Insurance Claims Adjustment Review Checklist
Ensure accurate and compliant claims handling. This checklist helps insurance professionals meticulously review claims adjustments, minimizing errors, fraud, and regulatory risks. Drive consistency and efficiency in your claims process today!
Initial Claim Receipt & Documentation
Verifies completeness and accuracy of initial claim information received.
Date of Loss/Incident
Claim Number (Assigned)
Claim Type
Summary of Loss Description (Initial Report)
Initial Police Report (If Applicable)
Claimant Full Name
Insured Full Name
Policy Verification & Coverage Assessment
Confirms policy validity, applicable coverage, and any exclusions.
Policy Status
Coverage Type
Policy Effective Date
Policy Expiration Date
Policy Limit
Coverage Details Summary
Endorsements Applied
Damage Assessment & Investigation
Evaluates the extent of the loss and gathers supporting evidence.
Detailed Description of Damage
Photos/Videos of Damage
Estimated Cost of Repair (USD)
Severity of Damage
Date of Damage
Location of Damage
Type of Damage (Select all that apply)
Liability Determination (If Applicable)
Determines liability for the loss, if relevant to the claim.
Primary Liability Party
Liability Assessment Narrative
Estimated Liability Amount ($)
Legal Counsel Involvement Required?
Date of Liability Determination
Reserves Establishment & Adjustment
Sets appropriate reserves for the claim and adjusts them as needed.
Initial Reserve Amount
Reserve Rationale
Date of Initial Reserve
Reserve Adjustment Amount
Reason for Adjustment
Date of Reserve Adjustment
Updated Reserve Amount
Vendor Management & Payments
Reviews vendor invoices and ensures payments are processed correctly.
Invoice Amount
Invoice Date
Payment Method
Check Number (if applicable)
Payment Date
Vendor Approval Status
Payment Notes/Comments
Communication & Customer Service
Assesses the quality of communication with the claimant and ensures satisfaction.
Summary of Customer Interactions
Customer Sentiment (Post-Interaction)
Number of Customer Follow-Up Calls/Emails
Date of Last Customer Contact
Communication Channels Used (Check all that apply)
Notes on Customer Concerns/Feedback
Regulatory Compliance & Reporting
Verifies compliance with relevant insurance regulations and reporting requirements.
Reporting Deadline
Applicable Regulations (e.g., NAIC, State Laws)
Reporting Form Version
Summary of Regulatory Changes Impacting Report
Supporting Documentation (e.g., Regulatory Correspondence)
Report Submission Method
Confirmation of Compliance Statement
Claim Closure & Documentation
Ensures proper documentation of claim closure and adherence to internal procedures.
Claim Closure Date
Summary of Claim Resolution
Claim Status
Total Paid Amount
Notes Regarding Closure (e.g., unusual circumstances)
Supporting Documentation (e.g., final inspection report)
Claims Adjuster Signature
Fraud Indicators Review
Checks for any signs or red flags indicating potential fraudulent activity.
Claimant Relationship to Insured
Claim Amount vs. Policy Limit
Date of Loss vs. Policy Inception Date
Suspicious Circumstances
Additional Notes/Observations
Independent Verification Needed?
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Lista de verificación de auditoría interna de seguros
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