Claim Management...


Claim Management interface.
The WSIB System Navigator now has true claims management capabilities. The key to this management is the system's ability to list the current status of each incident that is in the program.

This status is presented as the Incident Type that is associated with each incident.

The Incident Type is determined by a combination of the current Claim State and the current Worker State.

There are two different yet related areas that are tracked by the system. These areas are the Current Claim State and the Current Worker State. Whenever there is a material change in either of these areas, the user would advance to the Claim Management Screen in the Incident Folder for that particular Incident. The button that would be selected is dependent on which area the material change occurred in.


Example:

If the worker suffered a recent injury at work that was work related:

Their Claim State would be: REPORTABLE INCIDENT - WORKER OFF WORK - F7 NOT SUBMITTED YET

The Worker's State would be: Not Working - Worker Not Participating in ESRTW or LMR

The unique combination of these two states would result in the current Incident being of type:

WSIB CLAIM: Lost Time Claim - Loss of Earnings

The current WSIB Claim Status would be: Reportable

The user manages the claim by updating the Claim and Worker State. The system aids the user in this process by presenting a select list of choices at every step. The system is built to recognize the current status of the claim and to present to the user only those possible changes in state that are applicable to this claim at that point. The user merely has to identify which change most accurately reflects the new Claim or Worker State in order to advance the system to the next status.

After each change, the system automatically notes this change in the Incident Folder’s History Notes Section and it even knows if this change requires a future action on the part of the user. If so, then the system will automatically add this required future action to the ToDo Action Item Section.

The user can also edit the History and the Action Lists manually. The user can add, edit and delete these items.


Intuitive Ease of Use
The user can option to have relevant items added to their ToDo list automatically based on the change to the claim status.

Claim Management allows the user to always know the exact State and Status of each claim.

 

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