FS335 EN Col92 PDF

FS335 SAP Claims Management Customizing
FS335
SAP Claims Management Customizing
THE BEST-RUN BUSINESSES RUN SAP
© SAP AG 2009 © SAP AG 2006
SAP for Insurance

Version 92
Material number: 50095672
© SAP AG FS335 Preface-1

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Course Prerequisites
Required Knowledge:
FS330 SAP Claims Management: Overview
Recommended Knowledge:
Basic IT Knowledge
© SAP AG 2006

Target Audience
This course is intended for the following audiences:

Project managers
Project members
Consultants
Duration: 3 days
© SAP AG 2006
User notes
These training materials are not a teach-yourself program. They complement the explanations
provided by your course instructor. Space is provided on each page for you to note down additional
information.
There may not be sufficient time during the course to complete all the exercises. The exercises
provide additional examples that are covered during the course. You can also work through these
examples in your own time to increase your understanding of the topics.

Course Overview
Contents:
Course Goals
Course Objectives
Course Content
Course Overview Diagram
Main Business Example
© SAP AG 2006
© SAP AG FS335 1-1

Course Goals
This course will prepare you to:

Understand the basics of SAP Claims Management
Customizing
Perform the key Customizing settings in SAP
Claims Management.
© SAP AG 2006
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Course Objectives
After completing this course, you will be able to:

Understand the basic functionality of Customizing
in SAP Claims Management
Customize policy products and internal claim types
Make basic changes to the user interface
Set up Tasks and customize basic business rules
Describe the supporting features of SAP Claims
Management
© SAP AG 2006
© SAP AG FS335 1-3

Course Content
Claims Management Customizing

Unit 1 Course Overview
Unit 2 Product Configuration
Unit 3 Claim Handling Configuration
Unit 4 User Interface Configuration (BDT)
Unit 5 Business Rules (BRF) and Tasks
Unit 6 Structured Facts Capture (SFC)
Unit 7 Claim Fulfillment
Unit 8 Claim Recovery
Unit 9 Claim Handling Supporting Features
Unit 10 Integration
Conclusion
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Course Overview Diagram
1. Course Overview
2. Product Configuration
3. Claim Handling Configuration
4. User Interface Configuration (BDT)
5. Business Rules (BRF) and Tasks
6. Structured Facts Capture (SFC)
7. Claim Fulfillment
8. Claim Recovery
9. Claim Handling Supporting Features
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 1-5

Main Business Scenario
You are working in the SAP Customer Competency

Center (CCC) of an insurance company.
You have been given the task to implement a new
product.
You Customize a new claim type in order to create,
handle and settle claims for the new product.
© SAP AG 2006
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The SAP Insurance Solution Map
Customer, Market Research & Market Development Underwriting Account Maintenance Claims & Benefits Investment & Risk Capital Market
Partner and Product Definition & Distribution & Customer Care Management & Reinsurance
Market
Product Management
Market Research and Product Ideas
Product Development and Implementation
Product Lifecycle Management
Sales
Sales Planning and Controlling
Sales Force Management
Customer Analysis and Marketing
Acquisition and Application Creation
Underwriting and Policy Administration

Underwriting and Policy Issuance
Mid-Term Policy Changes and Information
Automated Policy Administration
Claims
Claims Handling and Fulfillment
Claims Recovery
Reinsurance
Reinsurance Risk Management
Treaty and Facultative Reinsurance Administration
Treaty and Facultative Reinsurance Accounting
Financial Asset
Management
Asset Allocation
Portfolio Management
Portfolio Accounting
Portfolio Controlling
Insurance Business Services

Collections and Disbursements
Financial Customer Care and Dispute Management
Business Partner Management
Enterprise Management & Support
© SAP AG 2006
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Insurance Solution Map Details
Claims
Claim Handling & Fullfillment Claim Recovery
Notice of Loss Subrogation

Clarifying Facts Salvage
Evaluating Claims Co-insurance
Negotiation Re-insurance
Litigation
Settlement (cash,
replacement, integration
of external services)
…
© SAP AG 2006
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SAP for Insurance: Solution Overview
Analytics
Strategic Enterprise Management Business Information Warehouse
Insight Driven Insurance Business Support

Sales & Service Core Applications Applications
Marketing Human Capital
Policy Claims Management
Management Management Management
General Ledger
Sales Collections & Disbursements
Management
Controlling
Commissions
Customer Supplier
Service Reinsurance Relationship
Management
Mobile Field Financial Asset Management
Enablement Procurement
Product Management
Projects, etc.
Business Partner
NetWeaver
Business Process Mobile,
MDM XApps XI Portal Management BI KM
etc
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Architecture of SAP Claims Management
Policy Management Customer service / Portal

(FS-PM) (CRM / Interaction Center) Supply Chain
Management
SAP Claims Management Business

Warehouse
(BW)
Claim Claim Claim Claim
Organization Structure Notification Handling Fulfillment Recovery
PD-ORG Document
Management
Business Partner
(FS-BP) Claims Management Supporting Features
(correspondence, notes, business rules, activity management, workflow,
sceen configuration, authorisations, reporting) Archive
Collection and Incentive Fraud /

General ledger Reinsurance Evaluation
Disbursements Management
(FI) (FS-RI)
(FS-CD) (ICM)
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SAP Claims Management Delivers a Complete
Claims Cycle…
12 Co-insurance Notice of Loss 1
Measurements/ Coverage
11 Reporting SAP Claims Verification 2
Management
Segmentation &
10 Recovery Assignment (Triage) 3
9 Claim Payments Facts Capture 4
Negotiation + Activity
8 Litigation Management Management 5
External Service
7 Provider Integration
Reserving 6
© SAP AG 2010
FNOL: Different process flows depending on the type of claim

Coverage verification: Rule-based verification of policy data and claim circumstances
Segment & Assign: Rule-based assignment of a claim, a sub-claim or task to the right team/person at
the right time in order to settle a claim in the best possible way
Facts Capture: Scripting (SFC), screens, dismemberment schedule, ICD, etc.
Activity management: Rule based generation of a settlement plan depending on the claim profile
Reserving: Rule-based case reserving with an interface to G/L, supplementary reserves (IBNR)
External service integration: Evaluate, select, instruct and control suppliers; procurement catalog
integration
Negotiation & Litigation: Capture of offers & demands, correspondence, legal court cases, legal
dates etc.
Claims payments: Check, bank transfer, payment authorizations, repetitive payments etc.
Recovery: Subrogation, Salvage, Re-insurance & Co-insurance
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…Underpinned by Enabling Technologies
12 1
11 Electronic Workflow 2
Claim File 13 17 Engine
Screen, Field &

10 Document and
14 18 Flow Configuration 3
Image Management
Toolset
9 Business Rules
15 19 Open Interfaces 4
Framework
8 Task
20
Reporting &
5
Management 16 Business
Warehouse
7 6
© SAP AG 2006
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Exercises
SAP WS Claims
Exercise: SAP Easy Access Menu Favorites
Status: ERP 2005
At the conclusion of these exercises you will be able to:

• Customizing the favorites of your SAP Easy Access Menu
• Access the most important customizing activities directly.
Situation:
You are an administrator at an insurance company. Your task is
to configure the SAP Claims Management system. In order to
simplify your work you will use your favorites to access the most
important customizing activities directly.
1-1 Log on to the system

Select the relevant system for this training session. Use the client, user name, initial
password, and logon language given to you by your instructor.
© SAP AG FS335 1-13

When you log on for the first time, a window appears in which you must enter a
password of your own choice twice.
Note down
Client: _ _ _ User: _ _ _ _ _ _ Password: ____________ Language: _ _.
1-2 Session
Target: Ability to create new sessions (e.g. for parallel work) and to get an overview
about open sessions.
Once you have started the R/3 system, the SAP Easy Access screen appears. Choose the
Creates new session icon in the toolbar to open a new session. Once you have opened
a new session, you see information on the number of open sessions in the status bar at the
bottom of the screen. (Prerequisite: You have selected System in the
status field ). Note: You can open up to 6 sessions.
1-3 Customize your SAP Easy Access Menu

Target: To facilitate your daily work by using Favorites.
1-3-1 Assign the most important FS-CM customizing activities
Add the following customizing activities to a new folder Customizing of your
favorites
- Transaction ICLIMG Access IMG of FS-CM
- Transaction ICLCVERM320 Define Policy Products
- Transaction ICLCVERM003 Configure Internal Claim Type
- Transaction ICLCVERM160 Define Benefit Type Tree
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Step-by-step procedure:
1. Create a favorite folder “Customizing”
2. Select your new folder and add the above customizing transactions
3. The end result should look like this
To show technical names make following settings in the SAP Easy Access
menu bar. Go to Extras Settings and activate Display technical names.
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1-3-2 Assign FS-CM transaction (optional)
Add the following FS-CM transactions to the new folder FS-CM of your
favorites.
- ICLNOT01 Create Claim (Notification Mode)
- ICLCDC01 Create Claim (Expert Mode)
- ICLCDC02 Change Claim (Expert Mode)
Transaction ICLIMG will take you to the Implementation Guide

(IMG) for SAP Claims Management. This is the area where your
configure the system to suit your individual requirements.
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Product Configuration
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 2-1

Policy Product Configuration
Contents:
Configure Products
Benefit Type Configuration
Benefit Type Tree Configuration
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Product Configuration: Unit Objectives
After completing this unit, you will be able to:

Describe the different elements of a product, e.g.
line of insurance, coverage types, incident types,
policy product and benefit type trees.
Configure policy products.
Configure benefit types and benefit type trees.
© SAP AG 2006
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Policy Product: Topic Objectives
After completing this topic, you will be able to:

Understand the function of the policy product
Locate the policy product in the FS-CM data model
Understand the most important attributes of the
policy product and its function
Understand the versioning concept of the policy
product.
© SAP AG 2006
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Policy Product: Definition
A policy product is a set of rules defining facts that

should apply equally to all policies of this product. The
most important definitions are which coverage types
and which loss incident types are permitted.
Together with the loss incident type and date of loss,

the policy product defines which rules should apply to
a claim.
© SAP AG 2006
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Policy Product – Data Model
Loss Incident Type n m n 1

Policy Product Line of Business
Examples: Examples:
m
Auto accident Auto insurance

House fire Homeowners
Coverage Types insurance
Glass breakage
Breakdown Commercial
Burglary General Liability
External damage Examples: Workers
Compensation
Collision
Comprehensive
Disability
Medical devices
Home health care
© SAP AG 2006
Loss Incident Type = What Happened? Coverage Type= Which part of the policy will respond to
what happened. Line of Business= Broad business category of types of policies.
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Policy Product – Customizing
Dialog Structure Policy Product K2000

Generation 1
Policy Product Policy Product Auto private

Generation Name Generation of 01.01.1998
Permitted Cov. Type
Det. Int. Claim Type Version 7
Policy Product Version
Version Name 7th Version

Insurance Line KD
LOB Name Auto Germany
Company Code V001
Company Name IDES Insurance Non-life
Currency EUR
CD Specification AAS1
Coll/Disb Active
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Policy Product – Attributes
Insurance Line of Business:

Similar risks are grouped together in an insurance line of
business (LOB). A standard policy product can be assigned
to an LOB, allowing users to open a claim without the policy
information.
Company Code:
Organizational unit within financial accounting
Currency:
Currency that applies to the limits, deductibles, and
statistical reserves for this policy product.
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Permitted Coverage Types
Input of a coverage type defines which risks are covered

by the product.
Input of the permitted coverage types restricts the

selection of the coverage type for the policy.
A policy belonging to this product can only contain

coverage types belonging to the set of permitted
coverage types.
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Loss Incident Types
The type of incident that triggered the insurance claim.
The product and the loss incident types defined in the

product combine to form an internal claim type. The
internal claim type is the central object that is
responsible for control of a claim in the Claims
Management system.
© SAP AG 2006
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Policy Product – Changes I
Product changes have an effect either on the generation,

or on the version.
Changes that are to apply to all claims that occurred after a

certain date of loss lead to new versions of the product.
Changes that are to apply to all claims whose policy was

renewed after a certain date lead to new generations of the
product.
© SAP AG 2006
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Policy Product – Changes II
Report
New New Claim 1 Renewal
Product Policy
Change of
Changes in product
legislation
Generation 1 Generation 2
Policy
Product
Version 1.1 Version 1.2 Version 2.1 Version 2.2
Policy New Policy Renewed Policy
Claims 1
Date of loss =
Date reported
© SAP AG 2006
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Policy Product – Changes III
Report Report
New New Claim 1 Renewal Claim 2
Product Policy
Change of
Changes in product
legislation
Generation 1 Generation 2
Policy
Product
Version 1.1 Version 1.2 Version 2.1 Version 2.2
Policy New Policy Renewed Policy
Claims 2
Date of loss <>

Date reported
© SAP AG 2006
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Policy Product – Changes IV
Options to change
Product Version
Options to change
Product Generation
© SAP AG 2006
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Policy Product: Topic Summary
You should now be able to:

Understand the function of the policy product
Locate the policy product in the FS-CM data model
Understand the most important attributes of the
policy product and its function
Understand the versioning concept of the policy
product
© SAP AG 2006
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Policy Product Configuration: Topic Objectives
At the end of this unit, you will be able to:
Configure policy products
© SAP AG 2006
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Policy Product Configuration - Definition
Meaning of the Policy Product:
A policy product is a rule tool that specifies facts that are valid
equally for all policies of this product. The most important
specifications are, for example, which coverage types and which
incident types are permitted.
Together with the incident type and date of loss/claim, the policy
product defines which rules apply for a claim.
Normally, several policies are assigned to a policy product, but only
one insurance line of business. Conversely, a policy belongs to
exactly one policy product.
If you enter a policy when you create a claim, the system
automatically determines and displays the associated policy product.
© SAP AG 2006
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Policy Product Configuration – Prerequisites
Prerequisites for Product Configuration:
Define insurance lines of business

Define incident types
Define coverage types
Define contract account creation variants for FS-CD
© SAP AG 2006
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Policy Product Configuration - Steps
1
2
4
5
© SAP AG 2006
Setup a favorite for transaction ICLCVERM320 in the easy menu to access Policy Product
configuration directly
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Policy Product Configuration – Line of Business 1
Meaning of Insurance Line of Business:
Similar risks are grouped in an insurance line of business.

The insurance line of business groups policy products
Insurance lines of business are required for:
Configuration of policy products
Configuration of tolerance groups
Line-related activities and rules in the Business Rule Framework
© SAP AG 2006
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Policy Product Configuration – Configuration of LOB 1
Configuration of Insurance Line of Business:
Key of insurance line of business

Name of insurance line of business
Assignment of a standard policy product
© SAP AG 2006
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Policy Product Configuration – Coverage Type I 2
Meaning of Coverage Types:
The coverage type classifies a coverage.

When you capture a claim item in claims processing, a coverage type
is needed for this claim item.
The coverage type indicates which coverage is valid for this claim
item according to the policy, and which benefit types are permitted.
Coverage types are required for:
Configuration of policy products:
The coverage type indicates which risks are covered by the policy product and
which benefit types are permitted for the insured risk.
Configuration of internal claim types
© SAP AG 2006
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Policy Product Configuration - Coverage Type II 2
Configuration of Coverage Types:
Key of the coverage type

Name of the coverage type
Specify whether this is a liability coverage type
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Policy Product Configuration – Incident Type I 3
Meaning of Incident Type:
The type of incident that triggered a claim.

Together with the policy product, the incident type determines which
internal claim type applies and thus which rules are valid for claims
processing.
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Policy Product Configuration – Incident Type II 3
Configuration of Incident Type:
Key of incident type

Name of incident type
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Policy Product Configuration - Configuration 4
Configuration of the Policy Product:
Key of the policy product

Name of the policy product
Period in which a version of the policy product is valid
Payment settings that apply for this policy product:
Company code
Name of company code or company
Currency
Specification for FS-CD
Permitted coverage types
Permitted incident types
Benefit type trees
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Policy Product Configuration: Topic Summary

Configure policy products
© SAP AG 2006
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Benefit Type Tree Configuration: Topic Objective
At the end of this unit, you will be able to:
Configure benefit type trees.
© SAP AG 2006
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Benefit Type Tree Configuration - Definition 2
Meaning of Benefit Type Tree:
Contains a hierarchical structure of permitted benefit types.

It is possible to group several trees in one benefit type tree
You can assign benefit type trees as follows:
Benefit type trees in the "Mixed" category can be assigned to a coverage
type in IMG activity Configure Policy Products, and to a subclaim type in
IMG activity Configure Internal Claim Types.
Benefit type trees in the "Losses" category can be assigned to a
permitted coverage type in IMG activity Configure Policy Products.
Benefit type trees in the "Expenses" category can be assigned to a
subclaim type in IMG activity Configure Internal Claim Types.
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Benefit Type Tree – Where used?
Limits/deductibles
across coverages
Policy product
Coverage type 1
Loss
benefit types
Coverage type 2
Benefit Type
Tree
Internal Claim Type
Expense
benefit types Subclaim type 1
Subclaim type 2
© SAP AG 2006
Benefit type tree defines the different limits and deductibles of a coverage type and the loss and
expense types that are permitted.
© SAP AG FS335 2-30

Benefit Type Tree Configuration - Steps
© SAP AG 2006
Setup a favorite for transaction ICLCVERM160 in the easy menu to access Benefit Type Tree
© SAP AG FS335 2-31

Benefit Type Tree Configuration - Structure 2
Benefit Type
Tree Generation
Benefit Type
Tree Version
Permitted
Benefit Type
Limit per Permitted

Benefit Type
Definition of Payment
Reason Groups
Permitted Object Type
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Benefit Type Tree Configuration - Version
Currency that is valid for all

Benefit Type
Tree Generation amount fields of the benefit
type tree.
Benefit Type Higher-level benefit type tree

Tree Version
Specify whether the benefit
Permitted
type tree is only used for
Benefit Type coverage types, not across
coverage types
Limit per Permitted
Benefit Type
Reason Groups
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Benefit Type Tree Configuration – Permitted Benefit Type I
Benefit type fixed per version

Benefit Type
Tree Generation of the benefit type tree.
Multi-level benefit type trees

Benefit Type with superordinate and
Tree Version subordinate benefit types can
be defined.
Permitted
Benefit Type This hierarchy is then also
valid for the limits and
Limit per Permitted deductibles of the Limit per
Benefit Type
Permitted Benefit Type level.
Reason Groups
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Benefit Type Tree Configuration - Permitted Benefit Type II
Benefit type: Losses or

Benefit Type
Tree Generation expenses
Specify the application type

Benefit Type of limits and deductibles in
Tree Version the compensation calculation
Permitted
Is subrogation possible?
Benefit Type
Procurement transaction
Limit per Permitted
Benefit Type
Reason Groups
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Benefit Type Tree Configuration – Limit I
The limits and deductibles

Benefit Type
Tree Generation used for checking:
Payments entered directly

Benefit Type
Tree Version Automatic creation of
payments from claim
Permitted
items
Benefit Type
Used by reserves
Limit per Permitted
Benefit Type Any relevant payments
already made are considered
Definition of Payment automatically
Reason Groups
Settings per permitted benefit
type
© SAP AG 2006
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Benefit Type Tree Configuration – Limit II
You can store a coverage type

Benefit Type
Tree Generation as a filter for the application of
limits/deductibles
Benefit Type You can store a formula for the

Tree Version calculation of the deductible.
Permitted
…
Benefit Type
Limit per Permitted

Benefit Type Settings per limit/deductible
Reason Groups
© SAP AG 2006
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Benefit Type Tree Configuration – Payment Reason
Definition of permitted
Benefit Type
Tree Generation payment reason groups
and thus of the permitted
payment reasons
Benefit Type
Tree Version
Permitted
Benefit Type
Limit per Permitted

Benefit Type
Reason Groups
© SAP AG 2006
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Benefit Type Tree Configuration – Object Type
Definitions for the procurement of

Benefit Type
Tree Generation claim items:
Benefit Type
Tree Version Permitted object type
Evaluation category
Permitted
Benefit Type
Evaluation type and thus the
leading evaluation system as
Limit per Permitted
Benefit Type well
ID of an external catalog
Reason Groups
© SAP AG 2006
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Benefit Type Tree Configuration – Benefit Type I 1
Meaning of Benefit Type:
Unique ID for classification of receivable or benefit

The benefit type defines which limits and deductibles apply, and
against which reserve the payments should be offset.
Each claim item must have a benefit type.

Each payment item must have a benefit type.
© SAP AG 2006
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Benefit Type Tree Configuration – Benefit Type II 1
Configuration of Benefit Type:
Key of benefit type

Name of benefit type
Losses or expenses
Cross coverage type usage?
Default value for category of insured object
Default value for type of insured object
Assignment to a benefit type area
© SAP AG 2006
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Benefit Type Tree Configuration – Loss vs. Expense
Definition: Losses
Claims Management (FS-CM)
Benefit or service made by an insurer to an entitled beneficiary when a claim or

loss is incurred. This benefit or service is covered by the insurance policy (such
as compensation for repair work).
Conversely, expenses are costs incurred by the insurer in settling the claim.
Definition: Expenses
Claims Management (FS-CM)
Costs incurred by the insurer in settling a claim.
Conversely, losses are benefits or services covered by the insurance policy.
© SAP AG 2006
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Benefit Type Tree: Topic Summary

Configure benefit type trees.
© SAP AG 2006
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Product Configuration: Unit Summary

Describe the different elements of a product, e.g. line
of insurance, coverage types, incident types, policy
product and benefit type trees.
Configure policy products.
Configure benefit types and benefit type trees.
© SAP AG 2006
© SAP AG FS335 2-44

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 2-45

© SAP AG FS335 2-46
Exercises
SAP WS Claims
Exercise: Policy Product Configuration
Status: Release ERP2005

• Create a Line of Business
• Create Coverage Types
• Create Incident Types
• Create a Product
Situation:
to configure a Policy Product

password, and logon language given to you by your instructor. When you log on for the
first time, a window appears in which you must enter a password of your own choice
twice. Note down
1-2 Create Line of Business

Target: Create the line of business L## for ## Home Insurance.
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Define Insurance Line of
Business.
Procedure:
1. Click on the customizing activity “Define Insurance Line of Business”
© SAP AG FS335 2-47

2. Press the „New Entries“ button
3. Enter the LoB for your group (03 in the example)
4. Save your entry. On the popup, create and save a new transport request “Transport
FS-335 ##”. Then confirm the popup by pressing . This way all your changes will
be recorded.
If you have not already created a transport request, press Enter on the corresponding
popup.
© SAP AG FS335 2-48

1-3 Define Coverage Types
Target: Create 3 coverage types for your new home product.
CT##B ## Buildings for damage to buildings
CT##C ## Contents for damage to the contents
CT##L ## Liability Property Damage for liability caused by owning a
building (Don’t forget to set the liability flag.)
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Define Coverage Types.

Procedure:
1. Create the new coverage types by pressing the “New Entries” button.
2. Enter the 3 coverage types and save your work.
1-4 Create Incident Type

Target: Create the following incident types for your new home product:
I##F Fire for damage caused by fire
I##T Theft for damage caused by thieves.
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Define Incident Types.
Procedure: Create the new incident types by pressing the “New Entries” button. Then
enter and save your entries.
© SAP AG FS335 2-49

1-5 Configure Policy Product
Target: Create the policy product PP## Home Owners Product.
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Configure Products.
1-5-1 Create Policy Product
1. Create the entry PP## Home Owners Product by pressing the icon . Set
the valid date to the beginning of this year. Notice that the status of the
policy product is in suspense.
2. Change your Product by selecting it and then pressing the change button.
Enter “Generation 1”.
3. Select the above entry and double-click on “Policy Product Version” on the
navigation tree on the left side of the screen. Enter the following
information on the version:
- Version: Version 1
- Line of Business: L##
- Company Code: V001
- Currency: EUR
- CD Specification: AAS1
- Collection/Disbursement: Active
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The benefit type tree will be added later on.
1-5-2 Add permitted coverage type

Add the coverage types from exercise 1-3:
1. From the version maintenance screen, double-click on “Permitted Coverage
Types” in the navigation tree on the left side of the screen.
2. Press the “New Entries” button
3. Enter the coverage types. Leave “country” and “region” blank. The
coverage types should be displayed if coverage exists. Therefore set the
Display Mode to „Display if covered“.
4. Save your entries, return to the last screen by pressing and repeat steps
1-3 for the other coverage types.
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1-5-3 Check the policy product
Target: You have created a policy product and assigned coverage and incident
types. Now check the consistency of your product.
Procedure:
1. Select your product and press the “check” button .
2. The system returns the results in form of a log. An error has happened
during the check which is marked by a red light.
© SAP AG FS335 2-52

3. What is the reason for the error? Click on the question mark next to the error
message to learn more about the error.
4. From the long description of the message you can directly navigate to the
point in customizing where the error can be corrected. Press the customizing
button to do so. Chose „Continue w/o Specifying Project“ when
prompted .
5. Execute the customizing activity “Define Time Reference per Policy

Product” and assign your policy product to a time zone.
6. Your product should now be error free. Repeat the check from step 1 to
verify.
1-6 Create claim

Using the notification mode, create a claim by using the line of business.
What happens and why?
1-7 Standard Policy Product

Target: In FS-CM you can create claims without specifying a contract number. To do this
you have to define a standard product and assign it to a line of business. In Exercise 1-5
you defined a Policy product. This will be the standard policy product of your insurance
line of business, which you created in exercise 1-2.
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Define Insurance Line of
Business
Procedure: Click into the field Stand. Product of your Line of Business L##. With either
selecting your Policy Product PP## over the F-4-help or just typing in the name of your
Policy Product PP## you will assign it to your line of business as the standard product.
Press the save button.
© SAP AG FS335 2-53

1-8 Note your new Entries in a list
At the end of this course book you will find 2 slides. These slides will help you to
consolidate your new customizing objects. Please fill in the names of your new created
objects in these slides. Please do this for all exercises in the following units.
© SAP AG FS335 2-54

SAP WS Claims
Exercise: Benefit Type Tree Configuration
Status: ERP 2005

• Create Benefit Type trees
Situation:
You are an administrator at an insurance company. Your task is to
configure a Benefit Type Tree

password, and logon language given to you by your instructor.
1-10 Define Benefit Types

Please note, that you have to create 12 benefit types
Create a benefit type for each box of the below displayed Benefit Type Trees.
Claims Management Æ ClaimÆ Business SettingsÆ Claim ItemÆ Benefit TypesÆ
Define Benefit Types.
Apply the naming convention BT##XY; where XY is a number e.g. 01, 02, etc. Make
sure that you assign the category according to losses and expenses.
The new benefit type trees should look like the following figures (note you will create
the benefit type trees in exercise 1-16):
© SAP AG FS335 2-55

Deductible 1.000 Building Limit 300.000
Door Other Structures Limit 10.000
Window Garage
Roof Dog kennel Limit 100
Painter
Figure 1 Benefit type tree for losses with buildings
Building
Expenses
Adjuster Fee
Police Report
In-house lawyer
Figure 2 Benefit type tree for expenses
© SAP AG FS335 2-56

1-11 Define Benefit Type Tree
1-10-1 Create Benefit Type Tree
Define Benefit Type Trees for the attached Benefit Type Trees by processing
customizing activity:
Claims ManagementÆ ClaimÆ Business SettingsÆ Claim ItemÆ Benefit
Types)Æ Configure Benefit Type Trees.
When creating the following benefit type trees, make sure you choose the
correct category of the tree (either loss or expense). If you chose the wrong
category you won’t be able to assign the benefit type tree.
BTT##B ## Building for losses with buildings
(Use category ONLY LOSSES)
BTT##BE ## Expenses for costs arising during the course of
claims processing
(Use category ONLY EXPENSES)
Set the validation date to January 1st of this year.
1-10-2 Change Benefit Type Tree
Enter a description for the generation and the version.
Set the currency to EUR. Flag the checkbox For Coverage Type.
1-10-3 Assign Benefit Types to Tree
Assign the Benefit Types to the Benefit Type tree.
Choose for each Benefit Type if it should be selectable for Claim Items and
Payments. Normally, “bundling” benefit types are not selectable, e.g.
Building, Other Structure, Building Expenses.
Enter the Higher Benefit Type according to the tree.
Select Deductible 01 After Limit if a deductible should be available for that
Benefit Type. This setting has the effect that in the compensation calculation
the limit is applied before the deductible. This is only possible for loss
benefit types.
Enable the display of Limits in the tree if any exist. This is only possible for
loss benefit types.
To visualize the structure of your benefit type tree, select your tree
in the benefit type tree overview screen and press the overview icon
.
To delete a benefit type tree, select your tree in the benefit type tree
overview screen. Then choose in the menu Benefit Type TreeÆ
DeactivateÆ Delete from the database.
© SAP AG FS335 2-57

1-12 Assign the loss Benefit Type Tree to Coverage Type
Assign the new loss Benefit Type Trees BTT##B to the Permitted Coverage Type
CT##B of the Product PP##.
Path: Claims ManagementÆ ClaimÆ Product ConfigurationÆ Configure Products.
© SAP AG FS335 2-58

Claim Handling Configuration
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 3-1

Claim Handling Configuration
Contents:
Internal Claim Types

Participants
Objects
Claim Items
External Service Providers
Reserves
© SAP AG 2006
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Claim Handling Configuration : Unit Objectives

Create the customizing for the internal claim type
Understand the customizing for participants
Understand the customizing for objects
Understand the customizing for claim items
Create the customizing for external service
providers
Create the customizing for reserve handling.
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Internal Claim Type: Topic Objectives

Understand the function of the internal claim type in
FS-CM
Locate the internal claim type in the FS-CM data
model
Understand the structure and the most important
attributes of the internal claim type and its function
Understand the versioning concept of the internal
claim type
Configure the internal claim type.
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Internal Claim Type: Definition
The internal claim type, together with the policy,

describes the overall appearance and behavior of a claim.
Each claim has exactly one internal claim type.
The internal claim type is derived from the policy product

and the incident type, when a new claim is created.
The internal claim type and the version thereof that are
used for a claim are determined when the claim is
created, and they are saved with the claim
Internal claim types and their determination are defined in

Customizing.
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Internal Claim Type - Data Model
Loss Incident Type n m

Policy Product
Internal Claim Type
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Internal Claim Type - Structure
Internal Claim Type
Claim Header
Subclaim
Damaged Objects
Claim Item Group
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Internal Claim Type – Versioning 1
Need for time-dependent changes

... extensive programming
Version-
enabled
Not
version- The screen sequences are defined in the BDT. The
BDT itself is not version-enabled.
enabled
Performance is increased if there is no version-
enabling
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This indicator determines the technical status of an object.

A = Active
There are insurance-related points in time at which this
version is the valid version. An object can have several
active versions at different insurance-related points in time.
S = Suspense
The version has been parked and saved. Otherwise it has
no effect on the behavior of the system.
I = Inactive
The version is no longer valid at any insurance-related point
in time. It is only retained for tracking purposes. An inactive
version is a version that was once active in the system.
D = Active Deletion Entry
This version is only for recording which user deleted the
object at what time. In addition, the deletion flag is always
set with entries with this technical status.
T = Transported
This entry was transported via the transport tool and needs
to be activated first. Then further changes can be
processed.
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Coverage types (creation of subclaims)
Benefit type tree
Reserves
SFC ....
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Corresponding to „version" of the product Version of benefit scope at the time of the loss
(on policy side) incident
Options to change
Internal Claim Type Version
Options to change
Internal Claim Type Generation
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Versioning of benefit side (claim)

Example: A legal change means that the
copayment for dental ceramic fillings is
increased from € 80 to € 85.
Result: Change to benefit tree independent of
What is the reason for a change to the tariff!
generation ?
Example: Changes in tariff (product) 2005 2006
TA09 TA09a
2005 2006
TA09 TA09a Generation Generation
1 2
Generation Generation € 80 € 85
1 2
Following a change to the tariff Regardless of the tariff, changes

(accompanied by a change to the might have to be made to the benefit
generation), the customer is usually sent scope because of legal stipulations;
a letter asking if he/she wants to convert this leads to a renewal of the valid
the existing tariff to the new one – he/she version (on the benefit side).
is not obliged to agree.
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When a claim is created, the generation and version of the

internal claim type that are valid at the time/date of loss are
stored in the claim.
Storage of this information is always associated with this
claim, regardless of new generations and versions of the
internal claim type.
There is a report for converting the internal claim type for
existing claims to another internal claim type
Update claims
© SAP AG 2006
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Configure Internal Claim Type
2
1
4
© SAP AG 2006
Setup a favorite for transaction ICLCVERM003 in the easy menu to access Internal Claim Type
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Configure Internal Claim Type 2
Structure of Internal Claim Type:
Internal Claim Type
Internal Claim Type

Generation
Internal Claim Type

Version
Claim Header
Subclaim
Damaged Objects
Claim Item Group
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Configure Internal Claim Type – Header level I 2

Settngs for duplicate check and no premium
Internal Claim Type paid check
Setting for when required entry check takes
place
Internal Claim Type Standard data for FS-CD document
Generation Sample template for contract account for
insurance object claim
Internal Claim Type Group of functions to be deactivated
Version Value requests for setting status (claim,
subclaim, payment, litigation)
Business process for internal claim type
Claim Header
Permitted claim bundle type
Specifies which dates are permitted for claim
creation
Subclaim
Number of permitted claimants for each claim
…
Damaged Objects
Settings for Each Version
Claim Item Group
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Configure Internal Claim Type – Header level II 2
Internal Claim Type Permitted Causes

Question Sequence for Facts Capture
Internal Claim Type Permitted Manual Tasks/Log Entries
Generation
Permitted Manual Documents
Internal Claim Type Permitted Claim Complexities
Version
Permitted Claim Status Reasons
Claim Header Permitted Categories Differences Log

Permitted Diagnosis Catalogs
Subclaim Permitted Participant Roles for

Interruption Times
Permitted Interruption Reasons
Damaged Objects
Permitted Document Types
Claim Item Group
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Configure Internal Claim Type – Subclaim level I 2

Specify how often a subclaim can be created
Internal Claim Type with this subclaim type, for each claim
Specify whether a subclaim is always to be
created or depending on an BRF expression
Internal Claim Type Standard reserve type
Generation Claims payment for deductible for direct
payments
Internal Claim Type Specify whether and when subrogation is to
Version be permitted for this subclaim
Reserve type for subrogation
Claim Header Specify whether and when salvage is to be
permitted for this subclaim
Reserve type for salvage
Subclaim Park payment default
Hide non-covered coverage types in claim
item list
Damaged Objects Benefit type tree (for expenses)
Settings for Each Permitted Subclaim Type

Claim Item Group
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Configure Internal Claim Type – Subclaim level II 2

Internal Claim Type
Permitted Subclaim Complexities
Permitted Claim Item Rejection Reasons
Internal Claim Type
Generation Permitted Subclaim Status Reasons
Permitted Manual Tasks/Log Entries
Internal Claim Type
Version Permitted Manual Coverage Referrals
Permitted Methods of Settlement
Claim Header Permitted Reserve Types
Permitted Manual Documents
Subclaim Permitted Benefit/Services/Fees Catalogs
Permitted Topics for Notes
Damaged Objects Permitted Communication Types for
Notes
Claim Item Group

Permitted Text Templates for Notes
© SAP AG 2006
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Configure Internal Claim Type – Damaged object 2
Internal Claim Type Permitted damage categories and

damage descriptors
Internal Claim Type Permitted damage severities

Generation
Internal Claim Type
Version
Claim Header
Subclaim
Damaged Objects
Claim Item Group
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Configure Internal Claim Type – Claim Item Group level 2
Internal Claim Type Value request for setting the status of claim
item grouping in this category
BRF expression for determining key date for
Internal Claim Type benefits catalog item determination
Generation
Permitted reasons for creation of claim item
grouping
Internal Claim Type Permitted specifications of a reason for
Version creation of claim item grouping
Permitted types for claim item grouping
Claim Header category
Permitted accident flags
Permitted subrogation claim flag
Subclaim
Damaged Objects
For each permitted subclaim type and claim
item grouping category
Claim Item Group
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Meaning of Subclaim Type:
The subclaim type classifies the subclaim
You must specify a subclaim type when creating a subclaim
In the customizing of the internal claim type, coverage types are

assigned to the permitted subclaim types
This subclaim type controls which rules apply in processing of the

subclaim.
For example, it determines the possible benefit types from the

expenses category, and the possible reserve types
© SAP AG 2006
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Define Screen Sequences for Expert Mode:
The definition of screen sequences takes place as:
A combination of internal claim type and claim handler

group
A standard screen sequence, meaning that you do not
specify the claim handler group
© SAP AG 2006
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Define Screen Sequences for Expert Mode:
For each internal claim type (or combination of internal claim type and claim
handler group), you define the screen sequences for the following areas,
specified by SAP:
Claim header
Subclaim (dependent on permitted subclaim types)
Damaged object (dependent on damage categories)
Participant (dependent on participant role)
You can also hide datasets
© SAP AG 2006
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Assign Internal Claim Type:
In this IMG activity, you assign an internal claim type

to a combination of policy product and incident type.
© SAP AG 2006
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Internal Claim Type: Topic Summary

Understand the function of the internal claim type in
FS-CM
Locate the internal claim type in the FS-CM data
model
Understand the structure and the most important
attributes of the internal claim type and its function
Understand the versioning concept of the internal
claim type
Configure the internal claim type.
© SAP AG 2006
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Participants: Topic Objectives
At the conclusion of this topic, you will be able to:

Configure participants.
© SAP AG 2006
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Configure Participants - Definition
Meaning of Participant Role:
You use the participant role to specify the meaning of the participant in
the current claim
The participant role is independent of the role in the business partner

system and the role in CRM
Changing or deleting entries delivered by SAP constitutes a modification

of the program.
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Configure Participants - Steps
1
2
3
4
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Configure Participants - Attributes 1
Enhance Participant Roles:
Key for participant role

Long name for participant role
Short name for participant role
BDT screen sequence category
Manual addition of participants permitted?
Is this a vendor role?
How often can you assign a participant role to a claim or a claim
subobject?
Specify whether you can swap participants with this role
Permitted claim subobjects (you can only create the participant
for these, in this role)
© SAP AG 2006
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Configure Participants – Role name 2
Define Names of Participant Roles:
You can adjust the names of the participant role to

accommodate company-specific terminology.
The long name is used on the participant screens.
The short name appears in expert mode, on the left-hand

side, in the list of participants.
© SAP AG 2006
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Configure Participants – Properties of roles 3
Characteristics of Participant Role:
Hiding in the participant list

Standard business partner category that is set as the default value
Subobject category that is set as the default value
Permitted as additional payee
You can use the Change BPCat field to specify whether the
specified business partner category can be changed when
creating a new business partner
Assignment of a business partner role to the participant role.
Assignment of a business partner role grouping
Define business partner relationship category.
© SAP AG 2006
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Configure Participants 4
Relationship Types to Policyholder:
In this IMG activity, you define the possible relationship

types for a claimant or a witness to the policyholder.
© SAP AG 2006
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Configure Participants – Screen Sequences
Define Screen Sequences for Participants in Expert Mode
© SAP AG 2006
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Participants: Topic Summary

Configure participants
© SAP AG 2006
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Objects: Topic Objectives

Configure objects
© SAP AG 2006
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Configure Objects - Definition
Meaning of Damage Category:
Classifies a damaged object.
Damaged objects with a different damage category have different

properties (such as different categories for insured objects)
© SAP AG 2006
Examples:
y Damaged vehicle
y Damaged building
y Injured person
y Damaged object
© SAP AG FS335 3-37

Configure Objects - Steps
1
2
© SAP AG 2006
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Configure Objects - Attributes 1
Enhance Damage Categories:
Key
Description
Category of insured object
Changing or deleting entries in this table that were delivered by

SAP constitutes a modification of the program.
© SAP AG 2006
Examples:
y AU Auto
y BI Injured person
y FL Financial loss
y PE Object
y RE Building
© SAP AG FS335 3-39

Configure Objects – Severity I 2
Meaning of Damage Severity:
Damage severity is used for:
Documentation for the claim
Definition of rules in the BRF for:

Controlling the claim
Statistical reserving
© SAP AG 2006
Examples:
y The following damage severities are defined for the Auto damage category: Undamaged/minor
damage/bodywork damage/total loss.
y A rule is defined in the BRF, which means that claims with the Total Loss damage severity can
only be assigned to certain claim handlers.
© SAP AG FS335 3-40

Configure Objects – Severity II 2
Define Damage Severities:
Damage category
Damage severity
Damage severity description
© SAP AG 2006
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Configure Objects – Types I 3
Meaning of object types:
The object types form a further grouping option within the

object category or damage category.
© SAP AG 2006
Example:
Object category/damage category vehicles -> types of damage/insured objects:
y Automobiles
y Motor vehicles
y Goods vehicles
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Configure Objects – Types II 3
Create Object Types:
Damage category
Object type
Description of damage category
Description of object type
© SAP AG 2006
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Configure Objects – Customizing Overview
Assignment of damage category to internal claim type and screen

sequence configuration
© SAP AG 2006
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Configure Internal Claim Type – Damaged object 4
Internal Claim Type Permitted damage categories and

damage descriptors
Internal Claim Type Permitted damage severities

Generation
Internal Claim Type
Version
Claim Header
Subclaim
Damaged Objects
Claim Item Group
© SAP AG 2006
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Objects: Topic Summary

Configure objects
© SAP AG 2006
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Claim Items: Topic Objectives

Configure claim items
© SAP AG 2006
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Configure Claim Items
© SAP AG 2006
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Configure Claim Items – Benefit types I 1
Unique ID for classification of receivable or benefit
The benefit type defines which limits and deductibles apply,

and against which reserve the payments should be offset
Each claim item must have a benefit type
Each payment item must have a benefit type
© SAP AG 2006
See details about Benefit types in Unit 2 Product Configuration
© SAP AG FS335 3-49

Configure Claim Items – Benefit type area I 2
Meaning of Benefit Type Areas:
Grouping benefit types

Benefit type areas are used for evaluations in reporting.
Configuration of Benefit Type Areas:
Key for benefit type area

Name of benefit type area.
© SAP AG 2006
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Configure Claim Items 3
Meaning of Object Type for Claim Item:
The object type classifies a claim item in greater detail than the
benefit type.
You can use the object type to enter additional data during claim item
entry.
The object type has no influence on limits and deductibles that are
valid for the claim item. The same limits and deductibles apply for all
claim items of the same benefit type.
All object types created here are automatically given the damage
category of item (PE). For other damage categories (such as Vehicle),
you create damaged objects. A damaged object can give rise to
several claim items.
The object type of the claim items is a special form of the object type
of the insured object, but it refers exclusively to the damage category
of Item (PE).
© SAP AG 2006
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Claim Items: Topic Summary

Configure claim items.
© SAP AG 2006
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External Service Provider: Topic Objectives

Understand the integration of external service
providers
Describe the steps how to create new evaluation
criteria
Configure external service providers.
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External Services
Claim handling may require the services of an external vendor

such as :
Rental car company
Water/smoke removal service
Repair shop
and so on
These vendors need to be managed to make sure that price and

service quality are maintained.
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External Service Provider – Customizing steps
Make add. evaluation criteria Create additional

available on relevant evaluation criteria
business partner roles
Define Procurement
Make add. evaluation
Transaction per type of
criteria available in the
service (Repair shop,
evaluation BAdI
Carpet cleaner etc.)
Assign Participant Roles

Assign LoB
Define evaluation criteria
© SAP AG 2006
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External Service Provider – Customizing Steps in the IMG
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External Service Provider – Evaluation Criteria
Define evaluation criteria for evaluating external services:
SAP standard delivered

evaluation criteria
© SAP AG 2006
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External Service Provider – Evaluation Criteria
After the definition of the evaluation criteria as such, the relevant

attributes need to be defined for the procurement transactions:
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External Service Provider – NEW Evaluation Criteria
For new non-standard evaluation criteria, the following steps need to

be performed:
Make criteria available in the evaluation BAdI
Make criteria available in the

external service provider
business partner role
via BDT
© SAP AG 2006
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External Service Provider : Topic Summary

Understand the integration of external service
providers
Describe the steps how to create new evaluation
criteria
Configure external service providers.
© SAP AG 2006
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Reserves: Topic Objectives

Understand the principle of reserves
Configure reserves
© SAP AG 2006
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Reserves - Definition
Meaning of Reserve Type:
Classifies a reserve.
Enables automatic assignment of payment items to the

correct reserve.
It determines how and whether automatic reserves are set,

and how the reserves should be posted to the general ledger.
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Reserves - Customizing
© SAP AG 2006
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Reserves – Types I 1
Define Reserve Types
Key
Description
Reservation category for reserve type
Standard unit for setting reserves
Specify whether the reserve type refers to losses or expenses (claim
settlement expenses).
Specify whether this is an expectation reserve
Specify whether the reserve type is claim-dependent or cross-claim
For each reserve type define the interface to the general ledger.
© SAP AG 2006
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Reserves – Types II 1
Define Reserve Types
b
c
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Reserves - Category a
Reserve Category
Controls which fields are used to set reserves.
Possible reserve categories are fixed and specified by SAP:
Per diem hospital benefit

Standard (with unit)
Standard (without unit)
Example: If you select the Per Diem Hospital Benefit reserve category, the system
includes the Number of Days and Per Diem Amount fields. The reserve is then
calculated from the number of days X per diem amount.
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Reserves – Expectation Reserve a
Expectation Reserve
If you set this flag, you expect incoming payments for the benefit type
and associated reserve type, meaning transactions for subrogation,
salvage or loss allocation agreements.
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Reserves - Assignment c
Reserve Type is Claim-Dependent or Cross-Claim
Defines whether the reserves for this reserve type can be set in
individual claims (claim-dependent), or whether they can be set for
claim bundles (cross-claim).
© SAP AG 2006
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Reserves - Customizing
Assignment of Reserve Types to Permitted Subclaim Types of the

Internal Claim Type:
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Reserves – Internal Claim Type I 2

Standard reserve type
Internal Claim Type Reserve type for subrogation
Reserve type for salvage
Internal Claim Type
Generation Permitted reserve types
Internal Claim Type

Version Settings for Each Permitted Subclaim Type
Claim Header
Subclaim
Damaged Objects
Claim Item Group
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Reserves – Internal Claim Type II 2
Configure Internal Claim Types – Subclaim Details
© SAP AG 2006
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Reserves - Types 2
Standard Reserve Type

The standard reserve type defines the reserve type that is created when opening a
subclaim. This must always be a Losses reserve. When opening a subclaim, the
user only enters the amount for the reserve, and does not need to manually define
the reserve type.
Reserve Type for Subrogation

The subrogation reserve type defines the reserve type that is created when
creating a subrogation in the subclaim. This is normally a Loss reserve. With
subrogation, the system calculates the reserve and the user does not need to
enter reserves manually for the subrogation.
Reserve Type for Salvage

The salvage reserve type defines the reserve type that is created when evaluating
a salvage in the subclaim. This is normally a Loss reserve. With salvage, the
system calculates the reserve and the user does not need to enter it manually.
© SAP AG 2006
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Reserves – Internal Claim Type 3
Configure Internal Claim Types
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Reserves – Permitted Reserve Type 3
Assign Permitted Reserve Type
Definition of permitted reserving methods for the

reserve type.
When opening a subclaim, the system automatically

applies the reserve type that was defined for each
subclaim type.
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Reserves - Methods 3
Reserving Methods
Statistical
Conditions that you can set produce a lump sum that is set as the
reserve. The processing clerk can overwrite this default value.
Manual
The processing clerk sets or increases the reserve.
Using Compensation Calculation

The reserve is calculated from the claim items (taking compensation
calculation into account, since deductible, underinsurance, and so
on, are not relevant costs for the payment).
Redistribution
If the reserve is increased (manually or automatically by the system),
the system redistributes the amount over the claims according to a
specific distribution key.
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Reserves: Topic Objectives

Understand the principle of reserves.
Configure reserves.
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Claim Handling Configuration: Unit Summary

Create the customizing for the internal claim type
Understand the customizing for participants
Understand the customizing for objects
Understand the customizing for claim items
Create the customizing for external service providers
Create the customizing for reserve handing.
© SAP AG 2006
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Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 3-78

Exercises
SAP WS Claims
Exercise: Internal Claim Type Configuration I
Status: ERP 2005

• Create Internal Claim Types
Situation:
to configure an Internal Claim Type

twice. Note down
1-2 Create an Internal Claim Type

Create Internal Claim Type CT## with the description ## Home Owners Fire.
Claims ManagementÆ ClaimÆProcess Control (Internal Claim Types)Æ Configure
Internal Claim Types.
Set the validation date to January 1st of this year.
© SAP AG FS335 3-79

1-3 Configure Internal Claim Type
1-3-1 Configure Claim Header
Select your new internal claim type, select the “Claim Header” radio button on
the right and press the change button.
Chose a name for the generation and the version of the internal claim type. Use
the navigation tree on the left to navigate between generation, version and other
levels of the internal claim type.
Set the currency to EUR on the version level of the internal claim type.
Enable the duplicate check and set the deviation period to 5 days.
Disable the premium check.
Select the BRF value request CLMST for setting Claim Status.
Select BRF value request SCLST for setting Subclaim Status.
Select BRF value request 5PAYSTATUS for setting Payment Status.
1-3-2 Define Subclaim Types
Create Subclaim Types by using customizing activity:
Claims ManagementÆClaimÆProcess Control (Internal Claim Types)Æ
Define Subclaim Types.
S##C ## Home Contents Damage
S##B ## Home Building Damage
S##L ## Liability Property Damage
Note that the subclaim type S##L represents a liability subclaim.
1-3-3 Configure subclaim level of internal claim type
Claims ManagementÆClaimÆProcess Control (Internal Claim Types)Æ
Configure Internal Claim Types.
Select your new internal claim type, select the “Subclaim” radio button on the
right and press the change button.
Create a new entry for each subclaim type of exercise 1-3.2.
For subclaim type S##B assign the benefit type tree BTT##BE for expenses.
Only allow the liability subclaim type to be created once per claimant. The other
two can only be created once per claim.
Create an additional entry for subclaim type blank that will represent the claim
level. In order to be able to create claim items and payments on the header of a
claim you can assign the benefit type tree BTT##BE to this subclaim type as
well.
1-3-4 Assign complexity levels
Select a subclaim and double-click on “Permitted Subclaim Complexities” in
the navigation bar on the left.
Chose complexity levels for each subclaim type of your choice.
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1-3-5 Assign screen sequence for Internal Claim Type
Process the following customizing activity in order to assign the (BDT) screen
sequences to the navigation tree of the notification mode.
Claims Management Æ Claim Æ Process Control (Internal Claim Types)Æ
Internal Claim Type: Specify CH Group+Screen Sequences for Other
Proc.Modes.
Create an entry for your Internal Claim Type, choose notification mode and the
standard user group.
Select the new entry and choose the Node Category in the navigation tree. Now
create the following entries:
Node Description Screen Sequence

Cat.
0 Claim ICNH
A Injured Third Parties CL56
B Witnesses CL64
Q Quick Claim QC02
Q1 Claimant in Quick Claim QC03
1-4 Assign Internal Claim Type to Product

Claims ManagementÆClaimÆ Process Control (Internal Claim Types)Æ Assign
Internal Claim Type to Combination of Policy Product + Incident Type.
Change the policy product PP##. Use the change button on the right-hand side.
Assign the Internal Claim Type CT## to the Incident Types I##F and I##T.
Activate the internal claim type and the policy product after you have done the changes.
To do that select your policy product PP## on the overview screen and press the
button to activate.
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SAP WS Claims
Exercise: Internal Claim Type Configuration II
Status: ERP 2005

• Assign Coverage Types to the Internal Claim Type
Situation:
configure an Internal Claim Type.

twice. Note down
1-6 Assign Coverage Types to Internal Claim Type

Once you have registered Subclaim Types to the Internal Claim Type, a Coverage Type
has to be assigned to each Subclaim Type. Select customizing activity
Claims ManagementÆClaimÆProcess Control (Internal Claim Types)Æ Configure
Internal Claim Types.
Select your Internal Claim Types and change the subclaim settings. Then choose the
navigation tree node Permitted Coverage Types in order to add the following assignment:
Subclaim Type Coverage Type

SXXB CTXXB
SXXC CTXXC
SXXL CTXXL
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© SAP AG FS335 3-84
SAP WS Claims
Exercise: Damaged Object Configuration
Status: ERP2005

• Create Damaged Object configuration
Situation:
configure a Damaged Object.

twice. Note down
1-8 Review category of damaged object

Have a look at the configuration of the damaged object for the category Building by
navigating to customizing activity.
Claims Management Æ Claim Æ Business SettingsÆ Damaged Objects/Diagnoses Æ
Damaged Objects/Injured PersonsÆ Enhance Damage Categories.
Which internal object category is assigned to entry Building? _________
Which screen sequence is assigned to entry Building? _______________
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1-9 Configure Damage Descriptors
1-9-1 Configure Damage Descriptors
Add damage descriptors for buildings by using customizing activity
Claims Management Æ Claim Æ Business SettingsÆ Damaged
Objects/Diagnoses Æ Damaged Objects/Injured PersonsÆDefine Damage
Descriptors.
Add the following entries for damage category RE - Building:
Damage Descriptor ##1 Wall
Damage Descriptor ##2 Roof
Damage Descriptor ##3 Door
Make sure you select the checkbox Damage Descriptor so the descriptors will
be available on the screen.
1-9-2 Assign to Internal Claim Type
Assign damage category RE to the buildings subclaim type of your Internal
Claim Type (choose level Damaged Objects when changing the Internal Claim
Type).
Assign the damage descriptors from above to the damage category RE.
Activate the internal claim type.
1-10 Review further setting

1-10-1 Type of Damaged Object
Review customizing activity
Claims ManagementÆClaimÆBusiness SettingsÆ Damaged
Objects/DiagnosesÆDamaged Objects/Injured PersonsÆDefine Type of
Damaged or Insured Object.
Which types of damaged objects are customized for Building (RE)?
1-10-2 Construction material
Claims Management Æ ClaimÆ Business Settings Æ Damaged
Objects/Diagnoses Æ Damaged Objects/Injured PersonsÆ Define Main
Construction Materials of Building.
Which materials are customized for Building (RE)?
1-10-3 Define Scope of Loss
Claims Management Æ Claim Æ Business SettingsÆ Damaged
Objects/Diagnoses Æ Damaged Objects/Injured Persons Æ Define Scope of
Loss.
Which values for scope of loss are customized for Building (RE)?
© SAP AG FS335 3-86

SAP WS Claims
Exercise: Reserve Configuration
Status: ERP 2005

• Configure reserves
Situation:
configure reserves.

twice. Note down
1-12 Define reserve types
Define reserve types by navigating to customizing activity:
Claims Management Æ ClaimÆ Business SettingsÆ ReservesÆ Reserving in ClaimÆ
Define Reserve Types.
Create the following reserve types:
- ## Losses for 1st party
- ## + 20 Expenses
The reserving will be based on the reserve category Standard (w/o Unit) and Claim-
Dependent. Select the corresponding category Losses or Expenses.
© SAP AG FS335 3-87

1-13 Define Standard Reserve Type for Internal Claim Type
1-13-1 Assign reserve types to internal claim type
Assign the reserve types to the internal claim type as follows:
Subclaim Reserve Method Default Minimum
type type reserve reserve
S##B ## Statistically, manually €200 €200
S##B ## + 20 Manually €20 €0
Blank ## + 20 Manually €10 €0
Activate your internal claim type!
1-13-2 Assign reserve types to Benefit Type Tree
Assign a reserve type to the top level benefit type of your corresponding benefit
type trees.
Chose ## for losses of coverage type Building.
Chose ## + 20 for expenses.
Activate your Benefit Type Trees!
© SAP AG FS335 3-88

User Interface Configuration
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 4-1

Integration
Contents:
Business Data Toolset (BDT)

Claim Handler Group Customizing
Screen Sequence Assignment
© SAP AG 2006
© SAP AG FS335 4-2

User Interface Configuration: Unit Objectives

Understand principles of the Business Data Toolset
regarding user interface configuration.
Adjust screen sequences and screens according to
customer requirements.
Understand how to create claim handler groups.
Understand how to assign screen sequences to
navigation tree nodes.
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BDT: Topic Objectives

Understand the principles of the Business Data
Toolset regarding user interface configuration.
© SAP AG 2006
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Official SAP Course on the BDT
CR 590
Business Data Toolset
© SAP AG 2006
© SAP AG FS335 4-5

Dramatic Increase in Speed of Change in Insurance Industry
Shorter product cycles

as a result of prevailing political situations
as a result of worldwide competition
call for
new products
with new attributes/features
with new functionality
placing new demands on
architecture/data models
integration of new entities
enhancement of old entities
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Integration of the BDT
Modification-free, customer-specific enhancement

For mapping highly specialized processes
In the structures of master and transaction data
Design targets
Extensibility
Configurability
Divisibility
Alternative user interfaces
Generic object services
The focus in the next part of this presentation is on Alternative

User Interfaces
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BDT - Screen Structure
Create your own screens with Drag & Drop

Screen Î Section Î View Î Field
A screen contains one
or more sections
A section contains
one or more views
In a view, several attributes
(fields) are grouped together
With Drag&Drop (Customizing) you can

Hide sections, change the sequence,
and add new sections
Hide fields
With programming you can

Add fields
Create other checks
© SAP AG 2006
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BDT - Screen Structure
Integrate your own attributes in the application

SAP Structure Own Structure
Own Attribute
SAP Attribute
Own Attribute
SAP Attribute
Own Attribute
SAP Attribute
Own Attribute
Enhancements
Own Attribute
Authorizations
Own Attribute
Own Attribute
Field status editable
Viewable?
Ready for input?
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BDT - Screen Sequence
Previous Picture
(F7, enter)
Picture Picture Picture Picture Picture

1 2 3 4 5
Next Picture
(F6)
Make the processes suit your own needs
Insert additional screen Group information

Previous Picture Previous Picture
(F7, enter) (F7, enter)
Picture Picture Picture Picture Picture Picture Picture Picture Picture

1 2 3 V1 4 5 1 2-4 5
Next Picture Next Picture

(F6) (F6)
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BDT in FS-CM
The Business Data Toolset is firmly integrated in FS-CM
The Business Data Toolset can be used immediately without any

further preparation
Significant features are already used in FS-CM

Screen sequences are configurable
Individual screens are configurable
Delivered functions use the Business Data Toolset

Claim handler assignment
Authorization assignment up to field level
and others . . .
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BDT in FS-CM - User Modes
You can create different user modes for a business

process - Example: Automobile
Quick claim Notification mode Expert mode
Start-to-finish Capture of complex claims Creation and processing of

processing of simple without further processing claims
claims
Realized as screen sequences that are processed one The claim handler recognizes the
after the other. Navigation with the mouse is possible. structure of the case immediately
and can navigate to specific targets
with the mouse
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BDT in FS-CM - Line of Insurance View
The user modes can differ with each line of insurance

Example: Notification Mode
Auto Content Home Content
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BDT in FS-CM – Screen Configuration I
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BDT in FS-CM – Screen Configuration II
Internal claim
types level
Screen
sequence type
Claim mode
level
Claim handler
group level
Configuration
applied
Screen
sequence level
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BDT in FS-CM – Screen Configuration III
Adjustments to
Screen sequence
Sections
Views
Field groups
possible
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BDT: Topic Summary

© SAP AG 2006
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Claim Handler Group: Topic Objectives

Explain the principles of the claim handler group.
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Claim Handler Group
Claim handler groups are required for determination of screen sequences.
A claim handler group is assigned to the profile of the user.
© SAP AG 2006
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Assign Claim Handler Group to User Profile
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Claim Handler Group: Topic Summary

Explain the principles of the claim handler group.
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Screen Sequence Assignment: Topic Objectives

Explain how to assign screen sequences to the
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Assignment to node Assignment of BDT

category of navigation tree screen sequence
Areas of the claim
© SAP AG 2006
You would normally define screen sequences for a combination of internal claim type and claim
handler group. However, you can also define screen sequences without specifying the claim handler
group. The system assumes that these screen sequences are standard screen sequences. You can also
define different screen sequences for special claim handler groups.
On the basis of the screen sequences provided by SAP in the Business Data Toolset (BDT) you can
also define own screen sequences and store them here. (You can find further information on the BDT
in the Application Help for the Claims Management system. Path: Claim Æ Basic Functions Æ
Business Data Toolset (BDT) in Claims Management System).
© SAP AG FS335 4-24

Screen Sequence Assignment: Topic Summary

Explain how to assign screen sequences to the
© SAP AG 2006
© SAP AG FS335 4-25

User Interface Configuration: Unit Summary

Understand how to create claim handler groups.
Understand how to assign screen sequences to
navigation tree nodes.
© SAP AG 2006
© SAP AG FS335 4-26

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 4-27

© SAP AG FS335 4-28
Exercises
SAP WS Claims
Exercise: Screen Sequence Configuration for Expert
Mode
Status: ERP 2005

• Create Screen Sequence Configuration for Expert Mode
Situation:
to configure the screen sequences for the Expert mode.

twice. Note down
1-2 Assign screen sequences for Expert Mode

In order to define the screen sequences that will be used in Expert mode, navigate to
customizing activity.
Claims ManagementÆClaimÆProcess Control (Internal Claim Types)Æ Internal Claim
Type:Specify Claim Handler Group+Scrn Sequences f.ExpertMode.
In order to simplify the customizing, copy the entries from the internal claim type CT99
to your internal claim type CT##.
Choose the internal claim type CT99 and press the “copy” icon. Specify your claim type
name (CT##) and press enter. On the following pop-up choose to copy all entries. The
system will produce an error on the subclaim screen – you have to overwrite the
subclaim types of the template with your subclaim types (i.e. S##B, S##C, S##L).
© SAP AG FS335 4-29

1-3 Create claim
1-3-1 Create claim
Create a claim for the incident type Fire by using the Expert Mode.
Choose your LoB, enter a claim date (today) and the incident type, and then
press enter.
Create a subclaim for coverage Building (press the „Maintain Subclaims“
button).
Use the checkbox Display Not Covered Coverages As Well.
Optional question: How do you control if the coverages are displayed or not?
Select the Building subclaim type and enter Siegel## as the insured person.
1-3-2 Reserves
Verify that your reserves are created statistically the way you set up the
customizing.
Goto the reserve screen of the subclaim.
Change the reserve manually and check the reserve history.
© SAP AG FS335 4-30

SAP WS Claims
Exercise: Contract Creation
Status: ERP 2005

• Create a contract
Situation:
configure a contract to simulate the integration to a policy system.
Note:
This exercise is only valid in this training system. The creation of a
policy will look different in your system. In this training system a policy
is sttored in a similar way as a claim. You will use this policy for creating
a claim to check further customizing.

twice. Note down
1-5 Contract Creation

Create a claim via Expert mode.
1-5-1 Entry screen
On the entry screen choose your line of business.
Enter January 1st of this year as the loss date.
Choose any incident type.
Enter CONTRACT##1 in the claim number field.
Press Enter.
1-5-2 Create dummy claim for Contract
Chose the “Change Pol. Snapshot” button or select Edit Æ Further Processing
Æ Change Policy Snapshot in the menu.
Enter CONTRACT##1 in the contract field.
Save the claim. Press Enter on the popup.
© SAP AG FS335 4-31

1-5-3 Change policy snapshot
Enter the following general information:
Contract Start January 1st of this year
Contract End December 31st of this year
Insured Alf Siegel##
In case the business partner does not exist, then press the Create New Business
Partner button at the bottom of the result screen of the business partner search.
Choose Person as the business partner type.
Complete the data for the new business partner:
Form of address: Mr.
Name: Siegel##
First name: Alf
Street: Walldorfer Str. 12
Postal Code/City: 75000, Karlsruhe
Date of birth: 12.02.1977
Tel. 0721/434394
Bank key: 30020900
Account: 123456
Account holder: Alf Siegel##
Enter the following coverages on the coverage tab:
Coverage Coverage Type
01 CT##B
02 CT##L
03 CT##C
1-5-4 Add insured object
Select the Insured Objects tab and add an insured object by pressing the Create
button.
Choose object type “Castle” and enter Heidelberg Castle (construction year
1742 and made of stone) in the description field.
As the address enter:
At the Castle 1
69124 Heidelberg
Germany, Baden-Württemberg
Save the policy snapshot.
© SAP AG FS335 4-32

SAP WS Claims
Exercise: Screen Configuration
Status: ERP 2005

• Change the screen configuration
• Use the visual configuration tool
Situation:
configure BDT screens.

twice. Note down
1-7 Create a new claim

Policy: CONTRACT##1 ## = Group Number
Incident Type: I##F
1-8 Analyze the screen configuration for the screen sequence category ICLC00 (Æ
function code SSEQ_DIAG)
To display the screen sequence, enter SSEQ_DIAG in the command line or enter “help”
in the command line and chose the above mentioned function code.
You will see the screen sequence of the node which you are currently displaying on the
navigation tree (context sensitive display).
1. Make yourself familiar with the meaning of the different terms.
Æ Screen Sequences
Æ Screens
Æ Sections
Æ Views
Æ Field Groups
Æ Fields
© SAP AG FS335 4-33

2. Write down the assigned screen sequence:
Claim Header Home Contents Overview: ____________
3. Write down the technical keys for the following screens:
Activity Log: ____________
Claim Header Notification Data: ____________
Claims Items: ____________
4. For the screen Claim Header: Write down the technical keys for the following
sections:
Change Information: ____________
6. Write down the technical keys for the following field group:
Authorization Group VIP _____________
1-9 Copy screen sequence

1. Open another mode and use transaction ICLWM
2. Navigate to Screen Layout Æ Screen Sequences
3. Copy screen sequence CL01H as Z##H ##: Group Number
Copy all depending entries
4. Why do you get a warning? Do you have to change something?
1-10 Assign new screen sequence Z##H to Screen Sequence Category ICL00
1-11 Change screen sequence in the implementation guide for Internal Claim Type CT##
1. Navigate to the screen configuration customizing of the expert mode (Claim Æ
Process Control Æ Internal Claim Type:Specify Claim Handler Group+Scrn Sequences
f.ExpertMode)
2. In the claim header configuration: Change screen sequence CL01H with your new
screen sequence Z##H
3. Open your claim and check the result with function code SSEQ_DIAG.
1-12 Change field status

Assume that the field “authorization group” is not needed in your companies claims
process. Here is what you need to do in order to hide the field:
1. Use transaction ICLWM Æ Customizing Æ Field Modification Æ Activity
2. For all three activities: Choose Data Set Claim 1 and Hide Field Group 144.
3. Open your claim and check the result with transaction SSEQ_DIAG.
© SAP AG FS335 4-34

1-13 Change screen configuration
Now you will change the sequence of screens. Assume that the first screen should be the
Claim Overview, the last screen should be the Activity Log. The [Claim Items] screen is
not necessary at all.
1. Use transaction ICLWM Æ Screen Layout Æ Screen Sequences
2. Mark your screen sequence Z##H and choose the folder Screen Sequence Æ Screens
3. Delete the line for the [claim item] screen and change the order of the other screens
according to the description above. To change the order of the screens simply copy the
Activity Log screen and assign it to the highest Item number (e.g. 2000010), then delete
the original row (Item 100000).
4. Open your claim and check the result.
1-14 Configure the screens with the visual configuration tool

1. Use transaction ICLWM Æ Customizing Æ Screen Configuration
2. Choose internal claim type CT## Æ Expert Mode Æ Standard User Group Æ Claim
Overview Æ Claim Header …
3. Change the screen sequences
4. Change the title for the tab [Claim Overview] to [Status]. Double-click on the title to
do that.
5. Change the order and description of some sections.
© SAP AG FS335 4-35

© SAP AG FS335 4-36
Business Rules BRF and Tasks
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 5-1

Business Rules (BRF) and Tasks
Contents:
Business Rule Framework (BRF)

Activity Management
Workflow
Claim Handler Assignment
Role Based Performer
© SAP AG 2006
© SAP AG FS335 5-2

Validations and Tasks: Unit Objectives

Understand the principles of the Business Rule
Framework (BRF).
Create BRF rules including expressions and tasks.
Understand Activity Management.
Explain how the workflow is integrated into the
Claims Management System
Configure claim handlers as part of an
organizational unit
Configure the assignment of claim handlers.
© SAP AG 2006
© SAP AG FS335 5-3

BRF: Topic Objectives

Framework (BRF).
Create BRF rules including expressions and tasks.
© SAP AG 2006
© SAP AG FS335 5-4

BRF- Basic Principle
At certain events
Example: Approval of a claim payment
...
rules are defined
Example: Check entitlement to payment
...
whose Boolean expressions are based on business data
Example: Check invoice items
Example: Check payout amount
...
and trigger one or more actions. Rule
Example: Generate coverage referral
Business
Example: Stop payment
... Framework
© SAP AG 2006
© SAP AG FS335 5-5

BRF in Program Flow
Program Flow
Business partner changed, Event ‚Change to business partner ‘

ENTER button pressed
‚Business partner address Rule

is incomplete‘ Rule ‚Notify claim handler‘
Rule
Calculating Rule
Actions
Expression
if business partner address is Action
incomplete, then notify claim handler Action
Action
Procuring Calculating Action
Expression Expression
Procuring Procuring
Expression Expression
Rule are implemented customer-specific and modification free
© SAP AG 2006
Customer can create own BRF Events in customer specific coding.
© SAP AG FS335 5-6

BRF – Events
Definition of Event:
Events are points in the program of the application using the BRF at
which there should be the possibility of using rules to evaluate current
data and possibly make changes.
BRF events and their relevant contexts are therefore defined by the
developers of the application.
Within the program, FS-CM offers around 150 events that have been
preconceived by developers and that can be "refined" by customers.
Within an application, calling an event triggers the BRF.
© SAP AG 2006
Examples of events in the FS-CM application:

y Check claim header
y Health insurance: Check invoice
y Duplicates found after initial screen
y Loss location address changed
y Change diagnosis
y Check claim items
y Perform pending task
y Send money request
y Policy snapshot has changed
y Create subclaim
y Witnesses exist
y …
© SAP AG FS335 5-7

Events: Example with Parameterization
© SAP AG 2006
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BRF – Rule
Definition of Rule:
(For practical purposes), any number of rules can be assigned to each

event. It is also permissible not to assign any rule
In the BRF the following principle is regarded as a rule:
if <Expression> then <Action>
or
„If a condition defined by an <Expression> is true, then the assigned
<Action> is performed.”
The BRF supports the possibility of parameterizing rules. In FS-CM,
parameterization takes place on the basis of the LOB and internal
claim type.
© SAP AG 2006
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Rule: Example with Parameterization LOB and Claim
Type
© SAP AG 2006
BRF Rules can be filtered by the line of business as well as by the internal claim type.
© SAP AG FS335 5-10

BRF – Rule Set
Definition of Rule Set:
The rule set concept offers the option of grouping rules that are
connected in the business sense but distributed over several
events, and then activating or deactivating them together.
© SAP AG 2006
Example:
y Rule set used for payment check
y Rule set used for coverage check
y Rule set used for invoice check
© SAP AG FS335 5-11

BRF – Expression
Definition of Expression:
An expression in BRF terms is an object that returns a result of a

primitive type.
Expressions can also be nested. This means that there are

expressions that access other expressions, and expressions that
do not access any other expressions (final expressions).
Expressions can be split into value requests (VR) and operations

(OP).
© SAP AG 2006
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BRF – Expression
Value procurement
Constant
Simple value request (field of a structure)
Field of a line of an internal table
Random figure generator
Call function module/method
Operations
Operators
Boolean 3-operand arithmetic
Truth table
Case expression
SAP formula interpreter
Single-line formula interpreter
Other
Control predicate
© SAP AG 2006
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Example of Expressions: Simple Value Request
Definition of Simple Value Request:

A simple value request enables access to a field of a structure of the application. On
the application side, only a procurement function module needs to be implemented.
This FM makes the structure available to the BRF. The BRF then extracts the
specified field itself.
Example:
© SAP AG 2006
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Example of Expression: Truth Table
Definition of Truth Table:

Truth table or 'Bit pattern detection' is an expression whose inbound expressions
are all Boolean, and that delivers a scaleable return value.
Example:
© SAP AG 2006
The example shows the truth table to determine the claim status.
The same concept is used for the determination of the subclaim and payment status.
© SAP AG FS335 5-15

Example of Expression: Field of a Line of an Internal
Table
Definition of Field of Line of an internal Table:

Like simple value request. In addition, the corresponding table line is specified
using a select-like mechanism: SELECT <FELD> FROM <ITAB> WHERE
<CONDITION>
Example:
© SAP AG 2006
© SAP AG FS335 5-16

BRF – Action
Definition:
An action is a BRF object.
An action is characterized by the fact that is does something

automatically.
Note that actions have nothing to do with Activity Management.
Examples:
Create output message
Create prompting text
Create log entry
Create/cancel task
Create correspondence proposal
Create coverage referral
Call function module
Trigger BOR event
© SAP AG 2006
An action is the term for any manipulation of any data sets that makes sense from a business point of
view and that can be performed technically.
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Example of Actions: Activity Log
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Example of Actions: Create Task Without Variables
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Example of Actions: Create Task with Variables
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BRF – Workbench
© SAP AG 2006
You can manage BRF objects in the BRF Workbench (this is similar to the ABAP Workbench).
Call up the BRF transaction.
The following administration functions are available in the BRF Workbench (among other things):
Display of a BRF Network Graphic
Navigation from BRF objects to Workbench objects – for example, from an action (BRF object) to a
class (Workbench object)
Navigation from a BRF object (such as an event) to another BRF object (such as an expression)
Navigation backwards
Navigation from one application class to another
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BRF – Formula Editor
© SAP AG 2006
The Formula Editor is used to create expressions.
© SAP AG FS335 5-22

BRF – Network Graphic
© SAP AG 2006
A BRF network graphic represents the relationships between the BRF objects in graphical form. The
dependencies of events and their expressions and actions are displayed, thus making rule
administration easier.
The events form the starting point. The associated expressions and actions are displayed in a tree.
© SAP AG FS335 5-23

BRF – Trace
Enter „help“ in Switch on BRF

the command line trace
Display trace
result
3
© SAP AG 2006
In order to start the trace type the function code BRF_TRACE_HELP in the command line when
working in a claim.
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Examples of Use of BRF by FS-CM
Business case 1:
Claims processing supported by fraud detection in
auto insurance
Procedure
Claim handler:
Creation of a payment during claims settlement
Administrator:
Creation of a rule for fraud detection
Male, < 30 years old
No witness
Payment below 3000 EUR
Claim handler:
Creation of a payment during claims settlement
Autom atic detection of potential fraud
Action:
if the rule becomes "Yes" a workflow will start and inform a fraud detection
group"
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Examples of Use of BRF by FS-CM
Business case 2:
Claims processing with integration of external service
providers
Procedure
Administrator:
Creation of a rule for engaging services of a service provider
Send document
Define task
Claim handler:
Select an external service provider
Autom atic creation of tasks and documents
Action:
if the rule becomes "Yes" a letter will be send to the external
service provider and a task will be set"
© SAP AG 2010
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BRF: Topic Summary

Framework (BRF)
Create BRF rules including expressions and tasks
© SAP AG 2006
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Activity Management: Topic Objectives

Understand Activity Management and how it is
integrated to the Business Rule Framework and to
Workflow.
© SAP AG 2006
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Activity Management - Motivation
The Claims Management application contains such a wealth of

data that there is no guarantee of situations requiring further
investigation/processing being detected at a glance.
Consequence: Need for a component that generates settlement

tasks and detects anomalies in the claim, signals these to the
claim handler, and supports the claim handler in further
processing.
•⇒ Detect anomalies, generation of tasks: (BRF)
•⇒ Claim handler assignment: (Workflow/OM)
•⇒ Processing: Activity Management
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Activity Management and BRF
Claims Management
Trigger
1 Edit claims
event
BRF event
data
2 Execute task
Business Rule Framework
Activity Management Why?
Execute
What? BRF rule
Create
task
© SAP AG 2006
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Activity Management - Cutomizing
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Activity Management – Attributes of Tasks
Characteristics of a task
Automatic creation
Manual task creation is possible, but that is not the main focus.
Assigned to a specific claim subobject
E.g. claim header, subclaim, loss location, participant, invoice or payment
Has a descriptive text
E.g. “Complete Loss Location” or “Complete Bank Details for Claimant Joe
Fox”
Due dates for
First appearance in inbox
Desired start date/time
Required end date/time
Validity
Status, such as
Waiting for transfer to inbox
Waiting for start of execution
Waiting for end of task
Done/Log Entry
Navigation target to view the anomaly
Priority
Tasks can be defined as process-preventing
Tasks can be completed manually or automatically by the system
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Definition of a task:
Special action that brings an anomaly to the attention of a claim handler, requiring the claim handler
to process it.
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Activity Management - Task Customizing
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Activity Management - Life-Cycle of a Task
Δt1 Δt2 Δt3 Δt4

Time
User selects User sets task to

Create Task: Task appears
activity which completed.
(if <condition> in Workplace
indicates start of Suppress creation
then <task>) Inbox
task processing of this task
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Activity Management – Task List
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Activity Management: Topic Summary

Understand Activity Management and how it is
integrated to the Business Rule Framework and to
Workflow.
© SAP AG 2006
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Workflow: Topic Objectives

Claims Management system
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Workflow – Delivered Workflow Examples
List of delivered workflows in FS-CM
WF Edit Claim (ICLClaim_001)

Assignment of claims to claim handlers
Replaced
by Role-Based
WF Edit Subclaim (ICLSucl_001)
Performer
Assignment of subclaims to claim handlers.
Different subclaims of a claim can be assigned
to different claim handlers.
WF Edit Task (ICLAct_001)

Assignment of (manually or automatically created)
tasks to claim handlers independent of claim or subclaim owner.
© SAP AG 2006
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Workflow Explorer – Structure
Business Workflow Builder – Transaction SWDD:
Structure of ‚Tasks Workflow‘ (WS20700072)
© SAP AG 2006
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Workflow – Assignment via Agent Determination Rules
© SAP AG 2006
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Activity Management, BRF and Workflow
Claims Management
1 Edit claims Trigger Business Workflow
event
BRF event
data
Who?
Trigger Execute Create

event
BOR event
WF Rule workitem
Execute 2
workitem
Activity Management
Execute
3 task Business Rule Framework
Why?
Execute
What? BRF rule
Create
task
© SAP AG 2006
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Workflow - Inbox
© SAP AG 2006
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Workflow - Customizing
© SAP AG 2006
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Workflow – Data Sources for BOR Event Container
BRF
expressions
© SAP AG 2006
When you open and reopen a claim, a subclaim, a task in the claim, a claim bundle, or a task in a
claim bundle, data can be transferred to the workflow that has been started. For example, this data is
required for rule resolution, monitoring deadlines (just with tasks), and for display in the workflow
inbox.
To be able to use the standard delivery rules for claim handler determination, define the
responsibilities and assign claim handlers. You can use the following expressions for the definition
of responsibilities:
y Country of policyholder
y Region of policyholder
y Postal code of policyholder
y Complexity (only for Claim and Subclaim)
y Task category (only for Task)
y User who started the workflow
For example, depending on the FS-CM Claim object type and the Claim Opened event (in the sense
of SAP Business Workflow), you can assign the Policyholder: Region expression to the REGION
parameter. Depending on the result that the calculation of the expression delivers to the parameter,
the relevant claim is assigned to a certain claim handler when it is opened.
© SAP AG FS335 5-44

Workflow: Topic Summary

Claims Management System
© SAP AG 2006
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Claim Handler Assignment: Topic Objectives

Configure claim handlers as part of an organizational
unit
© SAP AG 2006
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Organizational Management
Definition of the Claims

Management Structure in the
Organizational Management
(transaction PPOME)
Tasks can be assigned according to the orginizational structure to:
Organizational Unit
Position
Employee
© SAP AG 2006
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WF - General WF Customizing as Prerequisite
Automatic WF customizing
© SAP AG 2006
IMG/WebAS/Business Management/Business Workflow/Maintain Standard Settings
© SAP AG FS335 5-48

WF - Activate Workflow
Activate WF
© SAP AG 2006
IMG/WebAS/Business Management/Business Workflow/Perform task-specific Customizing
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WF - General Task
Define WF task as „General Task“
© SAP AG 2006
IMG/WebAS/Business Management/Business Workflow/Perform task-specific Customizing
© SAP AG FS335 5-50

WF - Assign Rule
Assign rule to WF step
© SAP AG 2006
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WF - Task Handler Assignment: Responsibility
Define responsibility and

assign task handler
© SAP AG 2006
SAP menu/Tools/Business WF/Development/Definition Tools/Rules for Agent Assignment
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WF - Task Handler Assignment: Conditions
Define conditions
Any attribute of
claims transaction
can be added
© SAP AG 2006
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WF - Define Task
Define task
© SAP AG 2006
IMG/SAP Insurance/Claims Management/Claim/Structuring Business Processes/Activity

Management
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WF - Attributes for WF Rules
Define any claim attribute

to be transferred to WF
© SAP AG 2006
IMG/SAP Insurance/Claims(Technical settings/WF integration
© SAP AG FS335 5-55

WF - Individual Task Handler Assignment
Individual assignment using function module

(customer development, e.g. load balancing)
© SAP AG 2006
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Claim Handler Assignment : Topic Summary

unit
© SAP AG 2006
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Role Based Performer: Topic Objectives

Configure Performer Roles
Set-up Performers as Business Partners
Assign Performer Roles to Internal Claim Types
Explain the methods for automatic performer
assignment
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Role Based Performer - Customizing
1
2
3
4
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Role Based Performer – Define Performer Role and assign
to tasks
1
Definition of Performer
Roles
Tasks generated during the

processing of a claim will be
assigned to a performer
according to this
configuration setting.
Each task can be assigned to

exactly one role.
© SAP AG 2006
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Role Based Performer – Configure Role Profiles I 2
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Role Based Performer – Configure Role Profiles II 2
Performer assignment is mandatory

In claims processing, a performer must be assigned to this role. The assignment
can also be done automatically through early or later performer determination. If no
performer has been assigned when the user saves, the system uses the
"performer for non-assignable tasks".
Additional display in lists
Performers in this role are displayed in the results list of the claim search in
addition to the queried performer. The attribute can only be assigned once within a
role profile.
Performer for non-assignable tasks
The performer in this role is assigned all tasks for which no other performer was
found when the user saved. The attribute must be assigned just once per role
profile. Within a claim, different roles can be given this indicator at claim or
subclaim level. The assignment of performers for such roles is always mandatory.
© SAP AG 2006
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Role Based Performer – Configure Role Profiles III 2
Confirmation upon change of performer

With roles with this attribute, any manual changes made to the assigned performer
must be confirmed explicitly by the user wishing to make the change. This is to
avoid changes being made by mistake.
Subclaim inherits performer
At subclaim level such roles automatically inherit the assigned performer from the
role of the same name at claim level, providing one exists. Already assigned
performers (through early determination or manual assignment, for example) are
not overwritten. This indicator is ignored at claim level.
Notification with new assignment of performer
In the event of a new assignment, performers in this role receive a notification from
the system.
Notes: This notification can be configured in the Business Rule Framework (BRF)
with event RBP_CHANGED. By default, action 9_RBP_CHANGED is executed for
this event, and with every change of a role-based performer it writes an entry in the
log file of the claim.
© SAP AG 2006
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Role Based Performer – Assign Role Profiles to an
Internal Claim Type
3
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Role Based Performer –Automatic Performer
Assignment
4
The Automatic Performer Assignment is performed by means of a BAdI

There are three points in time for automatic performer assignment, and
you can implement an own method for each of these:
Early assignment
You can use this method to search for performers who can already be identified at the
start of claims processing on the basis of existing information. The method is executed
when new claims are created after all claim data is read at event ISDAT of the
Business Data Toolset (BDT).
Later assignment
You can use this method to search for performers who cannot be identified
until more information becomes available in the course of claims processing.
This method is always executed when the claim is saved at BDT event
ONSAV before evaluation of the role attributes for the claim and subclaim
level.
You can have performers assigned automatically to roles in the claim on the
basis of any criteria.Manual assignment
Manual
This method is executed as soon as you choose Automatic Performer Assignment in
the toolbar of the overview for role-based performer.
© SAP AG 2006
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Role Based Performer : Topic Summary

Configure Performer Roles
Set-up Performers as Business Partners
Assign Performer Roles to Internal Claim Types
Explain the methods for automatic performer
assignment.
© SAP AG 2006
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Validations and Tasks: Unit Summary

Framework (BRF)
Create BRF rules including expressions and tasks
Understand Activity Management
Claims Management system
unit
Configure the assignment of claim handlers
Configure performer roles and assign tasks.
© SAP AG 2006
© SAP AG FS335 5-67

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 5-68

Exercises
SAP WS Claims
Exercise: BRF Configuration
Status: ERP 2005

• Configure a BRF rule with a BRF action
Situation:
to configure a new rule via BRF which creates an entry in the
claim log when a subclaim is created.

twice. Note down
1-2 Define BRF rule

1-2-1 Navigation
Add a rule to a BRF Event which creates an entry in the activity log when a new
subclaim is created.
Choose ICLWMÆ Customizing Æ Rules and press the “Rule” button
In the Field Event type in: SBC01 and press enter. In the event screen, press the
change-button.
1-2-2 Configuration
Create/add a rule to the BRF Event SBC01 for your line of business (L##)
which consists of the expression COVERAGE_1ST_PARTY and the BRF Action
9_SC102.
Make sure you activate the flags for Repeat and Single Instance mode.
The expression will check at the event of opening a subclaim, whether the
subclaim is a first party subclaim. If this condition is true the system will
perform the action to write an entry accordingly into the claims log.
© SAP AG FS335 5-69

1-2-3 Questions
Which expressions are used to determine the value of the expression
COVERAGE_1ST_PARTY?
1.
2.
Which table is selected?
What is the name of the function module (data source) that accesses the data?
1-2-4 Test
Test your configuration by creating a new claim with a first party coverage.
© SAP AG FS335 5-70

SAP FS Claims
Exercise: Configuration of Role Based Performer
Status: ERP2005

• Create roles
• Create tasks
• Create performers
• Assign tasks to roles
• Assign roles to claims
Situation:
configure role based performers in FS-CM.

twice. Note down
1-4 Create a role (Define Performer Roles and Assign to Tasks)

Claims ManagementÆ ClaimÆ Business SettingsÆ Role-Based PerformerÆ Define
Performer Roles and Assign to Tasks
Define Claim Handler as a new performer role using the following data:
Performer Role = CH##
Name of Role = Claim Handler ##
Assign the tasks that this claim handler can perform
Note: During the Activity Management exercises, you have created task T## - Capture
information on third party. Assign the task T## to the Claim Handler.
Create another performer role for Supervisor.
Performer Role = SP##
Name of Role = Supervisor ##
Note: Do not assign tasks to the supervisor role
Save your changes.
© SAP AG FS335 5-71

1-5 Configure Role Profiles
Claims Management Æ Claim Æ Business SettingsÆ Role-Based performerÆ
Configure Role Profiles.
Create a new role profile RP## by using the following data:
Role Profile: RP##
Description: Claim role profile ##
Assign the roles you created in above step (1-2) to the role profile
For the role CH## check the following boxes
1. Mandatory: To indicate that a performer must be assigned to this role during the
claim processing.
2. Non-Assignable Tasks: All tasks for which no other performers have been found to
date will be assigned to this role.
3. Inherits Performer: The role at subclaim level will inherit the performer assigned at
the claim level to the same role.
4. Notification: To use this indicator in BRF event RBP_CHANGED to send
notification to the assigned performer.
For the role SP## check the following boxes
1. Confirmation: Change of the performer for this role must be confirmed during the
claim processing.
2. Inherits Performer: The role at subclaim level will inherit the performer assigned at
the claim level to the same role.
3. Notification: To use this indicator in BRF event RBP_CHANGED to send
notification to the assigned performer.
Save your changes.
1-6 Assign Role profile to Internal Claim type

Claims ManagementÆ ClaimÆ Business SettingsÆ Role-Based performerÆ Assign
Role profile to Internal Claim type.
Create two entries. In the first entry do not choose any subclaim and assign your RP##.
In the second entry choose a subclaim type and assign your RP##.
Assign the role profile RP## created in above step (1-3) to the internal claim type you
have created.
Save your changes.
© SAP AG FS335 5-72

1-7 Create a performer
Exit the implementation guide (IMG) and access Business Partner (enter /nBP in the
command line or follow the path in the easy access menu: Insurance Æ Claims
Management Æ Master Data Æ Business Partner in Claim Æ Maintain Business
Partner).
Create a performer (Employee of the Insurance Company) for the role claim handler ##.
Using transaction code BP, create a person using the following data
1. Create a business partner of type “Person”.
2. Create the business partner in the role “Employee” (technical key BUP003). Confirm
the pop-up by chosing the “Create” button – the general role (technical key 000000)of
the business partner will automatically be created in the background.
3. Enter first name, last name. (Use your First name and last Name)
4. Choose the Identification Tab. Enter your user name that you used to login to the
system in the field “User Name” located in Employee data section.
5. Choose the save button. This will create a business partner. Note down the BP
number. BP number: ______________
1-8 Create a new claim and test your settings

Create a claim in expert mode with the same internal claim type for which you have
defined the role profiles.
Go to the RBP overview section and verify that the roles of Claim Handler and
Supervisor have been assigned to the claim.
Try to save the claim. You will be forced to enter a performer to the role Claim Handler.
Can you answer why? ______________________________________________
Assign the performer you created in above step (1-5) as the performer of this role.
Save the claim. Note down the claim number: ______________________
© SAP AG FS335 5-73

© SAP AG FS335 5-74
Structured Facts Capture
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 6-1

Structured Facts Capture
Contents:
Types of structured facts capture
Configuration of structured facts capture
© SAP AG 2006
© SAP AG FS335 6-2

Structured Facts Capture : Unit Objectives
Explain the different types of structured facts

capture
Understand how to configure structured facts
capture
© SAP AG 2006
© SAP AG FS335 6-3

Structured Facts Capture: Topic Objectives

Explain the types of structured facts capture
© SAP AG 2006
© SAP AG FS335 6-4

Structured Facts Capture - Definition
Structured Facts Capture (SFC) is a tool for capturing information

related to claim handling in a structured way. Questions defined in
customizing can be answered with defined answers.
Information captured in this way is available for validation and

reporting purposes.
Customers can also create their additional SFCs in order to

support customer specific requirements.
© SAP AG 2006
In FS-CM, SFC can be used to capture details on the following, for example:
y Loss event
y Loss location
y Participants
y Damaged objects
© SAP AG FS335 6-5

Structured Facts Capture – Two Types of Sequences I
Quick question group for Standard question group for

simple questions/answers: complex question sequences
Questi on
Ans wer
Questi on Ans wer
Questi on
Questi on Ans wer
Questi on Ans wer Ans wer Ans wer Ans wer
Questi on Questi on
Ans wer Ans wer Ans wer
Questi on Questi on
An y BRF action can be
triggered with each answer Ans wer Ans wer
End
© SAP AG 2010
Quick question group

You can use a quick question group to create a free sequence of question/answer pairs that are not
inter-dependent. In contrast to the standard question group, several starting questions are possible.
You can use the quick question group in
y a list of questions without follow-on questions
y questions that are to be answered with Yes or No. Here you can only define one follow-on question.
Standard question group
Only one starting question is permitted. Proceeding from this starting question you can create any
number of branches.
Within a standard question group you have the following options for configuring a question
sequence:
y You can define any number of questions
y You can define any number of answers for each question
y You can use the Multiple Answers indicator to specify that the user can enter more than one answer
to a question.
y You can define different next questions for the different answers to a question (a question tree that
branches off).
© SAP AG FS335 6-6

Structured Facts Capture – Two Types of Sequences II
Simple structure
Quick answer
Radio buttons
Structured trees
Questions with
Follow-up questions
© SAP AG 2006
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Structured Facts Capture: Topic Summary

Explain the types of structured facts capture
© SAP AG 2006
© SAP AG FS335 6-8

SFC Customizing: Topic Objectives

Configure structured facts capture
© SAP AG 2006
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SFC Customizing – Customizing I
1
2
© SAP AG 2006
The facts capture category indicates the place in the Claims Management system where you can
enter additional details on facts using question sequences that you have defined yourself. You define
which question sequence is displayed in IMG activity Configure Internal Claim Types . There you
assign one or several question sequences to an internal claim type, dependent on the facts capture
category
A question sequence is always created for one or several specific facts capture categories. Before you
create a question sequence, you must be sure of the facts capture category you want to create this
question sequence for.
© SAP AG FS335 6-10

SFC Customizing – Customizing II
© SAP AG 2006
This allows you to capture facts related to a claim on the basis of questions and answers. The data
that has been captured in this way is available for all types of evaluation.
© SAP AG FS335 6-11

SFC Customizing – Creation 2
© SAP AG 2006
You can create standard question groups or quick question groups here. You use the starting
question to control which question group you create. On the Structured Facts Capture: Change
screen, choose the Create Starting Question icon and then the required question group.
You can assign an BRF action to a question.
© SAP AG FS335 6-12

SFC Customizing – Facts Capture Category 1
SFC is used
On different screens and
Assigned to different objects of the claim.
Each occurrence is identified by a Facts Capture Category.
© SAP AG 2006
Examples:
y Damaged Objects
y Driver's Obligations
y Loss Location
y Participant
y Cause of Loss
y Obligations Real Estate
© SAP AG FS335 6-13

SFC Customizing – Internal Claim Type Settings 3
Internal Claim Type
Internal Claim Type

Generation
Internal Claim Type

Version
Claim Header
Subclaim
Damaged Objects
Claim Item Group
© SAP AG 2006
For the same category several question/answer sequences can be assigned. By using BRF
expressions you can control which of the assigned sequences should be chosen.
© SAP AG FS335 6-14

SFC Customizing : Topic Summary

Configure structured facts capture
© SAP AG 2006
© SAP AG FS335 6-15

Structured Facts Capture: Unit Summary

Explain the different types of structured facts
capture
Understand how to configure structured facts
capture
© SAP AG 2006
© SAP AG FS335 6-16

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 6-17

© SAP AG FS335 6-18
Exercises
SAP WS Claims
Exercise: SFC Configuration
Status: ERP 2005

• Configure a Question&Answer Sequence with the Structured
Facts Capture Tool (SFC)
• Assign a new Question&Answer sequence to an internal claim
type
• Create a new claim and test the new customizing settings
Situation:
to configure a question& answer sequence with the structured
facts capture (SFC) tool.

twice. Note down
1-2 Create new question and answer sequence

In the following exercise you will create a new question and answer sequence with the
SFC Tool. The SFC tool can be accessed via the IMG:
Claims Management Æ Claim Æ Structuring Business Process Æ Structured Facts
Capture Æ Configure Structured Facts Capture
1-2-1 Create new question sequence
Capture the following data and use the create button.
Application: ICL
Question Seq.: Q## (## = Group Number)
Version
Press the Enter buttom.
© SAP AG FS335 6-19

1-2-2 Capture general information and create start question
1. Capture the following data and use the create button.
Application: ICL Claims Management
Question Seq.: Q## Origin of Loss - Fire- Group ## (##=Group Number)
…
Press the Create Starting Question buttom.
2. In the pop up choose: Quick Question Group
3. What is the difference between Quick Question Group and Standard Question
Group?
4. Capture the following data and use the Continue button.
Question 00001
Enable Multiple Answers.
Short Text Fire Type
Long text Fire Type
1-2-3 Capture the possible answers for the first question

1. Use the [Add Answer] Button, capture the following data and finalize this
with the [Continue] Button.
Reply 001
Variant
Answer Position 1
User-Defined Text No free text entry
Short Text External Fire
Long Text External Fire
Plausib. Check Module
Action
Next Question
2. Create two more answers for the first question. As a result you should have
the following entries in the answer table.
Answer Short Text Long text
001 External Fire External Fire
002 Internal Fire Internal Fire
003 Unknown Unknown
3. Use the [Test] Button to display your first question.
© SAP AG FS335 6-20

1-2-4 Capture the second question
Use the [create starting question] button and capture the following data.
Question 00002
Category: 2
Short Text Third Party Involved?
Long text Third Party Involved?
1-2-5 Capture question three
1. Double-click on answer 1 from the second question and capture question
00003 in the field for the next question.
2. Question number three should allow capture of a character string to be able to
capture more information on the third party.
1-2-6 Test your Q&A Sequence with the [test] button
1-2-7 Activate your Q&A sequence
1-3 Configure Internal Claim Type

1-3-1 Configure Claim Header
1. Change the active version of the claims header for internal claim type CT##.
2. Select the folder [Question Sequence for Facts Capture].
3. Create a new line in the table for the Question Sequences and capture the
following data:
Category PR
Question Seq. Q##
1-3-2 Save and activate your internal claim type
1-4 Create a new claim and test the new Q&A sequence
On the navigation tree select the screen “Incident” and select tab “Property obligations”.
1-5 Create a second Q&A sequence for the loss location (Optional)
1-5-1 Check in notification mode what kind of question group you need to configure.
1-5-2 Create a standard question group.
1-5-3 Assign the new question group to your internal claim type (category: LO)
© SAP AG FS335 6-21

© SAP AG FS335 6-22
SAP WS Claims
Exercise: Configuration of Actions
Status: ERP 2005

• Create coverage referrals
• Create tasks
• Create actions
• Assign actions to Q&A sequences
Situation:
configure actions in the Activity Management of FS-CM.

twice. Note down
1-7 Create a coverage referral

Claims Management Æ Claim Æ Structuring Business Processes Æ Activity
Management Æ Define Coverage Referrals.
Create a new coverage referral by using the following data:
CR## Internal Fire - Check fraud potential
Assign overruling reason R2 to this new coverage referral.
1-8 Create a new action
Claims ManagementÆClaimÆStructuring Business Processes Æ Business Rule
Framework Æ Define Action.
Create a new action A## by using the following data:
Action: A##
Press the Continue (Enter) buttom
Short Text: Set Coverage Referral ##
Group: SFC
© SAP AG FS335 6-23

Implementation Class: 1RF001 (after you have selected the implementation class you
have to double click on the new entry in order to navigate to the next data screen)
Coverage Referral: CR##
1-9 Create a new task

Claims ManagementÆClaimÆStructuring Business Processes Æ Activity Management
Æ Configure Tasks, Log Entries and Activities
Create a new task by pushing the New Entries button and using the following data:
Task: T##
Entry is a task: Yes
Description: Third Party
Text: Capture info on third party ##
Txt after Compl: Finalized
Navigation Target: A
Task completed through navigation: Yes
1-10 Create a new action

Claims Management Æ Claim Æ Structuring Business Processes Æ Business Rule
Framework Æ Define Action.
Create a new action A** by using the following data:
Action: A** (** = 50+group number)
Short Text: Create Task ##
Group: SFC
Implementation Class: 1LG001
Task: T##
1-11 Assign new actions to Question&Answer Sequence

1. Change your Q&A Sequence Q##.
2. The coverage referral should be created if there is an internal fire.
3. The task should be created if there was a third party involved.
Activate your new settings!
1-12 Create a new claim and test your settings
© SAP AG FS335 6-24

Claim Fulfillment
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 7-1

Claim Fulfillment
Contents:
Compensation Calculation
Payments
© SAP AG 2006
© SAP AG FS335 7-2

Claim Fulfillment: Unit Objectives

Understand the underlying concept of the
compensation calculation
Configure the system to enable the compensation
calculation
Understand the principles of payment customizing
Configure payments.
© SAP AG 2006
© SAP AG FS335 7-3

Compensation Calculation: Topic Objectives

calculation.
© SAP AG 2006
© SAP AG FS335 7-4

Configure Compensation Calculation - Steps
© SAP AG 2006
© SAP AG FS335 7-5

Configure Compensation Calculation – Benefit Type
Tree
Benefit Type Tree Compensation
1. Recursion (Cash)
Benefit Type: Valuables
3000 > 1000 (Limit)
Limit: 5200 Euro 1000
Deductible: 800 Euro
./. 200 (Deductible)
800 Euro
Benefit Type: Cash Benefit Type: Savings
Limit: 1000 Euro Limit: 5000 Euro 2. Recursion (Savings)

Deductible: 200 Euro Deductible: 500 Euro 8000 > 5000 (Limit)
5000
4500 Euro
Claim
3. Recursion (Valuables)
3000 Euro / Cash 5300 > 5200 (Limit)
8000 Euro / Savings 5200
4400 Euro -> Compensation
© SAP AG 2010
© SAP AG FS335 7-6

Configure Benefit Type Trees – Structure I
Currency that applies to all amount fields

Benefit Type of the benefit type tree
Tree Generation
Higher-level benefit type tree (for
expenses)
Benefit Type
Tree Version Specify whether the benefit type tree is
only used for coverage types, and not on
a cross-coverage type basis
Permitted
Benefit Type
Limit per Permitted

Benefit Type
Reason Groups
© SAP AG 2006
© SAP AG FS335 7-7

Configure Compensation Calculation – Higher-Level
Benefit Type Tree I
Higher-Level Benefit Type Tree
© SAP AG 2006

Note: The Higher-L.BnTree and For Coverage Type fields are only relevant if the benefit type tree
contains benefit types in the Compensation category. If the benefit type tree only contains
benefit types in the Expenses category, both fields are irrelevant.
Use
• If a benefit type at the highest level of this benefit type tree has a higher-level benefit type that
is in a cross-coverage type benefit type tree, you must specify this benefit type tree here.
• A cross-coverage type benefit type tree means that the benefit types of this benefit type tree are
valid across coverage types.
• For information on the different assignment of benefit type trees, read the "Activities" section in
the documentation for IMG activity Configure Benefit Type Trees
Dependencies
The For Coverage Type indicator must be set.
© SAP AG FS335 7-8

Configure Compensation Calculation – Higher-Level
Benefit Type Tree II
The Higher-L.BnTree and ForCoverageType fields are only

relevant if the benefit type tree contains benefit types from the
Losses category.
If a benefit type on the highest level in this benefit type tree has
a higher-level benefit type, which is in a cross-coverage type
benefit type tree, you must specify this benefit type tree here.
Cross-coverage type benefit type tree means that the benefit

types for this benefit type tree are valid on a cross-coverage
type basis.
You have to set the For Coverage Type flag.
© SAP AG 2006
© SAP AG FS335 7-9

Configure Compensation Calculation – Benefit Types I
Define benefit types for each version of

Benefit Type the benefit type tree.
Tree Generation
You can define multi-level benefit type
trees with higher and subordinate
Benefit Type benefit types.
Tree Version
This hierarchy is then also valid for the
limits and deductibles on the Limit for
Permitted
Benefit Type
Permitted Benefit Type level.
Limit per Permitted

Benefit Type
Reason Groups
© SAP AG 2006
© SAP AG FS335 7-10

Configure Compensation Calculation – Benefit Types II
Benefit Type Benefit type: Losses or Expenses

Tree Generation
Specify the application type for the
limits and deductibles in the
Benefit Type compensation calculation
Tree Version
Subrogation possible?
Permitted
Benefit Type
Procurement transaction
Limit per Permitted

Benefit Type
Reason Groups
© SAP AG 2006
© SAP AG FS335 7-11

Configure Compensation Calculation - Relationship
Benefit types for each Higher benefit

version of the benefit types
type tree
© SAP AG 2006
© SAP AG FS335 7-12

Configure Compensation Calculation – Attributes I
a
b
c
© SAP AG 2006
© SAP AG FS335 7-13

Configure Compensation Calculation – Attributes II a
Flag: Level for Higher Benefit Type
Defines the level for the permitted higher benefit type:
In the same coverage type

Cross-coverage type
If you do not specify a higher-level benefit type, you must place the
value In Same Coverage Type in this field.
© SAP AG 2006
© SAP AG FS335 7-14

Configure Compensation Calculation – Attributes III a
Flag: Level for Higher Benefit Type
If you select Cross Coverage Type as the level of the higher-level benefit
type, you must consider the following:
You can only define one benefit type in the Higher Ben. Type field, for
which the Cross-Coverage Type flag is set in the Define Benefit Types
IMG activity.
A cross-coverage type benefit type links all assigned subclaims and
coverage types with one another, as the system assumes that a joint
upper limit must be considered.
If the For Coverage Type indicator is set for the benefit type tree, then
the higher-level benefit type must belong to another benefit type tree.
This must be a benefit type tree that can be used across coverage
types, in other words, the For Coverage Type indicator is not set.
© SAP AG 2006
© SAP AG FS335 7-15

Configure Compensation Calculation – Attributes IV b
Higher Permitted Benefit Type
If you want to construct a tree from benefit types, you can select the
higher benefit type directly here.
The limits and deductibles for the higher benefit type are considered in
the compensation calculation.
© SAP AG 2006
© SAP AG FS335 7-16

Configure Compensation Calculation – Attributes V c
Coverage for Benefit Type
Defines whether a benefit type
Is always covered if the coverage type is covered.

Is only covered if the benefit type is specified in the policy.
Is not covered if it is not specified in the policy, although the
coverage type is covered. You have to define a rejection reason.
Is never covered. If the benefit type is never covered, you need to
define a rejection reason.
General principle: If the coverage type is not covered, no individual

benefit type for the coverage type is covered, regardless of this field.
© SAP AG 2006
© SAP AG FS335 7-17

Configure Compensation Calculation – Attributes VI d
Apply Deductible Before or After Limit
This flag defines whether the deductibles for this benefit type are to
be valid for compensation (= after deduction by the limit) or for the
claim (= before deduction by the limit).
With a deductible for the claim, potential deductions with limits are
calculated in subordinate benefit types.
© SAP AG 2006
© SAP AG FS335 7-18

Configure Compensation Calculation – Attributes VII e
Display Option for Limit
Defines the points in the policy snapshot at which the limits are displayed
You can choose between the following options:
0 = No display:
The limit is not displayed in the coverage overview. It is only displayed in
the overview tree on the screen for limits and deductibles if the processing
clerk wants to display all limits covered by the policy. The clerk must then
click on the middle selection button (policy details).
1 = Display in tree
The limit is not displayed in the coverage overview. It is always displayed
in the overview tree on the screen for limits and deductibles (for policy
overview, details and product).
4 = Display for coverage

The limit is displayed in the overview as a limit for the coverage. It is
always displayed on the screen for limits and deductibles.
© SAP AG 2006
© SAP AG FS335 7-19

Configure Compensation Calculation – Limit I
Limits and deductibles are used to

Benefit Type check:
Tree Generation
Directly entered payments,

For the automatic creation of
Benefit Type
Tree Version
payments from claim items
For reserves.
Permitted Relevant payments that have already

Benefit Type been made are considered
automatically.
Limit per Permitted
Benefit Type
Setting for Each Permitted Benefit
Type
Reason Groups
© SAP AG 2006
© SAP AG FS335 7-20

Configure Compensation Calculation – Limit II
Limits and Deductibles
© SAP AG 2006
© SAP AG FS335 7-21

Configure Compensation Calculation – Limit III a
Coverage Type as Filter for Application Limits/Deductible
You can define other limits and deductibles for the coverage type specified
here.
If a corresponding coverage with this coverage type exists in the policy,
these different limits and deductibles are applied in the compensation
calculation.
If you define multiple limits and/or deductibles for the same benefit type, the
system determines which limits and deductibles are to be applied on the
basis of the specified priority (at benefit type tree level).
The system evaluates the defined limits and deductibles in this specified
sequence. As soon as a coverage with the coverage type defined here exists
in the policy, the limits and deductibles of this coverage type are applied.
© SAP AG 2006
© SAP AG FS335 7-22

Configure Compensation Calculation – Limit IV b
Limits
Upper limit for amounts or quantities (such as days).
The limits are specified in the policy for each covered benefit type
and insured object. A limit of 0.00 is not regarded as a limit.
A limit can also be stored in cross-policy structures for each benefit

type.
© SAP AG 2006
© SAP AG FS335 7-23

Configure Compensation Calculation - Deductible c
Deductible
Contractually agreed own share of the policyholder in an insured

claim.
This agreement means that:
The insurer must only make a claim payment if the claim exceeds
a certain amount
The policyholder is responsible for his/her own share (for the
agreed amount) in the claim.
© SAP AG 2006
© SAP AG FS335 7-24

Configure Compensation Calculation – Product Rule d
Product Rule for Determination of Limits and Deductibles

0 Policy, otherwise product
Like rule 1, but if there is an entry in the policy, this is used instead of the
values defined in Customizing for limits and deductibles.
1 Product
The limit defined in Customizing is always used, even if there is an entry in
the policy.
2 Maximum policy / product

The system determines the greater limit and the lower deductible from policy
and product.
3 Minimum policy / product

The system determines the lower limit and the greater deductible from policy
and product.
4 Policy + product
The system takes the total for the amounts from policy and product
© SAP AG 2006
© SAP AG FS335 7-25

Configure Compensation Calculation – Assignment I
Assignment of Benefit Type Trees
Benefit
Type Tree
Category: Category: Category:

Losses Mixed Expenses
IMG -> Configure Policy IMG -> Configure Internal Claim

Products Types
Assignment to a permitted Assignment to a subclaim type
coverage type
a c b
© SAP AG 2010
© SAP AG FS335 7-26

Configure Compensation Calculation – Assignment II a
Assignment of Benefit Type Trees from Losses Category
You assign benefit type trees belonging to the Losses category to a

permitted coverage type in IMG activity Configure Policy Products.
The following rules have to be adhered to:
If the benefit types of the benefit type tree are to be valid for just
one permitted coverage type, assign the benefit type tree to this
coverage type.
If the benefit types from the benefit type tree are to be valid on a
cross-coverage type basis, assign the benefit type tree to the policy
product on the Policy Product Version level. In this way, you can
define cross-coverage type deductibles, for example.
© SAP AG 2006
© SAP AG FS335 7-27

Configure Compensation Calculation – Assignment III a
Assignment of Benefit Type Trees from Losses Category
OR
© SAP AG 2006
© SAP AG FS335 7-28

Configure Compensation Calculation – Assignment IV b
Assignment of Benefit Type Trees from Expenses Category
You assign benefit type trees belonging to the Expenses category to a

subclaim type in IMG activity Configure Internal Claim Types.
If the benefit types of the benefit type tree are to be valid for just
one permitted subclaim type, assign the benefit type tree to this
subclaim type.
If the benefit types in the benefit type tree are to be valid for the
claim header, on a cross-subclaim basis, create an entry without
specifying a subclaim type. Leave the Subclaim Type field empty,
and define a benefit type tree for this entry. This is valid for the
claim header.
© SAP AG 2006
© SAP AG FS335 7-29

Configure Compensation Calculation – Assignment V b
Assignment of Benefit Type Trees from Expenses Category
© SAP AG 2006
© SAP AG FS335 7-30

Configure Compensation Calculation – Assignment VI c
Assignment of Benefit Type Trees from Mixed Category
You can assign benefit type trees from the Mixed category to a coverage
type in the Configure Policy Products IMG activity, or to a subclaim type in
the Configure Internal Claim Types IMG activity.
The system only reads the benefit types from the Losses category, from
benefit type trees that are assigned to a coverage type in the Configure
Policy Products IMG activity.
The system only reads the benefit types from the Expenses category,
from benefit type trees that are assigned to an internal claim type in the
Configure Internal Claim Types IMG activity.
© SAP AG 2006
© SAP AG FS335 7-31

Compensation Calculation: Topic Summary

calculation.
© SAP AG 2006
© SAP AG FS335 7-32

Payments: Topic Objectives

Understand the principles of payment customizing.
Configure payments.
© SAP AG 2006
© SAP AG FS335 7-33

Payments - Definition
Unique flag for classification of receivable or claim payment
The claim payment type defines the limits and deductibles that are valid, and
the reserve against which you are to calculate payments
Every payment item must have a claim payment type.
Every claim item must have a claim payment type.
© SAP AG 2006
© SAP AG FS335 7-34

Payments – Customizing Benefit Types
© SAP AG 2006
© SAP AG FS335 7-35

Payments
a b
a Loss or expense
b Benefit type is cross-subclaim
Ensures that the benefit type can be used on a cross-coverage type basis (and not
just within a coverage).
This flag is only relevant for benefit types from the Loss category, not for benefit
types from the Expenses category.
© SAP AG 2006
© SAP AG FS335 7-36

Payments
© SAP AG 2006
© SAP AG FS335 7-37

Payments - Selection
Flag:
Can be selected for direct payments
This flag determines whether a benefit

type can be selected during direct entry
(not using claim items) of payments or
advance payments.
© SAP AG 2006
© SAP AG FS335 7-38

Payments – Disbursement Integration I
© SAP AG 2006
© SAP AG FS335 7-39

Payments – Disbursement Integration II
Internal Claim Type
Standard data for FS-CD document

Internal Claim Type
Generation
Specification for FS-CD Claim Standard
Properties
Internal Claim Type
Version
Claim Header
Subclaim
Damaged Objects
Claim Item Group
© SAP AG 2006
© SAP AG FS335 7-40

Payments – Disbursement Integration III
a
b
a Standard data for FS-CD document

Data used as standard when posting payment transactions from the Claims Management system to
the Collections/Disbursements system.
b Sample template for contract account for insurance object case

Internal key for Claims Management system, whose attributes are used to define the properties for
the insurance object and contract account objects in FS-CD.
© SAP AG 2006
© SAP AG FS335 7-41

Payments: Topic Objectives

Configure payments.
© SAP AG 2006
© SAP AG FS335 7-42

Claim Fulfillment: Unit Summary

calculation
Configure payments.
© SAP AG 2006
© SAP AG FS335 7-43

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 7-44

Exercises
SAP WS Claims
Exercise: Deductible Before or After Limit
Status: ERP 2005

• Configure Compensation Calculation
Situation:
to configure the behavior of the Compensation Calculation

twice. Note down
1-2 Define calculation method for deductible

1-2-1 Calculation Method: To Compensation
Claims Management Æ Claim Æ Business Settings Æ Claim Item Æ Benefit
Types Æ Configure Benefit Type Trees
Define the calculation method for the deductible of the benefit type Building
(top node of Building Damage benefit type tree with limit: €300,000 and
deductible €1000) as After Limit. Activate the benefit type tree.
Create a claim with subclaim Building. Create a claim item for benefit type
Roof and claimed amount of €301,000.
Create a payment for the above mentioned claim item. Apply limits and
deductibles.
What is the compensated amount? €_____________________
© SAP AG FS335 7-45

1-2-2 Calculation Method: To Claim
Define the calculation method for the deductible of the benefit type Building
(top node of Building Damage benefit type tree with limit: €300,000 and
deductible €1000) as Before Limit.
Create a claim with subclaim Building. Create a claim item for benefit type
Roof and claimed amount of €301,000.
Create a payment for the above mentioned claim item. Apply limits and
deductibles.
What is the compensated amount? €_____________________
1-2-3 Which method do you like best?
After Limit
Before Limit
Provide a reason for your answer!
© SAP AG FS335 7-46

SAP WS Claims
Exercise: Payment Authorization Configuration
Status: ERP 2005

• Create Payment Authorization configuration
Situation:
configure payment authorization.

twice. Note down
1-4 Define authorization process for payments

1-4-1 Define authorization limits
Set the authorization limit for payment creation according to your line of
business L## and your subclaim types by using the following customizing
activity:
Claims Management Æ Claim Æ Business SettingsÆ
Payments/Subrogation/RecoveryÆAuthorizations for Payments and
Subrogation/ RecoveryÆ Define Limits for Payments for Each Authorization
Group.
Set the limit for creation of single payment to €500 and for the subclaim type
SXXB to €1500. Choose the Authorization Group P00
Set the limit for approval of single payment to €1000 and for the subclaim type
SXXB to €1,000,000. Choose the Authorization Group P00.
Create log entries and tasks for the approval process for payments
Enter the following BRF rules for your line of business L## in the BRF event
F0002 (belongs to group 0PAYMNT) in order to
- Create log entries and
- Tasks
for payments to be approved.
© SAP AG FS335 7-47

Expression Description Action Description
PYL03AUTHORITY_KP Payment Release PAYL3AUTHORITY_LOG Activity Log for

Due to Payment
Authorization Approval Due to
Authorization
PYA06 Payt Cat: PAYL2 Payment Release

Payment (0)
Approval
Note that expression PYL03AUTHORITY_KP is an expression of type

predicate that contains the tasks. Which task is being created?
__________________
1-4-2 Create a payment
Create a payment which exceeds your authorization for single payments. Note
how the payment status changes after you save the claim. Also check the claim
log to see whether a log entry has been created accordingly.
1-5 Random selection of payments for approval

1-5-1 Define random selection
Define how many payments should be selected randomly for the approval
process by using the following customizing activity:
PaymentsÆAuthorizations for Payments and Subrogation/Recovery Æ Control
Random Approval of Payments.
Enter the value 1 for your line of business so each payment will be selected.
1-5-2 Create log entries and tasks for the approval process for payments.
Enter the following BRF rules for your line of business L## in the BRF event
F0002 (belongs to group 0PAYMNT) in order to
- Create log entries and
- Tasks
for payments to be approved.
Expression Description Action Description
PYL03RANDOM_KP Payment Release PAYL3RANDOM_LOG Activity Log for

Due to Random Payment
Principle Approval Due to
Random Principle
What does the action PAYL3RANDOM_LOG do?

1-5-3 Create a payment
Create a payment to test your customizing.
Change the setting for the random generator to the value 2 so every other
payment will be selected. Test your settings by creating payments.
© SAP AG FS335 7-48

Claims Recovery
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 8-1

Claim Recovery
Contents:
Refunds (receivables)
Subrogation
Salvage
Multiple Insurance
© SAP AG 2006
© SAP AG FS335 8-2

Claim Recovery: Unit Objectives

Configure the system for refunds (receivables)
Configure the system for subrogation
Understand the configuration for salvage
Understand the configuration for multiple
insurance.
© SAP AG 2006
© SAP AG FS335 8-3

Refunds: Topic Objectives

Configure the system for refunds (receivables).
© SAP AG 2006
© SAP AG FS335 8-4

Refunds – Customizing Benefit Type Trees
Receivables: Selectable
This flag determines whether

a benefit type can be
selected for refunds
© SAP AG 2006
For refunds the same customizing has to be done as for payments:

y Define Benefit Types
y Define Benefit Types with benefit types selectable for receivables
© SAP AG FS335 8-5

Refunds: Topic Summary

Configure the system for refunds (receivables).
© SAP AG 2006
© SAP AG FS335 8-6

Subrogation: Topic Objectives

Configure the system for subrogation.
© SAP AG 2006
© SAP AG FS335 8-7

Subrogation – Activation in Internal Claim Type
© SAP AG 2006
Configuration for processing Subrogation, is defined through the internal claim type under the
subclaim level.
The values that defined capability for salvage processing are:
y Not Permitted – no Subrogation processing is available for the subclaim of the internal claim
type.
y After Claim Closure – Subrogation processing can only be process after the subclaim is closed.
y After Subclaim Closure – Subrogation processing can only be processed after the claim is
closed.
y Always Permitted – Subrogation processing can be processed
© SAP AG FS335 8-8

Subrogation – Authorizations
Similar to payments, subrogation limits can be assigned to

authorization groups
© SAP AG 2006
You can find the IMG activities for authorizations for payments and subrogation under Claims
Management Æ Claim Æ Business Settings Æ Payments Æ Authorizations for Payments and
Subrogation.
© SAP AG FS335 8-9

Subrogation – Setting the screen sequence
In this activity, set up a screen sequence:
You must specify on level “Claim” en entry for the node06 and assign a screen sequence
© SAP AG 2010
© SAP AG FS335 8-10

Subrogation – Determination of Subrogation Items
Searching for payment items for subrogation other then the

standard determination types.
© SAP AG 2006
You can find the IMG activities for BAdI: Functions for Determining Subrogation Items under
Claims Management Æ Claim Æ Business Settings Æ Payments Æ BAdI: Functions for
Determining Subrogation Items
© SAP AG FS335 8-11

Subrogation: Topic Summary

Configure the system for subrogation.
© SAP AG 2006
© SAP AG FS335 8-12

Salvage: Topic Objectives

Understand the configuration for salvage.
© SAP AG 2006
© SAP AG FS335 8-13

Salvage – Customizing Benefit Type Trees
Payments: Selectable
This flag determines whether a

benefit type can be selected for
salvage or any other direct
payments
© SAP AG 2006
For salvage payments the same customizing has to be done as for payments:
y Define Benefit Types
y Define Benefit Types with benefit types selectable for payment
© SAP AG FS335 8-14

Salvage – Activation in Internal Claim Type
© SAP AG 2006
Configuration for processing salvage, is defined through the internal claim type under the subclaim
level.
The values that defined capability for salvage processing are:
y Not Permitted – no salvage processing is available for the subclaim of the internal claim type.
y After Claim Closure – Salvage processing can only be process after the subclaim is closed.
y After Subclaim Closure – salvage processing can only be processed after the claim is closed.
y Always Permitted – salvage processing can be processed.
© SAP AG FS335 8-15

Salvage: Topic Summary

Understand the configuration for salvage.
© SAP AG 2006
© SAP AG FS335 8-16

Multiple Insurance: Topic Objectives

Understand the configuration for multiple insurance.
© SAP AG 2006
© SAP AG FS335 8-17

Multiple Insurance - Customizing
© SAP AG 2006
In the customizing of FS-CM there is a detailed part for the multiple insurance to be settled:
Referring to the distribution plan and its effects to the payments.
© SAP AG FS335 8-18

Customizing - Distribution Plan Type
The type of distribution has to be entered considering

Expenses only
Losses (compensation) only or
Expenses and losses (compensation) mixed.
© SAP AG 2006
© SAP AG FS335 8-19

Customizing - Participation Type
The participation type defines the role of the insurer in a distribution

plan.
© SAP AG 2006
This is used for the determination of the function profile.
© SAP AG FS335 8-20

Customizing - Settlement Type
The shares can be settled via the leading insurer or by own

settlement.
© SAP AG 2006
© SAP AG FS335 8-21

Customizing - Payment Item Type
The types of payment items are relevant for the settlement of the
distribution plan.
© SAP AG 2010
The payment item typs are assigned in the following customizing set „Function profiles“.
© SAP AG FS335 8-22

Customizing - Payment Item Type Details
© SAP AG 2006
You can assign a determined benefit type for the compensation and/or for the expenses. These are
not mandatory fields.
A permitted change means that in claims processing you can manually change the payment amounts
of payment items that have been created automatically.
© SAP AG FS335 8-23

Customizing - Function Profile
© SAP AG 2006
Grouping of functions that are performed automatically when payments in multiple insurance are
created.
Examples of function profiles are Own Settlement or Settlement via Leading Insurer.
You can define a maximum of two functions for each function profile
© SAP AG FS335 8-24

Customizing - Function Profiles (cont.)
© SAP AG 2006
For each function profile you have to define whether a payment item has to be created on the claim,
the way of posting it and if the coinsurance key has to be transferred to FS-CD in the posting
document.
© SAP AG FS335 8-25

Customizing - Function Profile Determination
© SAP AG 2006
You thereby specify which function profiles are used in creation of a payment in multiple insurance .
© SAP AG FS335 8-26

Customizing - Function Profile Determination (cont.)
© SAP AG 2006
You have to determine at which level the function profile determination has to take place.
You have also to assign the type of payment affected by the function profile determination
(disbursement, refund, advance payment, subrogation).
You have also to assign the distribution plan type, the participation type of the own company and the
role of a participant in the distribution plan. The settlement type can be also settled.
The own share flag is set for own function profile.
© SAP AG FS335 8-27

Multiple Insurance: Topic Summary

© SAP AG 2006
© SAP AG FS335 8-28

Claim Recovery: Unit Summary

Configure the system for refunds
Configure the system for subrogation
Understand the configuration for salvage
© SAP AG 2006
© SAP AG FS335 8-29

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 8-30

Exercises
SAP FS Claims
Exercise: Subrogation Configuration
Status: Release ERP2005

• Create configuration needed to process subrogation payments.
Situation:
to configure Subrogation Process.
1-1 on to the system

twice. Note down
1-2 Define process for Subrogation

1-2-1 Define the configuration needed at the subclaim level for the internal claim type.
In this configuration, we will specify whether the subclaim is eligible for
subrogation. The values that defined capability for subrogation processing are:
1. Not Permitted – no Subrogation processing is available for the subclaim of
the internal claim type.
2. After Claim Closure – Subrogation processing can only be process after the
subclaim is closed.
3. After Subclaim Closure – Subrogation processing can only be processed after
the claim is closed.
4. Always Permitted – Subrogation processing can be processed
Follow the below IMG path and configure the subrogation process for the
subclaim of the Internal claim type.
Claims Management Æ Claim Æ Process Control (Internal Claim Types) Æ
Configure Internal Claim types
Select your internal claim type (High light the internal claim type from the list
on the left of the screen), then choose the radio button for Subclaim on the right
side and then press the change button.
© SAP AG FS335 8-31

Choose to change the active version of internal claim type. In the following
screen, find the column with title “Subro Permitted”. Here define that
subrogation is always permitted for the given subclaim.
1-2-2 Define Record type and Transaction type for Subrogation:
Each record type is assigned to a posting transaction type for the FS-CD
document.
Define the standard data for the FS-CD document in the IMG activity using
“Define Standard Data for FS-CD Document “
Payments/Subrogation/Recovery Æ Special Settings for FS-CD Æ Define
Standard Data for FS-CD Document.
Create an entry for “Receivables Posting from Subrogation”. The posting key
for this is “6”. SO create an entry with Posting data as 6.
Also for this entry define “Posting Procedure Type, Define Posting Field”.
Define Payment Amount Category for Repayment of Deductibles (Subrogation)
This amount category represents a payment amount that is to be repaid to the
claimant after a successful subrogation process.
1-2-3 Authorizations for Payments and Subrogation
Define the following as needed
You can find the IMG activities for authorizations for payments and subrogation
under
Claims Management Æ Claim Æ Business Settings Æ
Payments/Subrogation/Recovery Æ Authorizations for Payments and
Subrogation Æ Define Limits for Subrogation/Recovery for Each Authorization
Group.
1-2-4 Special Settings for Subrogation/Recovery
Define the following as needed.
You can find the IMG activities for defining subrogation/recovery types and
reasons under
Claims Management Æ Claim Æ Business Settings Æ
Payments/Subrogation/Recovery Æ Special Settings for Subrogation/Recovery.
1-2-5 Define Recovery Claim Indicator.
The following settings are optional and relevant for Health Insurance.
Claims Management Æ Claim Æ Business Settings Æ Claim Item Grouping
Categories Æ Define Recovery Claim Indicator
1-3 Collective Subrogation.

It is possible to define Subrogation for a group of claims (Claim Bundles).
Claims Management Æ Claim Bundle Æ Business Settings Æ Define Recovery Claim
Types in Collective Subrogation/Recovery.
Claims Management Æ Claim Bundle Æ Business Settings Æ Define Reasons for
Changing the Status of Collective Subrogation/Recovery.
© SAP AG FS335 8-32

Claim Handling Supporting Features
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 9-1

Claim Handling Supporting Features
Contents:
Incoming documents
Outbound correspondence
Notes
Reporting
© SAP AG 2006
© SAP AG FS335 9-2

Claim Handling Supporting Features: Unit Objectives

Configure the system for incoming documents
Understand the customizing for outbound
correspondence
Explain the customizing for notes
Understand the existing claims management report
Understand the concept of BW extractors.
© SAP AG 2006
© SAP AG FS335 9-3

Incoming Documents: Topic Objectives

Configure the system for incoming documents.
© SAP AG 2006
© SAP AG FS335 9-4

Incoming Documents: Used Components
Used Components
Document creation: Business Document Management
Document storage: Archive Link
© SAP AG 2006
© SAP AG FS335 9-5

Incoming Documents – Customizing Activities
The relevant customizing for

incoming documents needs to be
performed in the Claims IMG
under the following path:
Claims Management / Claim /

Technical Settings / SAP
Archive Link Integration
© SAP AG 2006
© SAP AG FS335 9-6

Incoming Documents – Edit Document Types
Documents are stored in an optical

archive attached to FS-CM via
ARCHIVE LINK
The documents must be available in the

storage system in a format that can be read by SAP ArchiveLink.
The following are examples of predefined formats:
FAX - scanned documents

PDF - outbound documents
ALF - print lists
REO - archive files
BIN - binary files
DOC, XLS - desktop files
Additional document types may be defined in this IMG topic as

long as they are supported in the optical archive.
© SAP AG 2006
© SAP AG FS335 9-7

Incoming Documents – Assign Document Types to a
Workflow
The actual storage of a document

is performed via a workflow task.
The workflow task is executed

automatically by the system at
predefined events depending on the object type to which the
document is attached, such as claim, subclaim, claim item, etc.
Predefined
assignments
for FS-CM
Starting either with
ISCM* or ICL*
© SAP AG 2006
© SAP AG FS335 9-8

Incoming Documents – Edit Links
Both for creation of the document

within the archive and the retrieval
from any SAP application, the links
between the documents and the
archive must be defined.
Pointer to archive table
where document is stored
Pointer to archive
Document definition
Period after which document

may be deleted in archive
© SAP AG 2006
© SAP AG FS335 9-9

Incoming Documents – Prerequisites and Results
Prerequisites:
Optical archive must be in place and connected to SAP system

Workflow for document creation defined
Results:
After the described steps have been performed, the document

types are available at all the points in the claims system where
documents can be created.
Context menu in navigation tree

Document tab in claim and subclaim
Claim item
© SAP AG 2006
© SAP AG FS335 9-10

Incoming Documents: Topic Summary

Configure the system for incoming documents.
© SAP AG 2006
© SAP AG FS335 9-11

Outbound Correspondence: Topic Objectives

correspondence.
© SAP AG 2006
© SAP AG FS335 9-12

Correspondence – Used Components
Used Components
Data buffer and storage: Correspondence Container

Origin FI-CA, now cross-application component
(CA-GTF-COR)
Data selection tool: Print Workbench
Developed by IS-U, now cross-application component
(CA-GTF-PWB)
Design and layout tools: SAPscript, Smart Forms
As of release 4.72: Only Smart Forms used
© SAP AG 2006
© SAP AG FS335 9-13

Correspondence – Overview
FS-CM Claims
Correspondence screen
User-def.text processing Sends claim data
Event Create
Correspondence Container
Event Print
Sends claim data

Print Workbench
(Data Retrieval from CC)
Smart Forms SAPscript

Design and Logic Design and TM Logic
© SAP AG 2006
© SAP AG FS335 9-14

Correspondence – Data Container
Correspondence Container
Data container filled by
Event Create (V854) that transfers current claim data to container:
Sample function ICL_SAMPLE_V854
Current claim data is sent to container:
Claim data (iclclaim)
Loss address (addr1_data)
Subclaim data (icl_iclsubcl)
Damaged objects (icl_damobj_ext, icl_itemau, icl_itemeq, icl_itemre)
Payment data (icl_payo, icl_payi)
Subrogation (iicl_subrogation_history, iicl_subrogation_item)
Participants (icl_partocc)
Procurement (icl_procure)
Items (icl_itemlist).
Event Print (V853) transfers data from container to print program:
Sample function ICL_SAMPLE_V853
© SAP AG 2006
© SAP AG FS335 9-15

Correspondence – Data Retrieval
The Print Workbench (cross-application component)

consists of
Form Class
Defines the data hierarchy that can be used in a form
Each class node has own form routine to retrieve data
Called by transaction EFCS
Application form
Based on a Smart or SAPscript form
Determines which data nodes are used within a form
Called by transaction EFRM
© SAP AG 2006
© SAP AG FS335 9-16

Correspondence – Data Retrieval in Form Class
© SAP AG 2006
© SAP AG FS335 9-17

Correspondence – Data Retrieval in Application Form
© SAP AG 2006
© SAP AG FS335 9-18

Correspondence – Form Design
SAPscript (Basis Component)
Defining the form layout

Language for output formatting in text modules
Logic exists in text modules
Is replaced by Smart Forms (no longer used)
© SAP AG 2006
© SAP AG FS335 9-19

Correspondence – Form Design
SAP Smart Forms (Basis Component)
Replace SAPscript forms

Layout of form pages
Logic of the form is mapped entirely in the Smart Form
Data retrieval takes place outside the Smart Form
Application program passes data via function module
interface to the Smart Form: Using the PWB this is done by
the PWB call
All new forms have to be created as Smart Forms
Transaction smartforms
Self-explanatory KW documentation
© SAP AG 2006
© SAP AG FS335 9-20

Correspondence – Smart Form Design
© SAP AG 2006
Open the SAP Form Builder by using transaction SMARTFORMS
© SAP AG FS335 9-21

Correspondence – Send Documents
Document is marked to be sent to
correspondence container. Document is sent to
Document with current claim data is sent correspondence container after pressing save
to correspondence container at once
(Event Create) and printed via PWB
(Event Print)
Assignment of attachments: Only documents of
archive link
Preview a document and start

of user-defined text processing
© SAP AG 2006
BDT view ICLC25
© SAP AG FS335 9-22

Correspondence – Sent Document
Without Print Date:

Document with current claim data was sent to
correspondence container (Event Create) but not printed
With Print Date:

Document was sent to correspondence container and
printed via print workbench.
© SAP AG 2006
BDT view ICLC24
© SAP AG FS335 9-23

Correspondence – Archived Documents (ICLZ00)
Document was printed via print workbench and

archived simultaneously
© SAP AG 2006
© SAP AG FS335 9-24

Correspondence – User-Defined Text Processing
© SAP AG 2006
© SAP AG FS335 9-25

Correspondence – Solution in FS CM 4.71
Correspondence Solution
Customizing steps for a new document:

Creating a new document in PWB
Defining the form with default document type and send type
Assigning roles of permitted recipients
Assigning manual permitted documents to internal claim type on
claim header or subclaim
User-defined text customizing
Creating a document based on a form class that allows user-defined
texts
Take over the desired user-defined text placeholder in the form
Assignment of text placeholder to subobject type (which subobjects
can be assigned user-defined text at this placeholder, which sample
text modules can be used)
© SAP AG 2006
© SAP AG FS335 9-26

Correspondence – Customizing
© SAP AG 2006
© SAP AG FS335 9-27

Outbound Correspondence: Topic Summary

correspondence.
© SAP AG 2006
© SAP AG FS335 9-28

Notes: Topic Objectives

Understand the principles of notes.
Understand the customizing for notes.
© SAP AG 2006
© SAP AG FS335 9-29

Notes - Definition
Notes can be used to store comments related to the processing of

the claim.
A note can be assigned to the claim or the subclaim level.
The following categories of notes are provided:

Standard notes with the following communication types
E-mail
Letter
Face time
Telephone notes
A telephone note can represent both inbound and outbound calls.
The following additional data is provided
Time of call
Call partner
Telephone number
© SAP AG 2006
© SAP AG FS335 9-30

Notes – Authorization Group
The assignment of authorizations can be used to control whether

other users can see or edit a note.
© SAP AG 2006
The assignment of an authorization group in claim processing has the following meaning:
If you assign an authorization group to a note, this note is only display to users in this authorization
group in claim processing, and only users in this authorization group can change this note.
• This allows you to create “secret” notes within a department, which can only be accessed by a
selected range of employees.
If you assign no authorization group to a note, this note is displayed to all users in claim processing
(meaning all users with display authorization), and all users can changes this note (all users with
change authorization).
© SAP AG FS335 9-31

Notes - Creation
Creation of standard or
telephone note
Additional attributes for

telephone note
Assignment of
authorization group
© SAP AG 2006
© SAP AG FS335 9-32

Notes - Customizing
Define if note
- Can only be extended
- Can be changed
Define
communication types
Define topics
for notes
© SAP AG 2006
© SAP AG FS335 9-33

Notes: Topic Summary

Understand the principles of notes.
Understand the customizing for notes.
© SAP AG 2006
© SAP AG FS335 9-34

Reporting: Topic Objectives

Understand the concept of extracting data to a
business data warehouse.
© SAP AG 2006
© SAP AG FS335 9-35

Reporting - BW Overview
Architecture:
© SAP AG 2006
© SAP AG FS335 9-36

Reporting - Business Content
Business Explorer Web Reporting
InfoCube InfoCube InfoCube
OLAP
ODS ODS ODS ODS ODS ODS ODS
OLTP
Claim Subclaim Reserve Payment Claimed Referral
Items
© SAP AG 2006
Extractors from Claims Management

y 0ISCM_CLTYPE_ATTR + TEXT
y 0ISCM_CLSTATUS_TEXT
y 0ISCM_COMPLEX_TEXT
y 0ISCM_LOSSTYPE_ATTR + TEXT
y 0ISCM_LOSSADDRESS_ATTR
y 0ISCM_SUBCLTYPE_ATTR + TEXT
y 0ISCM_SUBCLSTATUS_TEXT
y 0ISCM_BENTYPE_ATTR + TEXT
y 0ISCM_PLINEOFBUS_TEXT
y 0ISCM_CLINEOFBUS_TEXT
y 0ISCM_PAYMENT12_TEXT
y 0ISCM_PAYTYPE_TEXT
© SAP AG FS335 9-37

…
y 0ISCM_PAYITEMCAT_TEXT
y 0ISCM_RESMETHOD_TEXT
y 0ISCM_RESTYPE_ATTR + TEXT
y 0ISCM_EVALCAT_ATTR + TEXT
y 0ISCM_EVALBASE_ATTR + TEXT
y 0ISCM_REFATTR_ATTR + TEXT
Standard extractors from other applications

y 0COUNTRY_TEXT, 0REGION_TEXT
y 0BPARTNER_ATTR + TEXT
y 0ORGUNIT_ATTR + TEXT
y 0ORGUNIT_HR01_HIER
y 0COMP_CODE_TEXT
© SAP AG FS335 9-38

Reporting – BW Extractors
Transaction RSA2: DataSource Repository
© SAP AG 2006
© SAP AG FS335 9-39

Reporting – BW Data Load Process
Transactional data supports two methods:

Full Upload
Delta Upload
Master data load only in full upload mode
Transaction RSA3 (Extractor checker)

Test tool for data load in source system
(Claims application)
© SAP AG 2006
© SAP AG FS335 9-40

Reporting – BW Data Load Process
© SAP AG 2006
© SAP AG FS335 9-41

Reporting - Delta-Management BW Extractors
© SAP AG 2006
© SAP AG FS335 9-42

Delta method ‘AIMD’

Only ‘After Images’ and ‘Delete Images’ will be extracted to BW.
Delta information will be stored in Claims application within

update module in a separate Delta-Queue table (direct push).
Use of an ODS-Object is obligatory for this delta method.
© SAP AG 2006
Please add some notes hereFunction modules:

y ICLC_ICL_EVENT_DTAKE_BWDELTA
y ICLC_ICL_EVENT_DSAVE_BWDELTA
y RSC1_TRFC_QUEUE_WRITE
© SAP AG FS335 9-43

Info
Package Full Upload Initialization Delta Upload
OLAP
OLTP
Extractor
RFC- Queue
Claims
© SAP AG 2006
© SAP AG FS335 9-44

Reporting: Topic Summary

Understand the concept of extracting data to a
business data warehouse.
© SAP AG 2006
© SAP AG FS335 9-45

Claim Handling Supporting Features: Unit Summary

Configure the system for incoming documents
Understand the customizing for correspondence
Explain the customizing for notes
Understand the existing claims management report
Understand the concept of BW extractors.
© SAP AG 2006
© SAP AG FS335 9-46

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 9-47

© SAP AG FS335 9-48
Integration
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 10-1

Integration
Contents:
Interfaces and technology

Interface to policy system
Interface to collections and disbursements system
© SAP AG 2006
© SAP AG FS335 10-2

Integration: Unit Objectives

Explain the principles of the interfaces and
technology used in FS-CM.
Explain the interface to the policy system.
Understand the interface to the FS-CD Collections
and Disbursements system.
© SAP AG 2006
© SAP AG FS335 10-3

Interface and Technology: Topic Objectives

List the most important interfaces of FS-CM
Understand the principles of Business Add-Ins
(BAdI).
© SAP AG 2006
© SAP AG FS335 10-4

BAdI – Definition I
A location in a program defined by the developer where

industries, partners and customers can insert additional code
without modifying the original object.
BAdIs are inserted into the SAP System to accommodate user
requirements too specific to be included in the standard delivery.
Business Add-Ins can be created at every level of a multi-level
system infrastructure.
Making enhancements with Business Add-Ins allows you to
distinguish between enhancements
that can have no more than one implementation, and those
that can be actively used by any number of customers at the same
time.
You can also define Business Add-Ins that depend on a filter

value, such as the line of business.
© SAP AG 2006
© SAP AG FS335 10-5

BAdI – Technical view
Business Add-Ins are based on ABAP Objects technology.
Business Add-Ins are divided into two layers:
Definition layer (transaction SE18)

SAP defines for a BAdI
The location in the program
The methods of the BAdI
The parameters that are exchanged between the program and the
addition coding.
Implementation layer (transaction SE19)

Users of BAdIs are able to bring in their own logic via the methods of
the BAdI.
In some cases SAP provides
Default implementations (e.g. interface to FS-CD)
Implementation is processed if there is no active implementation
Sample implementations
© SAP AG 2006
© SAP AG FS335 10-6

BAdI - Architecture
© SAP AG 2006
© SAP AG FS335 10-7

BAdI – Upward Compatibility
SAP guarantees the upward compatibility of all Business Add-In

interfaces. Release upgrades do not affect enhancement calls
from within the standard software, nor do they affect the validity of
call interfaces.
© SAP AG 2006
© SAP AG FS335 10-8

BAdI - Guideline for Implementation
SAP Library - Path:
> SAP Library:

> Basis Components
> ABAP Workbench (BC-DWB)
> BC – ABAP Workbench: Tools
> Changing the SAP Standard
> Business Add-Ins
© SAP AG 2006
© SAP AG FS335 10-9

BAdI - Examples
More than 60 BAdIs have been implemented in FS-CM, including:
BADI for FNOL Validations ICLN_FNOL_VALIDATE

BAdI: Interface to Policy System ICL_POLS_IMPORT_POLS
Interface to External Policy System ICL_EXT_POL_IMPORT
FS-CM: FS-PM Interface: PM Proxy ICL_PMI_PROXY
BAdI: Interface to Collections/Disbursements ICLF_CD
Integration of External Catalog Systems ICL_CATALOGS
Call Business Partner Full Maintenance ICL_BP_FULL_MAINTENA
Claim Search ICL_CLSRCH
Find Possible Duplicates
During Claim Creation Process ICL_DUPLICATE_CHECK
BAdI for Claim Items ICL_ITEM
Call Claim Examination System (such as ISP) ICL_CLAIM_EXERCISER
Calculation Methods for IBNR Reserves ICL_IBNR_CALCULATE
Customer Enhancements for Payments ICL_PAYMENT
Distribution Plan ICL_DIPL
Activity Management - General ICL_ACTIVITY_MGMNT
Workflow: Modify Event Container ICL_WF_EVT_CONTAINER
© SAP AG 2006
© SAP AG FS335 10-10

Interface and Technology: Topic Objectives

List the most important interfaces of FS-CM
Understand the principles of Business Add-Ins
(BAdI).
© SAP AG 2006
© SAP AG FS335 10-11

Interface to Policy System: Topic Objectives

Understand the interface to the policy system.
© SAP AG 2006
© SAP AG FS335 10-12

Interface to Policy System
Among other things, this BAdI enables you to
Check whether the policy exists

View all policies for a business partner
Determine the related policy product and version of the policy
product for a policy.
Get additional information on the policy, e.g.

Policyholder
Insured objects / insured persons
Validity period of policy
For the area of multiple insurance, distribution plans are

transferred from the policy system to the policy snapshot.
© SAP AG 2006
© SAP AG FS335 10-13

Interface to Policy System - Customizing
© SAP AG 2006
In 4.72 gab es noch nicht den Knoten Schnittstelle zu Bestandssystem (Interface to Policy
Management System); das BAdI war nur über Product Configuration Æ Business Add-Ins verfügbar
© SAP AG FS335 10-14

Interface to Policy System – BAdI Methods
© SAP AG 2006
© SAP AG FS335 10-15

Interface to Policy System – Method POLICY_LOAD
Press ENTER and

BAdI method
POLICY_LOAD
is processed
© SAP AG 2006
© SAP AG FS335 10-16

Interface to Policy System : Topic Summary

Understand the interface to the policy system.
© SAP AG 2006
© SAP AG FS335 10-17

Interface to Collections & Disbursements: Topic
Objectives

Explain the interface to the FS-CD Collections &
Disbursements system.
© SAP AG 2006
© SAP AG FS335 10-18

Collections and Disbursements
General settings
for collections &
disbursements
system
1
Settings for
2 SAP Collections
and
3
Disbursements
4
© SAP AG 2006
© SAP AG FS335 10-19

Collection and Disbursements – BAdI Methods I
© SAP AG 2006
© SAP AG FS335 10-20

Collections & Disbursements – BAdI Methods II
- DOCUMENT_CHECK - DOCUMENT_CHECK
- DOCUMENT_CLEAR - ONLINE_CHECK_PRINTING
- DOCUMENT_DISPLAY
- DISBURSEMENT
- SCHED_POS_MODIFY
- SCHED_POS_COMPRESS
- CHECK_PAYMENT_PLAN
- PAYMENT_METHOD_GET
- BULK_CHECK
- BANKID_GET
- ADDRNUMBER_GET
© SAP AG 2006
© SAP AG FS335 10-21

FS-CD Interface
FS-CM
General Ledger
Outbound payments
Money requests Special Ledger
Interface
(salvage, subrogation,
refunds) Profitability Analysis
FS-CD
Reversal Cost centers /
Hand written checks orders
(payment + clearing)
Online check printing Cash Management
Report
Incoming payments ...
© SAP AG 2006
© SAP AG FS335 10-22

FS-CD Interface - FS-CD Master Data
Business Partner
n n
Insurance Relationship
n
m 1 m
Contract Account
Insurance Object
© SAP AG 2006
An insurance object can be assigned to more than one business partner, and more than one insurance
object can be assigned to a business partner.
A contract account can be assigned to more than one business partner, and more than one contract
account can be assigned to a business partner.
Each unique combination of business partner / insurance object (I.e. insurance relationship) can be
assigned to exactly ONE contract account, and a contract account can have more than one
combination of business partner / insurance object (insurance relationship) assigned to it. This
means that an insurance object can exist on more than one contract account master record.
© SAP AG FS335 10-23

FS-CD Interface - Process
General Ledger
ICL_CF_POST2CD
Special Ledger
Profitability Analysis
FS-CD
Payment Cost centers /
orders
Cash Management
...
If { BP (i.e. payee and/or policyholder) in role “MKK” does not exist }.
Create BPs in role “MKK”.
Endif
If { IO for policy does not exist }. Scenario 1 for
Create CA for policyholder. determination of
2 Create IO for policy. contract account
Endif. only
If { IO for claim does not exist }.
Create CA for policyholder.
1 3 Create IO for claim.
Endif.
4 Create posting data (i.e. fill SVVSCPOS_B).
Post posting data.
© SAP AG 2006
Anlage von BP in Rolle MKK

Zahlungspositionen werden zusammengefasst, wenn Haupt- und Teilvorgänge sowie
Steuerkennzeichen identisch sind
© SAP AG FS335 10-24

FS-CD Interface – Master Data: Insurance Object 1
Insurance object represents one claim

ID of the insurance object is the same as the ID of the claim
(since there is no reference field available)
Conflict if other component (e.g. FS-PM, FS-CM) uses same

number range
Î Today‘s approach by FS-CM

Usage of 3 digit prefix (determined in FS-CM customizing), e.g.
‘ICL’ + ‘4711’ Æ ICL4711 for claim 4711

‘POL’ + ‘4711’ Æ POL4711 for policy 4711
© SAP AG 2006
© SAP AG FS335 10-25

FS-CD Interface – Master Data: Contract Account 2
General Ledger
ICL_CF_POST2CD
Special Ledger
Profitability Analysis
FS-CD
Payment Cost centers /
orders
Cash Management
...
Scenario 1: Same account used for premiums and claims

payments (determined through policy IO)
Scenario 2: A different account is used for claims payments
than for premiums
Scenario 3: A different account is used for each claim as well
as a separate account for premiums
© SAP AG 2006
© SAP AG FS335 10-26

FS-CD Interface – Customizing for Contract Account 2
Description of key, Account creation

table TICL326 variant for policy
Key used as
reference Which account is Object category of
in policy product to be used ? account for policy
© SAP AG 2006
© SAP AG FS335 10-27

FS-CD Interface – Policy-Product-Related
Customizing
IMG: -> SAP Insurance -> Claims Management -> Claim -> Product Configuration
-> Configure Policy Products
CD Specification
© SAP AG 2006
© SAP AG FS335 10-28

FS-CD Interface – Master Data for Claim 3
Key used as
reference in Account creation
internal claim variant for claims
type
Description of key, Object category of

table TICL327 Insurance object
representing claim
© SAP AG 2006
© SAP AG FS335 10-29

FS-CD Interface – Standard Posting Data 4
Posting procedure type Value of attributes
Attributes of Posting Document:

Fields of SVVSCPOS_B
© SAP AG 2006
© SAP AG FS335 10-30

FS-CD Interface – Internal Claim Type Customizing
IMG: SAP Insurance Æ Claims Management Æ Claim Æ Process Control

(Internal Claim Types) Æ Configure Internal Claim Types
Standard Posting Data
Reference for FS-CD

master data creation
© SAP AG 2006
© SAP AG FS335 10-31

FS-CD Interface – References 1
Payment FS-CD
ISCD_POS_MAINTAIN
of $100
John
John Doe
Doe
for Repair Shop
$100
References
In FS-CM: document reference
ICLPAY-DOCUMENTREF = DFKKOP-OPBEL
In FS-CD: reference to payment in claims system
DFKKOP-REFCLAIM = <ICLPAY-SUBCLAIM> + <ICLPAY-PAYMENT>
Reference to claim is determined by

ID of Insurance Object
© SAP AG 2006
© SAP AG FS335 10-32

FS-CD Interface - Bulk Payment 1
Payment FS-CD
ICL_CF_POST2CD
of $100
John Doe Repair Shop
for Repair Shop
$100 $100 $100
Payment Run
© SAP AG 2006
© SAP AG FS335 10-33

Interface to Collections&Disbursements: Topic Summary

Explain the interface to the FS-CD Collections and
Disbursements system.
© SAP AG 2006
© SAP AG FS335 10-34

Integration: Unit Summary

Explain the principles of the interfaces and
technology used in FS-CM.
Explain the interface to the policy system.
Understand the interface to the FS-CD Collections
and Disbursements system.
© SAP AG 2006
© SAP AG FS335 10-35

Course Content

Unit 10 Integration
Conclusion
© SAP AG 2010
© SAP AG FS335 10-36

Exercises
SAP WS Claims
Exercise: FS-CD Configuration
Status: ERP2005

• Create the configuration for the interface to FS-CD.
Situation:
to configure the interface to FS-CD.

twice. Note down
1-2 Define master data

1-2-1 Define product-related settings
Define the settings related to your product PP## by navigating to customizing
activity:
Claims Management Æ ClaimÆ Product Configuration Æ Configure Policy
Products.
Navigate to the header of the policy product version. Here, enter AAS1 –
Scenario 1 as the value for the CD Specification. Choose the Collections &
Disbursements interface to be Active.
Set the status of the Collections & Disbursements interface to Active.
© SAP AG FS335 10-37

1-2-2 Define internal claim type related settings
Define the settings related to your internal claim types by navigating to
customizing activity:
Navigate to the claim header of the internal claim type. Enter the value Home
for the Sample Template for Contract Account for Insurance Object (field CA
SmplTemplate).
1-2-3 Define standard data for FS-CD documents
Define the standard posting data by navigating to customizing activity:
Enter the value TP for the standard data for FS-CD documents.
1-3 Approval of payments

Open your workflow inbox. Select approval tasks and approve the payments.
Check the Activity log of the related claims. Provide feedback to the owner of the claim.
© SAP AG FS335 10-38

Conclusion
1. Course Overview
8. Claim Recovery
10. Integration
© SAP AG 2006
Conclusion
© SAP AG FS335 Conclusion-1

Course Objectives

Understand the basic functionality of Customizing
in SAP Claims Management
Customize policy products and internal claim types
Make basic changes to the user interface
Set up Tasks and customize basic business rules
Describe the supporting features of SAP Claims
Management
© SAP AG 2006

Recommended Follow-Up Activities
Go through the exercises using IDES data or your own

data.
Read the online documentation.
Read the Implementation Guide (IMG).
Read Release Notes.
© SAP AG 2006

Lines of Business
Line of Business: L##
Line of Business: ...
Policy Products
Policy Product: PP##

Coverage Type: CT##B
Benefit Type Tree Losses: BTT##B
Coverage Type: ...
Determine Intern. Claim Type

Incident Type: I##F Int.Claim Type.: CT##
Incident Type: …. Int.Claim Type.: ….
Policy Product: ...
Screen Sequences
Internal Claim Types Quick, Notific. Mode
Internal Claim type: CT##

Screen Sequ.
Claim Header Expert Mode
Question Sequence for SFC
SFC: Q##
SFC: ...
...
Permitted Subclaim Types

Subclaim: S##C
Ben.Type. Tree Exp.: BTT##E
Coverage Type: CT##B

Coverage Type: ...
Permitted Reserve Types
Reserve Type Losses: ##
Reserve Type Exp: ##
...
Subclaim: ...
Damaged Objects
Internal Claim Type: ...
This list will help you to consolidate the customizing entries you will create during the
next exercises.

Your Naming
Customizing entry Key convention Name
Line of Business L## ## Home Insurance.
Coverage type CT##B ## Building
CT##C ## Contents
CT##L ## Liability Property Damage
Incident type I##F Fire
I##T Theft
Policy product PP## Home Owners Product
Benefit type BT##01 Building
BT##02 Door
BT##03 Window
BT##04 Roof
BT##05 Painter
BT##06 Other Structures
BT##07 Garage
BT##08 Dog Kennel
BT##09 Building Expenses
BT##10 Adjuster Fee
BT##11 Police Report
BT##12 In-house Lawyer
Benefit type tree BTT##B Building
BTT##E Expenses
Internal Claim Type CT## ## Home Owners Fire
Subclaim type S##B ## Home Building Damage
S##C ## Home Contents Damage
S##L ## Liability Property Damage
Damage descriptors ##1 Wall
##2 Roof
##3 Door
SFC Q## Origin of Loss - Fire- Group ##
Coverage referral CR## Internal Fire - Check fraud potential ##
Action A## Set Coverage Referral ##
A** Create Task ##
Task T## Capture information on third party

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FS335 SAP Claims Management Customizing

THE BEST-RUN BUSINESSES RUN SAP

© SAP AG 2009 © SAP AG 2006

 SAP for Insurance

© SAP AG FS335 Preface-1

Copyright 2009 SAP AG. All rights reserved.

© SAP AG FS335 Preface-3

© SAP AG FS335 Preface-4

© SAP AG FS335 Preface-5

This course is intended for the following audiences:

© SAP AG FS335 Preface-6

© SAP AG FS335 1-1

This course will prepare you to:

© SAP AG FS335 1-2

After completing this course, you will be able to:

© SAP AG FS335 1-3

Claims Management Customizing

© SAP AG FS335 1-4

3. Claim Handling Configuration

4. User Interface Configuration (BDT)

5. Business Rules (BRF) and Tasks

6. Structured Facts Capture (SFC)

9. Claim Handling Supporting Features

© SAP AG FS335 1-5

You are working in the SAP Customer Competency

© SAP AG FS335 1-6

Underwriting and Policy Administration

Insurance Business Services

© SAP AG FS335 1-7

Claim Handling & Fullfillment Claim Recovery

Notice of Loss Subrogation

© SAP AG FS335 1-8

Insight Driven Insurance Business Support

© SAP AG FS335 1-9

Policy Management Customer service / Portal

SAP Claims Management Business

Collection and Incentive Fraud /

© SAP AG FS335 1-10

12 Co-insurance Notice of Loss 1

9 Claim Payments Facts Capture 4

FNOL: Different process flows depending on the type of claim

© SAP AG FS335 1-11

Screen, Field &

© SAP AG FS335 1-12

At the conclusion of these exercises you will be able to:

1-1 Log on to the system

© SAP AG FS335 1-13

1-3 Customize your SAP Easy Access Menu

© SAP AG FS335 1-14

3. The end result should look like this

© SAP AG FS335 1-15

Transaction ICLIMG will take you to the Implementation Guide

© SAP AG FS335 1-16

3. Claim Handling Configuration

4. User Interface Configuration (BDT)

5. Business Rules (BRF) and Tasks

6. Structured Facts Capture (SFC)

9. Claim Handling Supporting Features

© SAP AG FS335 2-1

© SAP AG FS335 2-2

After completing this unit, you will be able to:

© SAP AG FS335 2-3

After completing this topic, you will be able to:

SAP for Insurance

A policy product is a set of rules defining facts that

Together with the loss incident type and date of loss,

Auto accident Auto insurance

Input of a coverage type defines which risks are covered

Input of the permitted coverage types restricts the

A policy belonging to this product can only contain

The type of incident that triggered the insurance claim.

The product and the loss incident types defined in the

Product changes have an effect either on the generation,

Changes that are to apply to all claims that occurred after a

Changes that are to apply to all claims whose policy was

Configure policy products

Define insurance lines of business

Similar risks are grouped in an insurance line of business.

Key of insurance line of business

The coverage type classifies a coverage.

Key of the coverage type

The type of incident that triggered a claim.

Key of incident type

Key of the policy product

Configure benefit type trees.

Contains a hierarchical structure of permitted benefit types.