SafetySuite covers all elements required for self-insurers and insured organisations to manage their claims.
The collection of claim details begins when an injury is recorded. Injury corporate code sets based on the NOHSC codes are mapped to each jurisdiction’s values to allow for legislative compliance without compromising corporate analysis.
As a claim’s status is updated, SafetySuite records the history, allows the recording of unique notes associated with each status and controls what payment facilities should be enabled. The claim status is based on each jurisdiction’s legislated status but allows an organisation to define additional internal steps between each status and allocate these to the appropriate value required in the relevant electronic interface.
Upon acceptance of a claim, a baseline is established representative of a person’s Average Weekly Earnings (AWE). In some instances, the baseline used for legislative calculations may be different than one included in an award or employment agreement. SafetySuite refers to these non-legislated rules as Make-up rules. SafetySuite records both the legislated and make-up pay values. AWE is a date delimited figure so that values can be indexed on anniversaries or changes to an award.
Throughout the life of a claim a person’s Capacity to Work may change. SafetySuite tracks this value as it evolves, this figure can be used as an input to automatically determine the appropriate weekly pay percentages in the Automated Weekly Payments Module (AWP).
The claims management process is required to track the date at each step in the process as well as Reason Codes in some circumstances (e.g. date claim rejected). SafetySuite provides a “Dates” tab that allows users to quickly refer to these important milestones.
Notification functionality is triggered by the number of absence days recorded against a claim.
Claim Logs are recorded allowing detailed date delimited case files to be established over the life of a claim. These logs are coded against customisable note types to easily differentiate between the different activities/conversations.
SafetySuite provides a tab that displays the financial summary of a claim. This includes the total of all estimated payments and recoveries for a claim as well as the actual payment and recovery amounts and the remaining outstanding liability.
Estimates are recorded against the specific code sets as defined by an insurer or a jurisdiction. These can be supplemented by other values specific to an organisation.
CMS’s Fast Payments screen reduces the time taken to record multiple payments. This is done by allowing more than one category and sub category of payment to be made against the same payee. Furthermore, re-occurring payments can also be created and posted to the appropriate places from this screen.
Medical and Sundry Payments (e.g. legal, lump sum, investigations) can be entered directly against a claim. These are allocated to the specific code sets as defined by an insurer or a jurisdiction. These can be supplemented by other values specific to an organisation. For organisations using the Electronic Interface (EIF) Module, only code sets flagged for reporting will be transmitted via an electronic interface.
Recoveries from either an insurer or third party can be recorded against a specific payment or generally against the claim. A recovery status exists on both payments and recoveries to easily enable the reporting of any outstanding amounts owed.
For organisations that utilise an insurer to manage all/some of the claims management financial information, SafetySuite provides the ability to upload files from the insurer to populate estimate, payment, and recovery details.
All SafetySuite code sets are date-delimited. This allows for the evolution of coding as a result of improved business processes or legislative requirements. If code sets have Safety related implications, a company wide structure is used with background mapping to WorkCover authority specific codes to enable consolidated corporate reporting. Alternatively, if the code set is for the purposes of claims administration, a WorkCover authority specific key drives each table.
The systematic application of legislation is often based on interpretation of the law. It is C-Net’s experience that different organisations do apply the legislation in different ways. In circumstances where the system requirements are subject to interpretation, C-Net performs a validation process to ensure SafetySuite will accommodate our customer’s business processes. This involves direct contact with the relevant Authority and our network of customers and insurers.
