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Run: Claim Severity Triage and Adjuster Assignment Worksheet

Use this worksheet to score incoming claims, document the triage rationale, and route each file to the right adjuster or specialty unit. It helps teams assig...

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Submission Notice

Submitter name (required)

Submitter role (required)

Claim reference number (required)

Submission date (required)

Claim Overview

Date of loss (required)

Claim type (required)

Loss location

Primary loss outcome (required)

Severity and Complexity Scoring

Complexity score (required)

Enter the triage score used by your team. Use a consistent scale such as 1-5 or 1-10.

Severity level (required)

Litigation risk (required)

Special handling flags

Routing Decision

Assigned path (required)

Assigned adjuster or unit

Enter the name or team responsible for next action after triage.

Routing rationale (required)

Summarize the observable factors that drove the severity score and assignment decision.

Target response time (required)

Escalation and Follow-up

Escalation reason (required)

Additional information needed

Supervisor notified

Yes No N/A

Follow-up due date

Audit Trail and Attestation

Triage completed by (required)

Completion date and time (required)

Audit notes

Optional notes for internal review, including any exceptions or manual overrides.

I confirm the triage information is accurate and the routing decision reflects the documented facts. (required)

Yes No N/A

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Email (required)

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