INSURANCE CLAIMS LEAKAGE PREVENTION CHECKLIST 2026

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--- PRE-CLAIM VERIFICATION & INTAKE AUDIT ---
[ ] Date of Loss Reported
[ ] Policy Number Verification
[ ] Coverage Status Confirmation (Active, Lapsed, Pending Renewal)
[ ] Initial Damage Type Identified (Physical Damage, Theft/Robbery, Natural Disaster, Liability/Injury, Other)
[ ] Initial Incident Description Summary
[ ] Proof of Loss Documentation
[ ] Adjuster Verification Signature

--- RESERVING ACCURACY & ADEQUACY REVIEW ---
[ ] Date of Initial Reserve Setup
[ ] Initial Estimated Loss Reserve Amount
[ ] Current Total Outstanding Reserve
[ ] Reserve Adequacy Status (Adequate, Under-reserved, Over-reserved, Requires Immediate Re-evaluation)
[ ] Justification for Reserve Adjustments
[ ] Supporting Actuarial or Loss Valuation Report
[ ] Claims Manager Approval Signature

--- CLAIMS HANDLING & ADJUDICATION OVERSIGHT ---
[ ] Date of Claim Assignment
[ ] Adjuster Assignment Status (Assigned, Pending Review, Escalated)
[ ] Adjudication Milestones Completed (Coverage Determination, Liability Assessment, Damage Estimation, )
[ ] Summary of Coverage Determination Logic
[ ] Estimated Loss Reserve Amount
[ ] Claim Decision Documentation
[ ] Supervisor Review Authorization

--- VENDOR & THIRD-PARTY SERVICE MANAGEMENT ---
[ ] Vendor Category (Independent Adjuster, Legal Counsel, Appraisal Services, Medical Examiner, Salvage/Auto Shop)
[ ] Vendor Name
[ ] Service Contract Expiry Date
[ ] Total Vendor Spend (YTD)
[ ] Compliance Audit Checklist Completed (Certificate of Insurance Verified, Background Check Performed, Service Level Agreement (SLA) Review, Fee Schedule Alignment Confirmed)
[ ] Vendor Contract/Agreement
[ ] Vendor Performance Notes & Discrepancies
[ ] Auditor Verification Signature

--- SUBROGATION & RECOVERY OPTIMIZATION ---
[ ] Third-Party Identity Details
[ ] Subrogation Potential Status (Confirmed Potential, Under Investigation, No Subrogation Identified, Closed - No Recovery Possible)
[ ] Evidence of Liability Summary
[ ] Date of Incident/Loss
[ ] Estimated Recovery Amount
[ ] Police Report or Incident Evidence
[ ] Action Items Completed (Notice of Intent Sent, Demand Letter Issued, Third-Party Insurer Contacted, Evidence Gathered)

--- SETTLEMENT & PAYMENT INTEGRITY ---
[ ] Settlement Date
[ ] Total Indemnity Amount Paid
[ ] Total Expense Reimbursement Amount
[ ] Payment Method Used (Electronic Funds Transfer (EFT), Physical Check, Digital Wallet/Mobile Payment)
[ ] Verification Checkpoints Completed (Policy Limit Verification, Tax Withholding Calculation, Subrogation Interest Check, Release Form Validation)
[ ] Signed Release Document
[ ] Claims Manager Approval

--- LITIGATION & LEGAL EXPENSE CONTROL ---
[ ] Litigation Status (Pre-Litigation, Active Litigation, Settled/Closed, Subrogation Pending)
[ ] Defense Counsel Name
[ ] Total Legal Fees Incurred
[ ] Date of Litigation Commencement
[ ] Legal Fee Invoice/Statement
[ ] Litigation Strategy Summary
[ ] Identified Leakage Risks (Excessive Attorney Fees, Lack of Regular Case Updates, Unapproved Settlement Authority, Inadequate Discovery Oversight)
[ ] Claims Manager Approval

--- FRAUD DETECTION & SIU COORDINATION ---
[ ] Fraud Red Flag Identified (No Red Flags Detected, Suspected Fraudulent Activity, Potential Documentation Discrepancy, Unusual Claim Pattern Detected)
[ ] Detected Red Flag Indicators (Inconsistent Statement, Pressure to Settle Quickly, Incomplete Accident Details, Frequent Claim History, Involved Parties Unverifiable, Physical Damage/Injury Inconsistency)
[ ] Fraud Investigation Summary
[ ] Date of SIU Referral
[ ] Supporting Evidence/Documentation
[ ] Investigator Verification

--- DATA INTEGRITY & DOCUMENTATION COMPLIANCE ---
[ ] Required Documents Present (Police/Incident Report, Medical Records/Estimates, Photographic Evidence, Witness Statements, Damage Assessment Report)
[ ] Last File Audit Date
[ ] Data Accuracy Rating (Fully Compliant, Minor Discrepancies, Critical Missing Data)
[ ] Discrepancy Notes & Remediation Plan
[ ] Auditor Verification Signature

--- POST-CLAIM ANALYTICS & CONTINUOUS IMPROVEMENT ---
[ ] Review Completion Date
[ ] Total Leakage Value Identified ($)
[ ] Root Cause Analysis of Leakage Incidents
[ ] Identified Leakage Drivers (Inaccurate Reserving, Vendor Overcharging, Process Non-Compliance, Failure to Pursue Subrogation, Inadequate Documentation)
[ ] Required Follow-up Action Level (Low - Monitor, Medium - Process Update Required, High - Immediate Training/Audit Required)
[ ] Updated Standard Operating Procedure (SOP) Document
[ ] Compliance Officer Approval

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