A useful initial design is routine residential water and wind repair estimating from existing inspection evidence, with a separate route for coverage questions, concealed damage and specialist losses.
Do not define “routine” solely by the estimated dollar amount. Instead, have technical claims approve an eligibility rule using the evidence, construction complexity and decisions required.
| Proposed starting category | Include when | Route elsewhere when |
|---|---|---|
| Residential interior water damage | Rooms, materials, measurements and observed damage are documented | Cause, damage extent, contamination, structural condition or coverage requires specialist investigation |
| Residential wind damage | A usable inspection and measurement package supports the proposed repair scope | Repairability, matching, structural damage or engineering questions remain unresolved |
| Revisions to an existing estimate | The reason for the revision and the previous accepted version are available | The request introduces a different loss, unresolved coverage issue or materially different scope |
| Inspection evidence from multiple partners | Each partner can meet the same input specification | The partner cannot supply required evidence or preserve source records |
These are suggested routing controls, not determinations that a particular loss is covered or suitable for remote handling.
What must the scope charter say?
Write a two-page charter containing:
- Included states, products, perils, building types and inspection channels.
- Excluded loss types and the person responsible for each exception route.
- Tasks performed by production: indexing, scope transcription, estimating, narrative preparation, checking and revision.
- Tasks retained by authorised claims personnel: investigation decisions, coverage, reserving, negotiation, settlement and payment.
- Who may request additional evidence and who may communicate with the policyholder or contractor.
- The carrier system that remains the official claim record.
- The output package and acceptance authority.
- The definition of a file, a revision and a supplement.
Recommended production unit: one identified claim/loss/building package with a version history. Do not count every estimate revision as another successfully produced file. Track supplements separately, including whether they reflect new evidence or correction of an earlier error.
Exit gate: the claims sponsor, technical claims lead and counsel approve the scope and authority map before live assignments begin.