Claims / Coverage verification
Coverage checked at first notice, decided by a person
When a claim is created, its loss date is compared with your organization’s policy book. A mismatch raises a soft coverage flag and a review diary — never a block — so the file opens with the question visible rather than discovered a week later.
Fetching the declarations pulls the coverage limits onto the claim, and from then each reserve is capped at its coverage’s remaining limit.
The question this answers
What happens when the policy cannot be matched?
The claim is still opened, so no loss is refused — but it is held for a manager instead of being auto-assigned, with a red strip on the claim and the reason in the Assignment Queue. On a claim whose policy cannot be verified, an indemnity line is refused and an expense line needs a supervisor’s reason code and a note.
What happens at intake and after
Check, flag, cap
The Policy Book Is Read
Your policy book and your administered policies are searched together. A policy you do not hold is “not found”, never shown as locked.
A Soft Flag, Not A Block
A loss date that does not fit raises a coverage-flag badge and a review diary. The claim proceeds; the question stays visible.
Declarations Cap Reserves
Fetch Declarations pulls the limits from the carrier feed, and each reserve is then capped at its coverage’s remaining limit.
People Own The Decision
Verification records what the book says. The coverage position is decided by someone authorized to decide it, and denials go to a second signature before any letter is sent.
Why timing matters
The hidden costs of delayed verification
Every one of these is a routine failure in operations that check coverage after assignment rather than at intake.
The Risk
What changes here
Mismanaged Expectations
The flag is on the claim header before the first contact
Reserves Above The Limit
Capped at the coverage’s remaining limit once declarations are loaded
Unmatched Claims Routed Anyway
Held for a manager, never auto-assigned
Indemnity On An Unverified Policy
Refused until the policy is verified
Prior Claims Missed
The Policy Info tab lists prior claims on the policy or insured
Read next
Put us to the test
Bring a claim filed against a policy that had lapsed. We will show you the flag it raises, where it waits, and what it refuses to let anyone reserve.