Both Lucy and Grover have been scratching consistently on their ears and shoulders and chewing at their feet.
Claim Lifecycle
Next
Claim Overview
Policy Information:
Policy Started On: 3/4/2025
Illness Eligible From: 3/18/2025
Orthopedic Coverage Eligible From: 4/3/2025
Policy Type: Cian, Vet Visit Fee add-on, Prev+ add-on
Claim Information:
Claim Filed On: 3/25/2025
Occurrence Date Per PH: 3/23/2025
Vet Visit Date Per PH: 3/24/2025
Claimed Condition: Skin Allergies
MRR?:
MRR is not completed at this time
Pre-Existing Conditions?:
No pre-existing conditions had been identified at the time the claim was filed
Next
Invoice
The submitted invoice is below (client information intentionally omitted, vet information omitted for space):
Invoice looks altered because it was cut from 2 pages to 1 for training purposes. So don't worry about possible misrepresentation! :)
How would you proceed with this claim with the information provided to you? Do we need additional medical records? Why or why not? Discuss before proceeding to the following page!
Next
Claim Investigation Determination
Click on the image below to see how a Claim Advocate would proceed with this claim!
Do we need additional medical records?
Do we need an MRR?
Defend your reasoning!
End
Do we need MR: Yes Do we need an MRR: Yes Why?: This claim was filed less than a week after the IWP ended. Additionally, it's an AHC (allergies). Due to the time factor and the fact that it's an AHC, we need to gather MR to perform an MRR to determine coverage.
Scenario #4 - Lucy
Lemonade
Created on September 4, 2025
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Transcript
Scenario #4
Lucy
Start
TL;DR + Claim Media
Both Lucy and Grover have been scratching consistently on their ears and shoulders and chewing at their feet.
Claim Lifecycle
Next
Claim Overview
Next
Invoice
The submitted invoice is below (client information intentionally omitted, vet information omitted for space):
Invoice looks altered because it was cut from 2 pages to 1 for training purposes. So don't worry about possible misrepresentation! :)
How would you proceed with this claim with the information provided to you? Do we need additional medical records? Why or why not? Discuss before proceeding to the following page!
Next
Claim Investigation Determination
Click on the image below to see how a Claim Advocate would proceed with this claim!
Do we need additional medical records?
Do we need an MRR?
Defend your reasoning!
End
Do we need MR: Yes Do we need an MRR: Yes Why?: This claim was filed less than a week after the IWP ended. Additionally, it's an AHC (allergies). Due to the time factor and the fact that it's an AHC, we need to gather MR to perform an MRR to determine coverage.