Claims, Broker phase two, Insurer phase one

ACORD-standardised messaging, ECOT, will be available from phase two. In this scenario, the broker, who is in phase two, triggers the claim submission process via ECOT (both XML and API variants will be supported). 

The broker’s choice of whether to use ECOT does not affect the insurer, who is still in phase one in this scenario. The insurer can keep operating in the same way as they did in phase one.

The claim submission can be made via the ICOS portal, which provides an alternative to ECOT and API.

ICOS, which goes live in phase one, is the new claims processing platform replacing ECF and CLASS. It will remain unchanged from phase one, although there will now be the option to interact with it via ECOT, EBOT and API.

Claim documents will continue to be submitted to the IMR as part of the claim process via the IMR portal or DRI.

The IMR will continue to be the platform that will store claim documents. The IMR portal will remain unchanged from phase one.

The Reach Back service will remain unchanged from phase one. It will enable legacy cases to be handled where claim data cannot be found in ICOS. In such situations, Reach Back will pull data from the old systems (e.g. CLASS, ECF, LIDS) into the new systems, IPOS and ICOS.

If Reach Back is required for a claim, it will be used once only:

1.    At FNOL, ICOS will look for premium information in IPOS. If it is not found, Reach Back will pull historical data from LIDS.
2.    If a claim originated in CLASS and a subsequent submission happens in ICOS, then the Reach Back service will get the previous claim history from CLASS.
3.    Raw historical LIDS and CLASS data will not be directly accessible by insurers and brokers, this is unchanged from phase one.

If there is a future subsequent submission in ICOS after that, there will be no more Reach Back calls because all the information will already be in IPOS and ICOS.
 

Both insurers and brokers (regardless of what phase they are in) are able to submit, view and respond to queries via the ICOS portal.

The ICOS Portal can also be used in the investigation process in claims, where insurers and brokers can upload and download supporting evidence to a claim. The ICOS portal will orchestrate the process of the agreement parties agreeing the claim. The broker can view the agreement status live in the portal. 

There are currently no dedicated roles in the system for third parties. Therefore, insurers and brokers will be responsible for managing queries and investigation with third parties out of ICOS.

In this scenario, the broker is in phase two, so it will be able to manage queries via ECOT and API.

In this scenario, the insurer is in phase one, so they will receive Standardised EDI messages with no change from phase one.

Both Writeback and CWT will be available during phase one and phase two, with a plan to sunset these services at some point later in phase two when the market deems them no longer necessary. Specific timelines have not been confirmed.

Writeback and CWT will be accessed via the Market Gateway (ASG Adept), this is unchanged from phase one.

The Market Gateway (ASG Adept) will remain unchanged from phase one. All ECOT, API, Standardised EDI, Writeback and CWT messaging will go through the Market Gateway (ASG Adept).