Claims Use Case

Description

The Claims Services are messages designed to manage and coordinate coverage for all claims resulting from a single accident, relating all the information to one electronic high level claim folder. 

Actors

  • VDI Provider: A Company whose main businesses concern is providing vehicle damage repairs to the collision repair industry. The provider can perform vehicle damage repairs solely or can coordinate repair operations on a vehicle in conjunction with conventional repairs.

  • Photo Estimating Companies and Software Providers: who generate repair estimates and supplements via photos and other imaging technologies.

  • Parts Providers: Any company who provides parts, OE or Recycled or Aftermarket, for vehicle repair

  • Salvage Vendors: Any company whose work includes the selling of damaged or gently used vehicles (frequently rental company vehicles).

  • Sublet Repair Vendors: Any company who does vehicle repair work on behalf of a repair facility including scanning and recalibration.

  • Paint Vendors: Any company who provides paint to facilities to paint vehicles.

  • Glass Suppliers: Those companies whose main business is to supply auto glass to the Glass Installers.

  • Glass Installers: Those companies whose main business is to install auto glass.

  • Data Recipients: Any company that utilizes vehicle damage appraisals, vehicle damage data communications and/or vehicle damage data. 

  • Third Party Administrators: TPA, the companies whose main business is to administer the claim process life cycle for insurance carriers, i.e. FNOL, Independent Adjusting Firms. 

  • Information Technology Providers: Any entity that develops and/or maintains applications and/or services related to damage appraisals, appraisal data communications and/or appraisal data consolidation.

  • Insurance Company:  Property and Casualty insurers in one or multiple lines of business who acts on behalf of their policy holder and impacted parties for the repair of vehicles.

  • Repair Facility: Any company whose business concern is to repair damaged vehicles.

  • Damage Appraisers: Any entity whose role is to estimate or appraise vehicle damage and/or record and process appraisal information.


 Note: Insureds and Vehicle Owners are also affected. 

Business Segments

  • Manage a Claims Folder Containing Multiple Claimants/Exposures/Suffixed

  • Provide Initial Claim Information

  • Provide Updated Claim Information

What are the Industry Benefits for Using Claims Services?

  • Establishment of an accurate and efficient industry standard - by and for industry participants - to be used in the creation and industry standard implementation of electronic messaging for assignments, reassignments, assignment changes & cancels, estimates, supplements, PDR estimates, towing messages, claim save messages, and invoice and remittance messages.
  • XML electronic messages provide capability and flexibility for smaller-scale organizations and applications.
  • Facilitates the integration of Vehicle Damage & Imaging messages exchange.
  • Eliminates redundant data entry and other manual processes which allows for improved integration of Vehicle Damage & Imaging information across applications.
  • Management of the standard by CIECA streamlines development, approval, revision, enhancement and publication.
  • Reduce cycle time
  • An accurate and efficient vehicle estimating and repair process
  • Improved accuracy and efficiency through an understanding and use of vehicle repair standards
  • An automated export and import models for repairing vehicles using standard terms, and thus eliminating current paper-based processes
  • Enable repairers to reduce cycle appraisal and repair time by increased accuracy and quality of estimate data
  • The ability to reduce errors when data is exchanged between applications 
  • The elimination of redundant data entry
  • It is accessible to smaller scale companies and/or applications participating in the industry
  • Improved accuracy and efficiency through an understanding and use of imaging technologies
  • An automated export and import models to augment and possibly eliminate the current manual estimating processes
  • Improved customer service
  • Management of the standard by CIECA streamlines development, approval, revision, enhancement and publication

What Triggers the need for using Claims Services?

Consumer submits Claim to Insurer, TPA confirms coverage and uses Insurers system to sent Claim folder to TPA

or

Consumer submits Claim to Insurer, Insurer confirms coverage and sends Claim Folder to TPA

or 

TPA sends Claim Folder on Invoice

or

Insurer sends Claim Folder Payment

Pre-Conditions

Before using Claims Services, please review implementation guides between business partners for security and privacy.

Workflows

 Claims Services are after an accident occurs and the Claim is submitted to the appropriate partner and goes through invoice and payment.

View Workflows

Outcome

The Claim is settled with payment

    

Claims Solutions Available in CIECA

Claim Save Request

The Claim Save Request message can be used to create or update a Claim.  Such a Claim may be the parent of an entire collection of related exposures.   

Claim Save Response

This message can be used as a generic response indicating the message was received and was able to be parsed.  The message may have flowed through Data Intermediaries