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Run: Claim Reserve Setting and Adjustment Worksheet

Track initial claim reserves and every adjustment in one worksheet, with the facts, documents, review, and approval trail needed to explain each change.

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Claim and Submission Details

Claim Number (required)

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 (required)

Reserve Action Type (required)

Select the action being documented for the claim file.

Effective Date (required)

Date the reserve action becomes effective.

Reason for Submission (required)

Briefly explain why this reserve worksheet is being completed.

Reserve Details

Reserve Category (required)

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 (required)

Supporting Facts and Assumptions (required)

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 (required)

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 (required)

Name or identifier of the person completing the worksheet.

Reviewed By

Name or identifier of the reviewer, if applicable.

Approval Status (required)

Approval Notes

Add any review comments, required corrections, or approval rationale.

Attestation (required)

Required acknowledgment for the audit trail.

Yes No N/A

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