claims
1. FNOL Intake — First Notice of Loss
Receiving and logging the initial loss report from the insured
1
Receive the Notice — Client may contact via phone, email, or walk-in. Regardless of channel, the 24-hour carrier reporting window begins NOW. Note the exact date and time received.
2
Identify the Insured — Pull up the client in the portal. Confirm their active policy(ies) and the applicable carrier for the reported loss type.
3
Do not give coverage opinions — At intake, never advise the insured whether the claim "will be covered." That determination belongs to the carrier/adjuster. State that you are logging the notice and will report to the carrier promptly.
2. Incident Report vs. Claim Report
This is the first and most critical triage decision before entering anything in the portal.
Ask: Is this a reportable claim or an internal incident record only?
📋
Incident Report
For Agency Records only. Do not report it to the carrier.
🚨
Claim Report
Must be reported to carrier within 24 hours.
⚖️
Liability (GL)
Customer slips & falls inside
business, sustains injury
🏠
Property
Building damage from broken
pipes, fire, weather
🦺
Workers' Comp
Employee injured on the job (e.g., cutting injury)
🚗
Commercial Auto
Company vehicle hits object or third party while in use
🏛️
EPLI
Discrimination, harassment, or wrongful termination claim
3. Gather First Notice of Loss Information
Collect all required loss data before entering or reporting
📅 Date of Loss
When the incident actually occurred (not when reported)
🔢 Claim Type
GL · Property · WC · Auto · EPLI (see Step 1)
📋 Detailed Incident Description
Who was involved · Where it happened · When it happened · What & how it happened. Must be specific enough to stand alone as a legal record. No vague language.
💡Best Practice
Write the description as if you are the only person who will ever read it. Include street address of incident, names of all parties, exact body part injured (for WC), and any witness information. This record may be used in litigation.
3. Enter the Claim in the portal
Search client → click Insurance → click 7. Claims
1
Click "New".
2
Date of Loss — Enter the date the incident occurred.
3
Claim Type — Select the coverage line (WC, GL, Property, Auto, EPLI).
4
Date Reported — The date the insured reported it to our agency.
5
Claim # — Leave blank on initial entry. Fill in after carrier confirms and assigns a claim number (typically within 48 hours of reporting).
6
Policy # — Use the most recent active policy. Found in the top-left corner of the client record under "Policies."
7
Notice Type
• Occurrence / File Claim → for all reportable claims
• Incident / Do Not File → for incident-only records (see Step 2)
8
Received By — Enter the name of whoever received the notice of the claim (e.g., "John Pappas")
9
Description — Enter a detailed, factual narrative. Include timeline of events. As the claim progresses, add dated follow-up notes here to maintain a running log.
10
Adjuster — Will be assigned on the claim within 48 hours. (An adjuster is an individual that reviews and investigates a claim)
Always ask for their contact information (email, direct phone number or extension)
11
Defense Lawyer — If a lawsuit has been filed, enter the defense attorney's information (our client's lawyer). Never enter the claimant's/plaintiff's attorney. We do not contact opposing counsel.
12
Click "Update" to save. Upload any attached documents (photos, lawsuit filings, complaints) per the 6-Year Document Retention Policy.
4. Report the Claim to the Carrier
Must occur within 24 hours of agency receipt of the notice
Hour 0 — FNOL Received
Insured contacts agency. Clock starts. Document exact date and time.
Within 24 Hours — Report to Carrier
Call or email the carrier using the contact info in the Carrier Directory above. Reference the policy number. Provide the full incident description. Obtain a reference or confirmation number. Enter it in the AMS claim record.
Within 48 Hours — Adjuster Assignment
Carrier assigns an adjuster. If no adjuster contact received within 48 hours, follow up with the carrier. Proceed to Step 6.
Ongoing — Every ThursdayOngoing — Every Thursday
Review all open (gray / unprocessed) claims. Log follow-up notes in the AMS description field with the date.Review all open (gray / unprocessed) claims. Log follow-up notes in the AMS description field with the date.
5. Obtain Adjuster Contact Information
48-hour window from carrier reporting to adjuster assignment
Standard Operating Procedure (SOP)
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Step 1 : Gathering of information
TYPES OF CLAIMS:
(1) LIABILITY (2) PROPERTY (3) WC (4) AUTO (5) EPLI
EXAMPLES:
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LIABILITY(See form): A customer slips and falls inside the restaurant & sprains their ankle
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PROPERTY(See form): There is property damage due to broken pipes
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WC(See form): An employee cut their finger while chopping onions
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AUTO(See form): While driving with clients Auto to get out of a parking spot
I hit a pole and the car has property damages or hit a pedestrian and have Liability claim
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EPLI(See form): Any incident related to discrimination and harassment
CLAIMS INFORMATION
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Is it an Incident Report or a claim report?
-
INCIDENT REPORT - For Agency Records only. Do not report it to the carrier.
- CLAIM REPORT - Report it to the carrier
-
-
An incident/claim report should be as specific as possible. We need to know:
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Who was involved
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Where it happened
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When it happened,
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What and How it happened
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If incident report, leave it in the portal as a processed claim but notes should state it is an incident report. Otherwise,
report the claim to the carrier and get a reference or claim #
What to know/have in advance:
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Date of Loss
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Very descriptive statement of what happened
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Have the Policy Number available
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If you are following up with an existing claim have your reference or claim number
Allow 48 hours for an adjuster to get assigned and if you do not receive anything from the carrier, follow up. EVERY THURSDAY WE CHECK ALL CLAIMS
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Step 2 : Enter the Claim
Search your client, press "Insurance" and click on “7. CLAIMS”
Enter the claim as per below.
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Click “ New”
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Enter the Date of Loss: When the incident occurred
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Select a Claim type: The product of the incident (workers comp, liability, etc.)
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Enter Date Reported: The day claim is reported to our agency.We have 24 hours to report to the carrier after it is reported to us
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Enter Claim #: This will be given after reporting claim to carrier or after 48 hours after the report
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Enter the Policy #- the policy number can be found in the top left corner under “Policies”, use the most recent policy to date
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Notice Type is always "Occurrence / File Claim" unless this is an incident and we choose "Incident/Do not File"
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Enter “John Pappas.” or whoever receive the notice of the claim.
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Enter a DETAILED description of the incident. Maintain a timeline of events and your follow ups
10. An adjuster will get assigned on the claim within 48 hours. (An adjuster is an individual that reviews and investigates a claim)
-
ALWAYS ask for their contact information (email, direct phone number or extension)
11. Enter the representing DEFENSE lawyer information if there is a lawsuit. Be carefull not to enter the opposing
lawyer. WE ARE NOT SUPPOSE TO CONTACT THE CLAIMANTS LAWYER
12. Click “Update” to save your claim.
We have a document retention policy of 6 years. All Docs such as Lawsuits and other forms are needed to be uploaded into the system.
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Step 3 : Report the Claim via Portal
We have a document retention policy of 6 years. All Email related to CLAIMS need to be through the portal due to email retention rules.
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After reviewing the claim info, you select the email icon to create the sample letter
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Email Selected Documents by clicking this box. It will create a sample email so you can review it
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Anything that is sent through the portal, will show under the communication log, keeping track of all emails
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Select corresponding product
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If it is a WC claim select WC, etc.
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Task is CLAIMS
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Drag & Drop the relevant claim documents in the attachment box
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EX: If client sends images, law suit documentation, complaints, etc.
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CC the Broker (John) and add the corresponding adjustor, you may include the client as well
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Review your letter, then hit “Send”
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Step 4 : Get Adjuster and Defense Lawyers Inf0
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You may call or email the carrier and ask for the Adjuster's information - Name, email, phone number.
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If there is a lawsuit make sure to get the Defense Lawyer's information - Name, email, phone number.
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Defense Lawyer is the lawyer who represent our client in the court.
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Step 5 : Send Introductory Email to all parties
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Go to the dashboard and locate the claim under 7. Claim.
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Click the email icon.
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For "To", add the adjuster and defense lawyer's (if applicable) email
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Note : Make sure you separate the email addresses with a semicolon ";".
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Client's email
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Broker's email should always be John's email.
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Proofread the email. Make sure the information are correct.
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Attach any necessary document - lawsuit, claim acknowledgement, etc.
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Click "Send".
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Step 6 : Closing the ticket
Ask John via email if you can close the ticket.
If he said close the ticket;
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Go back to the claim and toggle "Processed".
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Click "Update"
Thursday Procedure
EVERY THURSDAY WE FOLLOW UP WITH CLAIMS
1) You can check CLAIMS through the Dashboard OR through the home page “7. CLAIMS”
2) You can edit the claim through the edit button or if you click on the insured name
3) If this button is GRAY, it means it is not processed
Reporting to a Manager
