Notification of loss, policy matching and verification
-
Customer makes a claim
-
Broker submits the claim with supporting documents
Broker submits a notification of loss to the Digital Processing Platform (ICOS) either:
- Directly through a portal; or
- Through an ECOT message via an API from their compatible broker system.
A minimum set of mandatory claim data will be required for a notification of loss to be submitted.
Broker submits a notification of loss to the Digital Processing Platform (ICOS) through a portal or an ECOT message.
-
Claim is matched against the relevant policy
The claim is automatically matched to the relevant policy by the Digital Processing Platform (ICOS) by retrieving data from the placement Core Data Record (CDR) and any subsequent endorsements. If data is not available, automatic matching will not occur.
Where a CDR does not exist, a transactional risk record will need to be created, or a broker will need to submit a Market Reform Contract (MRC) v3 to create a new CDR.
Claims data in the Digital Processing Platform (ICOS) is matched against the policy details, using data from the placement Core Data Record (CDR), enabling automatic matching of the claim to the policy.
-
Policy and premium verification checks are performed
Identification of the lead underwriter and claim agreement party, and initial verification checks, will automatically be performed on the policy based on the data provided in the notification of loss and placement Core Data Record (CDR). Premium data will be sought from the Digital Processing Platform (IPOS)
Policy verification rules built into the Digital Processing Platform (ICOS) will be used to carry out policy and premium paid verification checks.
How we’re delivering the Digital Processing Platform
The placement Core Data Record (CDR) identifies the lead underwriter and claims agreement parties relevant to the claim.
Triaging, routing and assignment
-
Lead underwriter and claim agreement party(ies) are notified of the claim (if required)
The lead underwriter and claim agreement party will be notified once the notification of loss is submitted and the policy is matched; either directly from the Digital Processing Platform (ICOS) portal or through an API.
The relevant parties will be notified of their involvement via messaging through the Digital Processing Platform (ICOS) portal, or an API. If applicable, the lead underwriter will identify whether a claim agreement party needs to be involved.
-
Lead underwriter and claim agreement party(ies) are assigned claims tasks
The lead underwriter and claim agreement party (if required) will be notified of any updates to the claim’s status and informed of actions directly through the Digital Processing Platform (ICOS), creating greater transparency and accountability.
The triage and agreement rules will be used to inform the claims triaging and routing in the Digital Processing Platform (ICOS). All participants on the risk will be able to see the status of the claim as it progresses in the Digital Processing Platform (ICOS).
Agreement
-
Query management and requests for additional information is undertaken (if required)
Broker and insurer will have the ability to view queries and interact with each other by accessing the Digital Placing Platform (ICOS) via the portal or ECOT message. This will enable:
- A shared view of the claim
- Queries to be answered in parallel rather than sequentially, reducing delays in query management.
Market participants will be able to resolve any queries directly using the Digital Processing Platform (ICOS) portal or an ECOT message. The Digital Processing Platform (ICOS) will enable queries to be handled in parallel, removing delays previously experienced through sequential processing.
-
Lead underwriter and broker negotiate, and agree or deny the claim
Claims will be negotiated and agreed or denied centrally through the Digital Processing Platform (ICOS). The Digital Processing Platform (ICOS) orchestrates and facilitates the process, enabling:
- Visibility of key decisions and the ability to collaborate
- Segregation of information and discussions through access management.
If a party is not digitally enabled, they will negotiate and agree claims using the portal the same way they use ECF today.
Market participants will be able to negotiate and agree or deny claims centrally using the Digital Processing Platform (ICOS) and ACORD messaging. Where the market participant is not digitally enabled, they will negotiate and agree claims using the portal the same way they use ECF today.
Digital processing
Settlement and claims payment
-
Technical processing checks conducted to review and finalise the claim
Technical and financial processing checks will be automatically completed by the Digital Process Platform (ICOS).
Technical and financial processing checks will be completed by the Digital Processing Platform (ICOS)
-
Funds or fees are moved
The broker creates the accounting instructions by sending an EBOT Technical Account (TA) and Financial Account (FA) to the Digital Processing Platform (ICOS).
Once the FA is approved by the agreement parties, the Digital Processing Platform (ICOS) will create the settlement instructions, which are sent to the requested payment provider.
Where central settlement is used, the Digital Processing Platform (ICOS) will send the payment instruction to the STFO (for the Lloyd’s market) or RBS (for the company market) for onward payment.
Where direct settlement is used, the Digital Processing Platform (ICOS) will send the payment instruction to the payment provider for faster payment (c.2 hours) direct to the nominated payee (e.g. customer, expert, etc).
The payment status will be viewable in the Digital Processing Platform (ICOS) portal.
Once the Financial Account (FA) is approved in the Digital Processing Platform (ICOS), the FA is used to create the settlement instructions and is sent to central settlement services. They will automatically settle funds with the STFO (for the Lloyd’s market) or RBS (for the company market) for onward payment.
For direct settlement where faster payment is agreed, Digital Processing Platform (ICOS) will send payment instruction to the payment provider for faster payment (c.2 hours) direct to the nominated payee (e.g. customer, expert, etc).How we’re delivering the Digital Processing Platform
Payment status is viewable in the Digital Processing Platform (ICOS) portal.
