Claim Lifecycle: Application to Resolution

1. Lifecycle Overview & State Diagram

Every victim compensation claim in VCPMS follows a defined lifecycle with 10 states (per the VcClaimState enum). The process begins when a victim submits an application through VCPOnline (or another intake channel) and concludes when the claim reaches one of the terminal states: Approved, Denied, Rescinded, or Withdrawn.

Complete State Diagram

Pending Board Determination is skipped when program configuration routes to an examiner/supervisor instead of a board.

Part 1: Submitting the Application (VCPOnline)

The VCPOnline application wizard guides victims or claimants through a 14-step form to submit a victim compensation application. The wizard auto-saves progress at each step, allowing applicants to complete the form across multiple sessions. Each step is described in detail below.

Step 1: Start Application

An introductory screen that explains the victim compensation program, provides important instructions, and outlines what information the applicant will need to complete the application. No data is collected on this step — the applicant clicks "Next" to begin.

Step 2: Victim Information

Collects the primary victim's personal and contact information. This is typically the person who was directly harmed by the crime.

Step 3: Additional Secondary Victims Conditional

This step only appears when Secondary Victim Support is enabled and the applicant indicated they are a secondary victim on Step 2. It allows listing additional secondary victims associated with the same crime.

For each additional victim:

• Name (first, middle, last)
• Relationship to primary victim
• Gender, Date of Birth, SSN
• Address, Phone, Email

Victims are added via a modal dialog and displayed in a summary list with edit/remove actions.

Step 4: Claimant Information

Collects information about the person filing the claim, who may be different from the victim (e.g., a parent filing on behalf of a minor victim, or a spouse filing on behalf of a deceased victim).

Step 5: Crime Information

Captures the details of the crime that led to the victim's injuries and the compensation application.

Step 6: Offender Information

Lists the offender(s) or suspect(s) involved in the crime. Multiple offenders can be added.

For each offender:

Offenders are managed via a modal dialog and displayed in a list view.

Step 7: Insurance Information

Records any insurance policies that may provide coverage for expenses related to the crime. Victim compensation programs typically serve as a payer of last resort, so insurance information is essential for determining the amount of benefits to award.

For each insurance policy:

Step 8: Civil Suit / Attorney Information

Captures whether the victim or claimant has filed a civil lawsuit related to the crime, and attorney details if applicable.

Step 9: Expenses & Benefits Information

The applicant selects which types of expenses they are claiming and provides details about service providers. This is one of the most comprehensive steps in the wizard.

Expense Category Checkboxes (18 categories)

When Funeral is selected, additional fields appear for Funeral Home Name and Funeral Home Address.

Service Providers

The applicant can list service providers who are providing care or services. For each provider:

• Service Description
• Provider Name
• Phone, Email, Address

Anticipated Expenses

A freeform textarea (max 500 characters) for describing anticipated future expenses not yet incurred.

Step 10: Employer / Income Information

Captures employment and income loss details if the victim was unable to work due to the crime.

Step 11: Demographics & Referral Source

Collects optional demographic information used for federal reporting (OVC Performance Report) and tracks how the victim learned about the compensation program.

Step 12: Document Attachments

Allows the applicant to upload supporting documents such as police reports, medical bills, receipts, and other evidence. Documents uploaded here are attached directly to the claim and become part of the case file in VCPOffice.

• Supported formats: PDF, DOC, DOCX, JPG, PNG, and other common document types
• Multiple files: Applicants can upload multiple documents
• Remove: Documents can be removed before submission
• File list: All uploaded files displayed in a summary list with file names

Step 13: Application Summary

Displays a read-only summary of all information entered across all wizard steps. The summary is organized in card-based sections:

1. Victim Information — Name, DOB, contact details
2. Additional Secondary Victims — If applicable
3. Claimant Information — Relationship, name, contact
4. Crime Information — Crime type, dates, location, officer
5. Offenders — Names, relationships, arrest status
6. Insurance — Coverage types, carriers, policy numbers
7. Civil Suit — Filing status, attorney details
8. Expenses — Selected benefit categories, providers
9. Employer — Employment details, income loss
10. Demographics — Race, referral source
11. Documents — List of attached files

Each card has an "Edit" link that navigates back to the corresponding wizard step for corrections.

Step 14: Signatures & Submission

The final step presents up to 10 acceptance statements that the applicant must acknowledge before submitting. These statements are configurable per state program and typically include:

• Acknowledgment that the information provided is true and accurate
• Consent to release medical and financial records
• Understanding of program eligibility requirements
• Agreement to cooperate with law enforcement
• Authorization for the program to verify information
• Understanding of payer-of-last-resort provisions
• Acknowledgment of potential subrogation
• Additional state-specific terms and conditions

All visible acceptance checkboxes must be checked before the "Submit Application" button becomes active.

Part 2: Processing the Claim (VCPOffice)

Once the application is submitted, the claim enters the VCPOffice back-office system where program staff review, verify, determine eligibility, create awards, and process the claim to its final resolution.

Claim Receipt & Auto-Assignment

When a claim transitions to Intake, the system automatically:

The assigned analyst finds the new claim in their task queue on the VCPOffice dashboard or through the VC Claims Search screen.

Claim Management Interface

The VCPOffice claim management page is a two-panel layout that gives staff access to every aspect of a claim:

Header Action Bar

The header bar above the panels provides all state transition and management actions:

Edit Tabs — Complete Reference

The left panel contains 14 tabs organized into logical groups. Each tab contains the relevant data fields for that section of the claim.

About Panel — Financial Summary & Payments

The right-side panel provides at-a-glance claim information and financial tracking.

Summary Header

Displays key claim metadata that is always visible:

• Claim Number (ShortName) — clickable to copy to clipboard
• Current State — color-coded state badge
• Received Date — when the application was submitted
• Victim Name & Claimant Name
• Date of Crime & Crime Type
• Owned By VCA User — the applicant who submitted via VCPOnline (clickable)
• Assigned To Advocate — the advocate user and user group (clickable)
• Is Primary Victim — flag indicating primary vs. secondary victim
• ED Approved DateTime / By User — when eligibility was determined and by whom

Financial Summary Tab

A hierarchical, drill-down financial view organized by benefit category:

Payments Tab

Lists all payments associated with the claim including payment ID, status (pending, processed, reversed), payee name, amount, payment date, and payment method. Click any payment to navigate to the Payment management page.

Benefit Adjustments Tab

Lists post-award adjustments with adjustment type (increase, decrease, reversal), affected benefit category, original and adjusted amounts, reason, and audit trail.

Eligibility Determination

During the Intake and Review phases, the Claims Analyst performs an Eligibility Determination (ED) — a structured evaluation of whether the claim meets the program's requirements for compensation.

Eligibility Criteria

The analyst evaluates each criterion and records the result as Yes, No, or Waived:

Once the eligibility determination is complete and the claim is verified, the analyst clicks the "Submit for Determination" button. The system validates that required fields (victim name, claimant name) are populated before allowing the transition to Pending Determination (or Pending Board Determination when board review is required).

Award Processing

When the analyst clicks "Submit for Award", the following automated sequence occurs:

Award Lifecycle

Resolution: Approved, Denied, or Withdrawn

Every claim reaches one of three terminal states:

Denial Reasons

When denying a claim, the analyst must select a specific reason. These are configurable per state program:

Access Control & Assignment

VCPOffice provides granular control over who can access each claim across different portals:

When replacing an existing assignment, the system checks for affected access invitations and presents a management dialog to process or delete them before completing the reassignment.

Key Features & Capabilities