TOPIC	CHARACTERISTICS
Documentation	Did the adjusters, supervisors, and vendors fully document their actions and plans so that anyone reading the file could understand the status and plans? Does the file show diaries, action plans, and supervisory oversight requirements that document a consistent and organized approach to managing the claim?
Setup & Assignment	Was the file promptly set up so that the action steps required to manage the claim could be accomplished as soon as practicable? Was the file promptly assigned to the adjuster with the appropriate level of experience and expertise, considering the claim type, the severity of any damage or injury, and the complexity of the claim?
Coverage Analysis / Confirmation	Was the coverage fully analyzed and properly applied to the loss? Were policy limits monitored throughout the life of the claim (and its respective features)?
Contact (Initial and Ongoing)	Was there prompt and meaningful contact with the insured and the claimant(s) within one workday of receipt of the claim? Were witnesses contacted within one workday of receipt of the witnesses' contact information? Was contact maintained with the insured and claimant(s) throughout the life of the claim?
Investigation	Was the investigation initiated at the time of initial contact? Did the adjusters' work include a thorough investigation and consideration of other avenues to investigate (potential recoveries, contribution, fraud, prior injuries or conditions)? If on-site investigation was needed, did the adjuster promptly assign the claim to a field adjuster or independent adjuster so a liability decision could be made promptly? Did the primary adjuster properly manage the field adjuster or independent adjuster?
Liability Determination	Was the insured responsible for the loss? Does comparable or contributory negligence apply? Are there aggravating or mitigating factors that will ultimately affect the value of the claim? If the third party was found to be responsible for the loss, was the information obtained, documented, and saved to successfully deny the claim and file a subrogation claim?
Damages Documentation	Did the adjuster gather objective proof and/or documentation of alleged damages, including, but not limited to: property damage, medical bills (past and future), wage loss (past and future), periods of disability (past, future, partial, full), or permanent impairment?
Reserving	Was the reserving process appropriate and followed? Were reserves estimated reasonably, and were the reserves reviewed and possibly revised at proper intervals and/or at times when conditions changed? Did supervisors and managers review the reserves at periodic intervals and/or when case reserves reached threshold values? Did the case reserves reflect the estimated ultimate value throughout the life of the claim? Were claims or features closed promptly when the case was resolved to reduce outstanding reserves to zero?
Potential Recoveries	Were potential recovery opportunities identified and investigated (subrogation, contribution, reinsurance/excess)? Was the investigation done promptly to obtain needed information? Were tort feasors promptly placed on notice? Was the recovery actively pursued?
Fraud / Referral to Special Investigation Unit (SIU)	Were red flags identified during the investigation that led to the need for a deeper investigation? Was the claim promptly referred to the SIU if applicable? Were findings used in negotiations and settlements?
Negotiation and Settlement	Was a proposed settlement range calculated based on the facts of the case and case law, and did the range appear to be realistic? Were proposed settlements approved by supervisors or managers with the appropriate authority? If the claimant was represented, then did the adjuster continue to negotiate with the claimant's attorney to try to resolve the case, even after suit was filed?
Payment	Were the required payments made promptly and accurately? Were the appropriate signed releases received prior to payment issuance?
Litigation Management	Was litigation avoided when possible through assertive claims management? If litigation could not be avoided, did the adjuster and approved defense attorney work as a team to reduce legal expenses while reaching the outcome?
Vendor Management	Did the adjuster assign claims or features to vendors only if they could provide useful and value-added services? Some of the vendors include: Appraisers for property damage claims Independent adjusters for field investigations Defense counsel for litigated claims (only if the adjuster cannot resolve the claim or feature) Structured settlement firms Surveillance specialists Engineers for expert examinations Independent medical evaluations (IMEs) Were necessary vendors managed so they could provide prompt and accurate services?
Planning for Resolution	Were the claims or features actively moved toward resolution at all times, based on documentation in the claim file? Were claims or features closed promptly when the case was resolved to reduce outstanding reserves to zero?

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