Insurance & Claims// topic
Claims Intake, FNOL and Triage
In short
Everything between the loss happening and the file reaching the right queue: how notice arrives, what gets captured at first touch, and how a claim is scored, routed and clocked before an adjuster ever opens it.
9 pages
definitions
- Cause of loss: the coded field, and why the caller's story is not itThe loss narrative and the coded cause of loss are two fields with two jobs. Conflating them gives reporting nobody trusts and routing nobody can explain.definition6 min
- Claim severity score: a routing input, not a reserve and not a decisionA severity score exists to decide which queue a new claim joins and how fast. Everything a licensed person is accountable for stays outside its remit.definition6 min
- Date of loss, date reported, date received: three fields that are not the same fieldOne date decides coverage, one decides whether notice was late, and one starts your service clocks. Collapsing any two of them breaks something you will not notice for months.definition10 min
- First notice of loss: the fields that turn a call into a workable fileA first notice of loss is not a claim file. It becomes one when it carries enough structure to be routed, clocked and reserved without a call back to the reporter.definition6 min
diagnostics
- Claimants start the online loss report and phone in anywayChannel fallback is measurable. A step-level drop table segmented by device and reporter, joined to inbound calls within the following hour, names the step that sends people to the phone.diagnostic11 min
- Low-severity files keep landing in the complex queue and nobody can say whyYou can see the outcome and not the reason, which is the actual defect. A per-claim decision log recording every rule evaluated, its inputs and the one that fired turns an argument into a 5-minute query.diagnostic10 min
- The damage photos come back too dark, too close, or missing the one angle the adjuster needsSplit your photo rejections by capture path and device class before redesigning anything. In-app camera and gallery upload fail for entirely different reasons and need different fixes.diagnostic12 min
- The policy lookup says no policy in force on a loss you know is coveredA not-found result is a statement about your search, not about the insured's coverage. Resolve by policy identifier, by named insured and address, and by asset, then compare what the 3 return.diagnostic10 min
- The same loss opens two claim numbers before anyone noticesTwo files on one loss means two adjusters, two reserves and occasionally two payments. A scored candidate-pair report over policy, date window, parties and asset identifier finds them first.diagnostic10 min
Other topics in Insurance & Claims
See allClaims Handling, Fraud Flags and RecoveryWhat happens after assignment: adjuster workload and diary, reserves and estimate review, fraud red flags and SIU referral, subrogation identification, and the payment and recovery steps that actually close a file.6 pagesThe Forms: Extraction and ClassificationThe artifacts insurance runs on — ACORD applications, declaration pages, loss runs, endorsements, schedules and carrier supplements — treated as engineering objects, with the structural quirks that make generic extraction fail on each of them.3 pages
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