When looking at difference processes with the variety of industries that can be supported by a Case solution, one of the examples that stands out is an Insurance Claim.
Why a Claim is a Case
In many ways, people may look at processing a claim as a simple process where the claimant provides a Notice of Loss and the insurer, is reviewed and gets paid. This will often lead people to trying to build a Business Process Management (BPM) or workflow based solution. When a claim is examined in more detail we will see exactly how it is better handled by the Case approach.
I will examine two claim scenarios to show both how the tasks can change within a claim and how the unpredictable and varied nature of a claim makes IBM Case Manager a perfect fit for building claim solutions.
First, I'm going to examine a simple auto insurance claim. Let's examine the scenario where we have a simple fender bender type of accident where the insured driver ran into a tree.
In this simple example the claim would be processed by gathering the required information. This content would include the Loss Notice, Police Report and estimate for repair. This could be processed in a very straightforward manner where the Claim Processor would work with the Support personnel to gather the content and once the claim is approved it would be forwarded for payment.
When examining a claim like this one there would be the tendency to look at claim processing as a workflow since the required activities are easily defined and fairly consistent. The problem is that this is only one example of a claim and a simple one at that. Now we will examine how a more complex claim will be processed.
Expanding the example previously provided, I will add a few new wrinkles to this claim. Instead of hitting a tree, our claimant hit another car. Immediately we now have new people involved and an additional claimant. Just adding this simple change to the claim will result in new tasks required to gather information about the other claimant in the accident.
If we were to examine some other possible scenarios we would see how quickly the tasks and activities would quickly outgrow the ability to a basic workflow. Take the following questions for instance and think about the new activities and tasks that would have to happen if any are answered yes.
- Was there an injury in the accident?
- Are additional claimants covered under the current policy?
- Do we insure all of the claimants?
- What happens when an injury is determined to be more severe than initially thought?
- What if someone died in the accident?
- What if one of the claimants files a lawsuit?
- What if the claim is closed and needs to be reopened later?
These questions could go on and on making it easy to see how there would be many people and activities/tasks needed to be able to successfully process this claim. The real question to examine is how many of these questions can be answered when the Notice of Loss is filed? The fact that many of the required tasks are not known at the beginning of the claim process and, more importantly, can change as the claim goes through its lifecycle make it a perfect fit for an IBM Case Manager solution.
The task based approach to work within IBM Case Manager allows a solution to be built that enforces the required tasks (through preconditions) while providing the flexibility to react to changes in the case and launch tasks for any of the actions or additional information that may occur while processing the claim.
For IBM Case Manager V5.2 related blog posts, see:
Sample case: Insurance claim
For IBM Case Manager V5.2 Redbooks publication, see:
- Advanced Case Management with IBM Case Manager (draft is now available!)
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