Social Insurance Claim Flows

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To make it easy for constituents to file claims and to capture all the details that you require to process the claims, provide guided flows for constituents on your Experience Cloud site. Public Sector includes sample components that you can use to set up two guided flows for workers’ compensation claims: the File a Claim flow and the Respond to Claim flow.

Injured workers can use File a Claim flow to apply for workers’ compensation benefits when they suffer a work-related injury. They can use the flow to:

• Specify the date and time of the injury, the worksite where the injury occurred, and how the injury occurred
• Describe the nature of the injury and its effect on their productivity and well-being
• Indicate their work capacity and upload a supporting certificate from a healthcare provider
• Provide details of their employment and the loss of income due to the injury

When an injured worker files a claim, the flow creates a claim and a related individual application. The flow stores the details that the worker provided in assessment records and in a PDF file, and relates the records and the file to the individual application.

Employer representatives can use the Respond to Claim flow to verify the information in filed claims, modify details and add comments about the changes, and provide additional information.

When an employer representative responds to a claim, the flow creates an individual application and relates it to the claim. The flow captures the representative’s responses in assessment records and in a PDF file, and relates the records and the file to the individual application.

The Benefit Assistance template includes pages and components to run the guided flows. When you build your Experience Cloud site by using the template, injured workers can access the guided flow on the File a Claim page. They can track their claims on the View Claims page.

Employer representatives can also find filed claims on the View Claims page, and they can use the Respond action for the claim and start the guided flow to verify it.

Customize the guided flow components for your workers’ compensation program, or clone them to build your own guided flows for other social insurance programs.

• Social Insurance Flows Components
  Review the Omnistudio components that Public Sector (formerly Public Sector Solutions) uses in the social insurance claim flows.
• Social Insurance Claim Flows Prerequisites
  Before you set up social insurance claim flows in Public Sector (formerly Public Sector Solutions), complete the prerequisites.
• Deploy the Social Insurance Discovery Framework Sample Template
  Deploy version v1 of the Discovery Framework sample template for social insurance in Public Sector (formerly Public Sector Solutions).
• Set Up the File a Claim Flow
  Activate the Integration Procedure and the Omniscript guided flow that injured workers can use to file workers’ compensation claims.
• Set Up the Respond to Claim Flow
  Activate the Integration Procedures and the Omniscript guided flow that employer representatives use to verify claims and provide required information. Configure the custom setting that makes the flow available on your social insurance Experience Cloud site.