Free Checklist Templates for Claims

Claims

OR

Claim Processing Checklist

FNOL Intake and Data Validation

Acknowledge FNOL receipt to the insured

Validate insured and claimant identifiers

Run OFAC SDN screening on all parties

Classify loss type and severity

Coverage and Eligibility Verification

Pull the dec page and policy form

Confirm policy was in force at date of loss

Issue a reservation of rights letter

Verify reporting was within policy notice window

Documentation and Investigation

Request loss documentation from the insured

Take a recorded statement from the insured

Order CLUE and prior-carrier loss runs

Refer suspected fraud to SIU

Reserves and Excess Notification

Set the initial case reserve

Notify the excess carrier when warranted

Open subrogation and salvage files

Decisioning and Payment

Decision the claim within the prompt-pay window

Issue the denial letter with policy citations

Re-screen payee through OFAC before issuing payment

Issue payment and obtain signed release

Closure and File Retention

Close reserves and reconcile ALAE

Apply the carrier's retention schedule

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Claims Assessment Checklist

Initial Claim Review and FNOL Intake

Verify the policy is in force at date of loss

Acknowledge the FNOL to the claimant

Run OFAC SDN screening on the claimant

Triage severity and assign the adjuster

Investigation and Documentation

Pull loss runs and CLUE history

Take a recorded statement with consent

Inspect damage or order field appraisal

Flag red flags for SIU review

Refer the file to the SIU investigator

Set the case reserve in ClaimCenter

Coverage Evaluation and Decision

Compare the loss against policy form and endorsements

Issue a reservation of rights letter

Notify the excess carrier at the 50% threshold

Decision the claim per the §542 window

Issue the denial or partial-denial letter

Settlement, Subrogation, and Closure

Negotiate settlement with claimant or counsel

Re-run OFAC screening before issuing payment

Issue payment and obtain signed release

Identify any third-party at fault

Open a subrogation file with the recovery vendor

Close the file and archive per retention schedule

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Claims Auditing Checklist

File Selection and Intake Review

Pull the claim file from ClaimCenter

Verify FNOL acknowledgment timing

Capture the coverage state and claim status

Screen claimant and payees against OFAC SDN list

Coverage and Documentation Verification

Match the loss to the declarations page

Audit the recorded-statement consent disclosure

Review the reservation of rights letter

Confirm subrogation notice on third-party losses

Reserve and Evaluation Review

Audit case reserves against the cadence

Validate ALAE reserves and vendor invoices

Assess reserve relative to the primary tower

Verify the excess carrier notification

Regulatory and Statutory Compliance

Audit Texas Chapter 542 prompt-pay timing

Audit the denial letter language and citations

Review the NAIC Data Security 72-hour trigger

Verify retention scheduling for the file

Audit Findings and Sign-Off

Score the file against the audit rubric

Issue the audit report and sign off

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Claims Intake Checklist

FNOL Intake

Capture claimant and insured contact details

Verify policy is in force on the loss date

Record date, time, and location of loss

Document the loss narrative

Request supporting documents and photos

Claim File Setup

Open the claim in ClaimCenter

Send acknowledgement to the claimant

Run OFAC screening on all parties

Issue litigation hold if suit is threatened

Triage and Routing

Score the claim for fraud indicators

Refer the claim to SIU

Set claim severity and complexity tier

Assign to the appropriate adjuster

Notify the excess carrier if exposure exceeds 50% of primary

Set initial case reserves

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Claims Investigation Checklist

FNOL Intake and Assignment

Log the FNOL in the claims system

Send the statutory acknowledgment letter

Verify policy is in force on the loss date

Run OFAC screening on claimant and payees

Coverage Analysis

Read the policy form against the reported facts

Identify coverage issues requiring an ROR

Issue the reservation of rights letter

Set the initial reserve

Investigation and Evidence

Take the recorded statement

Order police, fire, or incident reports

Collect scene photos and damage estimates

Pull the CLUE and prior loss history

Assess SIU referral indicators

Open the SIU referral

Decision and Communication

Reconcile evidence against coverage

Evaluate subrogation potential

Document the claim decision

Notify excess carriers if reserve crosses 50%

Send the coverage position letter to the insured

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Claims Settlement Checklist

Claim Verification and FNOL Intake

Acknowledge FNOL within statutory window

Verify policyholder identity and policy in force

Confirm coverage triggers and exclusions

Run OFAC screening on insured and payees

Pull prior loss history and CLUE report

Determine coverage position

Damage Assessment

Assign a field or desk adjuster

Set the initial case reserve

Inspect the loss site and photograph damage

Estimate repair cost in Xactimate

Engage experts for specialized causation

Determine SIU referral need

SIU Investigation

Open the SIU file and notify the state fraud bureau

Take recorded statement and EUO if needed

Document SIU findings and disposition

Settlement Processing

Calculate net settlement with deductible and depreciation

Issue the settlement offer letter

Negotiate disputes and supplements

Obtain signed release and approvals

Disburse funds and issue 1099 if applicable

Close the file and set subrogation diary

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Insurance Committee Meeting Planning Checklist

Pre-Meeting Preparation

Define the meeting type and decision needed

Identify required attendees and quorum

Schedule within the carrier decision window

Distribute the agenda and pre-read packet

Materials and Data Pull

Pull current loss runs from the AMS

Compile the underwriting or claim file packet

Redact NPI before external distribution

Confirm binding authority for the carrier in scope

Engage coverage counsel and confirm litigation hold

Logistics and Roles

Reserve a secure conference room or video bridge

Assign scribe, timekeeper, and decision-recorder

Verify recorded-statement disclosure language

Test screen-share with redacted sample data

Post-Meeting Follow-Up

Distribute the decision memo and action items

Update reserves, UW notes, or the compliance log

Schedule any follow-up referral or escalation

Archive the meeting record per the retention schedule

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