Self Insured / Large Deductible Compensator

Transcription

1 Self Insured / Large Deductible Compensator May 2013

2 Self Insured / Large Deductible This document provides guidance on the set up options in the Claims Portal available to self insured organisations or those with a large deductible who deal with EL/PL claims in house or via Third Party Administrators (TPAs). This should be read in conjunction with the information contained within Section A of the Administrator User Guide found on the Using the Portal page at. Follow the chart on page 3 to see what options are available for your organisation. 2

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4 Set up - Option 1 4

5 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 4 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. 5

6 Set up - Option 2 6

7 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 helpdesk@rapidclaimsettlement.org.uk. 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. 7

8 Set up - Option 3 8

9 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 someclaims 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 Page 8 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. 9