Insurance Claims Subrogation Workflow

Rozpoczęcie przepływu pracy/procesu.

Fetch all details from the original Insurance Claim entry to identify potential third-party liability.

Search the Policy Data Model for any existing records related to the identified adverse driver/party.

Calculate the net amount recoverable by subtracting deductibles and processing fees from the total paid loss.

Generate a new entry in the Subrogation Case Data Model linked to the original claim.

Create a task for an Investigator to verify fault and gather evidence (police reports, photos).

A checklist within the investigation task to ensure all necessary documents are attached to the case.

Update the Subrogation Case entry with the determined percentage of fault for the third party.

Fetch contact information and claims handling details for the identified adverse insurer.

Send a formal demand for payment to the third-party insurer's claims adjuster.

Create a task to follow up if no response is received from the third-party insurer within 30 days.

Update the case record to reflect that a demand has been issued.

Fetch any incoming payment offers or correspondence linked to the case.

Compare the settlement offer against the calculated recoverable amount to determine if the offer is acceptable.

Create a task for a Claims Manager to review and approve the settlement amount.

Update the Subrogation Case entry to 'Closed' and record the final settlement amount.

Update the original Insurance Claim entry to reflect the recovered funds.

Aggregate all closed subrogation entries to calculate the total monthly recovery amount for reporting.

Create a performance report showing the ratio of recovered amounts vs. total claims paid.

Send an email to the policyholder informing them that the deductible has been recovered.

Delete or move temporary internal notes that are no longer required after case closure.

Koniec przepływu pracy/procesu.