Claims Processing
This is the first step in the claims process where the loss is reported to the insurer.
What is First Notice of Loss (FNOL)?
This coverage applies when the at-fault driver has no insurance.
What is Uninsured Motorist Coverage (UM)?
This is an activity or condition that may affect the coverage provided in a policy.
What is a Risk?
This must be confirmed to determine which laws and claims handling rules apply.
What is the loss state?
A claim where payment cleared after the loss, even if the policy shows active dates, will most likely result in this outcome
What is coverage denial due to lapse?
This document outlines the damages and estimated repair costs for a vehicle.
What is a Repair Estimate?
Frequent travel across the border that must be flagged to underwriting.
What are Multiple Trips to Mexico?
A person operating the vehicle who is not listed on the policy.
What is an Unlisted Driver?
This doctrine determines whether recovery is possible when the insured shares fault.
What is comparative negligence?
If the police report and insured statement disagree on the loss date, this source is prioritized when available.
What is the police report?
This occurs when the cost to repair a vehicle exceeds its actual cash value.
What is a Total Loss?
This system automatically stamps the claim once a risk alert is submitted.
What is Guidewire?
This change should trigger a risk alert if the insured starts using their car for business purposes.
What is a Change in Use of Vehicle?
Before processing a claim, adjusters must confirm these four core eligibility elements
What are active policy, eligible driver, eligible vehicle, and valid time/territory of loss?
This section requires documenting what happened, how it happened, and who was involved using FNOL details.
What is a New Note summary?
This doctrine allows an insurer to recover costs from the at-fault party after paying a claim.
What is Subrogation?
After selecting Risk Alert, this is the final action taken to submit it to underwriting.
What is Email to Underwriting?
If a vehicle is no longer primarily kept in the state where the policy was written, this must be reported.
What is a Change in Garaging Location?
The insured insists the policy is active, but AS400 shows a lapse due to non-payment during the loss date. This system must be relied on for verification.
What is AS400 payment and esign?
The insured claims the accident happened on June 1, but the police report says June 3, which falls outside the policy period. This is the correct adjuster action.
What is contact all parties to verify the true date of loss before making a coverage decision?
WHAT DEPARTMENT WILL ASSIST WITH COMPLETING AN INSPECTION OF THE VEHICLE?
WHAT IS APD
WHAT IS THE FORM CALLED FOR APPROVED BUISNESS USE?
WHAT IS AN ARTISAN ENDORSMENT
WHAT SHOULD THE SALES OFFICE COLLECT IF THE INSURED WANTS TO ADD COLLISION OR COMPREHENSIVE TO THE POLICY?
WHAT IS PICTURES OF VEHICLE FOR PRIOR DAMAGE
WHAT DEPARTMENT IS RESPONSIBLE FOR CLAIMS THAT INVOLVE PREGANCY
WHAT HAPPENS AFTER AN INSURED OR CLAIMANT ADVISES US THEY HAVE RETAINED AN ATTORNEY?
WHAT IS ASSIGNING CLAIM TO ATR (ATTORNEY REPRESENTED) DEPARTMENT