Insurance claims process flowchart

Insurance claims process flowchart

A worked example to adapt. Rename steps, add branches and owners to match how your team actually works.

flowchart TD
  s(["Claim reported"])
  fnol["Record first notice of loss"]
  d1{"Policy active and loss covered?"}
  deny(["Deny with explanation"])
  doc["Collect photos, reports and receipts"]
  d2{"Simple, low-value claim?"}
  inv["Adjuster investigation"]
  ass["Assess loss amount"]
  d3{"Claim approved?"}
  pay["Pay settlement"]
  e(["Close claim"])
  s --> fnol
  fnol --> d1
  d1 -->|No| deny
  d1 -->|Yes| doc
  doc --> d2
  d2 -->|Yes| ass
  d2 -->|No| inv
  inv --> ass
  ass --> d3
  d3 -->|Yes| pay
  d3 -->|No| deny
  pay --> e

About this insurance claims process flowchart

Claims handling starts with first notice of loss and ends with payment or a reasoned denial. This flowchart sends simple, low-value claims straight to assessment and routes complex ones through an adjuster investigation.

It is a generic example for property and casualty claims. Your policy terms and regulations decide the actual steps.

Step by step

1. Report. The policyholder reports the loss and the claim is recorded.
2. Coverage. The policy is checked; losses outside coverage are denied with an explanation.
3. Documents. Photos, reports and receipts are collected.
4. Investigate. Complex or high-value claims get an adjuster investigation.
5. Decide and settle. The loss is assessed; approved claims are paid and closed, and claims the investigation does not support are denied with an explanation.

How to make it in flow-chart.io

1. Start from the example. Edit the text in the generator box above so it names your own claim types and approval limits, then press Generate. The free preview needs no sign-up.
2. Add the branches. Add the decision points that matter for you, for example fraud indicators? or subrogation against a third party?. Each decision becomes a diamond with labeled outcomes.
3. Assign owners. Save the diagram to the editor (free account) and rename steps to show who does what: policyholder, claims handler, adjuster and finance.
4. Share or export. Share a read-only view link: people with the link can view the diagram but not edit it. Downloads as PNG, SVG or PDF are part of Flow Pro (see pricing).

Tips

• Write the fast-track criteria on the decision.
• Keep the policyholder updated at each stage.
• Record the reason for every denial.

Frequently asked questions

What is first notice of loss?

The first report of a loss to the insurer, which opens the claim.

Why fast-track simple claims?

It reserves adjuster time for complex claims and speeds up payment on straightforward ones.

Can I generate a version for my claims process?

Yes. Edit the steps in the generator box and press Generate.

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