Claim Settlement Authority and Approval Routing Form

Documents proposed claim settlement amounts against adjuster authority limits and routes higher amounts for supervisor or manager approval, with an audit trail of settlement decisions.

Submission Overview

• Request type
• Claim number
  Enter the internal claim reference number used for tracking and audit trail.
• Submission date
• Requestor name
  Name of the adjuster or claims handler submitting the request.
• Requestor role
• Line of business

Claim and Settlement Details

• Current claim status
• Proposed settlement amount
  Enter the total proposed settlement amount in the claim currency.
• Claim currency
• Settlement category
  Select all that apply.
• Settlement basis
  Summarize the facts, coverage position, negotiation outcome, or reserve rationale supporting the proposed amount.
• Supporting documents
  Upload only documents necessary for review, such as demand letters, estimates, or negotiation summaries.

Authority Limit Review

• Adjuster authority limit
  Enter the maximum amount the requestor is authorized to approve.
• Does the proposed amount exceed the requestor's authority limit?
• Approval level required
• Routing reason
  Explain why the request is being routed for additional approval, including any policy or authority limit reference.
• Urgent decision needed?
• Decision deadline
  Optional date by which a decision is needed.

Supervisor or Manager Approval

• Approver name
  Name of the supervisor or manager reviewing the request.
• Approver role
• Approval decision
• Approval conditions
  Describe any conditions attached to the approval, such as revised wording, reserve changes, or additional documentation.
• Approval comments
  Provide the approval rationale, rejection reason, or follow-up instructions.
• Approval date

Audit Trail and Submission

• I understand this submission will be retained in the audit trail for claims governance and review.
• Consent to process PII for claim handling and approval routing
  Only the minimum necessary personal data should be collected and processed for claim administration and approval routing.
• Final submission notes
  Add any final notes relevant to the settlement decision or routing history.