Electronic Claims File Update The Old Library, Lloyds 4 th September 2006.

Electronic Claims File Update

The Old Library, Lloyd’s

4th September 2006

Agenda

• Introduction and Welcome Trevor Maddison

• A Broker’s View Trevor Maddison

• ECF and Market Reform Andy Brookes

• ECF Underwriter View point Carl Phillips

• Electronic Claims Files Steven Matthews

• Questions and Close Trevor Maddison

A Broker’s View

Trevor Maddison Marsh and BEFIT

Electronic Claims Trading is Simple

• Electronic transfer of data and documents, broker desktop to underwriter desktop.

• Claims workflow managed from the desktop electronically.

• Removal of the paper claim file.

• Simple claims – straight through processing, no broker involvement.

• Claims advocacy – broking where it matters.

• Delivery of a quality client and underwriter service.

ECF – Key Messages

• Market reform is no longer a set of words. This project is real, ECF is real.

• In one weeks time the potential to trade new claims electronically with Lloyds syndicates (day 1 in-scope) will become a reality.

• The IUA are catching up fast, pilots have commenced and the commitment is there – we expect them to be live mid 2007.

• Reform of the claims process is happening, ECF is the catalyst to a modern market place.

• The London market is changing, market reform and electronic trading will work this time.

• Are you preparing for change?

Key criteria for ECF success • Full commitment of all syndicates to trade claims

electronically.• Full commitment of IUA carriers to trade claims

electronically.• Full commitment of brokers to move to electronic claims

trading within a reasonable timeframe.• All new claims received in the 4th Qtr 2007 traded

electronically, all brokers, all underwriters. • Underwriters are making a commitment, brokers need to

respond.• There will be issues, this is not Big Bang brokers need

to work in partnership with Underwriters to make ECF a London market success.

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ECF & Market Reform

Andy Brookes

Market Reform Programme Office

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ECF: Key part of the London process reform programme

• Overall aim:

– A framework of standards for business processes that enables firms to deliver services efficiently to customers at a cost and level of risk comparable with other platforms

• Note:

– Any costs inherent in a subscription market must be offset to deliver this comparability.

– Any changes in business process must be managed in such a way as to avoid undermining the unique qualities/competitive advantages of the London Market.

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ECF is not happening in isolation

• Claims beyond ECF

– Change requests – no system stays put

– Claims infrastructure to include IUA

– Protocols (LMP2001); Lloyd’s Claims Scheme

– Support Claims Strategy & Minimum Standards

• Integration with other reform workstreams

– Accounting & Settlement

– Repository use; DRI standards; P2P strategy and claims

– Contract Certainty

– Roles and responsibilities clearly defined

– Repositories……..again

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Implementation approach

• Lead implementers

• Prepare to follow

– Commercial

– Lloyd’s performance standards

– Regulatory

• Sponsors; project managers

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E.C.F. Underwriter Viewpoint

Carl Phillips

Amlin & LMA Systems Delivery Group

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Why Do Underwriters Need A Claim File?

• Good Business Practice - Easy way of supporting / evidencing decisions

• Justify Reserves and Payments to Shareholders

• FSA Requirements

• Lloyd’s Claims Management Principles and Minimum Standards

• Claims Agreement for Followers (CAF) - Consistency of information

• Goshawk / Tysers

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Why An Electronic Claim File (E.C.F.)?

• Concurrent/Contemporaneous Access

• Transparent and Auditable Process

• Improve service levels to customers

• Removal of dead time (transporting files)

• Worldwide access to the file 24/7

• Data Integrity and Backup

• Collaborative Agreement -Lloyd’s Claims Scheme/ Claims Agreement for Followers

• The Technology Exists - in everyday use by all London Market Practitioners

• Storage and filing requirements

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LMA ECF Objective

• To replicate today’s file electronically

– Not a Blue Sky Claims System development

• Based on existing products

– No changes to CLASS at this stage

– Seamless access to CLASS information and documents through an Integrated Repository using Windows

• Provide a base product in September 06

– To be evolved once experience gained

• Post implementation of base product

– Strategic review of on-going development– e.g. Third Party Access / Leader Reserves/Web Services etc.

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Features

• Broker submits claim electronically

– Enables parallel presentation to insurers

– Reduces data transcription errors

– Allow brokers to concentrate on complex claims

– Facilitates improvements in claims settlement time

– Improves Customer Service

• Improved insurer access to information

– It’s the insurers’ file

– Concurrent access to all subscribing insurers

– 24/7 access, worldwide

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Overview

· References· Paid / Outstanding

Amounts· Claim Status /

Agreement· Reports· Correspondence· Bordereau· Placing Documents

ECF Screens

CLASS

Repository

Broker Input

Agreement Parties Can Review All Claim Details, Perform Updates & Record Agreement in One Place

(Without a Broker?)

Data

Documents

Insurer Access &

Input

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Status todayKey Enhancements in 5 Phases

Phase 1 - See all documents in one view

Phase 2 - Leader control of file/improved searching

Phase 3 - ACORD DRI (receipt of documents)

Completed 2005

Phases 4/5 – Merged into a single phase -

CLASS @ Lloyd’s data through GUI, full DRI and

Seamless link with documents in repository

On target for September Roll out Go/No Go Decision 7 Sept

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Systems Processes & Procedures

• Systems Processes and Procedures Guide

– Broker & Underwriter Collaborative Approach

– High-level guide

– NOT a systems user manual or adjusting manual

– Focuses on process

• Workshops have been convened to review generic process and class of business variations

– Confirmed generic process

– Confirmed little variation by class of business

– Many Issues identified and documented for resolution.

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Types of claim

The majority of all new claims can be processed via ECF. However there are certain circumstances that ECF has not been required to support and some other instances where system change or further definition of market processes is required to enable full support.

• Business or Claims types that ECF has never been required to support

–Claims on unsigned risks

–General Average

–Proportional treaties

–Scheme Canada

–Direct Livestock

–Claims Payable Abroad

–Letters of credit, loss reserves and Outstanding Cash Advance (OCAs)

–Bulk Settlements

• Business or Claims types excluded from the current implementation of ECF

Solution is currently being developed

– Delegated Lead to XCS (other than 100% Delegation, which is in scope)

– Binding Authorities, Cover Collections and other Bordereaux Claims

Require further analysis

– Political Risk

– Aviation verticals

– Certain Multiple OSND claims

– Third Party Access to ECF

– Existing paper claims files

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Next Steps

• GO LIVE – September 2006

• Delivers first version

– of an integrated electronic claims service for Lloyd’s

– replicating existing file electronically

– with improvements where possible

– companies and syndicates can see the same claim

– BUT a step-change for the London Market

• There will be more issues and enhancements

– Legacy claims

– Issues recorded and initial plan for resolution

• Things change and we won’t have thought of everything

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ECF is here and we’re ready

• MAT approaching completion

• Staff training underway

• 16 Managing Agents participating from next month

– Representing about 60% of Lloyd’s Market Capacity

• 5 Brokers submitting ECFs next month– Representing about 40% of Lloyd’s Market Capacity

– There won’t be a paper file!

• Increasing commitment every week

A Partnership Approach that Benefits all - But not least the Policy Holder.

Amlin’s Approach

Experience and extracting maximum benefit

• Have built experience in ECF through 7 pilots across 7 classes of business with 7 brokers over 2 years

• All claims teams have been engaged in ECF, some since April 2004; claims handlers now looking forward to going live with Electronic Claims.

• Implemented new repository workflow system specifically to handle all claims electronically

• It works!

Amlin’s Approach

Preparedness

• Amlin have begun internal training in preparation for live date.

• Little change for those that have used CLASS before

• Amlin confident that 80% of their new claims can be handled through ECF now without impediment.

• There will be pain to get the gain!

© Xchanging 2006, no part of this document may be circulated, quoted or reproduced without prior written approval of Xchanging.

Electronic Claim Flies

Stephen MatthewsTim LovickDate: 4 September 2006

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Agenda

What is ECF?

Process Overview

Roles and Responsibilities

Validation Checks

Mandatory Rules

Roll Outs

Lessons Learnt

System Overview

Practical Help

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…combination of new systems and procedures

ECF

What is ECF?

Market Repository

Tracker

Converged CLASS

Workflow

C@L

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ECF Process Overview

MARKET XCS

4. CLASSCLASS

Database

ECF System XCS CLASS(XCS Internal System)

SCM & BSM

Document storage system

Once all agreement Parties ‘Accept’ claim

Supplement claim details e.g. i. FILii. NAIC iii. TF codes

Broker

Agreement Party

Roles & Responsibilities of ECF Parties

Lead Lloyd’s UnderwriterBroker XCS

Role

Responsibilities

• Agent of the (Re)Insured

• Collate and present claims data / information to Insurers - will include first and subsequent claim advices

• Collection of claim monies on behalf of (Re)Insured

• Review claims information provided by broker and other parties

• Represent the interest of Leading Lloyd’s Syndicate in any claims handling decisions, including coverage, recovery, litigation etc

• Review claims information provided by broker and other parties

• Represent the interest of Following Lloyd’s Syndicates (if CAF or Peer Review, will include claims handling decisions including coverage, recovery, litigation)

• Advise claim details to Lloyd’s Syndicates and process claims, recoveries and/or fees via Lloyd’s Market claims system

• Create / update claims data in CLASS @ Lloyd’s in a timely fashion. Will include:-

– Claims– Refunds– Fees, if included in indemnity amount

(optional for brokers if not))• Upload correct supporting claims documentation

onto Market Repository. Will include (but not limited to):-

– Slip with OSND and policy, if available and all relevant endorsements (including AP/RP and Non Premium)

– Cover Note / Certificate / Declaration, where applicable

– Preliminary and subsequent loss details– Expert reports– Release Form / Proof of Loss– Correspondence from (Re)Insured– Supporting claim documents (e.g.

bordereau, shipping documents, invoices receipts, etc)

• Convey instructions to experts on behalf of Insurers • Calculate claim adjustments, including application

of any applicable deductibles, orders, reinstatements - where applicable etc

• Arrange payment of claim funds to (Re)Insured on behalf of Lloyd’s syndicates

• Arrange payment of expert’s fees on behalf of Lloyd’s syndicates, if included in indemnity amount (or broker elects to collect fees if not)

• Confirm broker has uploaded correct claim documents and review same. Will include:-


– Cover Note / Certificate / Declaration, where applicable– Expert reports, invoices, receipts, shipping documents etc

• Check coverage details and confirm:-– Certificate / Insured / interest / declaration attaches to

policy and sum insured– DOL / DCM falls within policy / certificate period– Claim falls within available policy / certificate limits– Applicable coverage type– Deductible / excess / franchise correctly applied– Loss location

• Review and assess claim documentation. Will include (but not limited to):-

– Identity of Insured / Coverholder / Cedant / Reinsured– Preliminary and subsequent loss details– Expert reports– Release Form / Proof of Loss Form etc

• Review broker loaded financials• Update Lead Underwriter comments on CLASS @ Lloyd’s entry• Route claim to other agreement parties, as necessary• Instruct and manage experts in conjunction with XCS• Manage disputes with insured in conjunction with XCS. Will

include:-– Arbitration hearings or court cases– Depositions etc

• Manage “Direct Report” claims files and agree any applicable “Direct Settlements”

• Determine and execute claims handling strategy in conjunction with XCS

• Confirm broker has uploaded correct claim documents and review same. Will include:-


– Cover Note / Certificate / Declaration, where applicable– Expert reports, invoices, receipts, shipping documents etc

• Check coverage details and confirm:-– Certificate / Insured / interest / declaration attaches to

policy and sum insured– DOL / DCM falls within policy / certificate period– Claim falls within available policy / certificate limits– Applicable coverage type– Deductible / excess / franchise correctly applied– Loss location

• Review and assess claim documentation. Will include (but not limited to):-

– Identity of Insured / Coverholder / Cedant / Reinsured– Preliminary and subsequent loss details– Expert reports– Release Form / Proof of Loss Form etc

• Review broker loaded financials• Update XCS comments on CLASS @ Lloyd’s entry• Route claim to other agreement parties, as necessary• Instruct and manage experts• Manage disputes with insured in conjunction with Leader. Will

include:-– Arbitration hearings or court cases– Depositions etc

• Manage “Direct Report” claims files and agree and process any applicable “Direct Settlements”

• Determine and execute claims handling strategy in conjunction with Leader

• Provide Technical Processing or CAF service, as required • Process corrections • Determine and create XCS CLASS entries in line with:-

– Regulatory requirements– CAT code splits– NAIC splits– Trust Fund– State Code requirements

• Create XCS CLASS entries and send SCM / USMs to Syndicates • Offer an Enhanced Claims Review service• Pursue recoveries, where appropriate

System Validation

Lead Lloyd’s UnderwriterBroker XCS

Class @ Lloyds Class @ Lloyds Class @ Lloyds XCS CLASS

Broker loads C@L Lead agrees C@L XCS agrees C@L XCS release XCS CLASS

and send SCM / USM to market

SCM & USMs

Claims Data

Mandatory Fields in C@L - 25(Entered by Broker)

- UCR (includes Original Broker)- TR (includes Payee Broker)- Bureau- LMP Indicator- First Advice Indicator- Advice to include Settlement- UMR- Broker Phone No.- Bureau Lead - Insured- Policy Period or Period Narrative- Slip Order 1 or Narrative- Loss Name- Loss Date From- Loss Details (Narrative)- Original Currency- O/S amt or O/S Qualifier- Order Settlement (if Settlement)- Settlement Currency (if Settlement)- Settlement Amount (if Settlement)- Original Signing No. & Date- Settlement Exchange Rate

Optional Fields in C@L - 42(Entered by Broker)

- Broker Claim Reference 1 & 2- Reinsured- Interest- Perils- Location / Voyage - SI Limits- Excess- Loss Location- Vessel / Aircraft- Lawyer- Adjuster- Previously Paid- VAT amount etc

Editable & Updateable Fields in C@L - 5(Data originally entered by Broker)

- Risk Code- CAT Code- PCS Code- Further Agreement Parties- Cause Codes (not used at the moment)

Editable & Updateable Fields in C@L - 5(Data originally entered by Broker)

- Risk Code- CAT Code- PCS Code- Further Agreement Parties- Cause Codes (not used at the moment)

Non-Editable Fields in XCS CLASS - 17 (Data originally entered by Broker)

- UCR- TR- Advice / Settlement- UMR- Syndicates on Risk (including Bureau Lead)- Slip Order- Original Currency- O/S Amount or O/S Qualifier- Settlement Currency- Settlement Amount- Original Broker (Calculated from UCR)- Payee Broker No. & Pseud (Calculated from TR)- Original Signing No. & Date- Settlement Exchange Rate- Broker Claim Reference 1 & 2- Interest- VAT amount

Editable Fields in XCS CLASS – 16 (Data originally entered by Broker)

- Broker Phone No.- Insured- Pol / Cert Period From & To- Loss Name- Date of Loss From & To- Loss Details (Narrative)- Reinsured- Original Insured- Perils- SI Limits- SI Currency- Excess- Loss Location- Vessel / Aircraft- Lawyer- AdjusterNB. Editing these fields will cause discrepancies between C@L and SCM/USMs sent to Syndicates

Additional Fields in XCS CLASS - 72(Entered by XCS on XCS CLASS)

- Presentation Date- Charge Type- Peer Review Indicator- Market Code etc

Getting the data right first time

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Contractual Framework – Mandatory Rules

• Licence to use and access to Documents

• Unintentional disclosure of Documents and Privilege

• True, fair and complete copies

• Use of ECF and A&S

• Response Buttons/Response Codes (for Lloyd’s only)

• Recording Transactions (ECF and A&S)

• Authentication of Users

• Governance

• Compliance

• Law and Jurisdiction

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Carriers

Brokers

Karl Ross

Joe Hayward

Stephen Matthews

Ninette Fernandes

David Price

Heather Loane

Tabir Shah

Niall Wapshott

Dave Warren

Claire Musson

Sean Finneran

Matt Shelton

Matthew Nicholas

Georgie Burrows

Tim Lovick

Darren Moles

Barbara Stuchberry

Mark Harrison

Rob Casserly

Simon Davies

Bernard Levy

Kennedy Paryag

Matthew Taylor

Nick Miller

74 Lloyd’s Early Implementers

Robin Morgan

Joy Lowry

Darren McEwan

Dean Gardiner

John Merrett

Clive Campbell

Rob Pearce

Shelley McCormack

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Lessons Learnt

To assist the efficient management of your ECF transactions and reduce rejections, the following points are important:

• Check the risk/class of business is applicable for ECF

• Check the data listed in the ‘Validation Checks’ (see previous page) is included in the presentation

• Ensure the correct signing number is presented

• Check a signed Slip is loaded on to the Repository (along with other relevant policy documentation such as schedules, breakdowns, APs, Endorsements etc.)

• Correct Slip order

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Lessons Learnt

• Ensure both the currency of limits and SI/limit amounts are entered (e.g. either both fields are completed or left blank)

• If a bordereau presentation includes a newly added US tax state or a Canadian province which requires a payment, this needs to be loaded as an advice prior to the settlement

• Check the Settlement currency is the same as the first and subsequent advice

• When a first advice with settlement is presented, the advise must be loaded on the first transaction then the settlement on the second transaction

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Practical Help

• XIS are running a number of familiarisation

sessions across September 06.

(Contact Graham Sheppard)

• XCS are planning a number of face-face

procedural workshops and demonstrations

with Brokers commencing September 06.


System Overview

Tim LovickDate: 4 September 2006

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Homepage Search

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Awaiting Action List

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Transaction Summary

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Transaction Summary (cont…)

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Market Summary

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Market Response

42


Market Response (cont…)

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Xchanging ECF Project Teams – Key Contacts

Tabir ShahEmail: [email protected]: 020 7780 5308Mob: 07919 564 214

Graham SheppardEmail: [email protected]: 07917 423 308

Kennedy ParyagEmail: [email protected]: 020 7780 5353Mob: 07748 761 977

Stephen MatthewsEmail: [email protected] : 07789 273760

XCS Project Team

XIS Project Team

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Questions

Questions & Close

Trevor MaddisonMarsh and BEFIT

How Do I Get Involved – What Do I Need?

To submit claims electronically you must have:

– Class @ Lloyds access either online or batch

– The ability to load scanned claims documents to the Xchanging hosted market repository either via DRI auto load or direct load

– Both Class and the ability to put documents in the repository are pre requisites to eclaims trading with underwriters

Key Contacts – Getting Started

• Market Reform Programme Office– Ben Sayles: [email protected] – Claire Bulman: [email protected]

• Xchanging– Geoff Kennard: [email protected]– Graham Sheppard: [email protected]

• LMBC– Matthew Bateson: [email protected]

Market Reform Website

• The website for all market reform matters is:

www.marketreform.co.uk

• Please pay a visit

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