Progress: Process status - Case accepted - Comments

During the entire business process – from the notification about the event up to the end of com-munication – the insurer provides the company with various status reports showing the insurer’s current status. The company can understand this way the process sequence for each event.

Response status

The response status is either accepted or rejected.

Process status

➢Notification received: the report is registered. If the event was not correctly registered, no status can be retrieved and the report must be sent again.

➢Check declaration: The insurer must complete the documents and get information from the company to clarify any open questions. The “Check declaration” status remains active until the documents have been completed.

➢Verify entitlement: All documents received; the insurer is now reviewing the claim. However, if, for example, a clarification with the insurer’s medical officer is required, the “Verify entitlement” status remains active until the insurer can decide on the entitlement to benefits.

➢Execute claim: If the insurer affirms the obligation to provide benefits, the “Execute claim” status remains until the communication is closed. If the event is reactivated by the company or if there is an objection, if new findings emerge that cause the insurer to re-examine the obligation to provide benefits after the closure, the status can be set to “Clarification”, “Verify entitlement” or right to “Entitled to benefits”.

➢Communication closed: The benefits covered have been provided to the company in full and the public process has been closed.

➢Reactivate: Basically, each participant can reopen communication by sending a story, provided that there is still a contractual relationship. The event remains accessible for at least 24 months after the last closure of communication. Depending on the situation and according to the story, the insurer will set a new status.

Case accepted

The company is informed about event acceptance by the insurer by means of the acceptance status. It usually says Unknown at the beginning of the process; it can later change to Yes or No in the course of the process.

Comments

In addition to the Process and Acceptance status, the insurer can also provide a comment. Comments is a free text field. The insurer informs in this text field, for example, that the case cannot yet be accepted because important documents are still missing.