Participant Role

Definition

Describes the relationship of the business partner to the current claim in which he/she is participating. A business partner of this type is described as a participant (claim participant).

The participant role is independent of the business partner role .

Use

A participant always occurs in one or more participant roles within a claim.That means that when you create a new participant in a claim, you always create it in a specific participant role.

You can only create participants in certain participant roles during claims processing. The selection of available participant roles depends on the following:

Internal claim type

In the IMG, you define which participant roles can be used for an internal claim type under Claims Management → Claim → Process Control (Internal Claim Types) → Determ.System Oper.Mode w. Creation of Claim Participants per Int.ClaimType . If you want to create a participant in claims processing, the system only proposes those participant roles that you have assigned to the relevant internal claim type.

Assigned claim subobject categories

You assign 1-n claim subobject categories to each participant role in the Implementation Guide (IMG) under Claims Management → Claim → Business Settings → Participants → Enhance Participant Roles .

The system makes a check for every participant role to verify whether the required claim subobject is available for the participant role. If you make the setting in the IMG activity mentioned above that a participant in the participant role of Appraiser can only be created for the claim subobject category Damaged Object , the system checks whether a damaged object exists. If no damaged object is available, the system does not offer the Appraiser participant role.

Structure

The following table provides an extract of the participant roles that are available in the Claims Management system:

Participant Role	Description
Agent	Person who services the policyholder
Additional Payee	USA-specific: Used in a payment with “check” payment method. All payees listed on the check must sign the check before it can be cashed. This means, for example, that a check might be sent directly to the auto repair shop, but it does not become valid until the claimant is satisfied with the repair work and signs the check.
Appraiser	P& C line of business: Appraiser is appointed if the repair costs for a vehicle need to be estimated in advance, for example. Health line of business: A medical appraiser service specific to the country in question might appear here. Other appraisers are possible.
Public Prosecutor	If the question of fault in a road accident is unclear, the investigation file can be requested from the public prosecutor.
Claimant	Claimants can be divided into the following groups: Liability line of business: Injured persons make a claim against the policyholder (auto owner, for example) Other lines of business: The policyholder makes a claim against the insurance company (real estate owner with a buildings claim, insured person with life insurance, health insurance: person in health insurance, care insurance: person in care insurance, and so on).
Check Recipient	Payments made by check; The check recipient is entered here, see also Addtl Payee.
Driver in Insured Vehicle	Driver of insured vehicle
Named Driver
Driver in 3 rd Party Vehicle	All drivers in the other vehicles involved in the accident.
Insurer	Insurance company, of 3rd party or of driver of insured vehicle, for example
Caregiver	Person (family member, for example) who cares for the claimant (stored in SAP Business Partner as a relationship)
Prescriber	Person who prescribed the medically required service.
Injured Person	Injured person, identical to claimant (technically, the injured person is a damaged object)
Lawyer	Lawyer of one or several claimants
Physician / hospital	The physician or hospital of one or several injured persons. This is displayed in the data on the injured person.
Payee	Recipient of a payment (by check, bank transfer, debit card, credit card, and so on).
Paying Party	Used in subrogation/recovery: Person against whom a claim is made.
Policyholder	Just one policyholder for each claim; other policyholders are entered as supplementary policyholders.
Supplementary policyholder	If there are multiple policyholders, you can enter more than one policyholder for each contract.
Repair Shop	External service
Retailer	External service

Example

Example from P & C insurance:

A policyholder with auto insurance and liability insurance can be the named driver and the driver of insured vehicle . The policyholder therefore occurs in two different participant roles. If the insured vehicle is also damaged, and appropriate comprehensive coverage is in place, this policyholder can also occur as claimant and payee in the comprehensive subclaim (other participant roles such as correspondence recipient are possible).