First notification of loss (FNOL)

🎯 purpose procedure for capturing and triaging a new claim notification across all intake channels, including call handling, digital portal submissions, intermediary referrals, and email notifications process owner claims operations manager operational sla acknowledgement within 4 business hours; triage completed within the same working day 🧭 process flow flowchart td a\[notification received] > b\[capture against policy] b > c{cover live on loss date?} c unclear > h\[flag for cover review] c yes > d\[reserve stub from guide] d > e{fraud indicators >= 2?} e yes > s\[special investigations queue] e no > f{classification} f fast track > ft\[fast track team] f standard > as\[assessor appointment] f complex > ml\[major loss handler] ✅ operational procedure capture notification record validate policyholder identity, confirm loss date, location and cause description, and ensure the notification is attached to the correct policy record establish initial reserve apply the reserve guide for the applicable loss category and record the rationale for any manual deviation perform operational triage classify the claim as fast track, standard, or complex based on financial exposure, clarity of cover, liability position, and stakeholder complexity complete fraud indicator screening run the fnol fraud indicator checklist and route automatically to the special investigations queue where two or more indicators are identified issue acknowledgement send acknowledgement confirming the claim reference, named contact, and next step expectations within the defined sla route to operational handling team assign the claim to the correct downstream handling pathway and notify reinsurance where delegation thresholds are exceeded ⚠️ silent investigation routing special investigations routing must remain operationally invisible to clients and intermediaries while a review is open ℹ️ cover validation requirement where the policy status appears lapsed or pending on the loss date, route the matter for cover review and avoid any statement that could be interpreted as confirmation or denial of cover 🔎 operational guidance and quality assurance ensure the loss narrative recorded at fnol matches all inbound evidence and communication channels record rationale for triage decisions where operational complexity or coverage uncertainty exists validate that reserve establishment aligns to the active reserve guide version confirm all acknowledgements are timestamped to support sla reporting and audit validation escalate recurring fraud indicators or repeat policyholder patterns to operational governance and siu management review queue assignments daily to prevent routing delays or unworked complex loss referrals 🧾 records and evidence the fnol record, triage classification outcome, reserve rationale, and fraud checklist result form part of the operational audit base for the claim file fnol to acknowledgement performance is reported through claims service measures and operational governance reporting