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Final stage of the insurance lifecycle. A claim is raised when a policyholder has experienced an event covered by their policy and is requesting a payout.
Requires: An active Insurance Policy and its associated Insurance Premium Schedule Ends: Once the claim is paid, the system automatically closes the premium schedule and the policy is effectively complete.

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Overview

When a policyholder experiences an event covered by their insurance - an accident, a health emergency, a loss - they raise a claim. The Insurance Claim records what happened, how much is being claimed, and what the team has approved for payout. The claims process involves verifying the details, approving the amount, and then settling the payment. The system handles the payment entry automatically and, once the claim is marked as paid, closes the premium schedule so no further invoices are raised.

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Who Uses This Feature

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Before You Start

Before you create an Insurance Claim, make sure the following already exist and are in order:
  • An active Insurance Policy for the policyholder - the policy must be in Active status, not Lapsed or Closed
  • The Insurance Premium Schedule linked to that policy - the claim must reference a specific schedule
  • The claim type - the category of claim (e.g. medical, accidental, life). Claim Types are set up by your administrator.
  • Supporting documents - the policyholder must provide evidence of the incident (hospital bills, accident report, photographs, etc.)

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How to Record and Process a Claim

1

Open a new Insurance Claim

From the Insurance Management workspace, go to Insurance Claim → New.
Insurance Management workspace showing the Insurance Claim option and New button
2

Link the policy and schedule

  • Insurance Policy - search for and select the policyholder’s active policy
  • Insurance Premium Schedule - select the premium schedule linked to that policy
  • Policyholder - this auto-fills from the policy, but confirm it is correct
Insurance Claim form showing the Insurance Policy, Premium Schedule, and Policyholder fields filled in
3

Fill in the claim details

  • Claim Type - select the category that describes this claim (e.g. Medical, Accidental, Death)
  • Date of Incident - the date the event occurred (required). This must match the supporting documents.
  • Remarks - describe what happened in plain language. Be specific - this becomes the official record.
  • Claim Amount - the total amount the policyholder is requesting
  • Company - the company the policy was issued through
  • Insurance Company (Supplier) - the insurance provider who will pay out
Insurance Claim form showing claim type, incident date, remarks, and claim amount fields
4

Upload supporting documents

Go to the Documents section and attach all evidence provided by the policyholder:
  • Hospital bills or medical reports (for medical claims)
  • Accident or police report (for accidental claims)
  • Death certificate (for life claims)
  • Any other documents the insurer requires
Also attach any required signatures in the Signature field.
Documents section showing file upload rows and a signature field
5

Save the claim

Click Save. The claim is now in Draft status. At this point it is a record only - no payment has been initiated.
6

Submit the claim for review

Once all details are complete and documents are uploaded, click Submit to officially log the claim and move it to the review stage.The Claim Status changes to Submitted.
Submitted Insurance Claim showing the Claim Status as Submitted and the Submit button
7

Insurance Manager reviews and approves

The Insurance Manager opens the claim, reviews the documents and amounts, and sets the Approved Amount - this may be the same as or less than the claimed amount, depending on policy terms and the insurer’s assessment.The Manager then updates the Claim Status to Approved.
Insurance Claim showing the Approved Amount filled in and Claim Status set to Approved
8

System creates a payment entry

Once the claim is approved and saved, the system automatically creates a Payment Entry - a financial record of the payout - and links it to the claim. You can see this in the Payment Reference field on the claim.The Accounts team then processes and confirms this payment entry.
Insurance Claim showing the Payment Reference field linked to the auto-created payment entry
9

Mark the claim as Paid

Once the payment has been processed and the policyholder has received their money, update the Claim Status to Paid and save.At this point, the system automatically closes the Premium Schedule - no further invoices will be raised for this policy.
Insurance Claim with Claim Status set to Paid, and a note showing the linked Premium Schedule has been closed

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Field Guide

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Workflow Journey

The claim moves through these statuses as it is processed:
Insurance Claim showing the Claim Status field at different stages of the process

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What Happens Next

Once the claim is marked as Paid:
  • The Premium Schedule linked to this policy is automatically closed - all remaining unpaid instalments are marked as done
  • No further invoices are raised for this policy
  • The policy’s lifecycle is effectively complete
  • A final record of the claim, approved amount, and payment reference is stored permanently against the policy
If the claim is Rejected:
  • The Claim Status is set to Rejected
  • The policyholder is informed
  • The Premium Schedule continues as normal - premiums are still due
  • The policyholder may appeal or submit a new claim if circumstances change

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Automatic Actions

As soon as a claim is approved and saved, the system automatically creates a draft Payment Entry in the accounts module. This payment entry is addressed to the insurance company (supplier) and pre-filled with the approved claim amount.The payment entry is linked directly to the claim - you can find it in the Payment Reference field. Your accounts team processes and finalises this entry to complete the payment.You do not need to create the payment entry manually.
When you update the Claim Status to Paid and save, the system automatically:
  • Finds the linked Insurance Premium Schedule
  • Marks all remaining Unpaid instalments as closed
  • Changes the schedule’s overall status to Closed
This means no further invoices are raised and the billing cycle stops. The policy is fully settled.

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Best Practices

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Do

  • Upload all supporting documents before submitting - incomplete claims cause delays and may be rejected on that basis alone
  • Record the exact date of incident - this is checked against the policy’s active period; a claim for an event before or after the coverage dates will be declined
  • Be specific in the Remarks field - a clear, factual description helps the manager assess the claim quickly and accurately
  • Confirm the approved amount with the Insurance Manager before processing payment - the approved amount may differ from the claimed amount based on policy terms
  • Update the Claim Status to Paid promptly - once payment is confirmed, mark it paid so the schedule closes and records stay accurate

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Don’t

  • Don’t submit a claim without documents - supporting evidence is essential for approval
  • Don’t enter a Date of Incident outside the policy’s active period - claims for events outside the coverage window cannot be approved
  • Don’t edit the claim after submission - the claim is locked once submitted. If a correction is needed, the Insurance Manager must cancel and amend it.
  • Don’t confuse Claim Amount with Approved Amount - the policyholder may request more than the policy covers. The Approved Amount is what gets paid.
  • Don’t forget to check the Payment Reference after approval - if the payment entry was not created automatically, alert your administrator immediately

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Common Mistakes & Troubleshooting

If the Payment Reference field is empty after the claim is approved and saved, the automatic payment entry creation may have failed. Do not process any payment manually - contact your administrator to investigate and resolve the issue before proceeding.
The Claim Status field must be updated manually as the claim progresses. The system does not automatically move a claim from Submitted to Approved - the Insurance Manager must review and change the status.
If you need to check whether a policyholder has made previous claims, open their Insurance Policy and look for the linked claims list. You can see all historical claims and their outcomes from the policy record.
Once a claim is marked as Paid and the Premium Schedule is closed, this cannot be undone without administrator involvement. Make absolutely sure the payment has been received and confirmed before updating the status to Paid.
If the Insurance Premium Schedule field is empty when you open a new claim, the policy may not have a schedule yet. This can happen if the policy was only recently approved. Wait a moment and refresh - if the schedule still does not appear, check with your administrator.
Rejected claims should have a clear reason recorded in the Remarks field before status is changed to Rejected. This protects the team if the decision is questioned later and helps the policyholder understand what went wrong.

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Workspace Access

You reach Insurance Claim through the Insurance Management workspace. Path: Insurance Management workspace → Insurance Management card group → Insurance Claim
Insurance Management workspace with the Insurance Management card group highlighted, showing the Insurance Claim link
The visual workflow pipeline shows the claim’s place in the business process. In the Insurance Claim Process lane, you can see the full chain: This mirrors exactly what happens in the system: the claim record is followed by the payment entry (created automatically) and any journal entries your accounts team raises for the payout. You can also access Payment Entries directly from the workspace by clicking Payment Entry in the Insurance Management card group - useful when checking the payment status of a claim.

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Number Cards - What to Watch

There are no number cards on the workspace dedicated specifically to Insurance Claims. Monitor your claims workload using the list view directly.
Open the Insurance Claim list from the workspace and use the Claim Status filter to create your own daily queue. Filter for Claim Status = Submitted to see claims awaiting review, or Claim Status = Approved to see claims ready for payment processing.

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Monitoring Without Reports

There are no dedicated reports for Insurance Claims. Use the list view with filters as your daily work queue:
Sort the list by Incident Date (oldest first) to prioritise claims that have been waiting longest. Policyholders filing a claim expect prompt communication - don’t let claims sit in Submitted status for more than a day or two without acknowledgement.

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Notifications & Alerts

There are no automated email notifications triggered specifically by Insurance Claim actions. All claim communication with the policyholder is currently handled manually. Recommended manual communications:
If your organisation needs automated emails sent to policyholders when a claim is approved, rejected, or paid, this can be set up by your administrator. Contact them with the specific triggers and message content you need.