INSURANCE CLAIMS SUBROGATION WORKFLOW

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

[ ] Retrieve Initial Claim Details: Fetch all details from the original Insurance Claim entry to identify potential third-party liability.
[ ] Identify Third-Party Policy Data: Search the Policy Data Model for any existing records related to the identified adverse driver/party.
[ ] Calculate Subrogation Recoverable Amount: Calculate the net amount recoverable by subtracting deductibles and processing fees from the total paid loss.
[ ] Create Subrogation Case: Generate a new entry in the Subrogation Case Data Model linked to the original claim.
[ ] Assign Investigation Task: Create a task for an Investigator to verify fault and gather evidence (police reports, photos).
[ ] Checklist: Evidence Verification: A checklist within the investigation task to ensure all necessary documents are attached to the case.
[ ] Update Liability Status: Update the Subrogation Case entry with the determined percentage of fault for the third party.
[ ] Retrieve Third-Party Insurer Contact: Fetch contact information and claims handling details for the identified adverse insurer.
[ ] Send Demand Letter: Send a formal demand for payment to the third-party insurer's claims adjuster.
[ ] Task: Monitor Response Deadline: Create a task to follow up if no response is received from the third-party insurer within 30 days.
[ ] Update Demand Status: Update the case record to reflect that a demand has been issued.
[ ] Retrieve Settlement Offers: Fetch any incoming payment offers or correspondence linked to the case.
[ ] Calculate Loss Variance: Compare the settlement offer against the calculated recoverable amount to determine if the offer is acceptable.
[ ] Task: Final Settlement Approval: Create a task for a Claims Manager to review and approve the settlement amount.
[ ] Update Case Outcome: Update the Subrogation Case entry to 'Closed' and record the final settlement amount.
[ ] Update Original Claim: Update the original Insurance Claim entry to reflect the recovered funds.
[ ] Calculate Total Recovered Monthly: Aggregate all closed subrogation entries to calculate the total monthly recovery amount for reporting.
[ ] Generate Subrogation Recovery Report: Create a performance report showing the ratio of recovered amounts vs. total claims paid.
[ ] Notify Claimant of Recovery: Send an email to the policyholder informing them that the deductible has been recovered.
[ ] Archive Closed Correspondence: Delete or move temporary internal notes that are no longer required after case closure.

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