Guidewire Claim Exposure

Guidewire Claim Exposure Detailed Explanation

In Guidewire ClaimCenter, an exposure represents the specific aspect of a claim that the insurer is responsible for paying. Each claim can have multiple exposures, depending on the incident and the different types of coverages involved. The concept of an exposure helps insurers break down and manage the financial liabilities associated with different parts of a claim.

1. Definition of Claim Exposure

   Exposure is a sub-entity within a claim that tracks the insurer's responsibility for a specific coverage type. For example, if an auto accident occurs, the claim might have several exposures, such as property damage, bodily injury, and medical payments. Each exposure corresponds to a different part of the claim and is handled individually, which allows the insurer to efficiently manage the claim's financials and operational tasks.

2. How Exposures Are Created

   - Automatic Creation: ClaimCenter can automatically create exposures based on the claim type and the coverages available on the policy.

   - Manual Creation: Adjusters can manually create exposures if additional responsibilities are discovered during the investigation (e.g., a new medical condition or third-party liability not originally considered).

3. Types of Exposures

   The type of exposure created depends on the claim type and the insurance policy coverages. Some common exposure types include:

   - Bodily Injury (BI)

   - Property Damage (PD)

   - Collision

   - Comprehensive

   - Personal Injury Protection (PIP)

   - Uninsured/Underinsured Motorist

   - General Liability

4. Exposure Lifecycle

   The lifecycle of an exposure generally follows the broader claim lifecycle but focuses on the specific type of loss or damage that the exposure covers.

   Key steps include: 

   - Exposure Creation

   - Initial Review and Setup

   - Investigation and Evaluation

   - Reserve Setting

   - Payments and Settlements

   - Resolution and Closure

5. Reserving for Exposures

   Reserves are critical in exposure management. ClaimCenter allows the user to set up exposure-level reserves, meaning each exposure can have its own reserve amount separate from the overall claim reserve.

6. Payments and Transactions for Exposures

   Each exposure has its own payment records. Payments are linked to specific exposures to ensure that funds are allocated correctly. ClaimCenter tracks every payment made for each exposure, ensuring accurate financial reporting.

7. Linking Exposures to Policy Coverage

   Exposures are closely tied to the specific coverages in the policy. Each exposure reflects the coverage limits, deductibles, and other terms specific to that part of the policy.

8. Key Features in Managing Exposures in Guidewire ClaimCenter

   - Exposure Templates

   - Adjuster Assignment

   - Multiple Exposures Per Claim

   - Exposure-Level Reporting

Example of Claim with Multiple Exposures:

Let's say a policyholder is involved in a car accident:

- Bodily Injury Exposure: The driver and a passenger are injured, and medical expenses will need to be covered.

- Property Damage Exposure: The driver's vehicle is damaged and needs repairs.

- Rental Car Exposure: While the vehicle is being repaired, the policyholder requires a rental car.

In Guidewire ClaimCenter, managing exposures is a critical part of handling claims. Each exposure represents a specific part of the insurer's liability, such as bodily injury or property damage, and allows claims to be broken down into manageable parts. This exposure-based approach helps adjusters track and process different parts of the claim efficiently while ensuring that financials are accurately managed.