The Claims Portal in practice

www.claimsportal.org.uk

The Claims Portal in practiceJune 2013


Agenda

• Introduction to the Claims Portal• The Behaviour Committee• Registration• User profiles• Branches• Compensator example set up

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Introduction to the Claims Portal


Who is Claims Portal Ltd?

APIL

LAW SOCIETY

MASS

TUC

ABI

INSURERS

MOTOR INSURERS’

BUREAU

INDEPENDENT CHAIR PERSON

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Protocols and the Portal

• It’s important to distinguish between the ‘what’ and the ‘how’.• The Protocols have been written and are owned by the

Ministry of Justice.• The Claims Portal itself is owned and managed by Claims

Portal Ltd.• Any issues, questions or concerns about the ‘what’ – i.e. the

rules, requirements and expectations – should be directed to the MoJ.

• Any problems with, or questions about, the ‘how’ – i.e. the technology solution – can be directed to Claims Portal Ltd.

• It is essential that users understand the Protocols and do not rely on the Claims Portal to comply.

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Staying informed

• New Claims Portal website - www.claimsportal.org.uk• The latest news and announcements.

• E-Newsletters:• Sign up at http://www.claimsportal-mail.org.uk/• The latest news, updates and any actions required delivered to your

mailbox

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http://www.claimsportal.org.uk/

http://www.claimsportal-mail.org.uk/

http://www.claimsportal-mail.org.uk/


What is the Claims Portal?

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POST BOX

CLAIMS UP TO £25K

MOJ PRE-ACTION

PROTOCOLS

RTA / EL / PL

ELECTRONIC

IMPLEMENTED APRIL 2010

Stakeholder solution for the benefit of users:

Secure electronic transmission of information between claimant and

insurer/compensator parties.Provides forms to help capture and

submit the right information.Speedy communication of key decisions.

‘Post box’:Not a compliance tool.

Not a Case Management System.Not an MI repository.


‘Web’ vs ‘A2A’

• There are 2 ways of accessing the Claims Portal:• Directly via a web browser.• Through an Application to Application (A2A) interface.

• Using the web browser offers a simple and low-cost route into the Claims Portal.

• An A2A interface enables you to link existing systems with the Portal for an integrated experience.

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Training and Support

www.claimsportal.org.ukUser guides for all users.

Walkthroughs of key elements.Frequently Asked Questions.

Latest news and announcements

‘One Stop’ Claims Portal Helpdesk:Core Hours 7am – 7pm Mon-Fri; 8am – 2pm Sat.

Supporting registrations, A2A credential requests, access to training and integration sites, Portal queries and more.

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‘Live’ and ‘Training’

• The Claims Portal has both a ‘Live’ and a ‘Training’ version.• The Training version:

• Provides a safe environment for practice and familiarisation.• Allows access to both Claimant Representative and

Compensator/insurer elements.• Looks and behaves identically to the Live site.

• The Live and Training sites have different user credentials.

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Management Information (MI)

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CLAIMS PROCESS

PORTAL SERVICE

UsersPerformanceAvailability

EXECUTIVE DASHBOARD



CLAIMS PROCESS MI: HIGH LEVEL ONLY

No OF CLAIMS SENT TO A COMPENSATOR

No OF CLAIMS THAT LEAVE THE PORTAL - STAGE 1

No OF CLAIMS THAT LEAVE THE PORTAL - STAGE 2

No OF CLAIMS THAT SETTLE - STAGE2

No OF CLAIMS THAT LEAVE THE PROCESS - EXIT FUNCTION

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•Things to remember / consider:•The Claims Portal is not a case management system

•Claims Process MI is High level only / Not at organisational level•Executive Dashboard is updated monthly, available to all and is published

at www.claimsportal.org.uk. •Portal User Agreements controls use of MI.

•Ad hoc bespoke MI reports are not produced. Claims Portal do respond to MoJ requests.

•Ensure you consider your own claims management information requirements and make appropriate provisions in your internal business

process/systems.

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The Behaviour Committee



• Formed to assist with the resolution of behaviour issues arising from use of the Portal:

• A balance of claimant and insurer representation • Meets on a bi-monthly basis and considers behaviour issues that

have been submitted• Compulsory, non-binding, arbitration• Provides general guidance on repeat behaviours (on the website)• Regarding the use of the Portal, in the context of the Civil Procedure

Rules, including in particular the Pre-Action Protocol for Low Value Personal Injury Claims and the spirit in which they was introduced.

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The reporting process:•Address any issues in writing directly to the organisation concerned

•Where a satisfactory outcome has not been achieved, the issue is reported to the Behaviour Committee using the Behaviour Report Form by a senior

representative of the complainant, with accompanying references to the protocol and documents as appropriate

Common behaviour issues include multiple CNFs and compensators contacting claimants directly

Consistent agreement within the Committee

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Registration


Registration

• Available online at www.claimsportal.org.uk

• Before you register you need to;

1. Decide whether you are using the Portal via Web or Application 2 Application (A2A)

2. Decide what Claim Types you want to process (RTA and/or EL/PL)

3. Nominate an Administrator4. Understand your set up options

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1. Registration - Web or A2AWeb• Simply connect via the internet and log in using one of two standard

browsers, Internet Explorer (version 6 or above) or Mozilla Firefox.

Insert User ID and Password to access the Claims Portal.

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1. Registration - Web or A2AA2A• You can choose to access the Claims Portal via A2A.

• This approach allows you to develop an interface to the Claims Portal from your own internal claims system whereby you send and receive XML messages to process claims.

• If you do develop internally you must have an appropriate level of IT competence and availability.

• A2A also allows you to use products to connect to the Claims Portal that have been developed by external software houses.

• If you choose to connect via A2A and are using a software house to develop a bespoke A2A solution for you, point them to the Developers section of www.claimsportal.org.uk

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2. Registration – Claims TypesClaim Types

There are three options available when completing your registration;

• Road Traffic Accidents Only (RTA Only)

• Employers’ Liability / Public Liability Only(EL / PL Only)

• Road Traffic Accidents and Employers’ Liability / Public Liability (RTA and EL / PL)

• Note: if you wish to add a claim type to your account at a later date your nominated Administrator can do this via Manage Your Account at www.claimsportal.org.uk

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3. Registration - AdministratorAdministrator

• The Administrator is responsible for your Claims Portal Account.

• They are responsible for;

• Accepting the Portal User Agreement on behalf of your organisation

• Creating and maintaining Claims Handler access to your account• Setting up user names and maintaining passwords• Disabling users

• Maintaining your organisation’s account• Change name and address• Adding branches• Adding Claim Types• Dealing with transition to A2A

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3. Registration – Second AdministratorSecond Administrator

• As part of setting up your account, you should create a second Administrator user.

• This will ensure you have cover for periods when your primary Administrator is temporarily not available, or has left your organisation.

• It is also useful if your Administrator forgets their password as the second Administrator can reset it immediately without having to contact the Helpdesk.

Administrator TIPs

• Administrators cannot access the Portal to process claims.• Ensure your claims handlers know who your Administrator is.• All users, including Administrators, are disabled if you have not logged in for

90 consecutive days. Set a reminder to log in.

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4. Registration – Set Up Options

Self Insured Organisations / Large Deductible

• Set Up options largely depend on whether you handle claims in house or via Third Party Administrators (TPAs) / legal advisors.

• Use the flow chart to help you understand the options available.

• The options set out are not mutually exclusive and it is entirely possible that you will require a combination. This will be determined by your requirements.

This information is contained within Section A of the Administrator User Guide found on the Using the Portal page at www.claimsportal.org.uk.

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www.claimsportal.org.uk 25


Set up - Option 1


Notes about Set Up Option 1• If your organisation handles and process all claims that fall within the Pre Action Protocol in Employers’ Liability

and Public Liability or you want to control access to your claims for a TPA you can register for an account on the Claims Portal.

• This compensator account will belong to your organisation and your nominated Administrator will be responsible for controlling and maintaining access for all users in all branches.

• This account will appear to claimant representatives when they look for a defendant/insurer when creating a Claim Notification Form and you will receive claims straight into this account.

• Within this account you can create branches and claim handler profiles to meet various requirements. For example, you may allocate work to internal teams and wish to recreate this structure within your Claims Portal account.

• By using branches and relevant branch claim handler profiles you can allow access for a TPA or other claims handling organisation. This allows you to maintain control over access to your claims.

• See Page 27 for an illustrated diagram of how the account could look.

• IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims handling organisation you must not create an Administrator user for them as this will enable the TPA to control access to all branches and all claims.

• For more information about branches and user profiles please see Section A2 and A3 of the Administrator user guide contained on the Using the Portal page at www.claimsportal.org.uk.

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Set up - Option 2

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Notes about Set Up Option 2• If your organisation wants all claims that fall within the Pre Action Protocol in Employers’ Liability and Public

Liability claims to go straight to a single TPA or other claims handling organisation you do not need a Claims Portal account.

• Providing your TPA or other claims handling organisation is already registered/or intends registering for a compensator account that receives EL/PL claims, it is possible to list your organisation on the Claims Portal so that when it is selected by a claimant representative the claim notification form is sent to your nominated TPA or other claims handling organisation.

• If you wish to pursue this set up you will need to speak with your TPA or other claims handling organisation and agree this approach.

• Once agreed your TPA Claims Portal Administrator will need to request this set up via the Helpdesk at [email protected].

• They will need to provide;• Your organisation name and address and• Written authority confirming that your organisation agrees to the TPA handling all EL/PL claims on your

behalf. • Once set up, your organisation name will appear to claimant representatives when they look for a

defendant/insurer when creating a Claim Notification Form. Once selected claims will be sent straight into the TPA or other claims handling organisation’s account.

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mailto:[email protected]


Set up - Option 3

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Notes about Set Up Option 3• If your organisation uses more than one TPA or other claims handling organisation to process claims that fall within the Pre Action

Protocol in Employers’ Liability and Public Liability claims you should register for an account on the Claims Portal. • This compensator account will belong to your organisation and your nominated Administrator will be responsible for controlling and

maintains access for all users in all branches.• This account will appear to claimant representatives when they look for a defendant/insurer when creating a Claim Notification Form and

you will receive claims straight into this account.• In order to pass claims to the relevant TPA or other claims handling organisation according to your own business rules, you can either

set up branches and allow access for your various TPAs (as described in Set Up - Option 1) or you can re-assign all or some claims from this account direct to the relevant TPA.

• IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims handling organisation you must not create an Administrator user for them as this will enable the TPA to control access to all branches and claims.

• If you intend re-assigning claims out of your account to a relevant TPAs, each TPA must already be registered/ intending to register as a compensator that receives EL/PL claims.

• See Slide 31 for an illustrated diagram of how the account could look and work if you were to re-assign all your EL/PL claims to the relevant TPAs with their own accounts.

• IMPORTANT: EL/PL claims can only be re-assigned at the outset of the claims process either before or after they have been acknowledged. It is not possible to re-assign a claim that has been Accepted.

• For more information about re-assigning claims please see section B3 of the Compensator User Guide on the Using the Portal page at www.claimsportal.org.uk.

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User Profiles


User Profiles• The way that users process claims depends on the account set-up and the

Profile given to them by their Administrator.• A full list of profiles is available at www.claimsportal.org.uk

Compensator profiles • The following profiles are available to compensators;

Profile TIP

• It is recommended that you use the profile associated to the claims type(s) you process. i.e. if you only process EL/PL claims only use the EL/PL user profiles.

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User ProfilesClaimant Representative• The following profiles are available to claimant representatives;

Profile TIP

• It is recommended that you use the profile associated to the claims type(s) you process. i.e. if you only process EL/PL claims only use the EL/PL user profiles.

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User Profiles Summary• Dispatchers (Compensators only)

Work with claims up to the point of acceptance, including acknowledgement, reassignment and reallocation. These profiles can also have their access restricted by claim type and

branch.

• Claims HandlersWork with claims according to their designation (EL/PL, RTA or

all), or branch.

• Team LeadersWork with claims according to their designation (EL/PL, RTA or

all). Can ‘log in as’ to log in as any other user in the organisation.

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Branches

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Branches - Compensators• Branches provide a way to place claims into different teams within the

Portal, to reflect different departments, geographies, responsibilities and/or scope of work.

• Branches can also be used to pass claims to third parties who have delegated authority/large deductibles or are claims handling agents

• All compensator organisations must have at least one branch, which is nominated as the Central Point, and will always be named ‘001’ by default.

• The central point is the branch into which all CNFs are received. There can only be one central point and it is possible to handle claims in the branch nominated as the central point.

• Additional branches may be created and are referred to as handling points. It is possible to set-up a number of branches and you should consider how to name your branches so that they remain appropriate over the long term.

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Compensator example set up (EL/PL)

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Notes about User Profiles (EL/PL Claims only)

• In this example set up, the Compensator organisation only receives EL/PL claims and has set up a number of branches to allocate work internally across teams (001 – 005).

• The compensator organisation has also created a branch (006) to allow access to claims for a TPA or other claims handling organisation.

• The appropriate user profiles in this set up are EL/PL specific i.e. COMP EL/PL Claims Handler Team Leader.

• The Comp Administrator user controls and maintains access for all users in all branches.

• IMPORTANT: If you create a branch in your account to allow access for a TPA or other claims handling organisation (as shown in Branch 006 above) you must not create an Administrator user for them as this will enable the TPA to control access to all branches and claims.

• The Comp EL/PL Claim Dispatcher (Branch 001) can only see new EL/PL Claim Notification Forms before they are accepted. They can re-allocate claims to branches.

• The Comp EL/PL Claim Handler Team Leader (Branch 001) can see EL/PL claims in all branches.

• The Comp EL/PL Branch Claim Handlers (Branches 002-006) can only see EL/PL claims in their associated branch.

• It is possible to re-allocate claims between branches.

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Notes About Re-assignment

• The re-assignment function allows you to pass a claim either to a third party administrator (TPA) that deals with your claims and has their own account or to another brand within your own organisation.

• If a claim has been sent to you in error you should not re-assign the claim to another compensator organisation. These claims should be rejected, which will return them to the Claimant Representative for resubmission to the correct Compensator/Insurer.

• It is only possible to re-assign a Claim Notification Form at the outset before you Accept the claim is one for your organisation.

• It is possible to acknowledge an EL/PL Claim Notification Form and then re-assign the claim to another compensator organisation such as a TPA.

• IMPORTANT: The re-assignment of a Claim Notification Form to another compensator does not reset the timeframes.

• For more information please see Section B3 of the Compensator User Guide found on the Using the Portal page at www.claimsportal.org.uk .

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Next steps

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• Visit www.claimsportal.org.uk for a wealth of Claims Portal information, including:• Walkthroughs of the claim handling process,• User guides,• Frequently Asked Questions,• The latest news and announcements.

• Once registered, access the training site at https://training.rapidclaimsettlement.org.uk


https://training.rapidclaimsettlement.org.uk/





Thank you

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Documents

The Claims Portal in practice