Claims Intake Checklist

Record full legal name, DOB, address, phone, email, and the relationship to the named insured. Confirm whether the caller is the insured, a claimant, an attorney, or a public adjuster — that drives consent language and recorded-statement disclosures downstream.

Pull the dec page in PolicyCenter or the AMS and confirm the policy period covers the date of loss. For occurrence vs. claims-made, confirm the trigger — claims-made requires both the retro date and the reporting date to fall within coverage.

Capture the claimant's account in their own words: sequence of events, parties involved, weather and road conditions if applicable, witnesses, and police or fire report numbers. If recording the call, disclose recording at the start — some states are two-party consent and undisclosed recordings are inadmissible.

Request police report, photos of damage, repair estimates, medical records (BI), and any third-party correspondence. For property claims, ask for a Statement of Values or contents inventory; for auto, request the other driver's insurance card.

Create the claim record, link to the policy, and attach all FNOL documents collected. The claim number generated here is what you give the insured for all subsequent contact.

Send a written acknowledgement with the claim number, adjuster contact, and a plain-language description of next steps. Texas Insurance Code Chapter 542 requires acknowledgement within 15 business days; missing it triggers 18% statutory interest plus attorney's fees.

Screen claimant, payees, attorneys, and any assignees against the OFAC SDN list before any payment authorization. Re-screen at every payment — parties can be added to the SDN list mid-claim, and screening only at policy issuance is a common gap.

If the claimant has retained counsel or threatened suit, issue a litigation hold to preserve the claim file, recorded statements, and any related underwriting file. Premature destruction of these records creates discoverable spoliation risk.

Check standard SIU red flags: loss within 60 days of policy inception, prior LexisNexis CLUE history, inconsistent narrative, claimant pressure for fast settlement, treating provider on a known-mill list. Document each flag — a referral to SIU needs articulable indicators, not a hunch.

Open the SIU referral in the case management system with the documented red flags. In NY, CA, FL, NJ, OH, NM, KY, LA, and MN the carrier's filed Anti-Fraud Plan governs referral timing and recordkeeping — follow the plan exactly so the file holds up at the next market conduct exam.

Tier the claim by exposure: low (under $10K, single party, clear coverage), medium (under $100K, no litigation), high (over $100K, multi-party, coverage questions, BI). The tier drives adjuster assignment and the reserve cadence.

Route by line of business, severity tier, and state license. Confirm the receiving adjuster holds an active resident or non-resident license in the loss state — assigning an unlicensed adjuster in TX, FL, or NY is a market-conduct finding waiting to happen.

Most excess policies require notice of any matter reasonably likely to involve the excess layer. Carriers commonly use 50% of the primary limit as the practical trigger. Missing the notice is a coverage condition violation that can forfeit the excess tower.

Set indemnity, ALAE, and (where applicable) medical reserves based on the severity tier and known facts. Schedule the next reserve review at 30 days — placeholder reserves left untouched are the most common driver of IBNR drift and a recurring market-conduct exam finding.