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Run: 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.

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Submission Notice

Purpose of submission

Claim number (required)

Line of business (required)

What happens after I submit?

Claim Overview

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

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

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

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

Submitted by (required)

Submitter role (required)

Submission date (required)

Attestation (required)

Yes No N/A

Get your results

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Email (required)

Your name (optional)

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