Triage new claims and suggest a fast track for simple ones

Fields

• How the claim was reported (phone, web, app or email)
• Line of business from the policy (motor or home)
• Call transcript or the customer's account of the loss

Questions

1. What caused the loss, as the customer describes it? Choice

   Choose the cause of the damage from what the customer says happened, not from what cover they think applies. When one event leads to another, such as a storm that lifts roof tiles and lets rain in, choose the first cause. Use the line field to tell a home claim from a motor claim.

   • Escape of water A leak or burst from pipes, tanks, radiators, a boiler or an appliance inside the home.
   • Storm or flood Wind, heavy rain, hail or snow, or water rising from outside, such as a river or overflowing drains.
   • Fire or smoke Fire, smoke or scorching in the home or the vehicle.
   • Theft or burglary at home Belongings stolen from the home, garden or outbuildings, or damage from a break-in.
   • Accidental damage at home Something in the home broken or damaged by accident, such as a dropped television or spilled paint, with no one else involved.
   • Subsidence or ground movement Cracks or movement in the building that the customer puts down to the ground shifting, sinking or heaving.
   • Collision with another vehicle The vehicle hit, or was hit by, another vehicle, moving or parked.
   • Single vehicle incident The vehicle hit a wall, a kerb, a post, an animal or an object, with no other vehicle involved.
   • Vehicle theft or break-in The vehicle, or something from it, was stolen, or it was broken into.
   • Glass only Only a windscreen or a vehicle window is damaged.
   • Vandalism or malicious damage Someone damaged the home or the vehicle on purpose, without stealing anything.
   • Injury or damage to someone else Someone else says the customer caused their injury or damage and the customer is reporting that claim against them.

2. Does the account say enough about what happened and what was damaged to triage the claim? Yes / No

   A short account is enough if it says what happened and what is damaged. Poor spelling or a transcript with small gaps does not make it insufficient. Yes: The account says what happened and what was damaged, clearly enough to pick a handler. No: The account is too short, cut off or vague to tell, such as "car damaged, please call".

3. Does the account say that anyone was hurt in this incident, even slightly? Yes / No

   Count anyone: the customer, a passenger, a member of the household, another driver or a passer-by. Soreness or shock that the customer mentions counts. Yes: The account says someone was hurt, felt pain afterwards or needed medical help. No: The account says nobody was hurt, or does not mention any injury. An illness or injury unrelated to the incident is No.

4. Does another person, vehicle, business or property outside the household play a part in the loss? Yes / No

   Count another driver, a neighbour, a landlord, a contractor or tradesperson, a business, or someone else whose property is damaged. People who live with the customer do not count. An unknown thief or vandal does not count unless they were seen or identified. Yes: Someone outside the household caused the loss, took part in it, or had their own property damaged by it. No: Only the customer, their household and their own property are involved.

5. Does the customer say the home, a key part of it, or the vehicle cannot be used? Yes / No

   Key parts of a home are the kitchen, the only bathroom or toilet, heating, hot water and power. A vehicle cannot be used when it cannot be driven safely or legally. Yes: The customer says the home, one of its key parts or the vehicle cannot be used, or cannot be used safely. No: The customer can still use the home and its key parts, or the vehicle.

6. Is the damage still happening, or likely to get worse without urgent action? Yes / No

   Judge from what the customer says now, at the time of reporting. Yes: Water is still coming in or dripping, the roof or a door is open to the weather, or the customer says it is getting worse. No: The cause has stopped and nothing suggests the damage is spreading.

7. Does the account describe a danger to people right now? Yes / No

   This sends make-safe advice and an emergency trade at once; it is not a judgement on the claim. Yes: The account describes water near electrics, a bulging or sagging ceiling, a gas smell, exposed wiring, an unsafe structure, or a vehicle left in a dangerous place. No: Nothing in the account suggests anyone is in danger now.

8. Does the customer mention circumstances that may mean they need extra support with the claim? Yes / No

   Use the four drivers in the context: health, life events, resilience and capability. Count only what the customer says about themselves or someone in their household. Do not infer anything from tone, accent, spelling or the way they speak. Yes: The customer mentions a health problem, a disability, a bereavement, a new caring duty, money trouble, a language or reading barrier, or a similar circumstance. No: The customer mentions none of these.

9. How complex does this claim look from the account? Scale

   Judge from the account alone. Do not weigh amounts, cover or the excess; those are checked elsewhere.

   • Simple One clear cause, damage to one item or one small area, facts not in doubt; a handler could settle from the account with a photo or an estimate.
   • Standard One cause, but a visit, a trade repair or a report is needed before the claim can be settled, as with most leaks and storm damage to one part of a home.
   • Complex Several separate causes, another party whose part must be looked into, facts in doubt or disputed, or damage through much of the home or to several vehicles.
   • Major Serious injury, a home made uninhabitable for a long time, a vehicle destroyed, or many people or properties involved.

10. Does the account fit the fast-track description in the context? Yes / No

    Check every part of the fast-track description in the context against the account. Judge only what the account says; cover, amounts and the excess are checked elsewhere. This is a suggestion for the handler, who confirms it with the customer, not a decision about the customer. Yes: The account fits every part of the description. No: At least one part does not fit, or the account says too little to tell.

Lens columns

loss_cause, loss_cause_probability, account_sufficient, account_sufficient_probability, injury_reported, injury_reported_probability, third_party_involved, third_party_involved_probability, loss_of_use, loss_of_use_probability, ongoing_damage, ongoing_damage_probability, safety_hazard, safety_hazard_probability, vulnerability_signal, vulnerability_signal_probability, complexity, complexity_average, fast_track_fit, fast_track_fit_probability