INSURANCE CLAIMS INVESTIGATION WORKFLOW

Created by ChecklistGuro (https://checklistguro.com)

[ ] Retrieve Claim Details: Fetch the initial claim entry including policyholder info and incident details from the Claims Data Model.
[ ] Get Policyholder Profile: Retrieve historical data and coverage limits from the Policyholders Data Model.
[ ] Calculate Estimated Liability: Calculate the potential payout amount based on reported damages and policy coverage limits.
[ ] Create Investigation File: Create a new entry in the Investigation Data Model linked to the original Claim entry.
[ ] Assign Field Investigator: Create a task for the Claims Adjuster to visit the accident scene and collect evidence.
[ ] Update Investigation Status: Update the status of the Investigation entry to 'In Progress' once the task is assigned.
[ ] Retrieve Evidence Attachments: Fetch all photos, witness statements, and police reports attached to the claim.
[ ] Verify Documentation: Create a task for the Legal Department to review the legitimacy of the uploaded evidence.
[ ] Sum Total Reported Damages: Aggregate all line-item damage costs from the related Damage Assessment entries to get a total sum.
[ ] Calculate Deductible Subtraction: Subtract the policyholder's deductible from the total estimated liability.
[ ] Update Final Claim Valuation: Update the Claim entry with the final calculated settlement amount.
[ ] Final Approval Task: Create a task for the Claims Manager to review the investigation findings and approve the settlement.
[ ] Notify Policyholder of Decision: Send an email to the policyholder informing them of the claim approval or denial.
[ ] Send Payment Alert: Send an SMS to the policyholder notifying them that the settlement funds have been released.
[ ] Close Claim Entry: Update the original Claim entry status to 'Closed'.
[ ] Generate Investigation Summary Report: Create a final PDF/Report summarizing all findings, costs, and decisions for the archive.

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