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Document No.

Version No.1.0
Date: 08/28/2006

Customer Name
Report Name

Westminster American Insurance Company

Claims paid without check number.

Functionality [Requirement in Detail]

This report provides the list of claims which have been paid but check number has not been captured. The
check details are captured in the claims settlement screen. The report should include both final payments
and partial payments, if any.
The filtration for claims which have to be considered for this report is based on the date of payment.
This report is run weekly or daily. This report can be viewed by Accounting & Claims users.
Report Options [Interface Parameters]

Filtration Criteria [Interface Parameters]

Option 1
Class of Business From
Line of Business From
State From
Agent From
Loss Payment Date From
All from and to dates should be defaulted with 0
and zzzzzzz.

Option 2
Class of Business To
Line of Business To
State To
Agent To
Loss Payment Date To

Field Description [Mapping Details]

Column ID
Claim No.
Policy No.
Insured Name
Paid Amount
Type of Payment

Policy State

Payee Name and


Source Table

This column lists the claim number. The claim no. may be
repeated in case multiple payments are made.
The policy number to which the claim pertains to. The policy
no. should be printed without the edition nos. or the
endorsement nos.
The name of the primary named insured in the policy.
The amount paid through the check.
The type of payment is the type of reserve for which the
payment was made, namely:
1. Paid Loss
2. Paid DCC
3. Paid AO
This is the state for which the policy has been issued. The
Policy State is the Policy State mentioned in the policy
issued. The state code is printed in this column i.e. MD or DC.
ASL is the Annual Statement Line the claim is pertaining to,
1. 040 Homeowners
2. 050 Commercial Multi Peril (BOP)
3. 090 Inland Marine (Not required currently)
4. 170 General Liability (Umbrellas)
Name and address of the Payee as captured in the Claims
Payment Screen.
The address field that will be displayed in the report are:
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Document No.
Version No.1.0
Date: 08/28/2006


Check Wording

No., Directional, Street Name, Street Type, DC-Quadrant, P.O.

Box, Address Line 1, Address Line 2, City, State and Zip Code.
There are no punctuations (,) required between any of the
fields. If there is no value in a particular field, then the next
field will move in the place of the previous one. Similarly if
there is no data in one line, then the next line will move up.
The layout of the fields will be as follows:
<No.>_<Directional>_<Street Name>_<Street Type>_<DCQuadrant>_<P. O. Box>- All in one line unless the text is
wrapped because of more length.
<Address Line 1>
<Address Line 2>
<City>_<State>__<Zip Code>
The _ between the address fields denotes spaces.
Check wording is any special wording that is to be included on
the check. This will be as captured in the Claims
Payment Screen.

Other Information
Group By
Sort By
Print Details
Report Type
Print Type

Grand Total for Paid Amount

Claim No.
PDF, Excel

Paper Size

8.5 x 11

Other Details
Layout - Excel Output required

Acceptance Criteria [Mandatory]

Prepared By
Approved By


Shaik Mohiyuddin Imran

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