What are the stages of the claims lifecycle?
- First notice of loss: the report that opens the claim; see FNOL.
- Coverage review: confirm the policy was in force and the loss falls within it, with a reservation of rights if the facts call for one.
- Investigation: gather statements, documents, and expert input on liability and damages.
- Evaluation and reserving: value the claim and set or update the reserve.
- Negotiation and settlement, or litigation management if a suit is filed.
- Payment and closure: pay within authority, then close the file after the final payment.
- Recovery: pursue subrogation, salvage, or contribution, which can continue after payment.
Who is involved in a claim?
The insured, the claimant, the adjuster and the supervisor, defense counsel, experts and other vendors, and often a reinsurer. When the carrier outsources the work, a TPA handles the file under the client's guidelines and authority.
Where do claims go wrong?
Claims quality reviews find the same misses repeatedly: slow first contact, no written coverage position, a reserve that was never updated, a missed statutory deadline, no current plan of action, and a recovery nobody pursued. Each maps to one stage above. See claims quality review.
How does the lifecycle look on a complex claim?
The stages overlap and repeat. A multi-party liability claim or a litigated bodily injury claim returns to investigation, evaluation, and reserving as new facts and demands arrive, and more people take part in each decision. The file needs monitoring through its whole life, not a check at each stage.
Elysian TPA handles claims across this lifecycle, from automated intake to resolution, with line-specialist adjusters.
