Claims Processing Value Chain - Road Accident Fund. RAF_ClaimsLitigation... · Claims Processing Value Chain 1.1. Hospital service centres ... · ICT - Information Communication ...
Post on 28-Jun-2018
235 Views
Preview:
Transcript
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management *
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
Version 20, 06 June 2013* Report to Correspondence Manager
Symbols and Abbreviations
On page reference
Off page reference
Action
Process
Decision
Symbols Abbreviations
· AMA - American Medical Association· BI - Body Identification· BIF - Banking Indemnity Form· CAFS – Central Archiving Filing System· CC - Compensation Commissioner· CLS - Legal and Compliance· CO - Claims Officer· COO - Chief Operations Officer· CSC - Customer Service Consultant/Centre· DM - Document Management· DOA - Date of Accident· DoB - Date of Birth· EA - Expenditure Authorisation· EIL - Employer Individually Liable· ES - Executive Summary· GD- General Damages· GM - General Manager· HCM - Hospital Case Manager· HPCSA - Health Professions Council Of South
Africa· HSC - Hospital Service Consultant/Centre· ICT - Information Communication
Technology· ID - Identity Document· ILD - Internal Law Department· IT - Information Technology· LCO - Legal Cost Officer· LoE - Loss of Earnings
· LoS - Loss of Support· MMI - Maximum Medical Improvement· MVA - Motor Vehicle Accident· NB - Nota Bene (Important)· OAR - Official Accident Report· PA - Panel Attorney· POP - Patient Outreach Program· RAF - Road Accident Fund· RAF 1 - Road Accident Fund Form 1· RAF 2 - Road Accident Fund Form 2· RAF 3 - Road Accident Fund Form 3· RAF 4 - Road Accident Fund Form 4· RAF 5 - Road Accident Fund Form 5· RSA - Republic of South Africa· SAPS - South African Police Service· SMR - Statutory Medical Report· SMS – Summons Management System· SOP - Standard Operating Procedure· U number - Undertakings Number· U system - Undertakings System· UBC - Unabridged Birth Certificate· UO - Undertakings Officer· V&V - Validation and Verification· WCC - Workmen's Compensation Commission
System intervention
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.1.1. Summons unit process (Part 1 of 3)
Administrative assistant
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Administrative assistant
Summons administration
officer
Summons served via sheriff/mailroom/
fax
Date stamp check claim number on
“Claims View”
The claim is traced by using the claim number, link number and/or claimant ID number
The system does warn the user if there are summonses already linked to a particular claim
Can claim be located physically
or at CAFS?Yes
File not found process
A
B
File in another region?
No
Yes
Write claim number on summons pack and
register summons on the Summons
Management System
Capture summons on distribution spread sheet
Place a note on Claims View and
Summons Management
System
Scan documents and send via docex to relevant region
B
No
3.1.1. Summons unit process (Part 2 of 3)
Summons team leader
Summons senior officer
Summons senior officer
Summons administration
officer
Summons administration
officer
Administrative assistant
Senior has rights to rectify appointment on the system process
Accept summons from summons administrator
Is summons from
High Court
Check if there are linked files
Are there linked files?
Did system allocate same
Panel Attorney?
No
Is attorney still on
the Panel?
No No
Did system allocate matter to a local Panel
Attorney?
A
E
DIs court outside
15km radius from the Fund offices?
Yes
File confirmation spread sheet
End
No
H
H
Forward summons to ILD team leader
for defending
Distribute summons to relevant unit
Indicate intention to defend on
system
Is the summons for a supplier
claim?
Is court within 15km radius
from the Fund offices?
No
Yes
H
No
E
No
Yes Yes
Yes
YesD
Yes
Senior has rights to rectify appointment on the system process
Yes
3.1.1. Summons unit process (Part 3 of 3)
D
Summons administration
officer
Summons administration
officer Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Summons administration
officer
Administrative assistant
Summons administration
officer
Summons senior officer
E
EndFile confirmationYes
Follow up telephonically and if
needs be, re-send instruction letter
NoYes
No
3.1.1.3. Follow up to check if matter
has been defended
Send confirmation batch for scanning
Raise matter with unit Senior
Determine whether an instruction was
sent to an incorrect attorney
Yes
Follow up telephonically and if needs be, re-send
withdrawal letter
No
Did Panel Attorney confirm receipt within 24
hours?
No
YesFile confirmation (of
withdrawal)
Print letter of instruction for
correctly appointed Panel Attorney
At end of day, send confirmation batch for
scanningG
G
G
Print instruction letter to be sent to
Panel Attorney
Was an instruction sent to an incorrect
attorney?
YesSend withdrawal
instruction
D
No
Did Panel Attorney confirm receipt in writing within 24 hours?
Did Panel Attorney confirm receipt in writing within 24 hours?
Did Panel Attorney confirm receipt in writing within 24 hours?
Send instruction letter via email
(with read receipt) or facsimile. Wait
for attorney to confirm receipt of
instructions
Override system appointment and
put notes on ‘Claims View’ and Summons
Management System
DD
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.2.1. Writ management process
Administrative assistant
Administrative assistant
Administra-tive
assistantAdministrative
assistant
Writ officer
Writ officer
Writ officerAdministrative assistant
Writ senior
Writ officer
Writ officer
Writ officerWrit officer Writ officer Writ officer
Writ officer
Writ officer Writ officer
A
Receive writs from sheriff
Acknowledge receipt (register) and stamp within
10 minutes
AIs the writ
valid?
Record on template and escalate to
senior
No
Record in writs register
Separate writs according to capital, legal cost and other
branch
Conduct writs assessment within
20 minutes of receipt
- Verify if it is a registered claim- Verify not a duplicate
End
Compare writ and payment checklist
to verify information is
complete
Yes
Communicate the invalid writ to
Sheriff
Capture writ in the writ system and
stamp as captured
Receive proof of payment from Writ
Payment unit
Prepare writs summary and
record assessed writ on excel register
and intranet
Refer assessed writ to senior for
review
Senior accept?
Yes
Refer writ to Forensics for investigation
No
End
EndPrepare trigger
document
Send file to Writ Payment unit for
payment
Is all the information needed to
prepare the trigger
available?
Scan writ and send to the relevant unit to get information
within 4 hours
Did you receive information?
No
Yes
BYes
Record on register and escalate to
senior
No
C
C
B
Together with senior, follow up with the relevant
unit
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.3.1. Magistrate court process (Part 1 of 2)
ILD officer ILD officerILD officer
ILD officer
ILD officer
ILD officer
ILD officer ILD officer ILD officer ILD officer
ILD officer
ILD officer
Has trial date been issued?
Yes
3.3.1.2. Prepare for
pre-trial
3.3.1.1. Pleadings draft
processesPrepare an offer
Has an offer been
accepted?
No
The file has to be pro-actively
prepared for trial, not only get
prepared when the matter is classified
as litigious
Load offer on system & generate update SMS to claimant/
representative
Make offer to plaintiff attorney
Accept offer on system, generate acceptance sms & request payment
Prepare file & deliver to capital payment unit for
settle3.1. Magistrate court
process (1/3)ment
End
A
A
Receive files from Summons
Administration
3.3.1.2. Prepare for
pre-trial
B
Reject and revise offer
C
Enter appearance to defend
Request further particulars for the
purpose of plea
No
Yes
C
3.3.1. Magistrate court process (Part 2 of 2)
ILD officer ILD officer ILD officer ILD officer ILD officer
ILD officer
ILD officer
ILD officer
ILD officer ILD officer ILD officer
ILD officer
Try to settle with the plaintiff before the matter goes to
trial
Attend to Pre-trials where the plaintiff attorney may
want to set the matter down for hearing
Officer continues to make an offer
before trial date
Determine contingency deductions to be applied
(apportionment and risk)
Consider any prior payments/interim payments/WCC/
social grants
BD
Prepare offer Make offer to
plaintiff attorneyD
Load offer on system & generate
update sms to claimant/
representative
No
No
Reject and revise offer
Is the offer accepted?
Prepare file & deliver to Capital payment unit for
settlement
End
Rule 18 tender or settlement agreement is drafted then signed by
both parties
Yes
3.3.1.3. A Panel Attorney
is appointedEnd
Are there any contentious
issues?Yes
Accept offer on system, generate
acceptance SMS & request payment
E
E
D
3.3.1.1. Pleadings draft processes
ILD officerILD officer ILD officer ILD officer
ILD officer
ILD officer ILD officer
Senior ILD officer
ILD officer DriverDriver Driver
Driver
Driver ILD officer
Receive notification from claims officer/
summons administrator to draft pleadings
Request all files from claims officers
Have all the files been received?
Notify claims officer and request
outstanding files
No
Peruse file and summons
documentationYes
Finalise notice of intention (10 days) and pleading (20
days) and submit to senior for review
Does the senior approve?
AYes
Suggest amendments to be
made
No
A Senior to sign off
Prepare 3 copies to be submitted to
Plaintiff Attorney, Court, and the Fund
Does plaintiff attorney accept?
Get all 3 copies stamped by plaintiff
attorneyYes
Return to RAF for amendments and
resubmission
No
B
B
Deliver stamped copy by plaintiff
attorney to court for
acknowledgement
Get all 3 copies stamped by court
C
CDriver to return stamped copy to
RAF
Place copy on file and prepare file to be returned to CO
for settlement
End
Draft notice of intention and
pleadings
Driver to serve all copies to plaintiff
attorney for acknowledgement
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.4.1. High court litigation process (Part 1 of 5)
Administrative assistant Administrative assistant Litigation officer Litigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officerLitigation officer
A
Share all the relevant
information with the Panel Attorney
Receive notification from the Summons Department that
the case will be defended by the Panel Attorney
Team Leader confirms receipt of notification and
allocates the file accordingly within his/her team
Trace the location of the file (follow up with ‘Claims Determination’
& CAFS)
Is the file located?
3.1.1. Request a copy of the file
contents from the Plaintiff attorney
No
Send a letter to the plaintiff and panel attorneys to
provide the contact details of the new officer within 5 days
of instruction
Yes A
Does the plaintiff attorney
want to discover?
Are there outstanding
docs?Yes
Panel attorney to provide
recommendations on merits
Yes B
Have merits been settled?
No
No
Yes
No
Has the quantum been determined?
Record quantum determined by the Panel
AttorneyYes
Sense-check the quantum assessment with respect
to the case and its supporting docs.
No
D3.1.4. Merits investigation
follow up
3.1.5. Quantum
Assessment follow up
C
B
Try settle the matter
If matter cant be settled, continue with process
C
3.4.1. High court litigation process (Part 2 of 5)
Litigation officerLitigation officer
Litigation officerLitigation officer
Litigation officer
Litigation officerLitigation officer
Litigation officer
DIs the Panel
Attorney's offer reasonable?
Has the offer been made?
Yes Has the offer
been accepted?Yes
Request the Panel Attorney to forward the
signed acceptance letter for payment
processing
Yes
FDiscuss the offer
made with the line manager/colleagues
No
Enquire why an offer has not been
made
No
Is the response acceptable?
Diarise and follow up within 3 days
Yes
X
G
No
Make an offer and communicate this
with panel attorney
No
E
D
Is the capital payment request within mandate?
Print expenditure authorisation
Yes
Prepare an executive summary
for approval
No
Send the executive summary to senior
for review and approval
Does the line manager think the
offer is reasonable?
Yes
K
No
J
X
3.4.1. High court litigation process (Part 3 of 5)
Litigation officerLitigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officerLitigation officer
Litigation officer
Litigation officer
F Does the senior accept?
Revise the executive summary
No
Send expenditure authorization and supporting doc. To
Capital Payment unit
Yes
Complete closure report, SLA breach report for
Panel Attorney management and
judgement monitoring
Send to senior for approval
Is the report satifactory?
Revert back to the officer
No
Revise the closure report
Forward the legal bills to the Legal
Costs Validation unit
End
Yes
Send executive summary for
approvalF
J
Forward closure report, SLA breach
report to Panel Attorney
management and judgement monitoring
3.4.1. High court litigation process (Part 4 of 5)
Litigation officerLitigation officer
Litigation officer
Litigation officer Litigation officer Litigation officer
Litigation officer
Litigation officerLitigation officerLitigation officer
Litigation officer
Revert to the Panel Attorney, discuss
the offer made and suggest changes
Does the Panel Attorney agree?
Diarise to follow up with Panel Attorney
within 2 daysYes
Is the offer too low or too high?
No
Analyse the scope to check if the offer
can be increasedToo lowToo high
Enquire reasons why an offer was
not accepted
Did the plaintiff deem the offer to
be too low?
Review the case and its supporting doc.
Yes Is there scope to
increase the offer?
Discuss the matter with the line
manager/colleaguesYes
Does the line manager agree?
Yes
No No
Assist in formulating the litigation
strategy
Are there any litigious disputes?
No
No
Revert back to Panel Attorney and
discuss the strategy.
Diarise and follow up before trial
2 weeks before trail: follow up with the Panel Attorney
on the matter and share newly discovered
information (if any) and trial matters
3.4.1. Escalate the litigious dispute to
senior
Yes L
K D
G
M
K
KKEnd
K
3.4.1. High court litigation process (Part 5 of 5)
Phase
Litigation officer
Litigation officer
Litigation officer
Litigation officerLitigation officer
Litigation officer
Litigation officer
M
Pre-prepare executive summary should the matter
go against the fund (i.e. w.r.t. mandate)
Post trail: enquire about trail outcomes and/or
out of court settlements
Are the matters resolved?
Request the Panel attorney to furnish all
required docs. To effect payment within 3 days
No
3.5.1. Matter goes to trial
Court order received for payment?
Yes NYes
N
Request capital payment to make
the payment
Liaise with the Panel AttorneyL
E
O
Is the settled amount above
approved mandate?
No
Prepare an ES for approval
Is the ES approved?
Yes RYes
R
K
K
No
No
3.1.4. Merits Investigation Follow Up
Litigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officerLitigation officerLitigation officer
Check if the report(s) has/have been received post
assessment
Have the reports been
received?
Forward reports to the Panel Attorney
Yes
Diarise Merit assessment follow up
with the Panel Attorney within a week
No
Enquire why merits were not settled
Does the panel attorney need to appoint an
expert?
Yes
Escalate the matter with the senior
officer
End
3.4.1.2. Senior follows up
with the Panel Attorney
No
Did the panel attorney provide an
acceptable response on what is holding up merits?
Yes
Liaise with senior and approve
appointment of experts
Inform panel attorney and diarise matter for follow up
P
P
No
End
N
If Panel Attorney doesn’t comply, request merits to conduct merits assessment
3.4.1.5. Quantum assessment follow up process
Litigation officer
Litigation officer Litigation officerLitigation officer
Litigation officer
Litigation officer
Litigation officer
Litigation officer
Are there any outstanding reports
(e.g. actuarial reports)?
Have these reports been requested?
YesHave the experts
been paid?Yes
3.1.5.1. Follow up with capital
payment and experts/service
provider
Yes
Approve appointment of
expert
No No
Enquire what is holding up quantum
determination
No
Is the response
acceptable?
3.1.5.4. Senior follows up with the
Panel Attorney
No
Diarise for follow up within a week
Yes
N
3.1.5.5. Expert payment process
C
C
O
Check if the report(s) has/have been received post
assessment
Have the reports been
received?
Forward reports to the Panel Attorney
N
Yes
No
Q
Q
Diarise Merit assessment follow up
with the Panel Attorney within a week
B
End
End
If panel attorney has not appointed an expert, appoint expert
3.4.1.5.4. Expert payment process
Senior officer Senior officerSenior officer Senior officer
Senior officer
Senior officer
Prepare an executive summary to address
the situation
Is the expenditure within mandate?
Forward to senior for approval
Yes
Executive summary/ expenditure authorization to be forwarded to finance
for payment
Diarise and follow up within 3 days
Forward executive summary to persons
with mandate
No
Is the executive summary approved?
Yes
Revise the executive summary/expenditure
authorization
No
Has payment been made?
EndYes
No
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.5.1. Panel attorney management (Part 1 of 2)
Administrative assistant
Panel attorney management officer
Panel attorney management
officer
Panel attorney management officer
Panel attorney management
officer
Panel attorney management officer
Panel attorney management
officer
Panel attorney management senior
Panel attorney management officer
Panel attorney management
officer
Panel attorney management
senior
Receive complaints and/or breach notices with regards
to attorney performance
Analyse breach as presented in the summary and/or breach report and/
or SLA
Is the complaint a minor breach?
Engage in conflict resolution with the
Panel AttorneyYes
Is the conflict/complaint resolved?
AYes
B
No
B
No
ADoes the report reflect the resolved issues and
is it satisfactory?
Send to the assistant for filling
Yes
Highlight the report’s shortcomings and revert
to the offer
No
Revise the report
End
BDiscuss the
recommended actions with senior
Are the recommended actions justified?
Yes
Discuss with officer and recommend justified penalty
No
Revise the recommendation
D
D
E
F
F
Compile a report to this effect and forward to
senior for review
Analyse and recommend what financial penalties or charges may be levied due to poor service delivery to
the office of the COO
3.5.1. Panel attorney management (Part 2 of 2)
Panel attorney management
officer
Panel attorney management officer
Panel attorney management officer
Panel attorney management officer
Sign off on recommendation as per delegation of
authority with respect to level of penalty
Is the reviewer mandated to sign
off penalty?
Escalate to relevant departments (IT if the Panel
Attorney has been suspended), office of the general manager
and the COO
Yes Liaise with relevant
Panel Attorney about penalty
End
Escalate recommendation to line manager for review
and/or sign off
No
E
3.5.2. Regular monitoring of litigation services by Panel Attorneys
Administrative assistantAdministrative
assistant
Panel attorney management officer
Panel attorney management
officer
Panel attorney management
officer
Panel attorney management
officer
Panel attorney management officer
Panel attorney management
officer
Panel attorney management
officer
Panel attorney management
officer
Panel attorney management
officerPanel attorney
management officer
Panel attorney management
officer
Receive closure reports from the magistrate and/or high
court units. Receive Quarterly reports from Panel Attorney
Assistant allocates the closure report to the
relevant officer/monitor
Officer updates the Panel Attorney SharePoint (with the service rating from the closure report and comments from the
Litigation Officer)
End
ACompile report for
senior to review and approve intervention
Senior agrees with recommended intervention?
Inform relevant officials in the office of the line manager, COO and General Manager
Yes
Review service ratings for each firm quarterly
Is there a need to liaise with
the firm?
No
AYes
End
No
Together with the manager, arrange to
meet the Firm’s directors and/or representatives
B
BHave raised matters been acknowledged
and accepted?
Escalate the matter to the Office of the COO (and the
GM) via an ES
No
End
Did the Panel Attorney commit to resolving the
issue(s)?
Yes
C
No
C
Through an ES, update the relevant
officesYes
Follow up with the Panel Attorney (within the agreed timeframe)
D
Does the COO approve?
Suspend/penalise/fine Panel Attorney
Yes
E
No
E
Panel Attorney resolved issues
Yes
C
No
Highlight service issues that have
been raised by the Fund
Finalise report and send to the office of
the COO
End
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
3.6.1. Judgement monitoring
Judgement monitoring officer
Judgement monitoring team leader
Judgement monitoring team leader
Judgement monitoring
officer
Judgement monitoring
officer
Judgement monitoring
officerJudgement monitoring officer
Judgement monitoring officer
Judgement monitoring
officerJudgement monitoring
officer
Judgement monitoring officer
Judgement monitoring officer
Judgement monitoring
officer
Propose cases to be analysed for the
month to the senior and/or team leader
A
Judgement monitoring officer analyses the cases as per set criteria
Team leader approves cases to be analysed?
AYesSelect judgements to be
monitored
At the discretion of the Unit senior, the cases which could be investigated may be based on the following: - Capital paid - Elapsed time between merits determination and capital payment request - etc.
Senior or team leader reviews cases
to be analysed for the month
Senior and team leader revise list
No
The evaluation criteria will be formulated and finalised when the SOPs are developed
Report on shortcomings and achievements for each case through a report.
Furthermore, highlight lessons or procedural suggestions which should be
implemented going forward
Forward the ES to the senior for
review and approval
Does the report accurately reflect the situation?
Forward the report to the team leader
for review and approval
Yes
Revert to the officer and highlight shortcomings of
the report
No
B
B
Is the report professionally
drafted for publication?
C
Revert to the senior for alterations
No
C
Forward a copy to line management (i.e. Senior Claims Manager and GM)
YesCan the report be forwarded to CLS and be published?
Revert to the senior and/or team leader and raise
concerns
No
C
Forward the report to CLS for review and publication
Yes End
Frequently asked questions in litigation
What should happen to files that have been summonsed post repudiated?Summons served after repudiation in merits should be sent to litigation not determination.
Should summons be defended by other regions (i.e. a Pretoria summons is defended by East London)Defend then forward the summons.
What should happen to supplier claims that have been litigated (summons served)?Litigated supplier claims should be sent to ILD.
Should a branch process a summons even if it is not for that branch in order to eliminate delays in transferring of summons?Summons received for other regions should be defended first before being sent to the correct region.
Do we defend all summonses?Yes, regions should defend all summonses.
top related