Instructions · 03
The claim journey, step by step
What to do at each of the fifteen steps from claim details to financial reports.
Every claim is shown as a rail of fifteen steps, in the order insurers expect a managed claim to progress. The rail is a read-out: each step's state is worked out from the data you record. You cannot tick a step as done: you do the work, record it, and the step turns green by itself.
- Intake
- Assessment
- Commercial
- Delivery
- Close
Does: what the step is for. Do: what you click and enter. Complete when: the exact test the rail applies. Watch for: the common traps.
Which steps does my claim have?
| Situation | Steps that show as "Not applicable" |
|---|---|
| Survey & assessment instruction | 6 Quick scope, 7 Scope of work, 10 Pre-commencement, 11 Work phases, 14 Customer satisfaction. Step 12 applies only if a survey service is ordered. |
| Assessment method is a desktop review or an existing external report | 3 Survey booking and 4 Risk assessment (no site visit). |
| Assessment method is "Existing insurer scope" (no new assessment) | 3, 4 and 5 (no survey and no report). |
Intake
Claim details
Does: holds the insurer, reference, policy, contacts and documents that the whole claim relies on.
Do: classify the instruction type and assessment method; chase any reference marked Awaiting insurer; assign a handler; record the policy details (type, dates, sums insured and excess).
Complete when: the instruction type is set, the claim reference and policy number are no longer "awaiting", a handler is assigned and policy details are recorded as received.
Watch for: the policy excess entered here drives step 10, so enter it accurately.
Discovery call triage
Does: the first contact with the policyholder (the "FNOL call") and a short triage.
Do: Log attempt for each call or voicemail (reached / no answer / left message). When you reach the person, record the property layout (storeys and rooms), habitability, vulnerability and a call summary.
Complete when: first contact has been made with the policyholder and every contactable risk contact, the property layout is recorded and the triage (habitability, vulnerability, summary) is complete.
Watch for: target is 1 hour from receipt by default. A risk contact with the same name as the policyholder is treated as the same person: one logged call covers both.
Assessment
Survey booking
Does: books the survey with an eligible internal or external surveyor, or records an external inspection or desktop report.
Do: Arrange an internal or network survey: pick the surveyor, date and time. The panel emails the surveyor with a calendar invite; moving or cancelling the survey sends an updated or cancelling invite. Or choose Record an external inspection or desktop report if the insurer's own surveyor did it.
Complete when: a survey is booked (the latest one not cancelled).
Watch for: a surveyor must pass the compliance checks (see gates), including on the appointment date. A survey has exactly one surveyor, internal or external. Target: 2 working days from receipt.
Survey risk assessment
Does: the pre-visit health and safety assessment: asbestos, structure, electrics, lone working and their controls.
Do: complete the assessment before the survey starts.
Complete when: the risk assessment for the current survey is recorded.
Watch for: the survey cannot be started until this is done.
Survey report
Does: room-by-room findings, photographs and the reviewed report that goes to the insurer.
Do: start the survey; summarise the findings; record the cause of damage; add the room-by-room findings with photographs. Then generate the report PDF, approve it internally and send it to the insurer (an email with the PDF attached and an optional covering note).
Complete when: a reviewed report has been delivered to the insurer. For an assessment-only claim, delivery also marks the assessment complete.
Watch for: delivery requires review of the same active report. If the report came from outside, upload it, review it, then record delivery. Target: report to the insurer within 2 working days of the survey.
Quick scope
Does: an early estimate of repair cost by trade, to support the first reserve.
Do: add a line per trade and price it; confirm the quick scope when every line is priced.
Complete when: the quick scope is confirmed (until then it shows the draft total).
Watch for: managed repairs only. It is an estimate, not the schedule of works.
Commercial
Scope of work
Does: turns the survey into a priced schedule of works, asks contractors to price it where needed, awards them and issues it to the insurer.
Do, in order:
- Rooms: add each room and its measurements.
- Schedule: build lines from the schedule of rates (each item carries a client rate and a contractor rate). Lines are grouped in numbered sections: the original schedule, then supplements.
- Off-schedule work: for work not in the rates, send a request for quotation (RFQ) by email to contractors (it carries codes, descriptions, rooms, units and quantities, never a price). Enter the returned prices, compare them and award one; the insurer rate is the awarded contractor rate plus markup.
- Issue to the insurer: review and issue the schedule. The insurer receives an email with the client PDF and total.
Complete when: the schedule has lines and has been issued to the insurer. If the insurer asks for amendments, the step reopens: start a supplement, change the schedule and issue again.
Watch for: you cannot issue until off-schedule lines have an awarded contractor quotation, and you cannot issue again until the insurer's decision on the last issue is recorded. Target: 5 working days from the report.
Claim reserves & recoveries
Does: records the money the insurer has set aside, by indemnity category: Buildings, Contents, Alternative accommodation, Loss of rent, Business interruption, Inconvenience allowance, Daily meal allowance, Electricity usage, Other, and Professional fees. Also records recoveries (e.g. from a third party) and the cash payments the insurer made to the policyholder or a third party.
Do:
- Set the reserve once the quick scope is confirmed; raise it if the cost estimate grows. Every change is kept, so the table shows for each category the initial reserve, the previous one, the current one and the movement (current minus previous).
- Read the summary: sub-total (all categories except fees), professional fees, VAT on the sub-total at the insurer's default rate, and the grand total.
- File each recovery under a category (or leave it Unallocated). The panel totals what is sought, recovered, outstanding and the total potential per category.
- Record a cash payment when the insurer settles part of the claim in cash (see below).
Reserve balance. Users who can view finance also see claim spend (sales invoiced, less credit notes, plus cash payments that are not voided) and the reserve balance (grand total minus spend). When spend passes the reserve the balance turns red with a warning. It never blocks anything; raise the reserve or check the invoices.
Complete when: a reserve is set and covers the best known cost (the quick-scope total or the latest schedule estimate).
Watch for: setting a reserve to the value it already holds is refused. A recovery cannot be marked recovered without the amount recovered. Cash payments are a record of what the insurer paid; nothing is paid from the panel. You can record one only after an insurer decision that allows payment (approved, cash settlement or partial repudiation), only in a payable category (not Professional fees), and not while the financial ledger is closed. They need finance payment permission (CEO and CTO). A wrong entry is voided with a reason, never edited, and a voided payment no longer counts in spend.
Claim decision
Does: records the insurer's decision. The outcomes are listed below.
| Outcome | What happens to the claim | Repairs authorised? | Fee |
|---|---|---|---|
| Approved | Claim becomes Approved. | Yes | Repair invoices. |
| Declinature | Claim becomes Rejected. | No | Assessment fee if the report was delivered. |
| Repudiated | Claim becomes Rejected. | No | As declinature. |
| Partial repudiation | Status unchanged. | Not by itself: the approved part is recorded on the schedule decision. | Repair invoices. |
| Cash settlement | Status unchanged; the next action is Review insurer outcome. | No | Assessment fee if delivered. |
| Alternative contractor · Claim tender · Desktop validation only | As cash settlement. | No | Assessment fee if delivered. |
| Withdrawn prior to site survey | Status unchanged. | No | No fee can be invoiced. |
| Withdrawn after site survey | Status unchanged. | No | Survey fee allowed without a delivered report, once the site survey is recorded as completed. |
| Withdrawn, only survey report submitted | Status unchanged. | No | Survey fee allowed. |
| Withdrawn, full client report submitted | Status unchanged. | No | Full fee allowed. |
| Further information requested · Repair approval withdrawn · Amendments requested | As before: the step stays open, or the schedule is re-issued. | No | No change. |
A withdrawn outcome never raises the Claim cancelled flag, because that would make the claim read-only and stop you invoicing the fee.
Do: record the decision as the insurer gave it, and attach their email or letter right in the form (Upload beside the document picker). Record the decision on the issued schedule (approved, amendments requested, rejected).
Complete when: the latest recorded decision supports the route taken.
Below the decision form, the Decisions by schedule table has one row per schedule issue (Original, Supplement 1 and so on): who issued it and when, the outcome, and who recorded it and when.
Watch for: the panel grants nobody authority to decide. No repair work can start until the latest decision approves repairs and its supporting file is still on the claim. Withdrawing the supporting document withdraws the authority.
Delivery
Pre-commencement checklist
Does: collects what must be in place before work starts.
Do: for each excess on the policy (buildings, contents and any other) say whether it applies and enter the date it was received. Record the customer contribution when the approved schedule carries one. If excess already received must be paid back, record the policy excess refund.
Complete when: every applicable excess and the customer contribution are received.
Watch for: an unreceived excess or contribution stops a phase from starting. A refund due keeps the step open but never blocks work. Target: 3 working days from approval.
Work phase management
Does: splits the approved work into phases (usually one per trade), assigns a contractor to each and tracks it to validation.
Do, per phase:
- Create the phase (e.g. "Scaffolding hire and erection") and allocate schedule lines to it. Provisional sums stay with the insurer and are not allocated.
- Assign the contractor: only an active network member who carries that trade and is compliant, and who was awarded the quotation for those lines.
- Raise the purchase order (step 12) and send the instruction to the contractor.
- Record acceptance, the pre-start meeting and the agreed start date.
- Record the actual start and progress against the estimated finish date (EFD).
- Record the actual finish, the contractor's completion report, defects and any certificates.
- Validate the work with its evidence. Only a user with the right permission can validate.
Complete when: every line sits in a phase and every phase that goes ahead is validated.
Watch for: a phase that has started cannot change contractor, lose lines or be rejected; add further work as a new phase. Phase statuses are To do, Active, Completed and Rejected. Each stage has its own deadline on the dashboard.
Close
POs & contractor invoices
Does: the money we owe. Raises purchase orders (PO) to contractors, records the invoices they send and pays them.
Do:
- Raise a PO for each assigned phase. It freezes the contractor's lines and rates, is numbered like
0000000001-0, filed as a restricted PDF and emailed to the contractor. A changed PO is a revision; the next revision supersedes the old one. - Commission a survey service (structural engineer, drainage or asbestos survey): a PO for a service bought in rather than a repair phase.
- Record the contractor invoice (reference, date, net, VAT, and the invoice file via Upload).
- Record a payment, full or part. The amount defaults to the balance.
- Record a credit note if the contractor credits an invoice.
Complete when: every phase that goes ahead has an order, every order is fully invoiced and every invoice is paid.
Watch for: invoices cannot exceed the order. Paying needs verified bank details for the contractor, or a payment reference and a written override reason. Contractor invoices are targeted for payment within 30 days of receipt.
Sales invoices
Does: the money the insurer owes us.
Do: Issue sales invoice PDF (interim or final; less the policy excess); Issue credit note PDF if one is needed; Record insurer receipt when money arrives. On assessment claims, and on claims the insurer withdrew, Record agreed assessment fee, then invoice it as an Assessment fee (see the outcome table in step 9 for what each withdrawal allows).
Complete when: at least one authorised invoice has been issued and nothing outstanding remains.
Watch for: every invoice, credit note and receipt is stored as its own record, so the history tab lists each once. Invoices cannot exceed the authorised value; a credit note cannot exceed the invoice's unpaid balance (a credit after payment would be a refund, which is not recorded in the panel). Invoices are numbered INV-…, credit notes CN-… from their own sequence.
Customer satisfaction
Does: a short call script with the policyholder after the repairs.
Do: read the opening line and ask five questions (kept informed? contractor conduct? quality of repairs? all work finished? would recommend?), then a rating out of 5 and comments. If nobody answers, choose No answer to log the attempt.
Complete when: a call records that the work is finished and its quality was not refused.
Watch for: the outcome is decided by the answers, you do not choose it. If the work is unfinished or quality is refused, the outcome is defects: a comment is compulsory and the step stays open until a later call. Target: within 5 working days of the last phase being validated.
Financial reports
Does: shows the claim's profitability and closes its ledger.
Do: review authorised value, invoiced, received, outstanding, contractor cost, other costs and gross margin (users without margin permission see only the figures they may see). Record any additional cost that had no PO. Then Close financial ledger.
Complete when: the ledger is closed.
Watch for: the ledger will not close while the panel lists blockers such as Invoice the remaining authorised value, Record the outstanding insurer receipts, Record payment of every additional cost, Validate every repair phase (or Deliver the reviewed assessment report), Record customer acceptance and resolve defects and Reconcile and pay contractor invoices. Reopening the ledger is CEO-only.
Operational completion (the repairs are done and validated) is separate from financial closure (all the money has settled and the ledger is closed). A claim can be operationally complete and still financially open.
A worked example
An escape of water at a house in Leeds, instructed by an insurer as managed repairs:
- Day 0, 09:10: claim opened
Added with the six-step form; status New; handler assigned. Steps 1 and 2 are due.
- Day 0, 09:45: discovery call
Policyholder reached; layout and triage recorded. Step 2 complete.
- Day 1: survey booked and done
Internal surveyor booked; risk assessment done; survey completed; report approved and emailed to the insurer (steps 3–5).
- Day 2–5: scope, reserve, decision
Quick scope confirmed, reserve set; rooms measured; schedule built from the rates; off-schedule joinery priced by RFQ and awarded; schedule issued; insurer approves and the decision is recorded (steps 6–9).
- Day 8: delivery
Excess received (step 10). Phases created: strip-out, plastering, decoration. Contractors assigned, POs raised, work done and validated (steps 11–12).
- Day 30+: close
Contractors invoice and are paid; sales invoice issued and receipt recorded; satisfaction call accepted; ledger closed; claim closed with a reason (steps 12–15).