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Accident Insurance (Enhanced) ( RELNFSCM_600_ACCIDINSUR )

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Short text

Accident Insurance (Enhanced)

Use

As of SAP ECC Industry Extension Insurance 6.0 the following enhancements are available for processing of private accident insurance claims:

You can define a benefit type determination in Customizing. In this way, you can control which benefit types and benefit catalogs are displayed or defaulted in the input help when you capture disabilities, accidental death, accident costs, injuries, and per diem hospital or sickness benefits.

When you capture such a claim item grouping (such as disabilities) in claims processing, the system determines the benefit types and benefit catalogs that can be used for this claim item grouping according to the contract data and benefit type determination.

There is a new view, Benefit Selection, for capturing the benefit type with disabilities, accidental death, injuries, and per diem hospital and sickness benefits. If there are several benefit types for a coverage (such as per diem hospital benefit and convalescence benefit with hospital stays), an overview of the existing benefit types is displayed.
This new view also contains additional information on sums insured and calculations.

From the new Benefit Selection view you can now set reserves. This means that you can use calculation results (for the amount of the disability benefit, for example) directly for reserving without having to transfer them beforehand to the reimbursement.

An overview of relevant previous illnesses is displayed for the claimant and insured persons. In addition to diagnoses, this overview contains preexisting disabilities of the business partner concerned.

You can use the search framework to flexibly group the data that has been compiled. If necessary, you can use authorization object I_ICL_CTYP to restrict data.

To guarantee consistent data and avoid possible incorrect entries by the user in data capture, consistency checks for certain claim item groupings have been enhanced:

• For hospital stays and work incapacity times

Period checks and period overlaps

• Disabilities and injuries

Check for same benefit catalog items

• Accident costs

Negative amounts

Effects on Existing Data

Effects on Data Transfer

Effects on System Administration

Effects on Customizing

• In IMG activity Assign Benefit Types to a Benefit Type Group you can group benefit types

• In IMG activity Define Benefit Type Determination you can assign benefit type groups to claim item groupings

If necessary, you can use the search framework to define own searches for determination of previous illnesses. To do so, perform the IMG activities under Insurance → Claims Management → Claim → Technical Settings → Search → Search Framework. You can find the standard search for previous illnesses in search application ICL, search category 004, search 0010_AC_DIAGINV. The associated search event is DIAGINV.

You can also use the customizing settings to control how any messages that are output with checks should be displayed (such as, error or warning message). Perform IMG activity Change Message Control.

Further Information

There is a release note on accident insurance in Support Package 04, Release 4.72. You can find this in the SAP Service Marketplace under the internet address service.sap.com/insurance → SAP for Insurance → SAP for Insurance-Key Functional Areas → Claims Management → Supplementary Release Information 4.72,SP04. Read section 1.2.1 Accident Insurance (New) in this document.

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Length: 4746 Date: 20240520 Time: 210533     sap01-206 ( 82 ms )