Spot the big claims on day one, not at the reserve review
Reads the first notice and early notes for serious injuries, a total loss or a business stopped, and how large it could get. A senior handler reads alerts.
Try it on this example
Class of business from the policy: Employers' liability, scaffolding contractor
First notice of loss and the claim notes to date, in date order
- Do the notes say enough about what happened, who was hurt and what was damaged to judge how large the claim may become?Yes92%
- What is the most serious injury to any person that the notes describe?Spinal injury100%
- Where does the information about the most serious injury come from?Injured person or family86%
- Do the notes describe more than one injured person, or more than one other party who may claim?Yes98%
- Do the notes describe a building, vehicle or major piece of equipment destroyed or beyond repair?No87%
- Do the notes say a business has stopped or cut back trading because of the loss?No87%
- Do the notes mention the press, a regulator, a police investigation or an inquest?Yes99%
- From the notes, how large could this claim become?Potential major loss99%
These are real answers stored from one run on this example.
The prism behind it
Spot the big claims on day one, not at the reserve review
Fields
- Class of business from the policy
- First notice of loss and the claim notes to date, in date order
Context
We are a UK commercial insurer writing liability and property business. Our claims administrator records the first notice and the notes of every new claim. Each claim is read here when it is reported and again whenever a note is added in its first 30 days. The answers tell our major loss team and our reinsurance team about a potentially large claim early, instead of when a handler raises the reserve weeks later. Nothing here sets a reserve, judges liability or cover, or assesses an injury medically. The notes are what people have said so far, and early notes are often wrong. An alert asks a senior handler to look; that handler decides what happens next. Code compares the answers with the notification clauses in our reinsurance treaties, and applies reserves and money thresholds. Our casualty treaties ask to hear early about these injuries, whatever the reserve: death, brain injury, spinal cord injury, amputation, severe burns and loss of sight. The exact wording is in each treaty.
Questions
Do the notes say enough about what happened, who was hurt and what was damaged to judge how large the claim may become? Yes / No
Short notes are enough if they say what happened and who or what was harmed. Yes: The notes describe the incident and the people hurt or the property damaged, clearly enough to judge its size. No: The notes are too short or vague to tell, such as "incident at site, details to follow".
What is the most serious injury to any person that the notes describe? Choice
Consider everyone the notes mention: employees, members of the public, drivers and passengers. Choose from the words in the notes, including an injury they call suspected or likely. This is not a medical judgement; it picks who should look at the claim.
Where does the information about the most serious injury come from? Choice
Take the most serious injury the notes describe. When the information is passed on, such as a relative telling the employer who tells us, choose where it started. When more than one note describes that injury, go by the latest one.
Do the notes describe more than one injured person, or more than one other party who may claim? Yes / No
Count people hurt and other parties whose property or business was harmed. The policyholder itself does not count. Yes: The notes describe two or more injured people, or two or more other parties who may claim. No: The notes describe one injured person or one other party at most.
Do the notes describe a building, vehicle or major piece of equipment destroyed or beyond repair? Yes / No
Yes: The notes say a building, a vehicle or a major item of plant or equipment was destroyed, burnt out, collapsed or written off, or will not be worth repairing. No: Nothing is described as destroyed or beyond repair. Damage to temporary works, such as a scaffold being replaced, does not count.
Do the notes say a business has stopped or cut back trading because of the loss? Yes / No
Count the policyholder or any other business. Yes: The notes say a business has closed, cannot trade, or is trading at a reduced level because of the loss. No: The notes say work or trading carries on, or say nothing about it. One area closed off while work carries on elsewhere is No.
Do the notes mention the press, a regulator, a police investigation or an inquest? Yes / No
Police attending the scene, or taking details as they do at most road accidents, is not an investigation. Yes: The notes say the press or social media is reporting it, a regulator such as the Health and Safety Executive is investigating, the police are investigating, or there will be an inquest. No: None of these is mentioned.
From the notes, how large could this claim become? Scale
Judge from what the notes describe, for this class of business. Do not weigh amounts or reserves; code applies those. When the notes point to more than one level, choose the higher.
Lens columns
enough_information, enough_information_probability, worst_injury, worst_injury_probability, injury_information_source, injury_information_source_probability, several_claimants, several_claimants_probability, total_loss, total_loss_probability, business_interruption, business_interruption_probability, outside_interest, outside_interest_probability, severity_outlook, severity_outlook_average
Run it on your own text
Add this prism in the app, change any question, and test it on a file of your own.