INSURANCE CLAIMS ADJUSTMENT REVIEW CHECKLIST

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--- INITIAL CLAIM RECEIPT & DOCUMENTATION ---
[ ] Date of Loss/Incident
[ ] Claim Number (Assigned)
[ ] Claim Type (Property, Liability, Auto, Workers' Compensation)
[ ] Summary of Loss Description (Initial Report)
[ ] Initial Police Report (If Applicable)
[ ] Claimant Full Name
[ ] Insured Full Name

--- POLICY VERIFICATION & COVERAGE ASSESSMENT ---
[ ] Policy Status (Active, Inactive, Lapsed, Cancelled)
[ ] Coverage Type (Property, Liability, Vehicle, Business Interruption, Other)
[ ] Policy Effective Date
[ ] Policy Expiration Date
[ ] Policy Limit
[ ] Coverage Details Summary
[ ] Endorsements Applied (None, Yes)

--- DAMAGE ASSESSMENT & INVESTIGATION ---
[ ] Detailed Description of Damage
[ ] Photos/Videos of Damage
[ ] Estimated Cost of Repair (USD)
[ ] Severity of Damage (Minor, Moderate, Severe, Total Loss)
[ ] Date of Damage
[ ] Location of Damage
[ ] Type of Damage (Select all that apply) (Water Damage, Fire Damage, Wind Damage, Impact Damage, Theft)

--- LIABILITY DETERMINATION (IF APPLICABLE) ---
[ ] Primary Liability Party (Insured, Third Party, Joint Liability, No Liability)
[ ] Liability Assessment Narrative
[ ] Estimated Liability Amount ($)
[ ] Legal Counsel Involvement Required? (Yes, No)
[ ] Date of Liability Determination

--- RESERVES ESTABLISHMENT & ADJUSTMENT ---
[ ] Initial Reserve Amount
[ ] Reserve Rationale
[ ] Date of Initial Reserve
[ ] Reserve Adjustment Amount
[ ] Reason for Adjustment (New Information, Legal Development, Settlement Negotiations, Re-evaluation of Damages)
[ ] Date of Reserve Adjustment
[ ] Updated Reserve Amount

--- VENDOR MANAGEMENT & PAYMENTS ---
[ ] Invoice Amount
[ ] Invoice Date
[ ] Payment Method (Check, Electronic Funds Transfer (EFT), Credit Card)
[ ] Check Number (if applicable)
[ ] Payment Date
[ ] Vendor Approval Status (Approved, Rejected, Pending)
[ ] Payment Notes/Comments

--- COMMUNICATION & CUSTOMER SERVICE ---
[ ] Summary of Customer Interactions
[ ] Customer Sentiment (Post-Interaction) (Positive, Neutral, Negative)
[ ] Number of Customer Follow-Up Calls/Emails
[ ] Date of Last Customer Contact
[ ] Communication Channels Used (Check all that apply) (Phone, Email, Mail, Online Portal)
[ ] Notes on Customer Concerns/Feedback

--- REGULATORY COMPLIANCE & REPORTING ---
[ ] Reporting Deadline
[ ] Applicable Regulations (e.g., NAIC, State Laws) (NAIC Model Laws, State-Specific Regulations, Federal Regulations)
[ ] Reporting Form Version
[ ] Summary of Regulatory Changes Impacting Report
[ ] Supporting Documentation (e.g., Regulatory Correspondence)
[ ] Report Submission Method (Online Portal, Email, Physical Mail)
[ ] Confirmation of Compliance Statement

--- CLAIM CLOSURE & DOCUMENTATION ---
[ ] Claim Closure Date
[ ] Summary of Claim Resolution
[ ] Claim Status (Closed - Paid, Closed - Denied, Closed - Withdrawn)
[ ] Total Paid Amount
[ ] Notes Regarding Closure (e.g., unusual circumstances)
[ ] Supporting Documentation (e.g., final inspection report)
[ ] Claims Adjuster Signature

--- FRAUD INDICATORS REVIEW ---
[ ] Claimant Relationship to Insured (Spouse, Family Member, Business Partner, Friend, Unknown)
[ ] Claim Amount vs. Policy Limit
[ ] Date of Loss vs. Policy Inception Date
[ ] Suspicious Circumstances (Unexplained Delay in Reporting, Conflicting Statements, Witness Unavailability, Damage Inconsistent with Reported Event, Prior Claims History (Claimant))
[ ] Additional Notes/Observations
[ ] Independent Verification Needed? (Yes, No)

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