Loading...
operations

Subrogation Identification and Referral Worksheet

Use this worksheet to flag third-party liability on a claim, capture the evidence, and route eligible matters to subrogation with a clear audit trail.

Fill it now — Free Get Started
Customize with AI →

Trusted by frontline teams 15 years of frontline software AI customization in seconds

Built for: Insurance Claims · Property And Casualty · Workers' Compensation · Risk Management

Overview

The Subrogation Identification and Referral Worksheet is a claim-handling form for spotting third-party liability, documenting why recovery may exist, and routing eligible matters to the subrogation unit. It brings together the claim basics, loss details, liability review, evidence summary, referral decision, and attestation in one place so the handoff is clear and traceable.

Use this template when a claim may have a recoverable third-party component and the adjuster needs a structured way to capture the facts before evidence goes stale. It is especially useful when multiple people touch the file, when referral criteria vary by line of business, or when you need a consistent audit trail for why a matter was sent or held. The worksheet also helps reduce back-and-forth by asking for the minimum necessary information up front, then using conditional logic for referral details and supporting files.

Do not use it as a generic claim intake form or for claims with no plausible recovery path. It is also not the right place to collect unnecessary PII, sensitive medical detail, or broad narrative fields that duplicate the claim file. If the loss is clearly not subrogable, the form should allow a quick no-referral outcome with a short rationale rather than forcing a full evidence package.

Standards & compliance context

  • Keep the form aligned with GDPR data minimization by collecting only the claim and evidence fields needed to evaluate recovery.
  • Use conditional logic and progressive disclosure to support WCAG 2.1 AA usability and reduce unnecessary form burden.
  • Avoid collecting sensitive personal data unless it is necessary to support the claim and referral decision, and disclose why any PII is requested.
  • Maintain an audit trail for submitted_by, submission_date, and attestation so the referral decision is traceable for internal review.

General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.

What's inside this template

Submission Notice

This section sets the purpose of the submission and tells the user what happens after they send it, which reduces confusion and duplicate follow-up.

  • Purpose of submission
  • Claim number (required)
  • Line of business (required)
  • What happens after I submit?

Claim Overview

These fields anchor the referral to a specific claim and loss event so reviewers can quickly understand the file context.

  • Date of loss (required)
  • State or province of loss (required)
  • Brief loss description (required)

    Summarize what happened in 2-5 sentences, focusing on observable facts and known parties.

  • Estimated paid amount

    Enter the current paid amount if known. Use dollars or the claim currency standard.

  • Open reserve amount

    Enter the current reserve amount if known.

Third-Party Liability Review

This section captures the core subrogation decision: who may be responsible, why, and whether there is a real recovery opportunity.

  • Is a third party potentially responsible? (required)
  • Third-party type
  • Basis for liability
  • Is there a recovery opportunity? (required)
  • Recovery rationale

    Explain why recovery is or is not likely, using facts, witness statements, police reports, contracts, or other evidence.

Evidence and Supporting Documentation

This section shows what proof exists and what each attachment supports, which is critical for a clean handoff.

  • Evidence available (required)
  • Evidence summary (required)

    Briefly describe what each attachment shows and how it supports liability or damages.

  • Supporting files

    Upload relevant documents, images, or reports.

Referral Decision and Assignment

This section turns the review into action by documenting whether the matter should be referred, how urgent it is, and who owns the next step.

  • Refer to subrogation unit? (required)
  • Referral priority
  • Recommended next step

    Note any immediate action such as preservation letter, demand package, vendor notice, or further investigation.

  • Referral owner

    Name or team responsible for follow-up after referral.

Audit Trail and Attestation

This section preserves accountability by recording who submitted the worksheet, when it was sent, and whether the information was affirmed as accurate.

  • Submitted by (required)
  • Submitter role (required)
  • Submission date (required)
  • Attestation (required)

How to use this template

  1. 1. Set up the form with required claim identifiers, line of business, and a clear submission notice that explains what happens after the worksheet is sent.
  2. 2. Assign the worksheet to the adjuster or examiner who has the loss facts and can complete the liability review without guessing.
  3. 3. Enter the claim overview fields, then describe the loss in enough detail to show why a third-party recovery review is being considered.
  4. 4. Use the third-party liability section to record who may be responsible, the liability basis, and whether a recovery opportunity exists, showing only the follow-up fields that apply.
  5. 5. Attach the supporting evidence, summarize what each file proves, and route the matter to subrogation or close it out with a documented no-referral decision.
  6. 6. Review the attestation, submit the worksheet, and confirm that the audit trail captures the submitter, role, date, and next owner.

Best practices

  • Mark required fields only where the subrogation decision truly depends on the answer, and keep the rest optional.
  • Use a date picker for date_of_loss and a numeric input for estimated_paid_amount and open_reserve_amount so the data is clean and searchable.
  • Show referral fields only when recovery_opportunity_exists is yes, so the form stays short for non-eligible claims.
  • Summarize what each attachment proves in evidence_summary instead of uploading files with no context.
  • Write the recovery_rationale in plain language that ties the facts to the liability basis, not just a one-line conclusion.
  • Capture the referral_owner as a named role or queue so the handoff is unambiguous.
  • Include a clear what happens after submit line so the user knows whether the matter is reviewed, assigned, or returned for more information.

What this template typically catches

Issues teams running this template most often surface in practice:

The loss description is too vague to support a liability review.
The recovery rationale says yes or no without explaining the facts behind the decision.
Evidence is attached but not summarized, so reviewers cannot tell what each file supports.
Referral priority is selected inconsistently, making queue handling harder.
The form is submitted before the third-party type or liability basis is identified.
Open reserve and estimated paid amounts are entered in free text instead of numeric fields.
The submitter leaves the attestation blank or does not confirm the information is accurate to the best of their knowledge.

Common use cases

Auto claims adjuster triage
An auto adjuster uses the worksheet after a collision report suggests another driver may be at fault. The form captures the claim number, loss state, liability basis, and photos before the file is routed to subrogation.
Property recovery review
A property examiner completes the form when a water or fire loss may involve a contractor, landlord, or utility provider. The evidence summary helps the subrogation unit see which documents support the recovery path.
Workers' compensation third-party screening
A workers' compensation team uses the worksheet when a job-site injury may involve defective equipment or a negligent vendor. Conditional logic keeps the form focused on the facts needed for referral.
Supervisor referral validation
A claims supervisor reviews submitted worksheets to confirm that the liability basis and evidence are strong enough to justify referral. The audit trail shows who made the recommendation and when.

Frequently asked questions

When should this worksheet be used?

Use it when a claim may involve another party whose actions, products, property, or maintenance could create recovery rights. It is most useful early in claim handling, before evidence is lost and before settlement decisions close off recovery. If there is no plausible third-party involvement, the worksheet can be left unsubmitted or marked not eligible.

Who should complete the form?

It is usually completed by a claims adjuster, examiner, or intake specialist who first identifies the recovery opportunity. A supervisor or subrogation specialist may review the referral decision before assignment. The key is that the person completing it can describe the loss, the liability basis, and the supporting evidence accurately.

How often should this be submitted?

Submit it as soon as a potential recovery issue is identified, not at the end of the claim. For active claims, it may be updated once new evidence arrives or the liability picture changes. If your process includes a separate referral queue, this worksheet should be the trigger for that handoff.

What kind of claims does it apply to?

It fits property, auto, liability, workers' compensation, and other claims where a third party may share responsibility. The exact fields can be adapted to your line of business, but the core purpose stays the same: identify a recovery path and document why the matter should or should not be referred. If your claims do not involve third-party recovery, this template is not a fit.

What evidence should be attached?

Attach only the evidence needed to support the referral, such as photos, incident notes, witness statements, police reports, repair estimates, or correspondence. Use progressive disclosure so the form asks for the most relevant evidence types first, then additional detail only when needed. Avoid collecting unnecessary PII or duplicate documents.

How does this help with audit and oversight?

The worksheet records who submitted the referral, when it was submitted, and the attestation that the information is accurate to the best of the submitter's knowledge. That creates a clear audit trail for claim review and recovery tracking. It also helps supervisors see why a matter was referred, declined, or held for more evidence.

Can this be customized by line of business?

Yes. You can tailor the liability basis options, evidence types, and referral priority values to match auto, property, casualty, or workers' compensation workflows. Keep the core fields intact so the form still captures the claim number, loss details, recovery rationale, and assignment outcome.

What are the most common mistakes when using it?

Common mistakes include leaving the recovery rationale vague, attaching files without summarizing what they prove, and referring matters before the liability basis is documented. Another issue is collecting too many fields up front instead of using conditional logic to show only what applies. A clear submit-confirmation line is also important so the user knows what happens next.

Related templates

Forms

SIU Fraud Referral Decision Worksheet

This SIU Fraud Referral Decision Worksheet captures claim red flags, carrier criteria, and the fi...
Forms

Policy Renewal Review and Remarketing Worksheet

A pre-renewal worksheet for reviewing an expiring policy, comparing coverage and premium changes,...
Forms

Claim Severity Triage and Adjuster Assignment Worksheet

Use this worksheet to score incoming claims, document the triage rationale, and route each file t...
Forms

Claim Settlement Authority and Approval Routing Form

Use this Claim Settlement Authority and Approval Routing Form to document a proposed settlement, ...
Forms

First Notice of Loss (FNOL) Intake Form

Capture first-contact claim details, insurer information, loss circumstances, and drivability in ...
Inspections

Catastrophe Tabletop Exercise Evaluation Form

Use this Catastrophe Tabletop Exercise Evaluation Form to score how well carrier teams activate, ...
Sop

Cash Drawer Open & Count

Cash Drawer Open & Count is the SOP for verifying a drawer, counting the starting bank, recording...
Hr Policy

Anti-Harassment & Anti-Discrimination Policy

Anti-Harassment & Anti-Discrimination Policy template for defining prohibited conduct, reporting ...

Go deeper on the topic

Related concepts
  • Standard Operating Procedure
    A standard operating procedure (SOP) is a documented, step-by-step procedure for a repeatable task — the written version of "how we do this here." Good SOPs...
  • Workforce Management
    Workforce management (WFM) is the operational discipline of getting the right employees, with the right skills, in the right place, at the right time — and...
  • Daily Huddle
    A daily huddle is a brief (10–15 minute) standing meeting held at the start of a shift or workday to align the team on priorities, surface issues, and...
  • Deskless Worker
    A deskless worker is any employee whose job happens without a desk, a company laptop, or a fixed workstation. They're roughly 80% of the global workforce —...
Related guides

Ready to use this template?

Get started with MangoApps and use Subrogation Identification and Referral Worksheet with your team — pricing built for small business.

Get Started
Customize with AI →