The review chain
Field → desk
- Field adjuster submits scope and estimate
- Desk adjuster reviews line-by-line
- Often where scope gets trimmed
- Typical turnaround: 3-7 days
Desk → supervisor
- Claims over authority limit
- Complex coverage questions
- Policyholder representation
- Typical turnaround: 5-14 days
Supervisor → manager
- Large losses
- Coverage disputes
- Bad-faith risk indicators
- Typical turnaround: 7-21 days
Manager → legal
- Denials
- Potential litigation
- Significant commercial claims
- Typical turnaround: 14-30 days
QA audit
- Random selection post-closure
- Complaint-triggered review
- Pattern detection
- Not time-bound (can reopen closed claims)
What each reviewer looks for
Desk adjuster
- Xactimate integrity (pricing, quantities)
- Scope reasonableness
- Coverage compliance
- Reserve adequacy
Supervisor
- Authority sign-off
- Prior claim patterns
- Reputational risk
- Cost vs. exposure analysis
Manager
- Large-loss management
- Litigation risk
- Regulatory exposure
- Financial reporting implications
Legal
- Coverage defensibility
- Denial letter risk
- Anti-bad-faith language
- Appraisal / litigation strategy
Strategic implications
Pace of review explains delay
- Don't assume silence = working on it
- Ask where in the chain the file sits
Different levels respond to different arguments
- Scope/pricing arguments reach desk and supervisor
- Legal arguments (statutes, case law) reach manager and legal
- Bad-faith arguments push legal-level review
Escalation paths map to review stages
- Mediation pushes supervisor engagement
- CRN pushes legal engagement
- Litigation pushes external counsel