Occupational medicine
Determination of origin
Definition of the origin of the event for occupational accidents and occupational diseases reported to the company, through the defined channels.
Determination of origin Occupational accident and/or occupational disease.
Determination of origin of occupational disease.
Follow-up and management of inherited disease, transferred cases, high-cost cases and diagnostic addition cases.
Qualification of loss of labor capacity - PCL
Reception, management and qualification of the percentage of affectation of the set
of skills, abilities, aptitudes and/or potentialities of a physical,
mental and social nature that allow the insured to perform in a regular job
, in accordance with the provisions of the single qualification manual
in force.
Comprehensive PCL qualification.
Preconcept high-cost cases.
Preconception and projection of possible disabling events.
Review of cases to validate continuation of disability pension.
Documentary and/or face-to-face assessments of cases under pension review.
Processing of disputes before the disability rating boards.
Processing and follow-up before the regional and national disability qualification boards for controversies generated by the origin determination and/or PCL processes.
Follow-up and management of cases before the boards.
Additional procedures required by the boards to determine the qualification.
Requests for payment of company fees.
Upload of origin reports or PCL in the system established by the company.
Pronouncement before opinions of origin or PCL.
Management of additional procedures for responding to requests for information from boards or interested parties.
Notification of qualifications of origin and PCL
Notification of ratings issued as a result of the management of the
determination of origin and PCL.
Validation and/or update of contact information of the insured and interested parties
.
Sending of notification notices to all interested parties.
Follow-up of notified cases in order to validate the effectiveness of the delivery of the official notice
by the established means of delivery.
Registration of information in the systems established by the company.
Micromanagement and structure
To provide the services of attention, follow-up and control of the assistance and economic benefits of the claims, for the different branches and products marketed by Positiva Compañía de Seguros S.A.
The project is organized by specialized services covering the entire Claims Management cycle, among which the following stand out:

Claims micromanagement
Monitoring and management of claims with deviations in performance.

Contractual legal
Legal validation of agreements with suppliers to ensure service quality.

Economic benefits
Analysis and decision on requests for temporary disability.

Welfare benefits
Management of reimbursement follow-up and assistance to providers in the health care network.

BEPS
Administration and payment of periodic economic benefits.

Life claims (A and B agreements)
Integral management of claims and life insurance policies.

Pension settlement
Liquidation, re-settlement and pension substitution processes.

Claims life policy A
Verification of policy coverage according to clinical history.

Documentary management of recoveries
Validation of recoveries for events of common origin, events without coverage, among others.

Health policies
Control of healthcare products focused on service and sustainability.
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