Claims and decisions

A claim identifies the policy, claim number, loss date, report date, claimed amount and loss evidence. Its status moves through reported, assessment and review work before an insurer decision. The Authorized Underwriter records an independent claim decision entry for the claim. Approve carries an approved benefit; Decline carries a reason. request for evidence leaves the decision path open while the team gathers what the reviewer needs.

Consider a cargo loss reported after a survey. The claim’s amount can differ from the survey’s assessed loss. Compare both against the policy coverage and the loss date. Keep the insurer decision on the claim rather than rewriting the original claimed amount. This lets the Auditor understand why the paid benefit is different from what was first reported.

• Reported loss. The claim keeps the first amount, date and policy reference.
• Assessment. Survey and loss evidence inform review without becoming the decision.
• Authorized decision. The underwriter records the benefit or reasoned decline in a separate decision record.

Decide how claims are numbered and which documents constitute loss evidence. Agree how the team checks coverage dates, exclusions, deductibles and limits against the loss. Assign underwriters who may make the insurer decision independently. Define how a request for evidence is answered without losing the earlier claim record. A claim approved for a benefit still needs a verified payment before the status can be Settled.

Start with a Reported claim for a policy with cargo coverage. Compare the loss date with the policy and line dates; review the reported evidence and any submitted survey. Move the claim into assessment and then review. Have the Authorized Underwriter record Approve with an approved benefit, or Decline with a reason. Confirm the claim status reflects that result and the separate decision remains attached. For a request for evidence, keep the claim open for review. Test a second decision attempt against the same claim so the team can see which decision is authoritative. Keep the original loss amount visible throughout the review and later settlement.

• Open Claims — Track reported, assessed, reviewing and approved losses.
• Claims Awaiting Decision — Focus the underwriter on claims ready for a decision.
• Approved Claims Awaiting Settlement — Separate benefit approval from completed payment.

Use claim decision to rehearse assessment and authorization, then claim settlement for verified payment.