Other extras that a good claim file might include are:

Reserve worksheets These show the process, but not necessarily a formula, that the claim person used to set a reserve. Note that we say worksheets, plural. As reserves are dynamic and changing, there might be multiple reserve sheets to help outsiders fathom how an adjuster came to put down a number at different points in a file's life cycle.
Adjuster file notes View these as progress notes, akin to the type of entries a nurse might write about a hospitalized patient. These provide a coherent narrative for outsiders to trace the progress of a claim. It also helps if the claim file were reassigned (a common occurrence in busy claim units) or if someone calls with a question or problem and the handling adjuster is away.
Payment information This includes copies of checks or drafts issued on a claim, printouts showing current reserves and cumulative payments to date, and erosion against the policy limit.
Correspondence The claim file also should contain copies of relevant correspondence, such as letters to and from the insured, the claimant or claimant's counsel, defense counsel, and the agent or broker. Correspondence is a broad term that includes letters, faxes, e-mail, etc. These items provide a narrative thread to those reviewing the file. They help outsiders understand what is happening, or what already has occurred. Furthermore, they function as a narrative road map to the adjuster's questions and thought processes during the handling of the file. The lack of such items might be another red flag that the case files are superficial.

Some files might contain copies of an insured's loss run, as well. Insurance companies' claim practices vary on this point, however, and the loss run is something that a client may not find in the claim file. There are many reasons for this. The loss run may contain information on unrelated claims, causing confusion. In addition, there are insurance company concerns about the discoverability of claim files. Loss runs typically reflect reserves. If an insurance company contests coverage but, for example, carries a significant claim reserve, the claim file will be produced in discovery and undermine the insurance company's coverage stance.

Special Reports /

Recipes for Success: What Should the Claim File Contain?

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