Claims management
Digital first notice of loss (FNOL), case reserve, surety claims, subrogation and recovery end-to-end.
What is the claims management module?
Claims management is the module that handles the full claim lifecycle from notification (FNOL) to closure, covering reserve, assessment, payment, recovery and reinsurance recoveries. For the surety line it supports the specifics of surety claim payouts (first-demand vs first-claim, recovery against the principal, collateral guarantees); for P&C it covers classic damage handling (appraisal, settlement, litigation). It computes IBNR and IBNER for Solvency II Pillar I reporting, automatically generates claims BDX to the reinsurer, and maintains an immutable audit trail of every claims-handler decision, from initial reserve to final payment.
Who uses the claims module
What the claims module does
- Multi-channel FNOL: portal, app, email/PEC with automatic OCR
- Automatic triage and routing to the right claims handler
- Case-by-case reserves + methodical reserves per line
- Assessment workflow with attachments, appraisals, communications
- Integrated SEPA payment with multi-level approvals
- Post-payment recovery and subrogation workflow
- Closure with documented justification
- IBNR and IBNER computation per line and type
- Solvency II Pillar I technical reserves
- Periodic QRT reporting
- Automatic loss advice to reinsurer
- Claims BDX to managing agent (Lloyd's) or cedent
- Immutable audit trail of every decision
From FNOL to claim closure
FNOL — claim notification
Beneficiary or principal opens the claim via portal, email/PEC, mobile app. Attachments extracted via OCR. The module verifies the existing policy and active coverage at the date of the triggering event.
Preliminary reserve
Automatic initial reserve computation via line tariff formula + assignment to claims handler by workload and specialisation. Push and dashboard notification.
Assessment
Claims handler requests additional documentation, orders an appraisal if needed, evaluates the claim's validity. For surety: checks the payout conditions of the underlying contract. Reserve updates with deviation audit log.
Decision & payment
Payment approval via multi-level workflow (by amount). SEPA transfer to beneficiary. Optional motivated denial with notification to principal.
Recovery
Claim transitions to \"RECOVERY\" status. Warning notice to principal, optional repayment plan, litigation. Tracking of all (partial) recoveries that reduce the final cost.
Reinsurance recovery & closure
Loss advice to reinsurer if the claim exceeds the priority. Recovery settlement. Claim closure with justification, IBNR/IBNER recomputation, full audit-trail archival.
Technical stack
Impact on claims operations
Frequently asked questions about claims management
What is the FNOL (First Notice of Loss)?
FNOL is the first formal notification of a claim to the insurer. In NewPicass 14.Net it can be opened from customer portal, mobile app, broker, call center or email/PEC ingestion with automatic OCR of attachments. Each FNOL generates a unique ID, a preliminary reserve and a triage workflow that routes the claim to the right claims handler.
How does a surety bond claim payout work?
The beneficiary submits the payout request (first-demand or first-claim depending on the contract). The module opens the claim with a dedicated dossier, tracks communications with principal and beneficiary, computes the reserve, manages merit checks, prepares the payment. After payment it kicks off the recovery workflow against the principal.
What is the difference between IBNR and IBNER?
IBNR (Incurred But Not Reported) = claims that already occurred but were not yet reported to the insurer, statistically estimated. IBNER (Incurred But Not Enough Reported) = reported claims where the current reserve is under-stated. Both are Solvency II Pillar I components for technical-reserve computation and must be separated in reporting.
How is the case reserve computed?
The module supports case-by-case reserves (assessed by the claims handler with justification) and methodical reserves (configurable tariff formula per line). The reserve is re-computed on every claim event (new documentation, legal evaluation, partial payment) with deviation logging. Quarterly reporting for Pillar I/III ready out of the box.
Is the recovery workflow against the principal supported after a surety claim?
Yes. After payment to the beneficiary, the claim auto-transitions to "RECOVERY" status with a dedicated workflow: warning notice to principal, optional repayment plan with scheduler, litigation management, actual recovery tracking. All recoveries reduce the final claim cost in technical reporting.
How are reinsurance recoveries tracked?
When the claim exceeds the reinsurance treaty priority, the module automatically computes the reinsurer's recoverable share, issues the loss advice and tracks the flow until recovery is collected. The claims BDX to the reinsurer is generated automatically by the linked BDX module.
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