Run Claim Red Flag Indicator Checklist — Free

Claim Intake and Loss Narrative

Loss date, time, and location are consistent across all claim documents critical (required)

Yes No N/A

Reported mechanism of loss is plausible and matches the physical evidence described critical (required)

Yes No N/A

Claimant provided a clear, detailed, and non-evasive statement

There are unexplained delays between the loss event and claim reporting

Yes No N/A

The claim involves unusual urgency, pressure, or repeated follow-up to accelerate payment

Yes No N/A

Behavioral Red Flags

Claimant or witness was reluctant to provide basic information or documentation critical (required)

Yes No N/A

Statements appear rehearsed, coached, or materially identical across different interviews

Yes No N/A

Observed behavior is inconsistent with the reported injury, damage, or claimed limitations critical (required)

Yes No N/A

There are signs of malingering, exaggeration, or symptom magnification critical (required)

Yes No N/A

The claimant has an unusual history of prior claims, prior similar injuries, or repeated loss patterns

Yes No N/A

Documentation and Evidence Review

Required supporting documents are complete and legible critical (required)

Yes No N/A

Medical, repair, or incident records contain inconsistencies with the reported facts critical (required)

Yes No N/A

There are signs of altered, duplicated, or potentially fabricated documents critical (required)

Yes No N/A

Photo, video, or digital evidence supports the reported claim timeline and severity

Yes No N/A

Document submission dates and metadata align with the stated sequence of events

Yes No N/A

Pattern and Exposure Analysis

The loss pattern is unusual compared with similar claims or expected exposure

Yes No N/A

Multiple losses, repeated repairs, or recurring injuries are present in the claim history

Yes No N/A

The claim involves multiple parties, addresses, vehicles, providers, or entities with unclear relationships

Yes No N/A

There are indicators of staged, inflated, or coordinated loss activity critical (required)

Yes No N/A

The claim has been referred previously for peer review, SIU review, or similar investigation

Yes No N/A

Referral Decision and Follow-Up

SIU referral is warranted based on documented red flags critical (required)

Yes No N/A

Peer review or supervisor review is recommended before claim disposition

Yes No N/A

Primary red flags identified

Note (optional)

Recommended next action

Note (optional)

Reviewer sign-off

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Run: Claim Red Flag Indicator Checklist

Claim Intake and Loss Narrative

Behavioral Red Flags

Documentation and Evidence Review

Pattern and Exposure Analysis

Referral Decision and Follow-Up

Get your results