Claims Handling, Investigation, and Documentation
The claim lifecycle
Every claim begins with first notice of loss: capture date, time, location, parties, witnesses, and reported facts, then open a claim number and verify the policy, named insured, dates, limits, and deductibles. Complete a coverage analysis before committing to payment. If coverage is uncertain, issue a written reservation of rights-it preserves the insurer's position and is not a denial. A non-waiver agreement serves a similar purpose.
Investigation should follow a plan: recorded statements, scene inspection, photographs, diagrams, police or fire reports, medical records and authorizations, wage-loss documentation, estimates, experts, and database checks. Use a proof of loss when required, an examination under oath for suspicious or complex claims, and appraisal for valuation disputes. Preserve evidence and maintain chain of custody; consider subrogation and salvage early.
Documentation standards
Document who, what, when, where, and why for every contact, and record the basis for each decision. File notes should show the coverage analysis, damages evaluation, authority, and communications. Kentucky's unfair claims practices regulation expects prompt acknowledgment and timely decisions; know the applicable timeframes and diary them. Never promise coverage, admit liability, or speculate about payment.
Worked example
An auto collision claim: verify the policy and drivers, obtain the police report and photos, inspect damage, secure an estimate, collect medicals and wage loss, analyze liability, and send a reservation-of-rights letter if a coverage issue exists. Diary follow-up and document the settlement rationale.
Traps: treating a reservation of rights as a denial; taking a recorded statement without identifying the speaker's capacity; ordering an EUO before coverage analysis; settling without a lien search; failing to document oral promises. Rule of thumb: if it is not in the file, it did not happen.