Release Notes SAP Claims Management

6.04
Release Notes
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Copyright
Copyright(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 any
means or translated into another language, without the prior consent of SAP AG. The
information 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 registered
trademarks of their respective companies.
1.2 FS-CM Claims Management 1
1.2.1 INS_FSCM_AUTO: Hide View for Injured Persons 1
1.2.2 INS_FSCM_AUTO: Business Function Insurance Auto Claim Best
Practise 2
1.2.3 Integration with SAP Business Information Warehouse 3
1.2.4 INS_FSCM_CI_2: Archiving Engine (New) 5
1.2.5 INS_FSCM_CI_2: Assignment of Benefit Catalogs to Classes
(New) 6
1.2.6 INS_FSCM_CI_2: Change Business Partner (New) 6
1.2.7 INS_FSCM_CI_2: Texts for Settlements in Collective
Subrogation/Recovery 7
1.2.8 INS_FSCM_CI_2: Integration with Classification System (New) 8
1.2.9 INS_FSCM_CI_2: Clauses with Coverage in the Policy Snapshot
(New) 9
1.2.10 INS_FSCM_CI_2: New Screen Sequence "Claim Summary" 9
1.2.11 INS_FSCM_CI_2: Inspection Location of Damaged Object 10
1.2.12 INS_FSCM_CI_2: Inactive Claims 10
1.2.13 INS_FSCM_CI_2: Business Function Insurance Claim Handling 2
(New) 11
1.2.14 INS_FSCM_CI_2: Point Values in Benefits Catalogs (New) 13
1.2.15 INS_FSCM_CI_2: Interface to Policy System (New) 13
1.2.16 INS_FSCM_CI_2: Policy Product - Override Company Code (New) 14
1.2.17 INS_FSCM_CI_2: Authorization with Repetitive Payments (New) 15
1.2.18 INS_FSCM_CI_2: Consideration of Taxes in Benefits Catalog
(New) 16
1.2.19 INS_FSCM_CI_2: Text Modules for Benefits Catalog Items (New) 16
1.2.20 INS_FSCM_CI_2: Navigation to Notes Processing 17
1.2.21 INS_FSCM_CI_2: Role-Based Performer, Display of Telephone
Number 18
1.2.22 INS_FSCM_CI_2: enterprise services 18
1.2.23 INS_FSCM_LIFE: Processing of Periodic Benefit Values 19
1.2.24 INS_FSCM_LIFE: Rollback Claims 20
1.2.25 INS_FSCM_LIFE: Fund-Based Benefit Determination 20
1.2.26 INS_FSCM_LIFE: Exercising Lump Sum Option 21
1.2.27 INS_FSCM_LIFE: Business Function Insurance Life Benefit
Process (New) 22
1.2.28 INS_FSCM_LIFE: Claims for Occupational Disability/Permanent
Incapacity 24
1.2.29 INS_FSCM_LIFE: Processing of Partial Surrender and Surrender 25
1.2.30 INS_FSCM_LIFE: Benefit Determination and Policy Loan 25
1.2.31 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 for
injured persons in claims for property damage.
Use the sample implementation of Business Add-In (BAdI) BADI_ICL_FMOD2. In claims with internal
claim 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 additional
transaction 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 Release
7.0.4. For more information, see the Release Notes for this release.
The new extractors are:
- 0ISCM_PAYMENTS_03
Enables 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_03
Enables extraction of the data fields at a certain event from the application tables
Subrogation/Recovery (ICL_SUBROG, ICL_SUBROGITEM, ICS_SUBROG,
ICS_SUBROGITEM)
- 0ISCM_CLAIM_03
Enables extraction of the data fields at a certain event from the application tables Claim
(ICLCLAIM, ICSCLAIM)
- 0ISCM_SUBCLAIM_03
Enables extraction of the data fields at a certain event from the application tables Subclaim
(ICLSUBCL, ICSSUBCL)
- 0ISCM_RESERVE_04
Enables extraction of data fields of the application table Reserve (ICL_RESERVE) The extractor
enables an additive delta via a delta queue (delta mode ADDD). Consider that in the GROSSRES
field, 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_TEXT
Master data of the fixed values for domains Status of Claim Investigation Match
(ICL_INVSTG_MATCH_STATUS)
- 0ISCM_LOSSCAUSE_TEXT
Master data of the Customizing table Cause of Loss (TICL008T)
- 0ISCM_MOS_TEXT
Master data of the Customizing table Settlement Type (TICL041T)
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- 0ISCM_REQEVALCAT_TEXT
Master data of the fixed values for domain Determination Category of Amount Requested
(ICL_REQEVALCAT_PE)
- 0ISCM_RESCHREASON_TEXT
Master data of the Customizing table Reserve Change Reason (TICL030T)
- 0ISCM_SIFSTATUS_TEXT
Master data of the fixed values of domain Status Second Injury Fund (Worker's Compensation)
(ICL_SIF_STATUS)
- 0ISCM_TAXROLE_TEXT
Master data of Customizing table Tax Role of Claim Payment Recipient (TICL550T)
- 0ISCM_DISTCHANNEL_TEXT
Master 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, claim
bundle, and so on). The IMP Manager scenario is an exception. Here the system merely deletes the old
entries 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 Archiving
Engine.
Effects on Customizing
SAP delivers the Archiving Engine with standard Customizing. This is split into development
Customizing 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-application
component Classification System to create classes that you can then assign to benefits, services and fees
catalogs.
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 to
create a new version of the internal claim type.
Effects on Customizing
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 partner
number 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 SAP
Business Partner.
1.2.7 INS_FSCM_CI_2: Texts for Settlements in Collective
Subrogation/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 in
collective subrogation/recovery (or in an accident event with subrogation/recovery). To do so, you assign
text modules that you can select from different categories to the individual settlements. You can change
the sample texts later on in the application if you need to.
Effects on Customizing
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 existing
or new screen sequence for collective subrogation/recovery (or accident event). If possible, insert
screen ICLS90 after the existing screen for settlements.
- If you create a new screen sequence with screen ICLS90 and want to use this alongside the previous
screen 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 collective
subrogation/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-application
Classification System component.
Integration with the classification system enables you to enhance SAP Claims Management, for example
by saving additional attributes (called "characteristics" in the classification system) for a claim or claim
bundle.
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 instead
of a list of benefit catalogs (IMG path: Claims Management -> Claim -> Process Control (Internal
Claim 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 new
catalog that needs to be added to the internal claim type. Instead, you can assign the new catalogs to
an 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.
Effects on Customizing
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 and
then:
- Master Data
- Characteristics
- Classes
- Assignment
- Assign Objects to Classes (this is the transaction displayed when the call is made from claim or
claim 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 Central
Component -> 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 are
now 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 the
claim 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 links
Effects on Existing Data
The screen sequence of the claim header has changed. The claim overview now follows the claim
summary.
Effects on Data Transfer
Objects of existing sections have been used for the new screen sequence. The layout of the new screen
sequence 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 inspection
location in claims involving property damage has been enhanced.
The input help now includes the claimant.
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1.2.12 INS_FSCM_CI_2: Inactive Claims
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 identify inactive claims. The
system informs the performer of the relevant claim that he or she needs to process the claim. This has
been realized using the Business Rule Framework .
You can use the following selection criteria to restrict the search for inactive claims:
- Internal claim type
- Claim status
- Number of days since the last change to the claim
Effects on Existing Data
The new transaction ICLCLAIMINACTIVE has been created for this function. Report
RICL_INACTIVE_CLAIMS_NOT is called in this transaction.
To call transaction ICLCLAIMINACTIVE, on the SAP Easy Access screen choose Insurance -> Claims
Management -> Claim -> Evaluations -> Inactive Claims.
See also
For more information, see the documentation of report RICL_INACTIVE_CLAIMS_NOT.
1.2.13 INS_FSCM_CI_2: Business Function Insurance Claim Handling 2 (New)
Use
As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), the
business function Insurance Claim Handling 2 (INS_FSCM_CI_2) is available. With this business
function you can use additional functions in claims processing, such as
- Identifying inactive claims
- Authorization check when paying out repetitive payments
- Call notes processing throughout expert mode
You can also integrate the Archiving Engine to archive various claim subobjects (such as claim, claim
bundle). You can use a mapping tool to load policy and contract data from the policy system to the policy
snapshot based on default mapping.
In the claim overview there is a new screen sequence with more extensive information on claims
processing.
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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 Insurance
Claim.
For the integration with Business Information Warehouse there are new extractors, for example for
payments, 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 in
benefits, services, and fees catalogs.
You can use this point value system to define composite services that are made up from multiple
subservices or standalone services. Both composite and standalone services and subservices each
represent one benefits catalog item.
In addition, you can use an expression of the Business Rule Framework (BRF) to change or completely
recalculate 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.
Effects on Existing Data
For the additional calculations using a BRF expression, the transactions for maintenance of benefits
catalog items (ICLSCT01, ICLSCT02 and ICLSCT03) have been enhanced to include the corresponding
field on the General Data tab page, in the Evaluation section.
Effects on Customizing
Make the Customizing settings for this function in Customizing of SAP Insurance under Claims
Management -> Master Data -> Benefits, Services, and Fees Catalogs:
- Define Benefit Catalogs
Define 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 the
category Subservices.
- Define Screen Sequences for Benefits/Services/Fees Catalogs
Assign screen sequence ICLB06 (for Benefits Catalogs with Point Values) to the benefits catalogs
with 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 has
the following new features:
- You can use several policy systems.
You define the policy systems in Customizing and assign an RFC target system (Remote Function
Call 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 are
aligned with one another. You can adjust and enhance this default mapping supplied by SAP.
Effects on Customizing
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 SMT
transformation 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 settings
that have been defined in Customizing for the policy product.
If you set the indicator in IMG activity Override Product Data, the system initially ignores certain
settings 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 on
Company Code. If no company-code-relevant data exists here, the system uses the settings from IMG
activity Configure Policy Products.
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Effects on Existing Data
Once you have set the indicator in IMG activity Override Product Data, the system expects the company
code of the policy snapshot. This is particularly relevant for claims that were created before the indicator
was activated and that are evaluated in reporting with the company code as the selection criterion. For
this reason, with existing claims you must transfer the company code from the policy product to the
policy 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 policy
snapshot.
Effects on Customizing
1. In Business Add-In (BAdI) Interface to Policy System of the active implementation for interface
method POLICY_LOAD (export parameter ES_POL-BUKRS), transfer the company code for the
relevant 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 with
repetitive payments.
In Customizing you define the maximum amount up to which a user in a certain authorization group may
create or approve a payment for a repetitive payment. You can further restrict this definition to the
subclaim type.
Effects on Existing Data
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 Be
Approved.
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Effects on Customizing
Perform IMG activity Define Maximum Amount for Repetitive Payment for Each Authorization Group.
1.2.18 INS_FSCM_CI_2: Consideration of Taxes in Benefits Catalog (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 assign a tax variant to each
benefits catalog item. If you create an invoice with benefits catalog items when you are processing a
claim, the system transfers the relevant tax variant to the invoice.
Effects on Existing Data
The transactions for maintenance of benefits catalog items (ICLSCT01, ICLSCT02 and ICLSCT03) have
been enhanced to include the appropriate fields on the General Data tab page, in the Evaluation section.
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.
1.2.19 INS_FSCM_CI_2: Text Modules for Benefits Catalog Items (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 store information on a
benefits catalog item that is then displayed in the Differences Log in the relevant benefits catalog item.
To do so, you define an expression of the Business Rule Framework (BRF) in the relevant benefits
catalog item. This BRF expression delivers the text module that is displayed in the differences log.
Effects on Existing Data
The transactions for maintenance of benefits catalog items (ICLSCT01, ICLSCT02 und ICLSCT03)
have been enhanced to include the corresponding field on the General Data tab page, in the Evaluation
section.
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Effects on Customizing
Make the Customizing settings for this function in Customizing of SAP Insurance under Claims
Management -> Claim:
- Create SAPscript Sample Text Modules
Path in IMG under Claim: Business Settings -> Correspondence -> SAPscript Sample Text Modules
-> Create SAPscript Sample Text Modules.
- Differences Log: Assign Sample Text Modules to Category
Path in the IMG under Claim: Business Settings -> Correspondence -> SAPscript Sample Text
Modules -> Differences Log: Assign Sample Text Modules to Category.
- Configure Internal Claim Types
Path in IMG under Claim: Process Control (Internal Claim Types) -> Configure Internal Claim
Types.
For more information on the settings for the individual IMG activities, see the documentation of data
element ICL_SERVCAT_TEXT_SAMPLE_EXP_D.
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.
1.2.20 INS_FSCM_CI_2: Navigation to Notes Processing
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 navigate to notes processing
from any screen in expert mode. There is a new Notes button in the configuration of the Business Data
Toolset (BDT) (function code: ICL_NOTE_OVRVIEW_NAV).
Effects on Existing Data
The new button is displayed at the far right of the toolbar.
Effects on Customizing
On the screens for litigation and negotiation there are now two buttons for navigation to notes.
- Deactivate the old function code in these screens in Customizing activity Configure Display of
Function Codes.
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- Delete the entries for process +, node category 04 and 05, function code ICL_NOTE_NAV_CLOV
in 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 the
above-mentioned function codes. The function code is always displayed if navigation to the BDT view
ICLN05 (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 header
level 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-based
performers also displays the telephone number of the performer. This is valid for the performer categories
US (user) and BP (business partner).
Further notes
If your system is connected to a telephone server, an additional button is displayed next to the telephone
number 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 Insurance
Claim 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)
Effects on System Administration
To be able to use all functions of the operation Find Insurance Claim Basic Data by Elements, you must
execute 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.
Effects on Customizing
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 benefit
values as annuities in life benefit claims.
You can divide the annuity payments among several payees. The repetitive payment function is used to
pay 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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You make this specification in the integrated policy system.
- You can distribute periodic benefit values to different payees. You can adjust this benefit split
during the annuity payment.
- The benefit split is made as a percentage of the overall amount of periodic benefit values to be
distributed.
Effects on Existing Data
In claims with annuity payments, the expert mode transactions (ICLCDC01, ICLCDC02 and ICLCDC03)
have sections for periodic benefit values and periodic benefit split on the Periodic Benefit Split/Payment
tab page.
These sections are included in the screen sequences delivered by SAP.
1.2.24 INS_FSCM_LIFE: Rollback Claims
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 reset acknowledged
benefits and claim back benefits that have been paid out.
Reset
You can reset a previously acknowledged benefit in the policy system. After confirmation of the reset,
you can process the associated claim again.
Refunds
Following a reset, changed claim data might mean that the amount still to be distributed changes. This
could lead do a negative benefit split amount caused by too many benefits paid out. To offset this
negative benefit split amount, you can create refunds from the benefit split itself.
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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 benefit
determination 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 policy
system 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 sum
option, if such an option has been agreed. The policy system provides information whether an option has
been agreed.
If a lump sum option exists, the Option section is displayed on the Entry and Check screen in claims
processing. 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 uses
this indicator to transfer the corresponding cause of loss to the policy system (see below under "Effects
on Customizing").
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Effects on Customizing
In IMG activity Create Benefit Processing Profiles at Product Level, define a default cause of loss for the
option at the level of Claim Type Definition.
1.2.27 INS_FSCM_LIFE: Business Function Insurance Life Benefit Process
(New)
Use
As of SAP ECC 6.0, Industry Extension Insurance, Enhancement Package 4 (INSURANCE 604), the
business function Insurance Life Benefit Process (INS_FSCM_LIFE) is available. You can use this
business function to process claims in the line of life insurance.
Insurance products
The following insurance products are supported:
- Life Capital:
- Endowment insurance
- Unit-linked combined insurance
- Fixed term insurance
- Combined insurance
- Combined insurance with alternative endowment benefit total
- Partial payment insurance
- Marriage insurance
- Risk insurance
- Linearly decreasing risk insurance
- Life Annuity:
- Deferred life annuity
- Immediate life annuity
Incident types
The following incident types are available for processing:
- Unscheduled claims:
- Death
- OD/PIW annuity
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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/Permanent
Incapacity 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 claims
for 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 and
can 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 or
whether 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 a
workflow, 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 the
benefit, a new button is available, namely Reactivate Contract. You can enter a reactivation date; this is
then transferred to the policy system.
Effects on System Administration
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 a
default cause of loss for the reactivation.
1.2.29 INS_FSCM_LIFE: Processing of Partial Surrender and Surrender
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 process partial surrender
or 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 which
benefit values.
Once the claim handler has processed partial surrender or surrender, the system transfers the withdrawal
amount 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 during
the benefit determination.
Information on policy loans is loaded and displayed from the policy system. In SAP Claims Management
you 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 periods
in claims. Waiting periods are often agreed in life insurance in the event of occupational disability or
permanent incapacity to work.
Keep in mind:
- SAP Claims Management takes the waiting period agreed in the contract directly from the policy
system.
- 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.
Effects on Existing Data
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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