COVERAGE OPENING PRACTICES

RESERVES💲

100

What are Reserves?

Funds set aside for claims for Obligations

200

What would be considered Obligations for reserves?

Liabilities for unearned premiums  or estimated costs of unpaid claims

300

Who determines Reserves?

Insurance Business Act

400

Is collision or comp statistical or average?

Statistical

500

Where is money taken from for Reserves?

Portion of the premium payments made by policy holders over the course of their insurance contracts

AUTOMATIC COVERAGE (PHYSICAL DAMAGE)

100

What will automatically open coverage for Collison or Comp?

Loss type and was the vehicle damaged (yes or unknown)

200

PDL COVERAGE: Does it have to be an association between the vehicle (asset) and participant? 

YES

300

What would the role be for participants for PDL coverage?

CLAIMANT/OWNER

400

When will PDL NOT automatically open?

• Parked Vehicle - Other party hit parked insured.
• Rear-end Accident - Other party rear-ended insured.
• Insured/Resident Relative - Injured Entering/Exiting Vehicle.
• Insured/Resident Relative hit as a Pedestrian/Bicyclist.

500

For PDL (NON AUTO), what are the 3 things that will need to apply for the coverage to automatically open?

• There must be an association between the participant and the Non-Auto (asset).
• The participant is assigned the role of Claimant and Owner.
• Was the property damaged?  Yes

AUTOMATIC COVERAGE (PIP/MED PAY)

100

Name when a PIP coverage will automatically open

If injury and any of the following roles are added:

• Insured.
• Insured-additional.
• Driver and the participant is associated to the insured asset.
• Passenger and the participant is associated to the insured asset.
• Pedestrian/bicyclist and the participant is also in the role of Insured-Additional or Resident Relative.
• Pedestrian/bicyclist for theses loss states:
  • DC, DE, HI, KY, MD, NY, ND, UT, WA
• Passenger and the role is Insured-Additional or Resident Relative and the Detail Loss Type = Insured/Resident Relative – passenger in other vehicle.

200

Name when a MED PAY  coverage will automatically open

• Insured.
• Insured-additional.
• Driver and the participant is associated to the insured asset.
• Passenger and the participant is associated to the insured asset.
• Pedestrian/bicyclist and the participant is in the role of pedestrian/bicyclist in the loss state of PA.
• Passenger and the role is Insured-Additional or Resident Relative and the Detail Loss Type = Insured/Resident Relative – passenger in other vehicle Insured-Additional or Resident Relative.

300

To properly open PIP/MED PAY do we use the drop down open coverage option?

NO, it will impact assignment and segmentation rule

400

If the injury is updated as soon as possible, how long does it normally take for coverage to be exposed?

3 calendar days

500

If the participant injury is unknown what do we enter and where?

 Injury and Compensation screen as Unknown Body Part and Unknown Injury/Complaint.

AUTOMATIC COVERAGE (BI)

100

What does BI stand for?

Bodily Injury

200

If the insured’s vehicle is a motorcycle and the passenger is the Insured or a Resident Relative, will BI coverage automatically open? 

No, coverage will need to be opened manually

300

TRUE OR FALSE: When an injured participant is assigned the role of Pedestrian/Bicyclist, you must associate the Participant to an involved property in order for Bodily Injury Coverage to open automatically 

TRUE

400

When an injured participant is assigned the role of Pedestrian/Bicyclist, you must associate the Participant to an involved property in order for Bodily Injury Coverage to open automatically. How is this done?

• Click Add Property to add the property (for example, the clothing or bicycle).
• Associate the Participant to the involved property in the role of Pedestrian/Bicyclist.
• Once the association is complete, the BI coverage will open

500

What triggers BI coverage to open?

• The participant is identified as injured and is associated with the insured vehicle (asset), claimant vehicle (asset) or involved property.

And

• The participant is assigned one of the following combinations of roles:
  • Insured and Passenger if BI Exposure (See BI Opening Tips below for resident relatives and when insured's vehicle is a motorcycle) 
  • Claimant and Passenger.
  • Claimant and Driver.
  • Claimant and Pedestrian/Bicyclist.
• After First Notice of Loss (FNOL), a body part and injury type must be entered in order for coverage to be opened.

REOPENING FINANCIALS

100

When will you reopen COMP, COLLISION, OR PDL coverage on a claim?

NextGen will show an error message on the screen if the 3 PAC system rule has been exceeded and that the financials need to be reopened.

200

TRUE OR FALSE: There are times when the Claim, Coverage or Financials must be re-opened.

TRUE

300

TRUE OR FALSE: Financials can be reopened without the Coverage being opened. 

False: 

Financials cannot be reopened unless the Coverage is open. When you re-open the financials, NextGen will automatically re-open the Coverage and Claim.

400

You have made it thru today's lesson, if you have completed all other categories

HAVE YOU?

500

IF all other categories aren't complete, try again

Congratulations if they are, well done on your review of opening practices.......