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July 2013 Version 3.0 A Guide to the MOJ Portal Process START
July 2013Version 3.0
A Guide to the MOJ Portal Process
START
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Contents
A guide to the MOJ process
Contents
1 Employers Liability Process
2 Public Liability Process
3 Process frequently asked scenarios
4 ‘Claims Notification Form’ vs ‘Defendant only Claims Notification Form’
5 The Portal
6 Portal frequently asked questions
7 References
8 Glossary
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Contents
1 Employers Liability Process
The likely flow of an EL claim
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
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
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
Flow
Await Stage 2 pack
Description Defendant action required
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2 Public Liability Process
The likely flow of a PL claim
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
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
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
Flow Description Defendant action required
Await Stage 2 pack
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Contents
Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios3
The most common deviations from the standard process
Process
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
Scenario/Question Response
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Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios (continued)3
The most common deviations from the standard process
Process
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
Scenario/Question Response
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Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios (continued)3
The most common deviations from the standard process
Process
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/email? • 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
Scenario/Question Response
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Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios (continued)3
The most common deviations from the standard process
Process
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
Scenario/Question Response
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Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios (continued)3
The most common deviations from the standard process
Process
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
Scenario/Question Response
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Policy Search Claims Notification Form First Notification of Loss Loss of Earnings Liability Investigation
The frequently asked scenarios (continued)3
The most common deviations from the standard process
Process
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
Scenario/Question Response
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Z acknowledge CNF electronically to CR within 24 Hrs
Liability Investigation
Z acknowledge claim on portal within 24 hrs of receipt
CR then has 30 days to submit CNF to Zurich on portal
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
Z acknowledge claim on portal within 24 hrs
CR sends the “CNF” to Zurich on the Portal
CR sends “Defendant only CNF” to defendant by post
Defendant acknowledges electronically with policy details within 24 hrs. Defendant should
notify Zurich & Broker
CR sends the “CNF” to defendant by post
Liability Investigation
“Defendant only CNF”
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
“CNF”
“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.
There will be no ‘defendant only CNF’
“Defendant only CNF”
‘CNF’ v ‘defendant only CNF’4
Who receives what, when, where and how
Scenario 1The Claimant Representative is able to identify
Zurich as the Insurer (typically EL)
Scenario 2The Claimant Representative is unable to identify
Zurich as the Insurer (typically PL)
Zurich Defendant Claimant RepKey:
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The portal5
Should I be registering for the portal?
• Registration for the portal can be done via the portal website (www.claimportal.org.uk)
• 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
NoZurich handles my claims
NoYou do not need to register
for the portal
Yeswe have self handling
authority on injury claims
YesYou need to register for
the portal
I have a TPA who handles my claims
Contact your TPAas they will need to be registered
on the portal
Do you handle any of your own claim that will be in scope for the portal?
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The portal… frequently asked scenarios6
Common questions about the portal
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
Can I still register for the portal even if I don’t self handle?
• 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
– 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 email/telephone for insurance claim enquiries. However, you must ensure you are operationally fit to respond within timelines
Scenario/Question Response
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References7
Where can I find more information
The claims portal website
www.claimsportal.org.uk
which includes:
•
•
•
•
Ask a question to the Zurich MOJ Helpline
Your Claims Relationship Contact
Zurich Municipal =
Zurich Global Corporate =
Zurich Commercial Broker =
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Contents
Glossary8
CI Claims Inspector
CNF Claims Notification Form
CR Claimant Representative
CPR Civil Procedure Rules
CPRC Civil Procedure Rules Committee
EL Employers Liability
ELTO Employers Liability Tracing Office
FNOL First Notice of Loss
MOJ Ministry of Justice
LOE Loss of Earnings
PL Public Liability
TPA Third Party Administrator
Z Zurich
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