Claims and decisions

Claims Specialist opens a claim under the policy that covers the traveler. The claim records its number, loss date, report date, claimed amount, status and loss evidence. Assessment is the team’s examination of those facts against the policy and applicable coverage. Claims Authorizer records the separate benefit decision, including whether to approve, decline or request evidence, the reason, approved benefit amount and the authorizing person’s name.

A claim can move from reported to assessment and review before its disposition. Staff should not infer approval from a claimed amount or from the presence of an attachment. The decision explains the approved amount, and the linked payment record later shows what was actually paid. These differences matter when the claimant asks why a settlement differs from the original request.

• Claim intake. Claims Specialist identifies the policy, loss date, report date, amount and initial evidence.
• Assessment. Claims Specialist checks policy status, effective dates and relevant coverage terms before sending the case for review.
• Benefit decision. Claims Authorizer records the outcome, reason and approved amount as a separate decision on the claim.

Agree which evidence is required for each common loss type and where it should be retained. Loss evidence is present on the claim; record attachments are linked to policies and can carry a visibility setting. Use the policy attachment title and evidence type to identify the loss it supports during review. Decide who may authorize a benefit and how the authorizing identity recorded in text is checked.

The team should also agree when a request for evidence keeps a claim in review and when a decline is appropriate. Make the reason useful to the next person who reads the case. Review the policy effective period and any endorsement when the loss happened near a boundary. Claims Authorizer should see the specific policy and coverage position used by the specialist.

A traveler reports a loss after returning from a covered trip. Claims Specialist enters the loss date and report date, the amount claimed and the evidence summary. The specialist opens the linked policy, checks its effective period and coverage line, and moves the claim into assessment. When the evidence is sufficient, the specialist sends it to review. Claims Authorizer decides the benefit, records a reason and approved amount, and sets the claim to its resulting status.

Rehearse a second case with incomplete loss evidence. Claims Authorizer records request evidence instead of a final benefit amount being mistaken for payment authority. The claim remains visible to the specialist for follow-up. A later payment must link to the particular claim decision that authorized it, keeping the final amount and event traceable.

• Claims needing assessment — Claims Specialist finds reported, assessment and review cases with their loss dates and amounts.
• Claim decision board — Claims Authorizer sees cases by status before and after the decision.

See claim assessment and claim settlement.