File A Claim

1. Overview

This solution provides a structured process for reporting various types of incidents and claims within a hotel, such as guest injuries, property damage, or employee incidents. It ensures that all necessary information is collected based on the specific type of claim, and then routes the report to the appropriate personnel for review and approval. The primary business problem it solves is standardizing the incident reporting and claims filing process to ensure consistent data collection and proper handling by the Risk Management team.

2. Glossary

3. Detailed explanation

This solution uses a single form to capture claim details and a workflow to manage the review and approval process. The form uses multiple sections that appear or disappear based on the Type of Loss selected. The workflow includes several integrations to send notifications at different stages.

Form

The form is designed to collect all relevant details about an incident. It is divided into several sections, many of which only become visible depending on the type of claim being filed.

• Incident Report Claim (Section)

• This section is always visible and captures the initial, high-level details of the incident.

• This is a confidential report that should NEVER be copied to the guest. (Section)

• This section contains key details about when the incident occurred and who is submitting the report.

• Required fields: Date and approximate time of incident:

• Claim Type (Section)

• This section determines the nature of the claim, which controls which other sections of the form will be shown.

• Required fields: Type of Loss:

• Hotel Info (Section)

• This section collects information about the hotel property where the incident took place.

• Required fields: Property Selection, Incident Reported by:

• Affected Guest/Employee Info (Section)

• This section, which appears conditionally, is for gathering personal details of the person affected by the incident.

• Required fields: Name:, Approx Age:

• General Attachments (Section)

• A general-purpose section for uploading any relevant files or documents related to the claim.

• Witness Information (Section)

• This section is for recording the details of any witnesses to the incident. It appears if the user indicates there was a witness.

• Medical (Section)

• This section appears for incidents involving injury and is used to document medical details.

• Pest Control Company (Section)

• This section appears for claims related to pests and collects information about the pest control vendor.

• Employee Information (Section)

• This section appears for employee-related incidents and gathers employment details.

• Required fields: Employee's Date of Birth:, Date of Hire:, Position:, Employment Type:, To ensure clear, timely, and appropriate communications with the injured worker, please indicate what language the associate prefers for communications:

• Police Notification (Section)

• This section appears conditionally to track whether law enforcement was notified.

• Police Information (Section)

• If police were notified, this section appears to collect details about the police report and responding officer.

• Guest Property (Section)

• This section appears for claims involving guest property and is used to record details about the property and the circumstances of the loss.

• Vehicle Information (Section)

• This section appears for incidents involving vehicles and is used to collect vehicle details.

• Additional Vehicle Information (Section)

• If a second vehicle was involved, this section appears to collect its details.

• Damage Information (Section)

• This section appears for claims involving property damage to record the type and cost of the damage.

• Third-Party Damage (Section)

• If damage was caused by a third party, this section appears to collect their information.

• Stay Information (Section)

• This section appears for guest-related incidents to collect details about their stay at the hotel.

• Compensation (Section)

• This section appears if compensation was offered to a guest, to document the details of the offer.

• EPLI Information (Section)

• This section appears for specific employment-related claims to gather details for Employment Practices Liability Insurance (EPLI).

• Contractor Info (Section)

• This section appears for incidents involving contractors to collect their business and contact information.

• Description of Incident (Section)

• A key section for providing a detailed narrative of the incident and any corrective actions taken.

• Required fields: Explain the circumstances surrounding the incident:, What is your position?, Your Name:

• Evidence to be Collected (Section)

• This section appears conditionally to document and collect evidence like photos and video footage.

• Inspection - Slip/Trip/Fall (Section)

• This section appears for slip, trip, or fall incidents to record inspection details of the area.

• Required fields: Who immediately inspected the area?, Date & Time of Inspection:, Observations:

• Primary Approval Comments (Section)

• This section is for approvers to add their comments and request more information if needed.

• Report Score (Section)

• This section is used by reviewers to score the quality and completeness of the submitted report.

• Computed fields: Report Score Total:

Workflow

The workflow begins when a user submits a new claim. The claim is then routed for approval based on the Type of Loss. If the approver needs more information, the form is sent back to the person who submitted it.

1. Start

This is the first step where the user fills out the form to file a new claim.

• Section permissions

• Hidden: Primary Approval Comments, Report Score, Hidden section for Risk Management Personnel only

2. Integration - GM Notification of submission

This is an automated step that runs in the background.

• Conditional execution: This step runs only if the condition _created_at.totext("yyyy-mm-dd") = "" is met.

• Assignee: Modified by

• Integrations: File A Claim - Above Property Notifications integration is automatically triggered when an item advances to next step.

3. Risk Managment Primary Approval

The claim is sent to the Risk Management Primary approver for review.

• Conditional execution: This step occurs if the Type of Loss is not "Employee Injury/Incident".

• Assignee: Risk Management Primary

• Section permissions

• Editable: Primary Approval Comments, Hidden section for Risk Management Personnel only, This is a confidential report that should NEVER be copied to the guest.

• Button permissions

• Hidden: Reassign

• Integrations: File A Claim - Risk Managment Primary Approval - Notify Email integration is automatically triggered when an item enters this step.

4. Employee Injury/Incident Review

The claim is sent to the Employee Injury Review group for review.

• Conditional execution: This step occurs if the Type of Loss is "Employee Injury/Incident".

• Assignee: wf-employeeinjuryreview

• Button permissions

• Hidden: Reassign

• Integrations: File A Claim - Employee Injury Approval CC integration is automatically triggered when an item is approved by an assignee at this step.

5. Parallel branch

After the initial review, the workflow follows one of several branches based on the Type of Loss. If more information is needed, the form is sent back to the original submitter.

• 5.1 Guest Injury (Branch)

• This branch is taken if Type of Loss is "Guest Injury". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.2 Guest Property (Branch)

• This branch is taken if Type of Loss is "Guest Property". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.3 Slip/Trip/Fall (Branch)

• This branch is taken if Type of Loss is "Slip/Trip/Fall". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.4 Illness/Death (Branch)

• This branch is taken if Type of Loss is "Illness/Death". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.5 Bed Bugs/Other Pests (Branch)

• This branch is taken if Type of Loss is "Bed Bugs/Other Pests". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.6 Guest Vehicles (Branch)

• This branch is taken if Type of Loss is "Guest Vehicles". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.7 Property Incident (Branch)

• This branch is taken if Type of Loss is "Property Incident". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.8 Employee Injury/Incident (Branch)

• This branch is taken if Type of Loss is "Employee Injury/Incident". It includes steps for the initiator to add information and for the primary reviewer to review it.

• Deadline: 48 Hours for the additional information task.

• 5.9 Auto Accident (Branch)

• This branch is taken if Type of Loss is "Hotel Vehicle". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.10 EPLI (Branch)

• This branch is taken if Type of Loss is "EPLI". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.11 Contractor/Contracted Labor Injury (Branch)

• This branch is taken if Type of Loss is "Contractor/Contracted Labor Injury". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.12 Police Activity (Branch)

• This branch is taken if Type of Loss is "Police Activity". It includes a step for the initiator to provide additional information if requested.

• Deadline: 48 Hours for the additional information task.

• 5.13 Trigger Litigation Hold form (Branch)

• This branch is taken if the Begin Litigation Hold Process for this Claim? field is checked.

• Integrations: File A Claim to Litigation Hold integration is automatically triggered when an item is about to enter the step.

6. Risk Management Primary - Additional Info Review

This step is for the Risk Management Primary user to review any additional information that was provided by the initiator.

• Conditional execution: This step occurs if the field wf Additional Info Review Required is set to 1.

• Assignee: Risk Management Primary

• Section permissions

• Editable: Report Score

• Button permissions

• Hidden: Reassign

7. Completed

This is the final step, which marks the end of the claim filing process.

• Section permissions

• Hidden: Hidden section for Risk Management Personnel only

4. Summary

The solution allows a user to submit an incident claim through a dynamic form. The workflow then routes the claim to the correct approver based on the claim type, and if necessary, sends it back to the submitter for more information before the process is completed.

• A user initiates the process by filling out the "File A Claim" form with details about an incident.

• The form is dynamic; sections and fields appear based on the selected Type of Loss.

• Upon submission, an automated notification is sent to the General Manager.

• If the claim is for an "Employee Injury/Incident," it is assigned to the Employee Injury Review group.

• For all other claim types, the report is assigned to the Risk Management Primary approver.

• The approver can review the claim, add comments, and either approve it or send it back to the submitter if more information is needed.

• If more information is requested, the original submitter receives a task to update the form.

• Once additional information is submitted, it goes back to the Risk Management Primary user for a final review.

• If the "Begin Litigation Hold" option is selected, a separate process is triggered automatically.

• After all reviews and information requests are handled, the workflow moves to the "Completed" step, finishing the process.

5. FAQ

Q1: How do I know which fields to fill out? A1: The form is designed to guide you. Start by selecting the Type of Loss. The form will then automatically show you only the sections and fields that are relevant to that specific type of incident. Required fields are clearly marked.

Q2: What happens after I submit a claim? A2: After you submit the claim, it is automatically sent to the correct department for review—either the Employee Injury Review team or the Risk Management Primary approver, depending on the claim type. You will be notified if they need more information from you.

Q3: Can I add attachments like photos or reports? A3: Yes. The form includes several sections for attachments, such as General Attachments and Evidence to be Collected. You can upload photos, witness statements, and other relevant documents directly to the form.

Q4: Who can see the information I submit? A4: The information is confidential and is only visible to the people involved in the review and approval process, such as the Risk Management team and designated approvers.

Q5: What if I make a mistake or need to add more information after submitting? A5: You cannot edit the form after submission. However, if the reviewer determines that more information is needed, they will send the form back to you. At that point, you will be able to add the required information and resubmit it.