Employee Claim Detail (CLAIM)
The Employee Claim Detail (CLAIM) transaction captures data related to the processing of a workers’ compensation claim. This transaction can be updated by HR based on information from a Third Party Administrator (TPA), Risk Management, doctors, the employee, and the supervisor. The Claim Information tab of this transaction is used to enter the specifics related to the initial claim and work status. The Detail Lines tab is used to track the incident plans, doctor visits, follow up calls, payments and injury plans. The CLAIM transaction can enforce a progression through a life cycle driven by Claim Status and Claim Type.
Note: A Employee can also create his claims via the Incidents and Claims Landing > Claims carousel tile. Employees should refer to the “Employee Claim Detail” topic in the Employee/Manager User Guide for more information.
The Employee Claim Detail transaction is comprised of the following tabs:
Claim InformationClaim Information
The Claim Information tab records the following type of information:
Record specifics related to the initial claim, the claim type, status, and the work status.
Record detailed claim information, such as the OSHA Case Type, any work restrictions, the dates that the employee entered the claim, the supervisor who reviewed the claim, and whether TPA was notified of the claim, a police report number and/or attorney if necessary, and the date the employee returned to work. Whether the claim has been paid by a TPA, has been accepted, is reportable, has had leave reimbursed or has had days away from work deducted from eligible retirement days is also captured along with the total payment for the claim.
Record detailed reporting on exactly what happened to cause the injury/illness, where and by whom the injury/illness was treated, and whether or not a trip to the emergency room or an overnight stay in the hospital.
Record additional information specific to the workers' compensation claim.
The Detail Lines tab records activity that has taken place for the claim, such as doctor's visits, follow up calls, payments, TPA investigations, Risk Management Action, and so forth.
The Employee Claim Detail transaction can be created in the following way:
Select the Create action on the Transaction Catalog.
Select the Create Claim row-level action on the Employee Claim or Claim Information tab of the Employee Claim (ECL) activity folder.
Select the Modify Claim row-level action on the Employee Claim or Claim Information tab of the Employee Claim (ECL) activity folder.
