Claims / Reserves and payments
Reserves per coverage line, payments checked before any check is requested
Each coverage line on a claim carries its own reserve, paid amount and status, capped at the coverage’s remaining limit when declarations are loaded and held to the adjuster’s authority.
Every payment passes the same server checks in order — the edit lock, the line, the payee by name, duplicates, sanctions, tax, payee verification, deductible, authority and the litigation gate.
The question this answers
What happens to a payment above the adjuster’s authority?
It stops for the right approver, with the reason shown. The adjuster’s own same-bucket total plus the payment is tested against their authority — and with Payment Authority Layers, against the check itself, the line’s incurred and the claim’s incurred, lowest wins. Above it, the payment is Pending with the failing layer named and a task for the approver.
Reserves, payments, checks
Line by line
A Reserve Per Coverage Line
Dwelling — Indemnity, Defense Fees — Expense. One line per coverage and sub-type, with a reserve history of who changed what, from and to.
Authority On Reserves Too
A reserve that would take the person past their indemnity or expense authority goes Pending, with the numbers, for a manager to approve, escalate or reject.
Sanctions And Payees
Every payee needs an eligible screening result; a flagged payee is refused unless an administrator overrides. A payee under review or with an unresolved duplicate is always refused.
Only Adjusters Issue
Managers and administrators approve; they do not issue. A check moves Requested, Issued, then Cleared — and Cleared only from the bank’s own feed or file.
Stop, Void, Transfer
The adjuster stops, voids or transfers a check in one step with a reason. A voided check reopens any medical bill line it paid.
The vocabulary
Terms used precisely, because they are not synonyms
Most leakage conversations founder on two people using “incurred” differently. These are the definitions the platform works to.
Feature
One coverage line on a claim, with its own reserve, paid amount, status and, optionally, its own adjuster
Paid
Money actually disbursed against the line
Incurred
Paid plus open reserve
Recovery
Money coming back: subrogation, salvage, refunds and reimbursements
Net Liability
Incurred less recoveries
Pending
A payment or reserve held for an approver, with the reason named
Other Currencies
A payment can be made in another currency; the claim carries the converted figure at the rate on your organization’s exchange-rate ledger
Where we are honest
Integrity is not adequacy
The platform guarantees the checks. It does not guarantee that the reserve is the right number.
Bands Are Your Configuration
Reserve bands per loss type are yours to set. A reserve outside its band is flagged for review, and the adjuster’s judgment stands.
Unverified Policies Are Constrained
On a claim whose policy cannot be verified, an indemnity line is refused and an expense line needs a supervisor’s reason code.
Money Moves In Your Accounts
The platform checks, authorizes and records. The money itself moves through your own bank and payment arrangements.
Read next
Bring a payment that should have been stopped
An unscreened payee, a duplicate, or a check over authority. We will put it through the checks and show you exactly where it stops and why.