Sort the claims inbox (US)

Fields

• Email subject
• Email or letter text
• Attachment text

Questions

1. What is this claims item, judged by what the sender needs from us? Choice

   Read the subject, the body and the attachment text together, and classify the item by what the sender needs from us, not by what is attached. An invoice attached to an email that chases progress is a progress chaser. Choose Complaint only when complaining is the main purpose and the sender asks for nothing else on the claim; dissatisfaction inside a chaser or another request is recorded by the complaint question, not here. A summons and complaint is court papers.

   • New claim notification Reports a loss or accident we have not been told about before and asks to make a claim.
   • Further information on an open claim Sends photos, statements, documents or answers to our questions on a claim already open, without chasing or complaining as the main point.
   • Proof of loss A signed or sworn proof of loss form, or an inventory of damaged property sent as the proof of loss.
   • Repair estimate or vendor invoice A contractor, repair shop or vendor sends an estimate or a bill for work, and asking for payment or approval of it is the point of the item.
   • Medical records or bills Medical records, a report or treatment bills sent as evidence on an injury claim.
   • Legal correspondence A letter from an attorney: a letter of representation, a demand, or legal argument. Court papers have their own option.
   • Court papers A summons and complaint, a petition, a subpoena, a court order or other papers filed or served in a lawsuit.
   • Complaint The main purpose is to complain about us, including a copy of a complaint to a state insurance department; the sender asks for nothing else on the claim beyond putting it right.
   • Progress chaser Asks what is happening on the claim, when something will be done, or why nobody has replied, even if it also complains or encloses documents.
   • Settlement response Accepts, rejects or questions an offer we made to settle the claim.
   • Recovery demand Another insurer, a rental car company or another party asks us to pay them back for a loss our customer caused, including a subrogation demand or an inter-company arbitration filing.
   • Withdrawal The customer asks to withdraw or close the claim.
   • Vendor update A repair shop, independent adjuster or other vendor reports progress on work we assigned, without asking for payment.
   • Not claims correspondence About a policy rather than a claim (renewal, coverage change, cancellation), or marketing, a newsletter, spam or an automatic reply.

2. Does the sender express dissatisfaction with our service, decision or conduct? Yes / No

   Count dissatisfaction whatever the main purpose of the item, whether or not the sender uses the word "complaint", and whether the sender writes for themselves or for a client. Frustration with the loss itself, such as the weather or another driver, is not dissatisfaction with us. A complaint served with a summons is a court paper, not dissatisfaction. Yes: The sender is unhappy with something we did, failed to do, or decided. No: The item expresses no dissatisfaction with us.

3. Does the item come from, copy or report a complaint to a state insurance department? Yes / No

   Count an inquiry from a state insurance department or division, a copy of a complaint filed with one, or the sender saying they have filed one. Saying they might complain to the department later does not count. Yes: The item comes from a state insurance department, encloses a complaint to one, or says one has been filed. No: No complaint to a state insurance department is made or reported.

4. Does an attorney act for the sender or claimant? Yes / No

   Answer from what the item says or where it comes from. A law firm writing for the claimant counts. A friend or relative helping the customer does not, and neither does a public adjuster. Yes: The item comes from an attorney, or says one now represents the claimant. No: Nothing in the item says an attorney acts for anyone on this claim.

5. Does a public adjuster act for the policyholder on this claim? Yes / No

   Yes: The item comes from a public adjuster, encloses a public adjuster contract or letter of representation, or says one has been hired. No: Nothing in the item says a public adjuster acts on this claim.

6. Does the sender say they are thinking of hiring an attorney or taking legal action? Yes / No

   This is about the sender considering an attorney or a lawsuit, without saying one already acts for them. It is a sign we need to contact the customer sooner and put the service right, never a reason to discourage them from getting legal advice. A complaint to a state insurance department is a complaint, not legal action. Yes: The sender says they may hire an attorney, have spoken to one, or may sue. No: No such intention is stated, an attorney already acts for them, or the only escalation mentioned is a complaint to the insurance department.

7. Does the item demand payment or action by a stated date or within a stated period? Yes / No

   Use the time-limited demands in the context: a policy-limits or other settlement demand with a time to accept, a demand that we pay or act by a stated date or within a stated period, or a summons and complaint with a date to answer. A date the sender gives for escalating a complaint, such as going to the insurance department by Friday, is not a demand. Do not work out whether any date has passed; that is done elsewhere. Yes: The item makes a demand of that kind or encloses papers that set one. No: No demand with a stated time appears, or the only deadline is for escalating a complaint.

8. Does the sender mention circumstances that may mean the customer needs extra support? Yes / No

   Use the extra support item in the context. Count only what the item says about the customer or someone in their household. Do not infer anything from tone, writing style or spelling. Yes: The item mentions health problems, disability, bereavement, old age, money trouble, a language, hearing or reading barrier, or similar circumstances. No: The item mentions none of these.

9. Does the sender ask us to pay or reimburse something, or say a payment has not arrived? Yes / No

   Money mentioned only as background, or an invoice enclosed without any request, does not count. Yes: The sender asks us to pay, reimburse or cover a cost, or says a payment we agreed has not arrived. No: No payment is asked for or chased.

10. Does the sender ask the claim handler to decide or authorize something? Yes / No

    A decision is accepting or denying coverage or liability, approving a repair or a vendor, agreeing a cost, or authorizing additional living expenses or a rental car. Asking for information, an update or a date is not a decision, and a request to be paid or reimbursed is covered by the payment question, not this one. Yes: The sender asks for a decision or an authorization of that kind. No: The sender asks for information, an update, a payment, or nothing at all.

11. How urgent is it to act on this claims item? Scale

    Judge the worst consequence of the item waiting in normal queue order, from what the item says. Do not compare dates with today; use only words such as "today", "tomorrow" or "this week".

    • Routine Can wait its turn in the normal queue with no harm to anyone.
    • Soon Should be handled within two business days: a chaser, a question, or an inconvenience the customer can live with for now.
    • Urgent Same day: the customer has no heat, water, cooking facilities or usable home or vehicle, or a stated deadline is close.
    • Emergency Ongoing danger to people or property now, such as an active leak near electrics, a gas smell or an unsafe structure.

12. Is the item complete and readable enough to judge what it is? Yes / No

    Scanned letters come through OCR and can be garbled, cut off or blank. Poor spelling or grammar does not make an item unreadable if its meaning is clear. Yes: Enough of the text is readable to tell what the item is and what the sender wants. No: The text is too garbled, truncated or empty to judge.

Lens columns

item_type, item_type_probability, complaint_expressed, complaint_expressed_probability, regulator_complaint, regulator_complaint_probability, legal_representation, legal_representation_probability, public_adjuster, public_adjuster_probability, considering_legal_action, considering_legal_action_probability, time_limited_demand, time_limited_demand_probability, vulnerability_signal, vulnerability_signal_probability, payment_issue, payment_issue_probability, needs_decision, needs_decision_probability, urgency, urgency_average, text_readable, text_readable_probability