business rule runs after the Exposure Workplan Gosu rules complete. It is triggered on creation of
claimant medical an exposure. If the policy type is Homeowners and the exposure type is Med Pay, medical payments, this
reports rule creates an activity to get the claimant’s medical reports.
Subrogation This business rule runs after the Claim Preupdate Gosu rules complete. It is triggered on update of a
Referral claim. The rule checks each subrogation on the claim for both a summary and a change that escalated
the subrogation for review. If these conditions are true, for each subrogation, the rule:
• Creates a new activity to check the subrogation and determine if there is an opportunity for
recovery.
• Sets the referral date on the subrogation summary to today’s date. Creates a custom history event
for the referral.
Reopened Claim claim. For each subrogation on the claim, the rule first determines if the following is true:
• The claim was closed and has been reopened.
• The subrogation has a summary.
• The subrogation is closed.
• A decision was not made to discontinue pursuing the subrogation.
If these conditions are true for the subrogation, the rule creates an activity to review the claim for
subrogation and determine if there is an opportunity for recovery.
Responsible Party claim. For each subrogation on the claim, the rule first determines if the following is true:
Added • The subrogation has a summary.
• The subrogation has a new responsible party assigned.
If these conditions are true for the subrogation, the rule creates an activity to notify the new third party
that they are being considered for the subrogation.
Business Rule Summary 567

Rule Description
Subrogation This business rule runs after the Transaction Set Preupdate Gosu rules complete. It is triggered on
Supplemental update of a claim’s check set. For each check in the check set, the rule first determines if the following is
Payment Created true:
• The claim has a subrogation summary.
• Either all the following conditions are true:
◦ The claim does not subrogate individual exposures.
◦ A decision has not been made to stop pursuing the subrogation.
◦ There is at least one new check payment that is a supplemental payment.
• Or all the following conditions are true:
◦ The claim does subrogate at least one individual exposure.
◦ A decision has not been made to stop pursuing the subrogation.
◦ There is at least one new check payment for the exposure that is a supplemental payment.
If these conditions are true for the subrogation, the rule creates an activity for the subrogation owner to
review the subrogation recovery financials.
TPU01000 - Create This business rule runs after the TransactionSet Preupdate Gosu rules complete. It is triggered by an
Activity After Check update to a check set. The rule determines for each check in the check set:
Denial • If the check status has changed.
• If the check has been denied.
If so, the rule creates an activity to look into the check denial and assigns the activity to the user who
created the check.
TPU02000 - Create This business rule runs after the TransactionSet Preupdate Gosu rules complete. It is triggered by an
Activity After update to a recovery set. The rule determines for each recovery in the recovery set:
Recovery Denial • If the recovery status has changed.
• If the recovery has been denied.
If so, the rule creates an activity to look into the recovery denial and assigns the activity to the user who
created the recovery.
See also

part 11
External System Integration

chapter 48
ClaimCenter Integration Points
ClaimCenter can integrate with many applications and services. These integration points need to be considered as
you configure the application. Some are mandatory while others are optional, depending on your business needs.
ClaimCenter integrates with external systems by using a set of services and APIs that can link ClaimCenter with
custom code and external systems. The code or mechanism used to exchange information with an external system is
known as an integration point. ClaimCenter can be integrated with any system that can make information available
externally through a commonly established technology. The following list shows the most common types of external
systems that might need to be integrated.
• Authentication system – Enables a person to access ClaimCenter.
• Policy Administration System – ClaimCenter pulls related policy information during the claim process from a
policy administration system, such as Guidewire PolicyCenter. To learn more how ClaimCenter integrates with a
policy administration system, see “Policy Administration System Integration” on page 573.
• Billing System – When a user creates a policy, the policy administration system can export billing information to
a billing system, such as Guidewire BillingCenter. ClaimCenter can communicate with the billing system as
needed.
• Contact Management or Address Book application – A separate application for contact information. It is often
necessary to store and maintain contact information separately from ClaimCenter to make the information
available both to different claims and to users outside ClaimCenter. For details on integrating with the Guidewire
contact management system, see the Guidewire Contact Management Guide.
• Document Production System and Document Storage System – ClaimCenter creates and manages claim-
associated documents. These documents can be online documents existing in or created in ClaimCenter as well as
hard copy, printed documents stored in a file cabinet. It is common to integrate your document management
system with ClaimCenter to store electronic versions of your claim-associated documents. See “Document
Management” on page 587 for details.
• Metropolitan Reporting Bureau – A nationwide police accident and incident reports service in the United
States. Many insurance carriers use this system to obtain police accident and incident reports, which can improve
record-keeping and reduce fraud. ClaimCenter built-in support for this service makes it easier to deploy
Metropolitan Reporting Bureau integration projects. See “Overview of Metropolitan Reports” on page 605 for
details.
ClaimCenter Integration Points 571

• General Ledger, Check Processing System, and Financial Institution – ClaimCenter passes financial
information to downstream systems for tasks such as check processing. See “Claim Financials” on page 323 for
more information.
• ISO – In the United States, ClaimCenter integrates with ISO, formerly known as the Insurance Services Office.
ISO provides a service called ClaimSearch that helps detect duplicate and fraudulent insurance claims. After a
claim is created, the carrier can send details to the ISO ClaimSearch service and subsequently get reports of
potentially similar claims from other companies. See “ISO and Claims” on page 611 for details.
• Geocoding Service – The Geocoding service works with Microsoft Bing Maps Geocode Service to geocode
contacts. One use is to help users find services within a given location. See the System Administration Guide for
details.
572 chapter 48 ClaimCenter Integration Points

chapter 49
Policy Administration System

Integration
In the base configuration, ClaimCenter provides integration points to use for a functional integration with Guidewire
PolicyCenter. You can also integrate ClaimCenter with the policy system of your choice. This topic describes how
ClaimCenter integrates with a policy system in general and with PolicyCenter in particular.
See also
Policy Administration System Integration Overview

In the ClaimCenter base configuration, you can do the following:
• Retrieve a policy snapshot in the process of gathering claim information – It is necessary for ClaimCenter to
have a verified policy to ultimately be able pay on a claim. For example, in the New Claim wizard when starting a
new claim, you must either find a policy or generate an unverified policy.
• View a policy in PolicyCenter – The integration opens an instance of PolicyCenter or any policy administration
system that has a web interface.
• ClaimCenter sends large loss notifications to PolicyCenter – Sending notifications to the policy’s underwriter
helps in determining risk and ultimately granting a policy renewal.
The following diagram shows the integration between ClaimCenter and a policy administration system at a high
level.
Policy Administration System Integration 573

ClaimCenter and a Policy System High Level Integration
ClaimCenter Policy System
First Notice of Loss ClaimCenter pulls policy snapshot, including contact information
Policy Data
Claims Summary ClaimCenter opens PolicyCenter to view a policy
Claims View
PolicyCenter pulls summary loss information
Renewal Processing
Claim Financials
Underwriting
ClaimCenter sends large loss notifications
Notification
See also
• For information about the parts of the integration that originate in PolicyCenter, see the PolicyCenter Application
Guide topic “Claim System Integration”.
Retrieving a Policy in ClaimCenter

In the base configuration, ClaimCenter defines a plugin interface called IPolicySearchAdapter. The default
implementation of this plugin, PolicySearchPCPlugin, pulls policies from a policy administration system into
ClaimCenter.
See also
• For information on how to do the integration, see the Installation Guide.
• For information on the plugin, see the Integration Guide.
Viewing Policies in a Policy Administration System (PAS)

If enabled, from the Policy screen you can open a web browser window of the policy administration system. This
policy administration system can be Guidewire PolicyCenter or another system if it has a web interface.
Viewing a Policy in PolicyCenter

Before you begin
The ClaimCenter Policy screen has a View Policy in Policy System button. This button appears if the PolicyCenter
integration is enabled and you have the permissions to view policies in the system. You must also have set the
PolicySystemURL exit point configuration parameter in config.xml to the URL for the policy system.
574 chapter 49 Policy Administration System Integration

About this task

If ClaimCenter is integrated with PolicyCenter, you can view policies in PolicyCenter as described in this topic.
Based on your business requirements, you can integrate ClaimCenter with several policy administration systems.
These integrations are seamless in the user interface.
Procedure
1. Open a claim and then click the Policy menu link in the sidebar.
ClaimCenter opens the Policy: General screen.
2. Click View Policy in Policy System.
The button opens PolicyCenter in a web browser window. You must have a user account in PolicyCenter to
use this functionality. If you are not logged in, the login screen appears. If you are logged in, PolicyCenter
displays the policy. If you have single sign-on, PolicyCenter opens directly with the policy summary screen.
3. Log in to PolicyCenter.
If the policy system finds the policy, it shows the information. If it does not find the policy, you can search for
it in PolicyCenter.
4. Click the policy link.
PolicyCenter opens the Policy Summary screen, in which you can view the policy information.
Next steps
See also
Large Loss Notifications

Sometimes a claim has a large loss associated with it. You determine the large loss amount based on your business
practices. The amount can vary depending on the line of business, or policy type. For example, a personal auto large
loss notification might have a lesser amount than a large loss notification for a homeowners policy. Large loss
information is critical to an underwriter who uses that information in determining risk and ultimately granting a
renewal policy. ClaimCenter can send large loss information to a policy administration system if the two systems are
integrated.
Policy System Notification Framework

Guidewire supplies a policy system notification framework that enables ClaimCenter to send messages to policy
administration systems, including Guidewire PolicyCenter. Large loss notifications use this framework.
Notifications are created as events, which generate messages in the Guidewire messaging system. A messaging
transport then delivers the messages to the policy system.
In the base configuration, ClaimCenter does not send large loss notifications to the policy system. You must
configure this integration.
See also
Administering Large Loss Notifications

You must configure one large loss notification threshold per line of business (policy type). You define and map
threshold amounts for large losses by using the Large Loss Threshold card.
Large Loss Notifications 575

Default Reserve Thresholds for Large Loss Notification

The following table lists the default large loss reserve thresholds for policy types in the base configuration of
ClaimCenter and the corresponding PolicyCenter base configuration lines of business, if any.
ClaimCenter Policy Type PolicyCenter Line of Business Default Large Loss Total Reserve
Threshold in US Dollars
Businessowners Businessowners 25,000
Commercial auto Commercial Auto 50,000
Commercial package Commercial Package no default
Commercial property Commercial Property 100,000
Farmowners not applicable 10,000
General liability General Liability 50,000
Homeowners not applicable 10,000
Inland marine Inland Marine 25,000
Personal auto Personal Auto 20,000
Personal travel not applicable no default
Professional liability not applicable 100,000
Workers’ compensation Workers’ Compensation 50,000
In the base configuration, ClaimCenter maps the workers’ compensation and personal auto lines of business to their
equivalent PolicyCenter lines of business for policy search and large losses.
Setting a Large Loss Notification Threshold
Procedure
1. Log in to ClaimCenter as an administrator.
3. In the sidebar, click Business Settings→Metrics & Thresholds.
4. Click the Large Loss Threshold card.
The following card opens.
5. From the Policy Type drop-down list, select the policy type for which you want to set the threshold amount.
7. Edit the value in the Large Loss Indicator field.
8. Click Update.
9. If you want to change additional thresholds, select another policy type and repeat these steps.

Next steps
See also
Permissions for Working with Policies

There are two permissions that allow the user to view policies in PolicyCenter:
• View claim Policy page – This permission controls the policy screens in ClaimCenter. The code for this permission
is viewpolicy.
• View policy system – You can select the View Policy button in the user interface, which opens PolicyCenter so you
can view a policy. The code for this permission is viewpolicysystem.
Coverage Term Mapping Between ClaimCenter and PolicyCenter

A coverage term is a value that specifies the extent, degree, or attribute of a coverage. Using a coverage term, you
can:
• Specify the limits or deductibles of a coverage
• Specify the scope of a coverage
• Specify a selection or an exclusion that is specific to a particular coverage
A coverage can have zero, one, or many coverage terms.
In the base configuration, ClaimCenter provides a CovTerm entity, along with multiple CovTerm subtypes, all of
which end in CovTerm. You use these coverage terms to map to the equivalent coverage terms in the policy
administration system.
You can enter coverage and coverage term information in ClaimCenter in the Policy screen. To access this screen,
open a specific claim, and then choose Policy from the sidebar menu on the left. After you choose a policy, you can
add coverage terms to that coverage, if any are available.
In the base configuration, ClaimCenter provides the following coverage term entities.
Entity Important fields Description

CovTerm • PolicySystemId Specifies the extent, degree, or attribute of a coverage. As the supertype, fields
• Coverage on the CovTerm entity are common to all its subtypes:
• CovTermPattern • PolicySystemID – The identifier for the coverage term in an external
policy system
• ModelAggregation
• Coverage – Foreign key to the coverage to which the coverage term
• ModelRestriction
belongs.
• CovTermOrder
• CovTermPattern – Typekey to the CovTermPattern typelist.
• ModelAggregation – Typekey to the CovTermModelAgg typelist. This value
indicates that the CovTerm applies to a subset or a subtype of the coverage.
• ModelRestriction – Typekey to the CovTermModelRest typelist. This value
indicates to what level of an event the CovTerm applies, for example, to a
single claimant or to a single accident.
• CovTermOrder – Provides a way to place the coverage terms in a particular
order. This field is set in Guidewire PolicyCenter. Its primary purpose is to
sort data in the user interface.
ClassificationCov • Code Specifies a class code. Policy systems often use classification codes to segment
Term • Description or categorize a large set of items. For example, there are jurisdictional class
codes that divide a geographical region into smaller areas, each with a specific
code. There are also medical class codes that assign every conceivable medical
condition a specific code.
Permissions for Working with Policies 577

Entity Important fields Description

IMPORTANT The Code field on a Classification coverage term must map to a
valid classification code in PolicyCenter.
FinancialCovTerm • FinancialAmount Specifies a non-negative currency amount.
NumericCovTerm • NumericValue Specifies a decimal value, along with its units. The CovTermModelVal typelist
• Units populates the drop-down list for the Units field.
See also
• “Adding Coverages to a Policy” on page 109
Coverage Term Typelist Mapping

ClaimCenter uses the following typelists in working with coverage terms. Most of these typelists exist in
PolicyCenter as well. If you make a change to a typelist that is common to both ClaimCenter and PolicyCenter, you
must duplicate that work in both applications.
Typelist PolicyCenter Comments

CovTermModelAgg Yes Used to populate the Per field drop-down list of the Coverage Term screen.
CovTermModelRest Yes Used to populate the Applicable To field drop-down list of the Coverage Term screen.
CovTermModelVal Yes Used to populate the Units field drop-down list on a Numeric type Coverage Term screen.
CovTermPattern No Used to populate the Subject field drop-down list of the Coverage Term screen.

chapter 50
ClaimCenter Contacts
Contacts are external people, companies, or locations that you connect with a claim. A contact can be the insured
party, the reporting party, a witness, attorney, doctor, repair shop, legal venue, and so on. The people who process
the claim, such as claims adjusters, are not contacts. They are users, and are typically employees of the insurance
company.
In ClaimCenter, you define and maintain contacts at the claim level. For example, you can define contacts in the New
Claim wizard when processing a new claim or in the Parties Involved→Contacts screen for an existing claim. In these
screens, you can view contacts and their data, like address, phone number, and so on. You can also create new
contacts for the claim, edit existing contacts, and delete them.
If ClaimCenter is not integrated with a contact management system, contacts stored with one claim have no
connection to contacts stored with another claim. Additionally, you cannot search for contacts in the Address Book.
For example, you can add a new witness, Samantha Andrews, separately to two claims. The contact information for
Samantha Andrews is stored separately with each claim and does not have to be the same. If an adjuster changes the
address for Samantha Andrews in one of the claims, the updated address is stored only with that claim. The address
for the Samantha Andrews contact in the other claim is not updated.
If ClaimCenter is integrated with a contact management system, like ContactManager, you have the option of
storing contacts in the contact management system and maintaining them centrally. Contacts stored in the contact
management system can be added to claims, and they are then stored with claims, as are any claim contacts.
However, ClaimCenter tracks claim contacts that are stored in the contact management system and keeps their data
in sync. For example, Samantha Andrews is a contact in the contact management system. You add her as an existing
contact, a contact retrieved from the contact management system, to two separate claims. The two copies of the
contact, one stored with each claim, are kept in sync by ClaimCenter.
Types of Contacts
Contacts have a data model, a set of tags, and a set of services that can be associated with contacts in
ContactManager, all of which define the contact. Contact tags define two major types of contacts, client contacts and
vendor contacts. In ClaimCenter, a contact can be a third type of contact, also defined by a tag, a claim party.
• Vendor Contact – A person or company that provides services for claims. In ClaimCenter, a vendor contact can
be a person like a doctor or attorney. Additionally, a vendor contact can be a company, such as a repair shop, a
ClaimCenter Contacts 579

bank, or a hospital. A vendor can also be a client and a claim party. See the Guidewire Contact Management
Guide.
• Claim Party – A person or company who has been added to a claim. For example, a witness can be just a claim
party and nothing else. A vendor is often both a vendor and a claim party, because vendors are added to claims to
provide services for the claim. A client, such as the insured party on a claim, can be both a claim party and a
client contact.
• Client Contact – A person or company that is a customer of a carrier, such as the owner of a policy. A client can
be both a vendor and a client. For example, a doctor who has a policy with the carrier also provides medical
services on claims. Client contact access requires that you license Client Data Management. See the Guidewire
Contact Management Guide.
A Contact is the ClaimCenter data model entity used in both client and vendor data management. In the base
configuration, this entity is the core application equivalent of the ContactManager entity ABContact, described in
the Guidewire Contact Management Guide.
The Contact entity has subtypes for various types of contacts, like Person, Company, and Place.
In ClaimCenter, these subtypes have additional subtypes, like Adjudicator, CompanyVendor, LegalVenue, and so
on. The following figure shows the Contact entity hierarchy. This entity hierarchy has a parallel in the ABContact
entity hierarchy in ContactManager. See the Guidewire Contact Management Guide.
Note: The following figure includes a special Contact subtype, UserContact. This entity, a subtype of Person, is
used by the User entity, which represents a user of the application, such as a claims adjuster. The User entity has a
foreign key to UserContact so it can store data like the user’s address and phone number. However, UserContact
entities are not intended to be used as either vendor contacts or client contacts, and in the base configuration they
cannot be stored in ContactManager.
Contact Entity Hierarchy
Contact
Person Place Company
UserContact PersonVendor Adjudicator LegalVenue CompanyVendor
Attorney Doctor
AutoRepairShop AutoTowingAgcy
Legend
A B A is a subtype of B
LawFirm MedicalCareOrg
Used by all core applications
Used by ClaimCenter only
The Contact entity is associated with other entities as well. A contact can have multiple addresses, related contacts,
and tags. A Contact entity that is stored in ContactManager must have at least one tag. Except for the primary
address, references to those entities are handled with arrays of join entities. For example, there is ContactAddress
for addresses and ContactContact for related contacts, as shown in the following figure:
580 chapter 50 ClaimCenter Contacts
Contact Entity Relationships
Contact
Name Address
HomePhone AddressLine1
WorkPhone AddressLine2
EmailAddress1 City
TaxID State
PrimaryAddress ContactAddress
Country
ContactAddresses Contact PostalCode
SourceRelatedContacts * Address
TargetRelatedContacts
Tags
ContactContact
«different instance of»
RelatedContact
* Contact
SourceContact
Legend
A B A has a B ContactTag
«typelist»
A B A has 0 or more Bs 1..* Contact ContactTagType
* Type
1..*
The mailing address of a Contact is stored in the Address entity. A Contact can reference a primary address and,
through the ContactAddress entity, other secondary addresses.
Contacts can have relationships with other contacts. For example, a Person might be employed by a particular
Company. The ContactContact entity maintains data about the relationships a contact can have with other contacts.
Note: For simplicity, the diagram shows ContactContact connecting to a different instance of Contact. However,
ContactContact can also point back to the original contact. For example, you can be your own primary contact.
Contacts can have tags, like Client and Vendor. A Contact entity references its tags by using the ContactTag entity.
A contact that has the Vendor tag can provide specialist services, like carpentry or independent appraisal. The
relationship between a contact and its services is maintained by ContactManager, which is why there is no Contact
property accessing services in the entity relationship model.
Additionally, a contact that has the Vendor tag can have documents associated with it in ContactManager. Those
documents are shown in ClaimCenter on the Documents tab of a vendor contact’s detail view.
See also
ContactManager Integration
ContactManager is a Guidewire application that serves as a central address book—a contact management system—
for ClaimCenter and the other Guidewire core applications. Most aspects of using ClaimCenter with
ContactManager are covered in the Guidewire Contact Management Guide.
ContactManager Integration 581

There are several reasons for having a separate contact management application:
• Sharing contact information with other applications, like PolicyCenter and BillingCenter
• Using a common administrative interface for creating, editing, deleting, and resolving duplicate address book
contacts
• Managing data for a contact across all claims
Before you can work with ContactManager, you must install it as described at the Guidewire Contact Management
Guide.
You can set up ClaimCenter and ContactManager to work together as described at the Guidewire Contact
Management Guide.
See also
Working with Contacts in ClaimCenter and ContactManager

After you set up ClaimCenter and ContactManager to work together and then start both applications, you can work
directly in ClaimCenter with contacts stored in ContactManager. These contacts are called linked contacts. For
example, you can use the Address Book tab to search for contacts stored in ContactManager. You can open the
Address Book Search screen by clicking the Address Book tab. This screen also opens when you choose in a claim to
add an existing contact, such as in the Parties Involved→Contacts screen or in the New Claim wizard.
Note: To search in ClaimCenter for contacts stored in ContactManager and see the results, log in as a user with a
role that has abviewsearch, abview, and anytagview permissions. See the Guidewire Contact Management
Guide.
You cannot create or edit contacts in the Address Book tab. However, you can open ContactManager for that purpose
from the Address Book Search screen by clicking either the Open ContactManager button or the Edit in ContactManager
button. If you are not already running ContactManager, you must log in when ContactManager opens. To log in, you
need a ContactManager user name with a role that has the permissions to work with contacts.
Note: These buttons use the ContactManager URL set in the configuration parameter ContactSystemURL. If the
URL is not set in that parameter, the system uses the ContactManager URL defined in suite-config.xml. See the
Guidewire Contact Management Guide.
You can also create and edit ContactManager contacts associated with claims by using the New Claim wizard or the
Parties Involved→Contacts screen of an open claim.
Notes:
• To be able to create, edit, and delete local-only, unlinked contacts in ClaimCenter, your role must include the
following permissions: anytagedit, ctccreate, ctcedit, and ctcview.
• Each contact that you access in the Address Book, the New Claim wizard, or the Parties Involved→Contacts screen
has a detail view consisting of multiple cards.
◦ The standard cards that appear for all contacts are Basics, Addresses, and Related Contacts. These cards provide
contact information that you can edit.
◦ If the contact is stored in ContactManager and has its Vendor tag set, the detail view has an additional
Documents card. This card displays a read-only list of documents that have been associated with the contact in
ContactManager.
See also
Pending Changes
Changes made in ClaimCenter to linked vendor contacts can be sent to ContactManager as pending changes, which
require approval in ContactManager.

How ClaimCenter handles creating and editing vendor contacts depends on the permissions of the user making the
changes. If a user does not have permission to create a new vendor contact or edit a vendor contact, ClaimCenter
sends the create or update to ContactManager as a pending change. If the user does have the needed permissions, the
changes are simply sent to ContactManager, where they take effect. For information on these permissions, see
“Contact Permissions and Contacts” on page 585.
In the base configuration, pending changes are created only when a user with insufficient permissions is working
with vendor contacts. The changes remain pending until a ContactManager user logs in to ContactManager and
reviews the pending changes. The reviewer either approves or rejects the pending contact creates and updates.
• If a pending change is approved, the contact becomes linked and in sync, meaning that the data for the contact in
ClaimCenter and in ContactManager is the same.
• If a pending change is not approved, the behavior depends on the type of change. A pending change can be a
pending create of a new vendor contact or a pending update of an existing vendor contact.
◦ Pending create – When a pending create is rejected, ContactManager retires the pending contact object and
notifies ClaimCenter. ClaimCenter updates the status of the contact as a broken link and creates a Pending
Create Rejected activity for the user that created the vendor contact.
◦ Pending update – When a pending update is rejected, ContactManager discards the pending updated data and
notifies ClaimCenter of the rejected update. ClaimCenter overwrites the data for the contact with the existing
data from ContactManager, making the contact in sync again. Additionally, ClaimCenter creates a Pending
Update Rejected activity for the user who made the update and associates a note with the activity that retains
the rejected change data.
This ClaimCenter pending contact behavior with vendor contacts is defined in the Gosu class
gw.plugin.contact.ab900.ContactSystemApprovalUtil. You can edit this class and change how ClaimCenter
determines the following:
• If a contact created in ClaimCenter will be created in ContactManager
• If a contact created or updated in ClaimCenter will be applied immediately, or if it requires approval in
ContactManager before being applied
Pending Create Example Process Flow

1. A user with the Clerical role opens a claim and navigates to Parties Involved→Contacts.
The Clerical role does not have permissions that allow creating or editing a linked vendor contact.
2. On the Contacts screen, the user creates a new vendor contact. The vendor contact has the minimum required
data, including a name and a tax ID.
3. The ClaimCenter user re-selects the new vendor contact to refresh the Basics card for that contact.
After the pending contact creation request is sent to ContactManager and a return message comes back, the
Basics card displays the following message:
The contact is linked to the Address Book and is in sync but the remote contact is pending approval.
4. A user who can review pending changes logs in to ContactManager and rejects the pending create.
The ContactManager user indicates on the rejection notice that more information is needed on the contact.
Additionally, the user specifies in the note for the rejection why the create was rejected and what needs to be
done to correct it.
5. After ClaimCenter gets the message from ContactManager that the pending create was not approved and the
user refreshes the contact screen, the Basics card shows the following message:
This contact has been removed in ContactManager
6. The user clicks the Desktop tab and then clicks Activities and chooses the All open filter to see if there is more
information on the rejected contact.
The Activity Detail worksheet indicates that more information is needed on the contact.
7. The user edits the contact and adds more information to the contact.
Pending Changes 583

8. After saving the contact change, the user clicks Relink in the Basics card.
9. After the pending contact creation request is sent to ContactManager and a return message comes back, the
ClaimCenter user refreshes the contact. The Basics card displays the following message:
The contact is linked to the Address Book and is in sync but the remote contact is pending approval.
10. A user who can review pending changes logs in to ContactManager and approves the pending create.
11. In ClaimCenter, the user refreshes the Contacts screen and selects the vendor contact. The Basics card now
shows the following message:
The contact is linked to the Address Book and is in sync
Pending Update Example Process Flow

1. A user with the Clerical role opens a claim and navigates to Parties Involved→Contacts.
The Clerical role does not have permissions that allow creating or editing a linked vendor contact.
2. On the Contacts screen, the user edits an existing, linked vendor contact that is in sync.
3. The user clicks Update to save the contact, and the Basics card shows the contact status as:
The contact is linked to the Address Book but is out of sync
This message appears because ClaimCenter has not yet received notification from ContactManager that the
pending update was received.
4. The user clicks another contact and then clicks the edited one to refresh the message on the Basics card.
The pending contact creation request has been sent to ContactManager and has been acknowledged, so the
The contact is linked to the Address Book and is in sync but the remote contact has pending updates.
5. A user who can review pending changes logs in to ContactManager and rejects the pending update.
The ContactManager user indicates on the rejection notice that more information is needed on the contact.
Additionally, the user specifies in the note for the rejection why the update was rejected and what needs to be
done to correct it.
6. After ClaimCenter gets the message from ContactManager that the pending update was not approved, the user
refreshes the contact screen.
The Basics card shows the following message:
This contact is linked to the Address Book and is in sync
This message appears because the update has been discarded and the contact data has been overwritten with
the current data in ContactManager.
7. The ClaimCenter user navigates to Desktop tab Activities and chooses the All open filter to see if there is an
activity providing more information on the rejected update.
The Activity Detail worksheet for the rejected update indicates that more information is needed on the contact
and specifies what information was incorrect.
8. The ClaimCenter user clicks View Notes on the Activity Detail worksheet. The note shows the original data that
the user entered for the contact.
9. The ClaimCenter user edits the contact and corrects the information for the contact.
10. The user clicks Update to save the contact, and the Basics card shows the contact status as:
The contact is linked to the Address Book but is out of sync
This message appears because ClaimCenter has not yet received notification from ContactManager that the
pending update was received.
11. The user clicks another contact and then clicks the edited one to refresh the message on the Basics card.
After the pending contact creation request is sent to ContactManager and a return message comes back, the
The contact is linked to the Address Book but is out of sync and the remote contact has pending updates.
12. A user who can review pending changes logs in to ContactManager and approves the pending update.
13. In ClaimCenter, the user refreshes the Contacts screen and selects the vendor contact. The Basics card now
shows the following message:
The contact is linked to the Address Book and is in sync
See also
Contact Permissions and Contacts

ClaimCenter contact and tag permissions are described in the Guidewire Contact Management Guide. These contact
permissions permit a user to make changes to contacts, with varying effects.
Following are some examples of actions you can perform with various groups of permissions.
Permissions required to save contacts locally only in ClaimCenter

In the base configuration, to be able to work with contacts stored only in ClaimCenter with claims, and not in
ContactManager, you must have at least the following permissions:
Code Enables a User to

anytagview See a contact that has any contact tag.
ctccreate Create a new, local contact.

ctcedit Edit local contacts.
ctcview View and search local contacts.
Permissions required to view ContactManager contacts in ClaimCenter, save locally, and make pending changes
and creates in ContactManager
In the base configuration, to be able to view, create, and edit contacts stored in ContactManager, you must have at
least the following permissions. In the base configuration, these permissions are in the role Clerical. These
permissions enable you to save pending creates and updates to vendor contacts in ContactManager.

abview View the details of contact entries retrieved from ContactManager.
abviewsearch Search for contact entries in ContactManager.

For example, with these permissions, you can do the following:

• Create or edit a contact that is stored only locally, an unlinked contact.
• Create or edit a non-vendor contact that is stored in ContactManager and have your changes saved in
ContactManager.
• Create or edit a vendor contact that is stored in ContactManager and have your changes saved as pending creates
or pending updates in ContactManager. Pending changes must be reviewed and either approved or rejected by a
ContactManager user. See the Guidewire Contact Management Guide.
Working with Contacts in ClaimCenter and ContactManager 585

Permissions required to view ContactManager contacts in ClaimCenter, save locally, and save changes in
ContactManager
In the base configuration, the following permissions give you all the capabilities described in the previous topic.
Additionally, you can create and edit vendor contacts and have your changes saved in ContactManager without
requiring approval. Unless you have preferred vendors defined in your system, these permissions give you
everything you need to work with contacts.
Note: If you are working in ClaimCenter, you cannot delete a contact in ContactManager. You can remove a
contact from a claim, but that removal does not delete the contact stored in ContactManager. You must log in to
ContactManager to delete contacts.

abcreate Create a new vendor contact in ContactManager. In the base configuration, this permission enables a
ClaimCenter user to create a vendor contact and have it saved in ContactManager. Without this permission, a
ClaimCenter user can create and save non-vendor contacts in ContactManager. Any vendor contacts created
by a user without this permission are created in ContactManager with pending status and must be approved
by a ContactManager user.
abedit Edit an existing vendor contact stored in ContactManager. In the base configuration, this permission enables a
ClaimCenter user to edit a vendor contact and have it saved in ContactManager. Without this permission, a
ClaimCenter user can edit and save non-vendor contacts in ContactManager. Any vendor contact changes by a
user without this permission become pending changes in ContactManager and must be approved by a
ContactManager user.
abview View the details of contact entries retrieved from ContactManager.
abviewsearch Search for contact entries in ContactManager.

anytagcreate Create a new contact regardless of which contact tag it requires.
anytagedit Edit a contact that has any contact tag.

Changing the Subtype of a Contact

If you have a contact that has the wrong subtype, you can change the contact’s subtype under certain conditions by
using a command-line tool. See the Guidewire Contact Management Guide.

chapter 51
Document Management
ClaimCenter enables you to create and manage documents that are associated with claims. These documents can
either be online—existing in or created in ClaimCenter—or printed documents. For example:
• You write and send the insured a letter to acknowledge the claim.
• The claimant emails you a map of the loss location.
• You have received a printed copy of a written police report.
This topic describes how to work with documents that are associated with claims and possibly associated as well
with entities that are part of a claim. There is a similar feature that enables you to associate documents with vendor
contacts in ContactManager, separately from claims, and then view those documents for vendors in ClaimCenter.
Guidewire recommends integrating with an external document management system rather than using the default
demonstration document management system on the ClaimCenter server. The default system is useful only for
demonstration purposes and does not support features of a real document management system, such as document
versioning.
Use document management in ClaimCenter to:
• Create new documents on the server from templates, and then download and edit them.
• Have another user approve a document you wrote before it is sent.
• Store documents, both those you create and those received from other sources.
• Search for documents associated with a claim, and categorize them to simplify the searches.
• Link to external documents.
• Indicate the existence of hardcopy, printed documents.
• Remove documents.
• Associate a document with a claim, exposure, matter, subrogation, service request, reserve, activity, or check.
• Create and send a document to perform a task for an activity.
• Create and send a document from rules or workflows.
• Extend these default capabilities by integrating with an external document management system (DMS).
Document Management 587

By default, ClaimCenter stores document contents as files on your ClaimCenter server. For more robust document
management, integrate documents with an external document management system.
See also
Claim Document Storage Overview

This topic describes how ClaimCenter stores documents as configured in the base product. You can configure how
ClaimCenter uses metadata properties and stores content.
In the base configuration, documents are stored as a combination of:
• Metadata – Properties that specify information about a document. In the base configuration, ClaimCenter stores
these properties in the database. For example, there are properties for the document’s name, the business object
associated with the document, the document’s file type, an optional type classification, and so on. When you
create a new document, you must specify some of its properties before you can save it.
For example, you see document properties when you click the Info action for a document in the Documents
screen.
• Document content – A file that is stored in the ClaimCenter file system. In general, you edit document content
as a file on your local system by using your editing software. Alternatively, you can create the file from a
template and, in some cases, edit that file on your local system. Before uploading the content, you select or
specify the metadata representing the document in ClaimCenter. You then upload the file to the server, which
associates the file with its metadata and saves the file.
For example, you can view a document’s content by clicking the document name in the Documents screen.
If you are just indicating the existence of a document, the document is hard copy and there is no content to upload.
The document is stored in the database as metadata only. In this case, typically the document name and description
indicate where the hard copy is stored.
See also
• “Document Metadata Properties” on page 588
• “Viewing Claim Documents” on page 589
• “Indicate the Existence of a Hard-copy Claim Document” on page 595
• For information on configuring document storage, see the Integration Guide.
Document Metadata Properties

When you create a new document or edit an existing document, you see a set of metadata properties that the base
configuration of ClaimCenter stores in the database. Document search uses a subset of these properties.
You can set the following metadata properties for a document:
• Name – The name of the document. ClaimCenter uses this name for the document content file. For example, if
you download the content for a document, this setting determines the name of the file name sent to the browser.
For hard-copy documents, this field provides information helpful for identifying the hard-copy document.
• Description – Especially useful for locating hard-copy documents.
• File Type – The type of content file, also known as a MIME type.
You can change the file type, but do so with caution. ClaimCenter uses your setting to set the MIME type for the
file. The operating system formats the document content file to match this MIME type when you upload the
content.
588 chapter 51 Document Management

This field does not apply to documents representing hard copy documents because there is no content for this
kind of document.
• Language – The language the document is written in.
• Section – A way to classify documents, such as legal, medical, or correspondence.
If the document is related to subrogation, choosing Subrogation from the Section drop-down list is the only way
to indicate this relationship.
• Related To – A document is always associated with a claim. It can also be related to an instance of an entity that is
associated with a claim. A document can be related to just one entity instance. The specific entity depends either
on where in ClaimCenter the document was created or which entity the user set this value to when creating the
document.
• Author – By default, the name of the user who associated the document with the claim. This field can be changed
to some other value, such as the sender of a document.
• Recipient – The person or business to which the document was sent, if applicable.
• Inbound – Indicates whether the document came from an external source or was generated internally. Typically
applies to emails and letters. A value of Yes means the document came from an external source.
• Status – A value from the DocumentStatusType typelist, such as Approved or Draft. You are required to set this
value when you create a document. Its main use is to track the approval process of a document in rules.
• Security Type – The default values are Sensitive Document and Unrestricted Document. For example, a document
related to a special investigation might be sensitive and might require extra restrictions on users who can view
and edit the document.
• Document Type – A value from the DocumentType typelist that classifies the document, such as Police Report or
Email Sent.
See also
• “Configuration Parameters for Claim Document Management” on page 602
• “Searching for Claim Documents” on page 592
Working with Claim Documents

You can open a claim or run the New Claim wizard and click the Documents link in the left Sidebar to work with
documents. Additionally, you can view and link existing documents from some claim-related entities, like activities,
service requests, subrogations, reserves, and checks.
In general, to create a new document, select any of the New Document menu choices from either the Actions menu or
the Documents screen while in any claim.
Viewing Claim Documents

You can view all documents associated with the claim or you can filter this list. Additionally, you can select a
service request, subrogation, activity, reserve, or check and view only those associated documents.
You can view all documents for which you have permission.
See also
• For information on document permissions, see “Document Security” on page 602.
• For information on document configuration parameters, see “Configuration Parameters for Claim Document
Management” on page 602.
Viewing All Claim Documents

The Documents screen shows all documents associated with a claim. To open this screen, open a claim and click the
Documents link, located on the left Sidebar of all claim and New Claim wizard screens.
Working with Claim Documents 589

The Documents screen initially displays the unfiltered list of all documents. Use the search pane at the top of the
screen to filter the list of documents.
For example:
• You can use the Related To drop-down list to select the current claim or an entity on the claim, such as a contact,
exposure, matter, or service request. The search results will show documents related only to the instance of the
entity you chose.
• To see all documents related to a subrogation on the claim, you can select Claim for Related To, and then for the
Section field, select Subrogation.
In the list of documents, you can:
• Click a document Name to download the document and view its contents.
◦ If the browser can open the document for viewing, a window opens showing the contents.
◦ If the browser cannot open the document for viewing, you see a message saying that the file was downloaded
for viewing. You can then open the downloaded file with the appropriate viewer.
If nothing happens when you click the document name, enable pop-ups for ClaimCenter in your browser.
• Click View Document Properties to see the document’s metadata properties on the Document Properties screen.
On that screen you can edit the properties, download the document content, or upload new content.
• Click Download to download, view, and possibly edit the document’s content.
• Click Upload to upload new or edited content.
If the document is linked to a service request and has been sent to a vendor, you cannot change its contents.
• Click Delete to delete the document.
If the document is linked to a service request and has been sent to a vendor, you cannot delete it.
View Documents for a Service Request
About this task

You can view documents specifically for service requests.
Alternatively, you can see all the documents for a claim on the Documents screen, and then filter by service request.
Procedure
1. With a claim open, click Services in the Sidebar menu on the left.
2. On the Services screen, select a service request from the list.
3. In the Details view for the service request, click the Documents card. See “Documents Card for a Service
Request” on page 590
Documents Card for a Service Request

The Documents card for a service request lists all documents linked to the service.
You can view a document’s contents, see or edit its metadata properties, and change the document’s contents.
While you cannot delete a document in this screen, you might be able to unlink it from the service request. The
document must not been sent to the vendor, and it must not be linked to a service request statement.
To unlink a document from the current service request, click the Remove Document action.

Additionally, you can link or upload a document from this tab for two purposes:
• Send to vendor – If you integrate with a vendor portal, you can use the Link and Upload buttons to send notifications
about a document to the portal. Otherwise, these actions apply just to documents stored by ClaimCenter. In either
case, the Date Vendor Notified field is updated with the date you did the link or upload.
• Associate only – Use the Link and Upload buttons to perform these actions on documents stored by ClaimCenter.
See also
• For information on using document Name and Actions for viewing content or metadata properties and
downloading and uploading content, see “Viewing All Claim Documents” on page 589.
View Documents for a Subrogation
About this task

You can view documents specifically for a subrogation.
Alternatively, you can see all the documents for a claim on the Documents screen, and then use the Section search
field to filter for Subrogation.
See also
• For information on using the Name and Actions for viewing content or metadata properties, downloading and
uploading content, or deleting a document, see “Viewing All Claim Documents” on page 589.
Procedure
1. With a claim open, click Subrogations in the Sidebar menu on the left.
2. On the Subrogation:Summary screen, click the Documents card.
3. On this card, you can see a list of documents currently linked to this subrogation.
You can view a document’s contents, see or edit its metadata properties, and download and upload document
contents. Additionally, you can use the buttons above the list to create a document from a template, upload
content, and link a document to the subrogation.
View Documents for an Activity
About this task

See also
• For information on using the Name and Actions for viewing content or metadata properties, downloading and
uploading content, or deleting a document, see “Viewing All Claim Documents” on page 589.
• “Link a Document to an Activity” on page 599
Procedure
1. Click the Desktop tab to view your open activities.
2. Select an activity.
3. In the Activity worksheet, the documents linked to this activity are listed in the Documents section.
You can view a document’s contents, see or edit its metadata properties, and download and upload document
contents. Additionally, you can click the Link Document button to link an existing document to the activity.
Viewing Claim Documents 591

View Documents for a Reserve
About this task

See also
• “Viewing All Claim Documents” on page 589
• “Link a Document to a Reserve” on page 599
Procedure
1. With a claim open, click Financials→Transactions in the Sidebar menu.
2. In the Financials: Transactions screen, click a reserve type or amount to open its Reserve Details screen.
3. Scroll down to Documents linked to Group.
For each document in the list, you can click the document name to view its contents or click View Document
Properties to see the document’s metadata properties.
View Documents for a Check
About this task

See also
• “Link a Document to a Check” on page 599
Procedure
1. With a claim open, click Financials→Checks in the Sidebar menu.
2. In the Financials: Checks screen, click a check number or amount to open its Check Details screen.
3. Scroll down to Documents linked to Checks.
For each document in the list, you can click the document name to view its contents or click View Document
Properties to see the document’s metadata properties.
View Documents for a Note
About this task

You can view documents as links in a note. When you create a new note, you can link one or more documents that
already exist. Documents are added to the body of the note as links to the document content stored on the server.
See also
Procedure
1. With a claim open, click Notes in the Sidebar menu.
2. In the Notes screen’s list of notes, any notes to which documents have been linked have links to those
documents in the Details column.
Searching for Claim Documents

Use the Search pane of the Documents screen to search for documents. You can use the following search parameter
values for a document after you create the document or link to it:
• Related To – A document created in an exposure, activity, matter, contact, or service request is related to the
instance of that entity that is associated with a claim. This filter specifies a search for documents related to a
specific exposure, activity, matter, contact, or service request. A document can be related to just one entity
instance.
• Section – A classification, like legal, medical, or correspondence.
If you want to search for documents related to subrogation, choose Subrogation from this drop-down list.
• Name or Identifier – The name of the document. Typically, also the name of the file in which the document content
is stored. The document name is especially useful for locating hard-copy documents.
• Status – A value from the DocumentStatusType typelist, such as Approved or Draft. You are required to set this
value in the user interface when you create a document. Its main use is to track the approval process of a
document in rules.
• Author – By default, the name of the user who associated the document with the claim. This field can be changed
to some other value, such as the sender of a document.
• Include Hidden Documents – Whether to search also for documents that have been hidden.
See also
• “Hiding a Claim Document” on page 600
Create a New Claim Document

Before you begin
You can create a new claim document when you have a claim open.
About this task

See also
• For information on creating a document from a subrogation, see “View Documents for a Subrogation” on page
591.
Procedure
1. Either use the Actions menu and go to the selections under New Document or open the Documents screen and click
New Document.
2. Click one of the following choices for adding documents to the current claim:
• Upload document
• Create from a template
• Indicate existence of a document
Upload Documents
About this task

When you upload a document, you replace the content for a document with a file from your file system. If you are
creating a new document, you must specify metadata properties for the document, and the upload becomes the
content. You can upload multiple documents at one time.

Procedure
1. There are multiple ways to get to the Upload Documents worksheet that enables you to upload one or more
documents:
• Click Actions, and under New Document click Upload documents.
• In the Documents window, click New Document and then click Upload documents.
The Upload Documents worksheet opens.
2. To add files that you want to upload, do either of the following, or both:
• Drag one or more files from your file system window, such as Windows Explorer, to the worksheet.
• Click Add Files, browse to the locations of your documents, and click Add.
• You can click Add Files multiple times for files in different folders. You can also select more than one
document in a folder.
3. Set the properties for the files you want to upload.
• You must have values for the Name, File Type, Related To, Status, and Document Type fields.
• You can set the properties one file at a time in the fields to the right of each file you added to the list.
• You can edit the properties for multiple files by selecting their check boxes and then clicking Edit Details.
• Do not set the Name field for multiple files. Files must have different names. Additionally, ClaimCenter sets
the file type for you based on the MIME type it detects. If you set the File Type field, the file contents will be
configured to match that MIME type when you upload it.
4. Click Upload to send the file or files to the server and create the link or links.
Replace Content for an Existing Document
Procedure
1. You can start the upload to replace a document’s content in two ways:
• On the Documents screen, for the document whose contents you want to upload, click Upload under
Actions.
• On the Documents screen, for the document whose contents you want to upload, click View Document
Properties under Actions. Then, on the Document Properties screen, click Upload .
2. In the Update Document Content screen, add the file that has the new content by:
• Browsing for the content file.
• Dragging the file from your file system window, such as Windows Explorer.
3. Click Update.
Create a New Claim Document from a Template
About this task

See also
• “Document Metadata Properties” on page 588
Procedure
1. Open a claim.
2. Select either of the following:
• Actions→New Document→Create from a template.
• Open the Documents screen, and then click New Document→Create from a template.

3. In the New Document worksheet, click the Select Template search icon so you can select a template. To create a
document, you must specify an existing template.
4. After you click the Select Template search icon, a search screen for document templates opens.
The search settings are based on the claim you have open.
a. If no results are showing, choose a document type from the Type picker.
For example, select Email.
b. Set any other search fields that will help you find the template.
For example, select <none> for the Line of Business and Jurisdiction fields.
c. Click Search.
The Search Results displays a list of matching document templates.
d. Click Select for the template you want to use.
The base configuration Sample Acrobat document, SampleAcrobat.pdf, uses Helvetica font. If you
intend to create a document that uses Unicode characters, such as one that uses an East Asian language,
the document template must support a Unicode font. Otherwise, the document does not display Unicode
characters correctly.
5. After you select a template, ClaimCenter displays numbered steps along the left side of the screen.
6. Follow the steps on the screen.
The document requires values for Name, Related To, Status, Document Type, and Hidden. Those values are filled in
for you, but you might want to change them. In particular, Name sets the file name of the content file.
If you integrate with a document management system, the file attributes used by that system need not be the
same as the comparable object values that appear in the document.
7. After filling in the fields, click Create Document.
8. If you see View/Edit, click this button.
• If you can edit the document content, your browser will indicate that it downloaded the file.
• You can use the browser feature that enables you to open the downloaded file in its native editor.
• If you edit the document content file, be sure to save it.
• Make note of the saved file name and location so you can browse for the file when you upload changes to
the document. The file you upload becomes the new content for the document.
Next steps
After you create the document, you can take additional steps, such as sending this document as an email attachment.
You can also print it and send it through the mail. Additionally, if you have integrated with a document management
system, you can use any features provided by that system.
Indicate the Existence of a Hard-copy Claim Document
About this task

If you keep claim documents as hard copies instead of scanning them into your file system, use this option to
describe the document in ClaimCenter. This description becomes searchable. However, you have to go to your file
cabinet or other storage location to retrieve the document. This option gives you all the document property fields
that you have for electronic documents except File Type.
Procedure
1. Click Action and under New Document choose Indicate existence of a document. An alternative is to open the
Documents screen and click New Document→Indicate existence of a document.
Create a New Claim Document 595

2. The New Document screen that opens enables you to set metadata properties for the document, but does not
enable you to select a file to upload. Enter attributes that describe the hard copy document sufficiently to
enable a user to find it.
3. Click Update to add the document describing the hard copy document to the database.
Using an Activity to Create a Document

In the base configuration, when you create an activity, you can select a document template from which to create a
new document. The activity then displays a Create Document button when a user opens it.
If a document template is specified in the activity pattern of an activity, all activities created from that pattern have a
Create Document button visible after the activity opens.
Clicking the Create Document button displays the New Document screen for creating a document from a template,
enabling you to create the document. Because an activity pattern can indicate only one template, any single activity
creates only one type of document.
In the default configuration, none of the activity patterns specify a document template.
See also
• “Create a New Claim Document from a Template” on page 594
Edit Content for a Claim Document

About this task
You can edit contents of documents in multiple places in ClaimCenter:
• The Documents screen of a claim can show all documents for the claim.
• The Subrogations screen has a Documents card.
• The Service Request detail screen has a Documents card.
• The Activity detail screen has a Documents card.
You can edit the content of a document if you have sufficient permissions.
Note: If you are using Microsoft Internet Explorer and you download a Microsoft Office document, the browser
can open it for you in the Office application, such as Microsoft Word. However, it is possible that the browser will
not use the correct file name for the document. Before saving a Microsoft Office document that you have
downloaded for editing, verify that the file name is correct, and enter it again if necessary.
See also
• “Upload Documents” on page 593
• “Claim Document Storage Overview” on page 588
Procedure
1. Click Download in the Actions column for the document. Alternatively, you can click the same button on
the Document Properties screen for the document.
Your browser indicates that it downloaded the file.
2. Edit the document content file in the appropriate editor.
Most web browsers can be configured to open some types of downloaded files in their native editors.
3. Save your work after you have made all your edits.
Make note of the saved file name and location so you can browse for the file when you upload changes to the
document. The file you upload becomes the new content for the document.
4. In the Documents screen, click Upload under Actions.

5. On the Update Document Content screen, click Browse, locate the file you saved, and then click Update.
Alternatively, you can drag a file from your file system viewer to this screen.
Edit Metadata Properties of a Claim Document

Before you begin
You can edit the metadata properties of a document if you have sufficient permissions.
About this task

You can edit metadata properties of documents in multiple places in ClaimCenter:
• The Documents screen of a claim can show all documents for the claim.
• The Documents card on screens for various entities associated with the claim. For example, the Subrogations
screen, the Service Request detail screen, or the Activity detail screen.
See also
• “Upload Documents” on page 593
• “Claim Document Storage Overview” on page 588
Procedure
1. Click View Document Properties in the Actions column for the document.
2. In the Document Properties screen, click Edit.
3. Make your changes.
If you change the Name field, ClaimCenter subsequently uses that name for the file it downloads for document
content.
4. Click Update when you have made all your changes.
Linking Documents to Claim-related Entities

In the details screen or new entity screen of some claim-related entities, you can click a Link Document button to link
existing documents to the entity. In some cases, such as reserves, new activities, and new notes, clicking Link
Document is the only way to establish a link.
The linking described in these topics applies only to claim-related entities. You can separately link documents to
vendor contacts in ContactManager.
• “Link a Document to a Reserve” on page 599
• “Link a Document to a Check” on page 599

See also
Link a Document to a Service Request
About this task

See also
Procedure
1. With a claim open, click Services in the Sidebar menu on the left.
2. On the Services screen, select a service from the list.
Below the list of services, the Details card is selected by default.
3. Click the Documents card.
On this card, you can see a list of documents currently linked to this service.
4. Click the Link button above the list of documents.
• If you have a vendor portal installed and you also want to notify the portal, click the Link button for Send to
vendor.
• If you want to work locally with the document, click the Link button for Associate only.
5. A search screen opens that by default shows all claim documents. In the Filter Documents section of the screen,
you can change the search criteria to narrow the selection.
6. On the search screen, click Select for the document you want to link to the service request.
7. The Services screen returns, and the document you selected is listed on the Documents card.
You can also work with a linked document by using any of the actions on the Documents card of the Services
screen.
Link a Document to a Subrogation
About this task

See also
• “Working with Subrogation” on page 289
Procedure
1. With a claim open, click Subrogations in the Sidebar menu on the left.
2. On the Subrogation: Summary screen, click the Documents card.
On this card, you can see a list of documents currently linked to this subrogation.
3. Click the Link button above the list of documents.
A search screen opens that by default shows all claim documents.
4. In the Filter Documents section of the screen, you can change the search criteria to narrow the selection.
5. On the search screen, click Select for the document you want to link to the subrogation.
6. The Subrogation: Summary screen returns, and the document you selected is listed on the Documents card.

You can link a document to a subrogation by using the buttons on the Documents card of the Subrogation:
Summary screen. Creating a new document or editing it by using the Create from Template or Upload button on this
screen also links the document to the subrogation.
Link a Document to a Reserve
Before you begin

You can link a document to a reserve only when creating the reserve.
About this task

See also
• “View Documents for a Reserve” on page 592
Procedure
1. Navigate to Actions→New Transaction→Reserve.
2. Select the check box to the left of the new reserve in the list of reserves.
3. Click the Link Document button.
A search screen opens that by default shows all claim documents. In the Filter Documents section of the screen,
you can change the search criteria to narrow the selection.
4. On the search screen, click Select for the document you want to link to the reserve.
The Set Reserves screen opens and displays the document you selected in the list under Documents Linked to
Reserves.
Alternatively, you can unlink a document in this screen by clicking Remove Document .
Link a Document to an Activity
About this task

See also
Procedure
1. Open an activity worksheet in one of the following ways:
• Click the Desktop tab, and then click an activity’s Subject.
• Open a claim and click Workplan to open all activities associated with the claim.
2. On the Activity worksheet, click the Link Document button.
4. On the search screen, click Select for the document you want to link to the activity.
5. The Activity worksheet returns and shows the document you added in the Documents section.
6. You can unlink the document by clicking Remove Document .
Link a Document to a Check
Before you begin

You can link a document to a check only when creating a new check.
Linking Documents to Claim-related Entities 599

About this task

See also
• “View Documents for a Check” on page 592
Procedure
1. Navigate to Actions→New Transaction→Reserve.
2. When you get to step 3 of the New Check wizard, click the Link Document button.
4. On the search screen, click Select for the document you want to link to the check.
5. The screen showing step 3 of the New Check wizard returns and shows the document you added in the Linked
Documents section.
6. While still in the New Check wizard, you can unlink the document by clicking Remove Document .
Link a Document to a Note
Before you begin

You can link a document to a note only when creating a new note.
About this task

See also
• “View Documents for a Note” on page 592
• “Indicate the Existence of a Hard-copy Claim Document” on page 595
• “Linking Documents to Notes” on page 266
Procedure
1. Navigate to Actions→New→Note.
2. On the Note worksheet in the Text field, put the cursor where you want the link to appear, and then click the
Link Document button.
4. On the search screen, click Select for the document you want to link to the note.
The Note worksheet returns. In the Text field, there is a link to the document you added in the Linked Documents
section. For example, $ccDocLink(17).
5. While creating the note, you can move the link text where you want it in the body of the note, or even delete it.
For documents that have content stored on the system, this link becomes JavaScript that downloads the
content of the document on the ClaimCenter server to your browser for viewing. A link created for a
document that indicates existence of a hard copy document cannot be active because there is no content stored
on the system.
Hiding a Claim Document

Hiding a document is a way to remove an obsolete document from your list of documents without deleting it. When
you hide a document, you no longer see it listed in the Documents screen unless you indicate that you want to see
hidden documents.

You can hide a claim document in a number of ways:

• With a claim open, open the Documents screen from the left Sidebar, select a listed document, and click Hide
Documents.
• Open the Documents screen or any screen that displays a list of documents, such as the Documents card of the
Services screen. Then click View Document Properties for a document to open its Document Properties screen,
click Edit, set Hidden to Yes, and then click Update.
Hiding a document in either of these ways sets the Obsolete flag on the Document entity and does not retire the
document in the database. You can view hidden documents by setting Include Hidden Documents to Yes in the search
section of the Documents screen.
Hiding a document is not the same as deleting it. The docdelete permission is necessary to delete documents. Only
users who have that permission can delete documents.
Delete a Claim Document

About this task
See also
• “Removing a Claim Document Link” on page 601
Procedure
1. Open the Documents screen and select the document in the Documents list.
2. Click Delete Selected.
If this button is dimmed or there is no Delete action visible in the Actions column, you might not have the
authority to delete that file.
Other reasons you might not be able to delete a document are:
• The document content is hard copy. The document indicates only the existence of a document.
• The document is in Final status and you do not have permissions that override this status.
• The document has been sent to an external contact.
Removing a Claim Document Link

In some cases, you can remove the link between a document and a claim-related entity. If you can remove a
document, the Remove Document action is available in the document’s Actions column. When you remove a
document, you change only the link between the document and the entity it links to. Removing a document does not
delete it.
For example, a document you added to a service is not really applicable to that service. You click Services in the left
Sidebar and then click the Documents card. You find the document in the list of documents and then click the
Remove Document action, and then you click OK in the confirmation dialog. The document remains linked to the
claim and you can still see it in the Documents screen.
See also
Configuring and Integrating Claim Document Management

The base configuration provides Document Management system permissions, configuration parameters, plugins, and
document templates that you can configure or manage as an administrator.

Guidewire recommends integrating with an external document management system rather than using the default
demonstration document management system on the ClaimCenter server. The default system is useful only for
demonstration purposes and does not support features of a real document management system, such as document
versioning.
See also
Document Security
ClaimCenter provides a set of system permissions to provide security for all documents, as seen in the following
table. You can also use these permissions to define security types for documents and assign permissions to users that
relate to these security types.
The RestrictSearchesToPermittedItems search parameter in the config.xml file determines whether you can
see a document in the list that you do not have permission to view.
The following system permissions provide security for documents.
Name Purpose of permission Also needed

viewdocs See the Claim Documents page.
doccreate Create documents for a claim.
docdelete Remove documents from any claim.
docedit Edit documents.
doccreateclsd Add documents to a closed claim. doccreate
docdeleteclsd Remove documents from a closed claim. docdelete
docmodifyall Modify any document, regardless of security type (ACL).

docview View the documents on a claim. viewdocs
docviewall View any document, regardless of its security type (ACL).
See also
Configuration Parameters for Claim Document Management

The following configuration parameters in the config.xml file control search for and the display and editing of files
in a document management system.
• DisplayDocumentEditUploadButtons
• DocumentContentDispositionMode
• DocumentTemplateDescriptorXSDLocation
• FinalDocumentsNotEditable
• MaxContactDocumentSearchResults
• MaxDocTemplateSearchResults
• MaximumFileUploadCount
• MaximumFileUploadSize
• MaximumTotalUploadSize
Another section of the config.xml file maps document file types—also called MIME types—to file extensions and
associated icons in the user interface. For example:

<mimetypemapping>
<mimetype name="application/msword"
extensions=".doc"
icon="mime_word_16.png"

</mimetypemapping>
See also
• To configure search parameters for documents, see “Searching for Claim Documents” on page 592.
• For details about document management and related integration points, see the Integration Guide.
Claim Document Management Integration

The following are the main plugin interfaces used to integrate with a document management system. Each plugin
interface has a default plugin implementation class.
Interface Description
IDocumentMetadataSour ClaimCenter passes search parameters—metadata—to the plugin implementation class registered
ce in this plugin registry. The class searches its metadata and returns a list of documents found.
You can implement your own plugin implementation class to interface with a system for storing
document metadata—name, id, status, author, and so on. If the plugin is not enabled, then the
ClaimCenter database stores the metadata.This interface is separate from IDocumentContentSourc
e because of different architectural requirements.
In the base configuration, this plugin is disabled, and the following plugin implementation class is
registered:
gw.plugin.document.impl.LocalDocumentMetadataSource
IDocumentContentSourc ClaimCenter passes to the plugin implementation class registered in this plugin registry the
e metadata for one document. The registered class registered returns the document content and
does the following:
• Interfaces with a document storage system.
• Contains methods for creating, updating, and retrieving document contents.
• Supports the following document retrieval modes:
◦ Document contents.
◦ Gosu executed by client rules.
◦ URL to a server content store.
In the base configuration, the following plugin implementation class is registered:
gw.plugin.document.impl.AsyncDocumentContentSource
• In the registry, the parameter TrySynchedAddFirst is set to true and SynchedContentSource
is set to gw.plugin.document.impl.LocalDocumentContentSource.
• These parameter values cause the class to first try to use synchronous document management.
If it fails, then it uses asynchronous document management.
IDocumentProduction This plugin registry registers a plugin implementation class that is the interface to a document
creation system.
The document creation process can:
• Involve extended workflow or asynchronous processes or both.
• Depend on or set document fields.
In the base configuration, the following plugin implementation class is registered:
gw.plugin.document.impl.LocalDocumentProductionDispatcher
IDocumentTemplateSour This plugin registry registers a plugin implementation class that searches for and retrieves
ce templates describing the document to be created. In the base configuration, the plugin
implementation class is:
gw.plugin.document.impl.LocalDocumentTemplateSource
Configuring and Integrating Claim Document Management 603

Interface Description
IDocumentTemplateDesc This interface describes the templates used to create documents. It include basic metadata (name,
riptor MIME type, and so on) and a pointer to the template content. In the base configuration, a class
that implements this interface is:
gw.plugin.document.impl.XMLDocumentTemplateDescriptor
See also
Creating a Claim Document Template

A document template consists of two files. One file is a document template descriptor file, which contains the
metadata, such as its name, ID, and MIME type. The other file is the document template itself, which contains the
document contents.
You can view and edit the document templates and descriptors by navigating to
configuration→config→resources→doctemplates in Studio.
Document template files are in the following directory:
ClaimCenter/modules/configuration/config/resources/doctemplates
There are several example files in that directory. The best way to create a new template is to edit copies of these
examples. The descriptor file is in XML format. Studio does not provide a special editor to help generate new
templates.
See also
• For details about document management, document templates, and related integration points, see the Integration
Guide.
• To automatically create documents by using rules, see the Integration Guide. Use similar rules to create a
document in a workflow.

chapter 52
Metropolitan Reports
Metropolitan Reporting Bureau (MRB) provides a nationwide police accident and incident reports service in the
United States. Many insurance carriers use this system to obtain police accident and incident reports to improve
record-keeping and to reduce fraud. ClaimCenter built-in support for this service reduces the amount of time it takes
to develop and deploy projects that integrate with the MRB.
See also
Overview of Metropolitan Reports

ClaimCenter integrates with the Metropolitan Reporting Bureau to enable you to request police accident and
incident reports that might be associated with a claim. You enter all the pertinent data in ClaimCenter and, through
the integration, send the data and request a report.
There are many report types. Metropolitan has approximately 30 report types, and ClaimCenter supports most of the
current report types. Some examples of the types of reports that MRB provides are:
• Police Accident and Incident Reports
• Fire Reports
• Insurance Check
• Title History Check
• Driver History
• Disposition of Charges
• Weather Reports
• Coroner and Death Certificate
• OSHA Reports
• Property and Judgment Search
Metropolitan Reports 605

MRB also offers additional services such as:

• People Search
• Financial Asset Checks
• Vehicle History Reports
• Vehicle Registration Information
• Court Records Search
• Locate Defendant/Witness
You can attach a report to a claim file as a document. After adjusters request reports, the reports are retrieved later,
asynchronously. After Metropolitan returns the report, ClaimCenter matches it to a specific claim and attaches it as a
document in the claim file. You can view or print the report as with any other document.
Reasons to Order a Report

• Ordering a report during claim intake – An adjuster or customer service representative is on the phone with an
insured customer taking in a First Notice of Loss (FNOL) report through the ClaimCenter New Claim wizard. The
adjuster or CSR can order a report during the claims intake process.
• Ordering a report on an established claim – If a police report was not requested originally during claim intake
(FNOL), the adjuster can order one later from the claim screens.
• Multiple reports on the same claim – Sometimes an adjuster requests a police report for a claim but has some
data incorrect, such as the police department details. An adjuster can change the appropriate information and
submit a request for another, new report.
See also
• For a full list of report types and request codes supported by ClaimCenter, see the Integration Guide.
Working with Metropolitan Reports

You can view a report and order a report.
Viewing a Metropolitan Report

About this task
You view a report in the Metropolitan Reports section of Loss Details.
Procedure
1. Open a claim and click Loss Details in the left sidebar.
2. Scroll down to the Metropolitan Reports section.
3. If there are no reports:
a. Click Edit at the top of the screen.
b. Scroll back down to the Metropolitan Reports section.
c. Click Add to add a report.
4. In the list of reports, click the type name link in the Type column, such as Auto Accident.
The Metropolitan Report Details screen opens, showing the data for the report.
5. If the report status is Received and you click the View Document button, ClaimCenter opens the actual report.
606 chapter 52 Metropolitan Reports

6. Use View Document if you need to print the report.
Next steps
See also
• “Metropolitan Reports Section” on page 607
Metropolitan Reports Section

The list of metropolitan reports on the Loss Details screen has the following columns:
• Type – The type of the report request. The list of types is in the MetroReportType typelist, visible in Guidewire
Studio.
• Status – The current status of the report request.
• Order Date – The date that the report request was sent to the Metropolitan Reporting Bureau. The order date is
empty if the report has a status of Insufficient Data.
• Document – The document column shows the name of the document if the report status is Received. The user can
view the document by clicking the View Document button in the Actions column.
• Actions – The last column is for buttons that enable you to view a document or to resubmit the report request. If
the original report request has insufficient data, you can update the claim with all the required properties. You can
then return to the Loss Details screen and click the Resubmit button to re-run pre-update rules. ClaimCenter can
send a new report request if the report passes preupdate rules.
See also
• “Viewing a Metropolitan Report” on page 606
• “Preupdate Rules and Metropolitan Reports” on page 609
Working with Metropolitan Reports 607

Ordering a Report
You can order a report either during claim creation, in the New Claim wizard, or for an existing claim.
Ordering a Report in the New Claim Wizard
Procedure
1. Create a new claim by using the New Claim wizard.
2. In the Loss Details step of the wizard, navigate to the At the Scene section.
3. In the Metropolitan Reports section, click Add.
The name of this section depends on the type of claim.
For example, for a personal auto claim, the section is Police Reports.
4. The Metropolitan Report Details screen opens where you can add details. When finished, click OK.
The type of report ordered shows on the Loss Details screen.
Ordering a Report for an Existing Claim
Procedure
1. Open a claim.
2. Navigate to the claim’s Loss Details screen.
3. Click Edit.
4. Click Add in the Metropolitan Reports section.
5. Click Update.
Configuring Metropolitan Reports

The topics that follow give a quick overview of some ways to configure the Metropolitan Reports feature.
See also
• For more details on configuring metropolitan reports, see the Integration Guide.
Metropolitan Reports Configuration Parameters

You enable or disable metropolitan reports by setting the EnableMetroIntegration configuration parameter in the
config.xml file. The default setting is true.
There is another configuration parameter in the config.xml file that affects the Metropolitan Reports feature, the
MetroPropertiesFileName feature. This parameter sets the name of the Metropolitan Reports properties file in the
ClaimCenter/modules/configuration/config/metro configuration directory. In the base configuration, this file
name is Metro.properties. ClaimCenter uses this file to set up fields in the XML messages sent to the
Metropolitan Reporting Bureau.
See also
Configuring Display Keys for Metropolitan Reports

About this task
In ClaimCenter Studio, you can set display keys to define your own error messages, property names, and other text
to display for metropolitan reports. In the base configuration, you can define them in U.S. English.

Procedure
1. Open Guidewire Studio, and then navigate in the Project window to configuration→config→Localizations.
2. Double-click display_en_US.properties to open this file in the editor
3. In the properties file, search for metro.
Next steps
See also
Preupdate Rules and Metropolitan Reports

ClaimCenter sends the metropolitan report request only if the claim contains all the required data. The claim
preupdate rule CPU08000 - Metro Report Request makes this determination. It checks, one at a time, the type of each
report requested and determines whether the claim contains the data required to request each of the requested
reports.
If there are any missing fields, an activity called Metropolitan Report Request Failed is created and assigned to the
person that created the request.
If the required data is added to the claim and the claim update completes successfully, the report status changes.
After the report status is validated, ClaimCenter starts a workflow that then changes the metropolitan report status to
Sending Order.
Activity Patterns and Metropolitan Reports

The Metropolitan Reports feature includes a set of activity patterns, which are a type of template for a user activity
notification. If you log in to ClaimCenter as an administrator, you can modify these activity patterns by clicking the
Administration tab and navigating to Business Settings→Activity Patterns.
For example, when a report request fails as InsufficientData, the Metropolitan Report Request Failed pattern
creates a metropolitan_request_failed activity and assigns it to the person that created the request.
See also
• “Understanding Activity Patterns” on page 234
Metropolitan Report Templates and Report Types

ClaimCenter report requests to Metropolitan must be formatted in the XML format required by the report type. To
generate this request, ClaimCenter runs a specific a Gosu template, which is a text file with embedded Gosu code.
This template generates the necessary XML-formatted text. ClaimCenter includes templates for all report types, and
these report types are auto-configured to correspond to the standard loss types in the ClaimCenter reference
configuration.
You can configure these templates and match them to loss types as described at the Integration Guide.
Metropolitan Report Data Types, Typelists, and Properties

The entity representing a metropolitan report is the MetroReport entity.
The MetroReport entity also references a Document, which represents the report returned from MRB.
There are several typelists used by the Metropolitan Reports feature:
• MetroReportType – Defines a type of report that adjusters can request, such as Auto Accident or Coroner
Reports and Title History. There is also a mapping defined between loss detail type and MetroReportType.
• MetroAgencyType– The investigating agency type for each report.
• MetroReportStatus – Indicates the current status of the report request, such as Accepted or Pending.
Configuring Metropolitan Reports 609
See also
Metropolitan Report Workflow

Interacting with the Metropolitan Reporting Bureau is an example of how ClaimCenter uses a workflow process to
implement a complex set of interactions. You can either modify this existing workflow or generate new ones to
model other business processes.
Workflows do not replace rules. If you can model a business practice with a rule set, a workflow is unnecessary. But
workflows are more powerful and flexible than rules in many ways. An advantage of workflows is that they can wait
for a defined time before checking to see if a condition has changed or before performing a specific action. This
ability to wait means that a process can go to the next step without manual intervention.
See also
• To learn more about workflows, see the Configuration Guide.
• See the metropolitan reports workflow diagram in the Integration Guide.
• For information on setting workflow timing, see the Integration Guide.

chapter 53
ISO and Claims
In the United States, ClaimCenter integrates with ISO, formerly known as the Insurance Services Office. ISO
provides a service called ClaimSearch that helps detect duplicate and fraudulent insurance claims. After a claim is
created, a carrier can send details to the ISO ClaimSearch service and subsequently get reports of potentially similar
claims from other companies.
The base configuration of ClaimCenter includes integration with this service. In the base configuration, you can
configure ClaimCenter for claim-level messaging.
ClaimCenter provides a special validation level for ISO that enables ClaimCenter to verify that all the required data
is entered into the system during the intake process. Once verified, ClaimCenter sends the claim to ISO and records
any ISO match reports associated with the claim or exposure.
ClaimCenter supports the ISO DataPower platform. It is necessary to edit the iso.properties file to configure
support for DataPower. Refer to the ISO web site for more information.
This topic introduces working with ISO and describes its general processes.
See also
How ISO Interacts with Claims and Exposures

If you integrate ClaimCenter with ISO, you send messages to ISO at the claim level.
You integrate with ISO at the claim level so that other carriers can receive a more complete picture of what
happened on a certain claim, aiding in fraud detection.
ISO and Claims 611

How ISO Works with ClaimCenter

ClaimCenter interacts with ISO when a triggering event occurs on a claim that is at the Valid for ISO validation
level. Triggering events can include:
• An exposure or claim was added, made valid, or changed.
• The policy changed.
• The claim contact changed.
• Important field information changed.
Note: You can send data to ISO automatically after completing the New Claim wizard if the claim has all the
required ISO information and passes validation.
The event triggers the Event Message rule set category, which in turn triggers the Event Fired rule set. The system
creates a message containing the required data and sends that payload generation request to ISO.
There are different payloads depending on the type of claim. For example, a payload for an auto claim can include
items such as VIN, make, model, and year of the damaged vehicle. A payload for WaterCraft/Boat might require
data on the loss for each boat property: boat year, boat make, and HIN or serial ID number. A large part of
configuration involves defining what data is to be captured and sent to ISO.
ISO sends a reply back to ClaimCenter indicating if there were any matches to the criteria it received. These
matches are useful in detecting fraud because the majority of carriers in the United States integrate with ISO. The
system updates the claim with the new response and match report. ClaimCenter stores the match reports as
documents. See “Viewing ISO Information” on page 613.
If, at a later date, certain data changes again, you can send that change to ISO by clicking the Send to ISO button
located on the ISO tab.
ISO Lifecycle
The following diagram shows the ISO Lifecycle.
612 chapter 53 ISO and Claims

ISO Lifecycle
ClaimCenter is configured to send a

A claim is created
message to ISO when an event triggers.
You can see what data is missing by

No
Ready for ISO? Data not sent to ISO validating the claim in the Actions
menu in the user interface.
Yes
Claim data ISO conducts a claim search. If a match is

sent to ISO found, it sends a match report.
ISO sends match report
ClaimCenter stores ISO ISO match report is stored with the claim as a
data document and as a match report.
Viewing ISO Information

Depending on your configuration, you can see ISO information at two locations for an open claim:
• The Documents menu link in the sidebar.
• The ISO card on the Loss Details→General screen.
The following commercial auto claim example shows data that ISO has sent to ClaimCenter. If you click the link
under the Claim/Exposure Number column, you can see the details.
How ISO Works with ClaimCenter 613

If you prefer to see detailed information, click Documents in the sidebar and then click View for that report to see
additional details. The following figure shows an example of the ISO report:

ISO Permissions
If you have the permissions required to view the claim, you can view the ISO match reports. You can also edit the
claim and click the Send to ISO button to send the message to ISO.
Additionally, the Administer Integration permission integadmin can be added to a role such as Claims Supervisor
or Adjuster. Use this permission to see and edit information that is not of interest to most users, but that can help in
rare cases. For example, with this permission you can edit information if the ISO state of the claim is no longer in
sync with the ISO server.
ISO Permissions 615

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Guidewire

Product Name: Guidewire ClaimCenter

About ClaimCenter documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

2 Claims Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

4 Changing the Screen Layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

5 Claim Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Using QuickJump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

8 Working with Policies in Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Add a Coverage Term to a Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

9 Accounts and Service Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

10 Special Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

11 Claim History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Validation Expressions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

13 Claim Fraud. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

15 Catastrophes and Disasters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

16 Service Provider Performance Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

17 Homeowners Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

18 Personal Travel Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

19 Workers Compensation Line of Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Manual Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

21 Weighted Workload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

22 Claim Segmentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

23 Working with Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Activity Pattern Types and Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

26 Legal Matters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Note Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

28 Holidays and Business Weeks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

29 Vacation Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

30 Question Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

Working with Salvage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298

32 Archiving in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

33 Personal Data Destruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317

Transaction Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

Applying Financial Holds to a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364

35 Multiple Currencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

36 Deductible Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387

37 Bulk Invoices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391

Messages Card for a Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

40 Team Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443

43 Reinsurance Management in ClaimCenter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467

45 Security: Roles, Permissions, and Access Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487

Data-based Security and Claim Access Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491

46 Administration Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511

Working with Authority Limit Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521

47 Business Rules Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 553

49 Policy Administration System Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573

50 ClaimCenter Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579

51 Document Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587

Configuring and Integrating Claim Document Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . 601

52 Metropolitan Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605

53 ISO and Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611

About ClaimCenter documentation

The following table lists the documents in ClaimCenter documentation:

About ClaimCenter documentation 23

Conventions in this document

bold Highlights important sections of code in for (i=0, i<someArray.length(), i++) {

About ClaimCenter documentation 25

26 About ClaimCenter documentation

Claim Management Process

Users Typical activities