There are several ways the Insurer/Compensator can respond to a claim.

 

Rejected claims

 A Compensator may reject a claim for one of three reasons:

  • Claim sent to the wrong organisation
  • AskCUE PI reference not valid (RTA claims only)
  • Mandatory fields incorrectly populated

You will receive a notification that the claim has been rejected and the reason why. 

The claim will appear in your Worklist with the claim status of "Acknowledge Rejected Claim".

Once you have acknowledged the rejected claim it automatically moves to the claim status of "Claim Rejected to CR", and you can resubmit the claim depending on the reason for rejection.

If the Compensator rejects the claim for the reason "CNF sent to wrong defendant" you can change the Insurer/Compensator and then resubmit the form to the correct Insurer/Compensator.

For RTA claims only a claim can be rejected because the "AskCUE PI reference not valid" and could not be validated by the Compensator using the askCUE PI reference number check service. You can correct the AskCUE PI reference number and resubmit the claim.

If the claim is rejected because "Mandatory fields incorrectly populated" it means that mandatory information is missing or incorrectly populated and must be completed before resubmitting the claim.

When you access the claim, the claim entry form will be re-opened, and you can make your necessary changes.  The notification date will be reset to the current date, from which the Liability decision timeout will be calculated.

Top Tip: In the case of a rejected EL / PL Claim the notification date is reset to the current date; however, it remains editable when it is resubmitted to another Insurer/Compensator.

 

Liability Decisions

When you receive a response from the Compensator after submitting a claim, it will indicate whether liability has been accepted under the following conditions.

  • Liability admitted: The Compensator has admitted liability.  You need to access the claim and press the Continue button.  The claim will move to Start of Stage 2.1.  
  • Liability admitted (child claim): The Compensator has admitted liability.  The claimant is under 18 years at the time of the liability decision.  You need to access the claim and press the Continue button.  The claim will move to Start of Stage 2.1.
  • Liability not admitted: The Compensator has accepted the claim but denies liability.  You need to access the claim and press the Continue button.  The claim will come to an end in the portal.
  • Liability admitted with negligence (other than seatbelt): – RTA claims only: The Compensator has accepted the claim, and admits liability.  However, due to contributory negligence (other than seatbelt), the claim will no longer follow the protocol.  You need to access the claim and press the Continue button.  The claim will then come to an end in the portal.
  • Liability admitted with negligence: – EL/PL claims only: The Compensator has accepted the claim, and admits liability.  However, due to contributory negligence, the claim will no longer follow the protocol.  You need to access the claim and press the Continue button.  The claim will then come to an end in the portal.


Liability Decision Timeout

If the Compensator does not make a Liability decision within the required time period, as per the protocols, the claim will go to the status of Liability Decision Timeout.  You need to access the claim and press the Continue button.  The claim will come to an end in the portal. 

 

Fraud Stated

The Compensator may have used the State Fraud function.  The claim will move to the status Fraud stated.  You need to access the claim, review the reason and press the Continue button.  The claim will then come to an end in the portal. 

 

Exit Process

The Compensator may also have used Exit process function. The claim will move to the status Exit process. You need to access the claim, review the reason and press the Continue button. The claim will then come to an end in the portal.

 

Creating an Interim Settlement Pack

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