Claims, Broker phase two, Insurer phase one

Managing Agent playbook – phase two

In this scenario, the Broker has adopted phase two solutions while the Insurer has only adopted phase one solutions

Phase two claims two diagram

Step 1: Claims Submission

Actor Broker DefiniteChange

ECOT & API

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.

Actor Broker NoChange

ICOS Portal

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

Actor Central Services NoChange

ICOS

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.

Actor Broker NoChange

Claim documents

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

Actor Broker Central Services NoChange

IMR / IMR Portal

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

Step 2: Investigation, Queries (if applicable), Claim Agreement

Actor Central Services NoChange

Reach Back

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.
 

Actor Broker Insurer NoChange

ICOS Portal

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.

Actor Broker DefiniteChange

ECOT & API

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

Actor Insurer NoChange

Standardised EDI

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

Actor Insurer NoChange

Writeback / CWT

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.

Actor Central Services NoChange

Market Gateway

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).

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Managing Agent playbook links