Claims and decisions

A claim records its number, policy, loss date, report date, claimed amount and loss evidence. The team can move it through Reported, Assessment and Review while collecting assessment information. The claim decision is a separate record with a decision date, reason, authorizing name and approved benefit amount.

An Approve decision triggers a workflow that moves the linked claim to Approved and raises a claim payment. Decline and request evidence remain distinct decision values. The reviewer should choose the value that reflects the actual decision and preserve the reason; an evidence request should not read as a paid claim. The payment record remains linked to both claim and decision.

• Trace the loss. Compare the report date, loss date and policy before reading the assessment.
• Decide with a reason. Record the authorized benefit and reason on the claim decision.
• Inspect both effects. An approval raises a payment, whose creation can immediately settle the claim.

Decide who may record benefit decisions and how the authorizing name is checked against the signed-in person. Agree how reviewers identify the right farm assessment when several claims share a policy. Decide how to handle an evidence request without presenting it as a paid outcome. Rehearse the decision and inspect the resulting payment and claim status before the handoff to Payment Operator.

Take a claim for a reported crop loss. Follow its policy to the coverage terms and find the submitted farm assessment. Compare the claimed amount with the assessed amount and write a reasoned decision. For an approved benefit, check the authorized amount and confirm that the raised payment points back to the same decision and claim. A reviewer should be able to retrace the date, evidence and authority from the claim.

The Claims Reviewer should find the decision reason, benefit and payment link on the same claim. Payment Operator then compares the event identifier and verification value with the provider result. A claim marked Settled after payment record creation still needs that provider check.

• Claim decision queue — Review claims waiting for a benefit decision, with the policy and loss evidence at hand.
• Open claim queue — Find reported and assessment-stage claims before they enter decision review.

Follow the related operating process and use the record definitions when checking a field or relationship.