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Release Notes SAP Claims Management6.04

Release Notes


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CopyrightCopyright(c) 2009 SAP AG. All rights reserved.

Neither this document nor any part of it may be copied or reproduced in any form or by anymeans or translated into another language, without the prior consent of SAP AG. Theinformation contained in this document is subject to change without notice.

SAP is a registered trademark of SAP AG.

All other products which are mentioned in this documentation are registered or not registeredtrademarks of their respective companies.


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1.2 FS-CM Claims Management 11.2.1 INS_FSCM_AUTO: Hide View for Injured Persons 11.2.2 INS_FSCM_AUTO: Business Function Insurance Auto Claim Best

Practise 21.2.3 Integration with SAP Business Information Warehouse 31.2.4 INS_FSCM_CI_2: Archiving Engine (New) 51.2.5 INS_FSCM_CI_2: Assignment of Benefit Catalogs to Classes

(New) 61.2.6 INS_FSCM_CI_2: Change Business Partner (New) 61.2.7 INS_FSCM_CI_2: Texts for Settlements in Collective

Subrogation/Recovery 71.2.8 INS_FSCM_CI_2: Integration with Classification System (New) 81.2.9 INS_FSCM_CI_2: Clauses with Coverage in the Policy Snapshot

(New) 91.2.10 INS_FSCM_CI_2: New Screen Sequence "Claim Summary" 91.2.11 INS_FSCM_CI_2: Inspection Location of Damaged Object 101.2.12 INS_FSCM_CI_2: Inactive Claims 101.2.13 INS_FSCM_CI_2: Business Function Insurance Claim Handling 2

(New) 111.2.14 INS_FSCM_CI_2: Point Values in Benefits Catalogs (New) 131.2.15 INS_FSCM_CI_2: Interface to Policy System (New) 131.2.16 INS_FSCM_CI_2: Policy Product - Override Company Code (New) 14

1.2.17 INS_FSCM_CI_2: Authorization with Repetitive Payments (New) 151.2.18 INS_FSCM_CI_2: Consideration of Taxes in Benefits Catalog

(New) 161.2.19 INS_FSCM_CI_2: Text Modules for Benefits Catalog Items (New) 161.2.20 INS_FSCM_CI_2: Navigation to Notes Processing 171.2.21 INS_FSCM_CI_2: Role-Based Performer, Display of Telephone

Number 181.2.22 INS_FSCM_CI_2: enterprise services 181.2.23 INS_FSCM_LIFE: Processing of Periodic Benefit Values 191.2.24 INS_FSCM_LIFE: Rollback Claims 201.2.25 INS_FSCM_LIFE: Fund-Based Benefit Determination 201.2.26 INS_FSCM_LIFE: Exercising Lump Sum Option 211.2.27 INS_FSCM_LIFE: Business Function Insurance Life Benefit

Process (New) 221.2.28 INS_FSCM_LIFE: Claims for Occupational Disability/Permanent

Incapacity 241.2.29 INS_FSCM_LIFE: Processing of Partial Surrender and Surrender 251.2.30 INS_FSCM_LIFE: Benefit Determination and Policy Loan 251.2.31 INS_FSCM_LIFE: Consideration of Waiting Periods (New) 26

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1.2 FS-CM Claims Management

1.2.1 INS_FSCM_AUTO: Hide View for Injured Persons

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Auto Claim Best Practice (INS_FSCM_AUTO) you can hide the view forinjured persons in claims for property damage.

Use the sample implementation of Business Add-In (BAdI) BADI_ICL_FMOD2. In claims with internalclaim type 4KHS, incident type Property Damage , the system then hides the view for injured persons.

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1.2.2 INS_FSCM_AUTO: Business Function Insurance Auto Claim Best Practise

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1.2.3 Integration with SAP Business Information Warehouse

Use

As of SAP ECC Industry Extension Insurance 6.0 Enhancement Package 4 , the following additionaltransaction data extractors are available for integration with SAP Business Information Warehouse (BW) .

They deliver additional extractors for use in financial reporting in Business Intelligence Content Release7.0.4. For more information, see the Release Notes for this release.

The new extractors are:

- 0ISCM_PAYMENTS_03Enables extraction of the data fields at a certain event from the application tables Payments

(ICLPAY, ICLPAYI, ICSPAY, ICSPAYI)- 0ISCM_RESERVE_03

Enables extraction of the data fields at a certain event from the application tables Reserves(ICLRESERVE, ICSRESERVE)

- 0ISCM_SUBROG_03Enables extraction of the data fields at a certain event from the application tablesSubrogation/Recovery (ICL_SUBROG, ICL_SUBROGITEM, ICS_SUBROG,ICS_SUBROGITEM)

- 0ISCM_CLAIM_03Enables extraction of the data fields at a certain event from the application tables Claim(ICLCLAIM, ICSCLAIM)

- 0ISCM_SUBCLAIM_03Enables extraction of the data fields at a certain event from the application tables Subclaim(ICLSUBCL, ICSSUBCL)

- 0ISCM_RESERVE_04Enables extraction of data fields of the application table Reserve (ICL_RESERVE) The extractorenables an additive delta via a delta queue (delta mode ADDD). Consider that in the GROSSRESfield, this extractor outputs the reserve expenditure and not the net reserve.

In addition to these transaction data extractors, you can also use the following master data extractors:

- 0ISCM_FORMSET_TEXT

Master data of the Customizing table Reason for Current Status (TICL018T)- 0ISCM_GROSSNET_TEXT

Master data of the fixed values for domains Type of Amount (ICL_GROSS_NET)

- 0ISCM_INVSTGMATCHSTATUS_TEXTMaster data of the fixed values for domains Status of Claim Investigation Match(ICL_INVSTG_MATCH_STATUS)

- 0ISCM_LOSSCAUSE_TEXTMaster data of the Customizing table Cause of Loss (TICL008T)

- 0ISCM_MOS_TEXTMaster data of the Customizing table Settlement Type (TICL041T)

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- 0ISCM_REQEVALCAT_TEXTMaster data of the fixed values for domain Determination Category of Amount Requested(ICL_REQEVALCAT_PE)

- 0ISCM_RESCHREASON_TEXTMaster data of the Customizing table Reserve Change Reason (TICL030T)

- 0ISCM_SIFSTATUS_TEXTMaster data of the fixed values of domain Status Second Injury Fund (Worker's Compensation)(ICL_SIF_STATUS)

- 0ISCM_TAXROLE_TEXTMaster data of Customizing table Tax Role of Claim Payment Recipient (TICL550T)

- 0ISCM_DISTCHANNEL_TEXTMaster data of Customizing table Insurance Distribution Channel (TICL500T)

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1.2.4 INS_FSCM_CI_2: Archiving Engine (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2), the Archiving Engine is available.This is based on the Archive Development Kit (ADK).

You can use the following archiving scenarios with the Archiving Engine:

- Claim

- Claim bundle

- Benefits, services, and fees catalogs

- Reserve lot

- IMP Manager

In each of these scenarios the system archives data of the corresponding business objects (claim, claimbundle, and so on). The IMP Manager scenario is an exception. Here the system merely deletes the oldentries from the database.

The functions that you can use with the Archiving Engine include:

- Parallel execution of archiving

- Enhanceable business checks for existing scenarios

- Enhancement of the scenarios to include new entities- Merging or splitting of archiving phases

- Extensive monitoring

You can view the archived objects of the archiving scenarios Claim, Claim Bundle, Benefits, Services and Fees Catalogsl in claims processing.

Effects on Existing Data

The Archiving Engine is not compatible with the archiving function of the Business Data Toolset (BDT).

Effects on System Administration

The archiving function of the BDT is still available but we recommend that you use the ArchivingEngine.

Effects on Customizing

SAP delivers the Archiving Engine with standard Customizing. This is split into developmentCustomizing and configuration Customizing.

Development Customizing is done via the Archiving Factory (transaction AR_FACTORY).

Here you can configure the following:

- Enhancement of existing business settings

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- Enhancement to include new entities

- Other archiving classes

Configuration Customizing is done via the Archiving Engine (transaction AR_ENGINE).

Here you can configure the following, for example:

- Package sizes

- Retention period

- Resubmission periods

- Archiving phases

1.2.5 INS_FSCM_CI_2: Assignment of Benefit Catalogs to Classes (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 ( INS_FSCM_CI_2) you can use the cross-applicationcomponent Classification System to create classes that you can then assign to benefits, services and feescatalogs.

This assignment is done in Customizing of the internal claim type at subclaim level. This means that it is

possible to assign individual benefits, services, and fees catalogs to a subclaim type without having tocreate a new version of the internal claim type.


In IMG activity Configure Internal Claim Types at the level of Subclaim-> Permitted Benefits, Services,Fees Catalogs , assign the required class to a benefits catalog (path in IMG: SAP Insurance -> Claims

Management -> Claim -> Process Control (Internal Claim Types) -> Configure Internal Claim Types ).

See also

For more information, see SAP Library under SAP for Insurance -> Claims Management -> Claim -> Administration of Claims Management System -> Benefits, Services, and Fees Catalog .

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1.2.6 INS_FSCM_CI_2: Change Business Partner (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 ( INS_FSCM_CI_2) you can enter the business partnernumber directly during claims processing if you want to change the business partner.

In addition, the new BusinessPartner field offers you the collective search help BUPA from SAPBusiness Partner.

1.2.7 INS_FSCM_CI_2: Texts for Settlements in CollectiveSubrogation/Recovery (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) you can enter texts for settlements incollective subrogation/recovery (or in an accident event with subrogation/recovery). To do so, you assigntext modules that you can select from different categories to the individual settlements. You can changethe sample texts later on in the application if you need to.


Before you can use the new functionality, you must make the following Customizing settings:

- In the Claim task level menu, add the new BDT screen ICLS90 Texts for Settlement to an existingor new screen sequence for collective subrogation/recovery (or accident event). If possible, insertscreen ICLS90 after the existing screen for settlements.

- If you create a new screen sequence with screen ICLS90 and want to use this alongside the previousscreen sequence, you must also create a new screen sequence category for the new screen sequence.You then assign this screen sequence category to a new claim bundle subtype for collectivesubrogation/recovery (or accident event) (IMG activity Define Subtypes per Claim Bundle Type).

- You performed the IMG activities for text modules:

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- Define Text Objects and Text IDs for Sample Text Modules

- Create SAPscript Sample Text Modules

- Differences Log: Assign Sample Text Modules to Category

1.2.8 INS_FSCM_CI_2: Integration with Classification System (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) there is a link to the cross-applicationClassification System component.

Integration with the classification system enables you to enhance SAP Claims Management , for exampleby saving additional attributes (called "characteristics" in the classification system) for a claim or claimbundle.

Integration with the classification system is possible in the following places:

- In claims processing and display of already saved claims in expert mode under Goto ->Classification System .

- In claim bundle processing and display of already saved claim bundles (standard, collective invoice,collective subrogation/recovery, accident event) under Goto -> Classification System .

- In Customizing, you can now also specify a class and class type of the classification system insteadof a list of benefit catalogs (IMG path: Claims Management -> Claim -> Process Control (InternalClaim Types) -> Configure Internal Claim Types -> level of Subclaim -> level of Permitted

Benefits, Services, and Fees Catalogs ).This means that you no longer have to create a new version of the internal claim type for each newcatalog that needs to be added to the internal claim type. Instead, you can assign the new catalogs toan existing class. You can also use superior classes and subclasses to form hierarchies.

The following class types are available:

- 650 - Claims

- 651 - Claim bundles

- 652 - Benefit catalogs

You need these class types when you create new classes for the data of SAP Claims Management .


To use the classification system, you must set up characteristics and classes in the classification system.The classes must refer to one of the above-mentioned class types.

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On the SAP Easy Access screen choose Cross-Application Components -> Classification System andthen:

- Master Data

- Characteristics

- Classes

- Assignment

- Assign Objects to Classes (this is the transaction displayed when the call is made from claim orclaim bundle maintenance)

- Assign Objects/Classes to Class

- Find - Find Objects in Classes

- Find Objects in Class Type

See also

For more information about the classification system, see SAP Library under SAP ERP CentralComponent -> Cross-Application Components -> Classification System (CA-CL) .

1.2.9 INS_FSCM_CI_2: Clauses with Coverage in the Policy Snapshot (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) , clauses assigned to a coverage arenow displayed in the policy snapshot together with the assigned coverage.

1.2.10 INS_FSCM_CI_2: New Screen Sequence "Claim Summary"

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) there is a new "Claim Summary"screen sequence.

The new screen sequence contains the following sections:

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- Details on loss and claim status

- Data on payments and reserves, date on which the claim was last changed, and date on which theclaim was opened

- Role-based performer/s in claim

- Subclaim data (payments, reserves, and possibly data on negotiation, litigation,subrogation/recovery and fraud potential)

- Offers and demands in negotiation

- Log entries

- Overview of notes

- Claim-claim linksEffects on Existing Data

The screen sequence of the claim header has changed. The claim overview now follows the claimsummary.

Effects on Data Transfer

Objects of existing sections have been used for the new screen sequence. The layout of the new screensequence matches the standard layout of these existing sections.

1.2.11 INS_FSCM_CI_2: Inspection Location of Damaged Object

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) the input help for the inspectionlocation in claims involving property damage has been enhanced.

The input help now includes the claimant.

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New functions are available for benefit catalogs, such as consideration of taxes.

The business function contains the new enterprise services Find Insurance Claim and Read InsuranceClaim .

For the integration with Business Information Warehouse there are new extractors, for example forpayments, reserves, subrogation/recovery.

For more information, see the following release notes:

- Archiving Engine

- Loading Policy and Contract Data from Policy System to Policy Snapshot

- New Screen Sequence "Claim Overview"

- Inactive Claims- Authorization with Repetitive Payments

- Role-Based Performer, Display of Telephone Number

- Navigation to Notes Processing

- Text Modules for Benefits Catalog Items

- Consideration of Taxes in Benefits Catalog

- Point Values in Benefits Catalog

- Assignment of Benefits Catalogs to Classes

- Policy Product - Override Company Code

- Clauses with Coverage in Policy Snapshot

- Integration with Classification System

- Change Business Partner

- Inspection Location of Damaged Object

- Texts for Settlements in Collective Subrogation/Recovery

- enterprise services

- Integration with SAP Business Information Warehouse

See also

For more information, see SAP Library under Business Function Sets and Business Functions -> Industry Business Function Sets -> SAP for Insurance -> Insurance Claim Handling 2 .

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1.2.14 INS_FSCM_CI_2: Point Values in Benefits Catalogs (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) you can use a point value system inbenefits, services, and fees catalogs.

You can use this point value system to define composite services that are made up from multiplesubservices or standalone services. Both composite and standalone services and subservices eachrepresent one benefits catalog item.

In addition, you can use an expression of the Business Rule Framework (BRF) to change or completelyrecalculate the price of a benefits catalog item. This new function is valid for all benefits catalog items,not just for composite services.

This new feature does not alter the usual way in which the benefit catalog items function.


For the additional calculations using a BRF expression, the transactions for maintenance of benefitscatalog items (ICLSCT01, ICLSCT02 and ICLSCT03) have been enhanced to include the correspondingfield on the General Data tab page, in the Evaluation section.


Make the Customizing settings for this function in Customizing of SAP Insurance under Claims Management -> Master Data -> Benefits, Services, and Fees Catalogs :

- Define Benefit CatalogsDefine at least one benefits catalog with the category Composite Services .Also define at least one benefits catalog with the category Standalone Services and also with thecategory Subservices .

- Define Screen Sequences for Benefits/Services/Fees CatalogsAssign screen sequence ICLB06 (for Benefits Catalogs with Point Values ) to the benefits catalogswith the category Composite Services .

See also

For more information, see SAP Library under SAP for Insurance -> Claims Management -> Claim -> Administration of Claims Management System -> Benefits, Services, and Fees Catalog .

1.2.15 INS_FSCM_CI_2: Interface to Policy System (New)

Use

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As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) , the interface to the policy system hasthe following new features:

- You can use several policy systems.You define the policy systems in Customizing and assign an RFC target system (Remote FunctionCall target system) to each policy system.

- You can use the Service Mapping Tool (SMT) to perform default mapping.The data structures of the policy system and the data structures of SAP Claims Management arealigned with one another. You can adjust and enhance this default mapping supplied by SAP.


Use of Several Policy Systems

Perform the following Customizing activities:

- Define Policy Systems for RFC Target Systems

- Define RFC Target Systems

Default Mapping Using SMT

If you want to adjust the standard mapping to suit the specific line of business, you must adjust the SMTtransformation IF_ICL_POLICY_OUT-CTR_BY_ID.

1.2.16 INS_FSCM_CI_2: Policy Product - Override Company Code (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604),

Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) , you can override certain settingsthat have been defined in Customizing for the policy product.

If you set the indicator in IMG activity Override Product Data , the system initially ignores certainsettings that have been defined for the relevant policy product in IMG activity Configure Policy Products .The system then determines the data defined in IMG activity Define Product Data Depending onCompany Code . If no company-code-relevant data exists here, the system uses the settings from IMGactivity Configure Policy Products .

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Effects on Existing DataOnce you have set the indicator in IMG activity Override Product Data , the system expects the companycode of the policy snapshot. This is particularly relevant for claims that were created before the indicatorwas activated and that are evaluated in reporting with the company code as the selection criterion. Forthis reason, with existing claims you must transfer the company code from the policy product to thepolicy snapshot (see next section "Effects on Data Transfer".)

Effects on Data Transfer

Execute the conversion program RICL_CONVERT_COMPANY_CODE_MP for all existing claims.The program takes the company code from the policy product of the claim and transfers this to the policysnapshot.


1. In Business Add-In (BAdI) Interface to Policy System of the active implementation for interfacemethod POLICY_LOAD (export parameter ES_POL-BUKRS), transfer the company code for therelevant contract.

2. Perform IMG activity Define Product Data Depending on Company Code.

3. In IMG activity Override Product Data, set the Override Product Data indicator.

1.2.17 INS_FSCM_CI_2: Authorization with Repetitive Payments (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) there is an authorization check withrepetitive payments.

In Customizing you define the maximum amount up to which a user in a certain authorization group maycreate or approve a payment for a repetitive payment. You can further restrict this definition to thesubclaim type.


The subscreen for the data record of a repetitive payment has the following new pushbuttons:

- Approve Repetitive Payment

- Reject Repetitive Payment

- Initialize Data Record

In addition, the data record of a repetitive payment can also have the following new status: To BeApproved.

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- Delete the entries for process +, node category 04 and 05 , function code ICL_NOTE_NAV_CLOVin the Control of Function Codes for Context Menu and Pushbuttons tree.

Further notes

Expression 0A1_1VIVC_ICLN05_NAV of the Business Rule Framework (BRF) controls display of theabove-mentioned function codes. The function code is always displayed if navigation to the BDT viewICLN05 ( Note Long Text ) is possible at subclaim/claim level.

If you remove view ICLN05 at subclaim level, the system switches to notes processing at claim headerlevel when you execute the function code.

1.2.21 INS_FSCM_CI_2: Role-Based Performer, Display of Telephone Number

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) the overview of role-basedperformers also displays the telephone number of the performer. This is valid for the performer categoriesUS (user) and BP (business partner).

Further notes

If your system is connected to a telephone server, an additional button is displayed next to the telephonenumber and you can use this to dial the displayed telephone number directly.

1.2.22 INS_FSCM_CI_2: enterprise services

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2) , the process component InsuranceClaim Processing offers the following new operations for enterprise services:

Process component Insurance Claim Processing

Business object Insurance Claim

- Service interface Query Insurance Claim In

- Operation Find Insurance Claim Basic Data by Elements (technical name:InsuranceClaimERPBasicDataByElementsQueryResponse_In)

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- Service interface Manage Insurance Claim In

- Operation Read Insurance Claim (technical name:InsuranceClaimERPByIDQueryResponse_In)


To be able to use all functions of the operation Find Insurance Claim Basic Data by Elements , you mustexecute the program BUP_BUSSRCHGF_REPAIR.

Transfer the following values for the parameters of the program:

- S_MANDT: Transfer the client.- S_OBJAP: ICL

The program creates the dynamic component of the BDT Search Framework.


Perform the following IMG activities:

- Define Context-Specific Data Selection

- Assign Context to Service 'Read Insurance Claim'

- Assign Context to a User

1.2.23 INS_FSCM_LIFE: Processing of Periodic Benefit Values

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can pay out periodic benefitvalues as annuities in life benefit claims.

You can divide the annuity payments among several payees. The repetitive payment function is used topay out the annuities.

Note the following:

- SAP Claims Management takes the periodic benefit values directly from the policy system.

- You cannot change the periodic benefit values in Claims Management.

- If there is a waiting period, no annuity is paid during this waiting period.

- You can pay out periodic benefit values synchronously or asynchronously to the insurance year / main due date.You make this specification in the integrated policy system.

- You can pay out periodic benefit values either in advance or at the end of a period.

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1.2.25 INS_FSCM_LIFE: Fund-Based Benefit Determination

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can perform a benefitdetermination and benefit split for fund-based contracts.

Fund-relevant data for benefits processing is loaded and displayed from the policy system. In SAP Claims Management you can adjust the following settings:

- Value date

- Calculation based on distribution

- Transaction charges

- Fund charges

- Distribution of withdrawal amount to the fund items

The calculation can be done based on approximate or final fund prices. The funds are settled in the policysystem when the benefit is acknowledged.

1.2.26 INS_FSCM_LIFE: Exercising Lump Sum Option

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can exercise the lump sumoption, if such an option has been agreed. The policy system provides information whether an option hasbeen agreed.

If a lump sum option exists, the Option section is displayed on the Entry and Check screen in claimsprocessing. To exercise the lump sum option, set the Option Exercised indicator.

If you then simulate and acknowledge the benefit during the course of claims processing, the system usesthis indicator to transfer the corresponding cause of loss to the policy system (see below under "Effectson Customizing").

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- Marriage

- Surrender

- Partial surrender

- Scheduled claims:

- Survival

- Partial payment

Subprocesses of benefits processing

The process of benefits processing comprises the following subprocesses:

- Claim opened

- Compensability check

- Benefit determination

- Benefit split

- Benefit disbursement

- Claim closure

You can find more information in the following release notes:

- Fund-Based Benefit Determination- Benefit Determination and Policy Loan

- Processing of Periodic Benefit Values

- Consideration of Waiting Periods

- Rollback Claims

- Exercising Lump Sum Options

- Claims for Occupational Disability/Permanent Incapacity to Work

- Processing of Partial Surrender and Surrender

See also

For more information, see the SAP Library under Business Function Sets and Business Functions -> Industry Business Function Sets -> SAP for Insurance -> Insurance Life Benefit Process.

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1.2.28 INS_FSCM_LIFE: Claims for Occupational Disability/PermanentIncapacity to Work (OD/PIW)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can capture and process claimsfor occupational disability/permanent incapacity to work (OD/PIW).

Special features in OD/PIW claims:- Level of impairment

- Review date

- Contract reactivation

Level of impairment

You can change the level of impairment. It is transferred to the policy system during the calculation andcan be considered there. Depending on the product configuration in the policy system, the level of impairment can influence the benefit.

Review date

You can enter a review date. On this date you can check whether the benefit should be continued orwhether it needs to be adjusted. There are two events of the Business Rule Framework (BRF):

- BRF event 0B1_DISAB is triggered when a review date is changed. You can use it to start aworkflow, for example.

- BRF event 0B1_DISAB_CORR is triggered before the review date; you can define the number of lead days in Customizing. As a reaction to this event, you can implement a request for documents,for example.

Contract reactivation

To end an OD/PIW claim, you must reactivate the contract involved. After acknowledgement of thebenefit, a new button is available, namely Reactivate Contract . You can enter a reactivation date; this isthen transferred to the policy system.


Create reactions to the BRF events 0B1_DISAB and 0B1_DISAB_CORR.

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Effects on Customizing- In Configure Internal Claim Types (Not Versioned), specify the lead days for OD/PIW

correspondence.

- In Create Benefit Processing Profiles at Product Level (level of Claim Type Definition ), specify adefault cause of loss for the reactivation.

1.2.29 INS_FSCM_LIFE: Processing of Partial Surrender and Surrender

UseAs of S AP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604),

Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can process partial surrenderor surrender without a contract termination.

The system applies the benefit values that are availabel in the coverages (for example, for the claim type"Partial Surrender"). The system then determines which amounts should be withdrawn from whichbenefit values.

Once the claim handler has processed partial surrender or surrender, the system transfers the withdrawalamount to the benefit split.

1.2.30 INS_FSCM_LIFE: Benefit Determination and Policy Loan

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can settle policy loans duringthe benefit determination.

Information on policy loans is loaded and displayed from the policy system. In SAP Claims Managementyou can make the following settings:

- Repayment amount for the policy loan

- Interest payments per interest payer

The policy loan is settled in the policy system when the benefit is acknowledged.

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1.2.31 INS_FSCM_LIFE: Consideration of Waiting Periods (New)

Use

As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), Business Function Insurance Life Benefit Process (INS_FSCM_LIFE) you can consider waiting periodsin claims. Waiting periods are often agreed in life insurance in the event of occupational disability orpermanent incapacity to work.

Keep in mind:

- SAP Claims Management takes the waiting period agreed in the contract directly from the policysystem.

- You can then adjust the waiting period manually when you process the claim.

- Using the claim-claim link function you can also consider waiting periods from previous claims.

- If you acknowledge the benefit, SAP Claims Management reports any waiting periods that might

have been changed back to the policy system.- If you create a repetitive payment for periodic benefit values (see Release Note INS_FSCM_LIFE:

Processing of Periodic Benefit Values), the payment of the agreed occupational disabillity annuity,for example, will be delayed by the waiting period.


In claims with internal claim type OD/PIW Annuity there is a new section called Waiting Periods on the Determination tab page in the expert mode transactions (ICLCDC01, ICLCDC02 and ICLCDC03).

The screen sequences delivered by SAP contain this section.

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Documents

RN ClaimsMgmt 604 En