Claim Documentation, Reporting, and Settlement Procedures
This domain tests the administrative discipline of a claim file: what must be on it, how reserves are set, how a settlement is documented, and how disputes and recoveries are handled.
The claim file
- Claim form, policy and endorsements, premium receipts, identity and ownership documents, damage reports, repair estimates, police or forensic reports, photographs and correspondence.
- A dated activity log showing every request, response and decision.
- The adjuster's report: mandate, facts, coverage analysis with clause references, quantum with calculation, salvage, excess, reserve and recommendation.
Reserving and reporting
Set a case reserve on the best current estimate of ultimate cost and revise it as evidence arrives; keep it separate from payment. Report interim findings on material claims rather than waiting for finality, and flag any coverage doubt explicitly.
Settlement
- Obtain the insurer's written authority before communicating an offer.
- Document the settlement in a discharge/release (estekhlas) signed by the insured, stating the amount and that it is in full and final settlement of that loss.
- Record salvage disposal, and take a subrogation letter where a third party is liable, so recovery rights are preserved.
- Give written reasons for any rejection, cite the clause and state the appeal route; keep records for the retention period required by the insurer and CII directives.
Worked example
A settlement is paid and a release signed. The insured later claims additional damage from the same fire. Reasoning: the release bars the further claim unless the later damage was expressly reserved out of it - so the release must be drafted to match exactly what was settled.
Traps that cost marks
- Paying before a signed release is on file.
- Losing subrogation rights by delay or by prejudicing the third party's position.
- Rejecting a claim without clause references or appeal information.
- Under-reserving, then surprising the insurer at settlement.