Claim Reserve Setting and Adjustment Worksheet

Documents the initial indemnity and expense reserve and any subsequent adjustments with supporting rationale to support financial accuracy and consistency across the claim file.

Claim and Submission Details

• Claim Number
  Enter the claim file identifier used in your claims system.
• Policy Number
  Optional if needed to link the reserve action to the policy record.
• Claim Type
• Reserve Action Type
  Select the action being documented for the claim file.
• Effective Date
  Date the reserve action becomes effective.
• Reason for Submission
  Briefly explain why this reserve worksheet is being completed.

Reserve Details

• Reserve Category
  Select the reserve category or categories affected by this action.
• Current Indemnity Reserve
  Current indemnity reserve amount before this action, if applicable.
• Proposed Indemnity Reserve
  New indemnity reserve amount after this action, if applicable.
• Current Expense Reserve
  Current expense reserve amount before this action, if applicable.
• Proposed Expense Reserve
  New expense reserve amount after this action, if applicable.
• Total Reserve Change Amount
  Calculated net change across indemnity and expense reserves.

Supporting Rationale

• Primary Basis for Reserve Decision
• Supporting Facts and Assumptions
  Summarize the claim facts, estimates, or assumptions used to support the reserve amount.
• Key Documents Reviewed
  Select the documents or sources used to support the reserve decision.
• Describe Other Basis
  Provide details when 'Other' is selected as a reserve basis.
• Reason for Change from Prior Reserve
  Explain what changed since the prior reserve was established.

Review, Approval, and Audit Trail

• Prepared By
  Name or identifier of the person completing the worksheet.
• Reviewed By
  Name or identifier of the reviewer, if applicable.
• Approval Status
• Approval Notes
  Add any review comments, required corrections, or approval rationale.
• Attestation
  Required acknowledgment for the audit trail.