A Guide to the MOJ Portal Process

Transcription

1 A Guide to the MOJ Portal Process July 2013 Version 3.0 START

2 A guide to the MOJ process Employers Liability Process Public Liability Process Process frequently asked scenarios Claims Notification Form vs Defendant only Claims Notification Form The Portal Portal frequently asked questions 7 References 8 Glossary

3 1 Employers Liability Process The likely flow of an EL claim Flow Description Defendant action required Accident occurs Employee has an accident at work No additional notification requirements beyond current arrangements Consider how the info captured here can assist quick decisions Policy search ELTO Employee visits Claimant Representative (CR) who looks up the defendant insurer and policy number on Employers Liability Tracing Office (ELTO) Unlikely they will need to contact defendant It is probable the Claim Representative (CR) won t need to contact the defendant at this point Claims Notification Form The claimant representative will complete the CNF and send to Zurich on the Portal Paper Defendant only CNF sent to the defendant When Defendant only CNF received inform broker no need to inform Zurich Acknowledge electronically within 1 day Start collating documents and await Zurich contact First Notification of Loss Zurich receives CNF, acknowledges on the Portal and adds claim to computer system Acknowledgement sent to customer/broker Customer receives Defendant Only CNF by post Liability Zurich claims inspector contacts defendant to discuss claim, advise documents required to determine liability Zurich communicate decision via the Portal Provide documents requested in order to support liability decision Provide loss of earnings (LOE) details Loss of Earnings During liability investigation Zurich will request loss of earning details Loss of earnings (LOE) supplied to claimant representative (CR) within 20 days of liability decision If not supplied prior to liability decision provide details within 20 days to both claimant representative (CR) and Zurich Await Stage 2 pack

4 2 Public Liability Process The likely flow of a PL claim Flow Description Defendant action required Accident occurs Claimant has an accident No additional notification requirements beyond current arrangements Consider how the info captured here can assist quick decisions Policy search Claimant visits Claimant Representative (CR) who must make reasonable enquiries to establish the defendant insurer and policy information Most likely that the CR will write/phone defendant to establish Try to establish as much info as possible to validate it is your claim Advise CR if needs to be redirected If correct provide policy details including division code if applicable Claims Notification Form The claimant representative will complete the CNF and send to Zurich on the Portal Paper Defendant only CNF sent to the defendant When Defendant only CNF received inform broker no need to inform Zurich Acknowledge electronically within 1 day Start collating documents and await Zurich contact First Notification of Loss Zurich receives CNF on the Portal and adds claim to computer system Acknowledgement sent to defendant/broker Defendant receives Defendant Only CNF by post Liability Zurich claims inspector contacts defendant to discuss claim, advise documents required to determine liability Zurich communicate decision via the Portal Provide documents requested in order to support liability decision Await Stage 2 pack

5 3 The frequently asked scenarios The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response What do I do if I receive an enquiry from a claimant representative requesting policy details Try to establish as much info as possible to validate it is your claim Advise Claimant Representative if needs to be redirected If correct provide insurer and policy details including division code if applicable

6 3 The frequently asked scenarios (continued) The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response What do I do if I receive a paper CNF? Acknowledge electronically within 1 day of receipt Confirm to Claimant Representative it is one of your claims Confirm to Claimant Representative insurer and policy details and division code if applicable Send CNF to Zurich and notify your broker if applicable Start collating documents Following receipt and acknowledgement of a paper CNF, what is the process? The claim still needs to go through the portal. Once the defendant has confirmed insurer and policy details the Claimant Representative must submit to the insurer via the portal within 30 days of sending the paper CNF to the defendant What do I do if I receive a Defendant Only CNF? Acknowledge electronically within 1 day of receipt No need to advise Zurich as we will have portal CNF Inform your broker if applicable Start collating documents How will I know the difference between the CNF and Defendant Only CNF The are almost identical, the main difference is the Defendant Only CNF is marked Defendant Only on the front page

7 3 The frequently asked scenarios (continued) The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response What do I do if I receive a CNF which has been incorrectly directed? Respond electronically within 1 day of receipt confirming incorrect defendant The 30/40 days only begins when the claim arrives with the correct defendant Will Zurich send me a copy of the CNF when acknowledging the claim No the acknowledgement will be as per current process You will have received the Defendant Only CNF, but if during the investigation you haven t received it we can provide details When sending a CNF to Zurich is there a different address/ ? No, CNF s should be sent to Zurich using current new claim process In the current process there are letters of claim received that we redirect so they never get logged as claims. Will we have the opportunity to triage? On EL probably not at the claim can be submitted to the insurer following an ELTO search On Public Liability the Claimant Representative will probably contact you to establish insurer and policy details. This step will provide opportunity to advise the CR if the claim is correctly channelled

8 3 The frequently asked scenarios (continued) The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response If the CNF goes to Zurich will I be aware of the claim? Defendant will receive Defendant Only CNF by post On PL it is likely defendant will be contacted pre portal notification in order to establish insurer and policy details

9 3 The frequently asked scenarios (continued) The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response What if I can t provide loss of earnings details prior to liability decision? Loss of earnings details must be provided within 20 days of portal acceptance Send electronically to the Claimant Representative and Zurich office

10 3 The frequently asked scenarios (continued) The most common deviations from the standard process Process Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation Scenario/Question Response Why are you using the claims inspector for stage 1 investigation? CI currently achieve an SLA within the MOJ timeline of 30 or 40 days CI has flexibility of desktop or site visit as appropriate We will take the early learnings to review our model and consider the most effective model CI vs office

11 4 CNF v defendant only CNF Who receives what, when, where and how Scenario 1 The Claimant Representative is able to identify Zurich as the Insurer (typically EL) Scenario 2 The Claimant Representative is unable to identify Zurich as the Insurer (typically PL) CNF Defendant only CNF The CR must make reasonable enquiries to identify insurer, this maybe phone, letter etc. There are no rules around this process. This is an opportunity to redirect claims. If insurer then identified see scenario 1. If not below scenario applies. CR sends the CNF to Zurich on the Portal CR sends Defendant only CNF to defendant by post CNF Defendant only CNF Z acknowledge claim on portal within 24 hrs Liability Investigation Defendant acknowledges electronically with policy details within 24hrs. Notify broker, no further action required as this means Zurich will have been notified via the portal CR sends the CNF to defendant by post Defendant acknowledges electronically with policy details within 24 hrs. Defendant should notify Zurich & Broker There will be no defendant only CNF Z acknowledge CNF electronically to CR within 24 Hrs Key: Zurich Defendant Claimant Rep CR then has 30 days to submit CNF to Zurich on portal How will I know the difference between CNF and Defendant only CNF? The two are almost identical, the key identifier the defendant only CNF is marked Defendant Only on the top Z acknowledge claim on portal within 24 hrs of receipt Liability Investigation

12 5 The portal Should I be registering for the portal? Do you handle any of your own claim that will be in scope for the portal? No Zurich handles my claims Yes we have self handling authority on injury claims I have a TPA who handles my claims No You do not need to register for the portal Yes You need to register for the portal Contact your TPA as they will need to be registered on the portal Registration for the portal can be done via the portal website ( If you do not self handle we strongly recommend that you do not register for the portal as this would add further complexity and potential delay in the process

13 6 The portal frequently asked scenarios Common questions about the portal Scenario/Question Response We will self handle MOJ claims but on ELTO Zurich are our insurer. What happens if claims go straight to Zurich? At the point we receive a CNF we will check if there is a self handling/ TPA in place and reassign the claim Are there any restrictions regarding when a claim can be reassigned? The claim must be reassigned before clicking accept and confirming the claim is with the correct compensator After accepting the claim can no longer be reassigned We strongly recommend that you don t for the following reasons: Just because you are registered on the majority of Employers Liability will still come to Zurich as we are listed on ELTO Can I still register for the portal even if I don t self handle? The above would lead to dual processes/confusion Potential need for handler to have multiple logins to access different portals For Public Liability in the majority of cases a Claimant Representative will need to contact you in order to establish insurance details- this will provide early notification and the opportunity to redirect claims if incorrect defendant Should I be advertising Zurich s portal address? To assist CR and reduce the number of CNF s sent to you we would recommend advertising Zurich s portal ID (C00108) on your website If you want the opportunity to triage / redirect claims before they enter the portal, you may wish to include a contact /telephone for insurance claim enquiries. However, you must ensure you are operationally fit to respond within timelines

14 7 References Where can I find more information The claims portal website Ask a question to the Zurich MOJ Helpline mojhelpline@uk.zurich.com Your Claims Relationship Contact Zurich Municipal = which includes: Zurich Global Corporate = Zurich Commercial Broker =

15 8 Glossary CI CNF CR CPR CPRC EL ELTO FNOL MOJ LOE PL TPA Z Claims Inspector Claims Notification Form Claimant Representative Civil Procedure Rules Civil Procedure Rules Committee Employers Liability Employers Liability Tracing Office First Notice of Loss Ministry of Justice Loss of Earnings Public Liability Third Party Administrator Zurich

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