Stage 1: FNOL intake and routing
First notice of loss is taken by an intake rep (usually a call center). The claim is classified by type (water, wind, fire, liability), severity tier, and routing destination. Severity classification drives which adjuster tier handles the file.
Stage 2: Reserves
Within 24–72 hours of FNOL, a reserve is entered: the carrier's estimated exposure on the claim. Reserves affect:
- Which adjuster level handles the file (junior vs. senior)
- Whether SIU (Special Investigations Unit) reviews for fraud indicators
- Whether the claim escalates to large-loss team
- Internal budgeting and reinsurance calculations
Reserves are adjusted as the claim progresses. Low initial reserves that get raised aggressively often signal the claim is being re-scoped upward.
Stage 3: Adjuster authority limits
Every field/desk adjuster has a dollar-amount authority ceiling: often $10K, $25K, or $50K. Claims exceeding authority require supervisor approval, which creates internal friction and is used strategically to pace payouts.
Stage 4: Desk adjuster review
The field adjuster's scope note and Xactimate estimate go to a desk adjuster who reviews line by line. Desk adjusters apply:
- Standardized pricing checks
- Depreciation tables
- Coverage-form comparisons
- Policy-condition compliance review
Desk adjusters often override field adjuster scope down, rarely up.
Stage 5: Supervisor / manager escalation
Large, complex, or contested claims escalate to supervisors. Typical escalation triggers:
- Reserve above threshold
- Policyholder represented by counsel or PA
- Coverage dispute
- Potential fraud indicators
- Civil Remedy Notice filed
Stage 6: SIU referral
Special Investigations Unit reviews suspicious claims. Triggers:
- Inconsistent loss-date / damage-pattern evidence
- Prior claim history
- Policy effective-date proximity to loss
- Common-indicator clusters (e.g., multiple vehicle / property claims)
SIU is not necessarily adversarial but dramatically slows the claim timeline.
Stage 7: Pay / deny decision
After internal review, the carrier issues a decision. For denials, a legal or senior-adjuster review typically signs off on the denial letter.
What this means for policyholders
- Document thoroughly at the first inspection. Field adjusters can't document what they don't see.
- Assume the desk adjuster will look for reasons to reduce scope. Every line item should be defensible.
- Expect delay when you escalate. Attorney / PA involvement triggers supervisor review, which adds days or weeks.
- Don't provide ambiguity. SIU referrals are fishing expeditions: clean documentation avoids them.