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Technical Data

Technical Name of Business Function

INS_FSCM_LIFE

Type of Business Function

Industry Business Function

Available As Of

SAP ERP 6.0 Enhancement Package 4

Technical Usage

Insurance

Application Component

FS-CM

Directly Dependent Business Function Requiring Activation in Addition

Insurance Claim Handling (INS_FSCM_CI_1)

Insurance Claim Handling 2 (INS_FSCM_CI_2)

You can use this Business Function to process claims in the line of life insurance. This covers the entire claim handling process from creation of a claim to payout of the benefit.

As well as life-specific functions, you also have all cross-line functions of SAP Claims Management to enable you to process a claim.

Integration

To be able to use the Business Function Insurance Life Benefit Process INS_FSCM_LIFE , you must also activate the Business Functions Insurance Claim Handling (INS_FSCM_CI_1) and Insurance Claim Handling 2 (INS_FSCM_CI_2) . Both these Business Functions provide the additionally required cross-line functions, such as default mapping for the interface to the policy system and archiving of claims.

Prerequisites

You have installed the following components as of the version mentioned:

Type of Component

Component

Is Needed Only for the Following Features

Software Component

INSURANCE 604

FI-CA

SAP_APPL

Other Prerequisites

  • You have activated the Business Function Set Insurance.

  • You have activated the Business Function Insurance Claim Handling (INS_FSCM_CI_1).

  • You have activated the Business Function Insurance Claim Handling 2 (INS_FSCM_CI_2).

  • You have made the necessary Customizing settings.

    For more information, see Customizing Settings for Life Benefit.

Features

The process of claims/benefits processing in life insurance comprises the following subprocesses and incident types:

Subprocesses

  • Creation of claim

  • Compensability check

  • Benefit determination

  • Benefit split

  • Benefit disbursement

  • Claim closure

Incident types

  • Death

  • Survival

  • Marriage

  • Occupational disability (OD) / permanent incapacity to work (PIW) annuity

  • Partial payment

  • Surrender

  • Partial surrender

To be able to map the above-mentioned subprocesses, you can use the following life-specific and cross-line functions:

Life-specific functions

  • Simulation of benefit determination

    When processing a claim you can trigger a simulation of the benefit determination. This gives you an overview of the likely benefits.

    For more information, see Simulation of Benefit Determination.

  • Annuity payments

    You can also pay out benefits as periodic benefits (annuities). For paying out periodic benefits, the Business Function uses the standard function Repetitive Payment.

    For more information, see Periodic Benefit Split and the standard function Use of Repetitive Payments.

  • Waiting periods

    With annuity payments related to occupational disability or permanent incapacity to work, you can consider waiting periods including previous claims.

    For more information, see Consideration of Waiting Periods.

  • Fund-based and non-fund-based benefit determination

    This Business Functions supports fund-based and non-fund-based benefit determination. With a fund-based partial surrender, for example, you can define which fund shares the withdrawal amount comprises.

  • Periodic and non-periodic benefit split

    This Business Function supports benefit splits for both onetime and periodic benefits.

    For more information, see Onetime Benefit Split and Periodic Benefit Split.

Cross-line functions

  • Structured facts capture

    During claims processing you can use structured question and answer sequences to control the process. For this, the Business Function uses the standard function Structured Facts Capture.

  • Correspondence

    During claims processing you can create and send all types of correspondence for each claim. For this, the Business Function uses the standard function Correspondence.

  • Activity Management

    As part of business process control, you can create tasks manually and also have them created automatically by the system. For this, the Business Function uses the standard function Activity Management.

Example

An endowment life insurance with the incident type Survival is to be paid out when the insurance matures.

The system automatically creates a claim in advance, checks the relevant insurance policy, and provides the benefit values for the final processing of the claim. The system also creates a task for the claim handler, prompting the claim handler to check the maturity benefit manually. The claim handler checks the benefit values, simulates relevant alternatives, and releases the benefit for payout. Optionally, the claim handler can split the benefit between various beneficiaries. The system automatically creates the final documents and transfers a payment request to the integrated collections and disbursements system.