Business logic

Inter-insurer agreements published by the Association of British Insurers that streamline UK subrogation between members.

Guidance from France's prudential supervisor (ACPR) on fair treatment, information duties and complaint handling for insureds.

French inter-insurer fraud bureau providing alerts, shared databases and investigation support on suspect claims.

Reference market value of used vehicles in France, used as a benchmark for total-loss settlements.

French indicative scales for valuing bodily-injury heads of damage (Mornet, based on the Dintilhac nomenclature).

Court decisions defining when and against whom an insurer can step into the insured's rights to recover.

Official French nomenclatures pricing medical and surgical acts, used to validate provider invoices.

UK whiplash reforms and tort case law that frame liability and quantum in personal-injury claims.

French Civil Code articles on extra-contractual liability — the general fault-based regime for damages.

French Insurance Code provisions on policy formation, scope of cover and the indemnity principle.

French Insurance Code rules on policyholder declarations, exclusions and the insurer's claim-handling obligations.

Statutory deadlines for offers and settlement payments under French auto and general claims rules.

Internal standard operating procedure defining how customer complaints are logged, escalated and resolved.

Published indexes tracking labor and material costs used to estimate property repair and rebuild values.

French inter-insurer conventions allocating liability and direct settlement on auto material-damage and bodily-injury claims.

Standardized fault and recovery grids applied between French motor insurers under the IRSA/IRCA conventions.

Authoritative definitions of every field, code and entity stored in the core claims platform.

Internal and market benchmarks for legal defense costs by jurisdiction and claim type, used to weigh settle-vs-litigate.

Automated rules enforcing completeness, consistency and format of claim data on capture.

Internal rules governing when and how deductibles or excesses are collected from the insured.

Heuristics that flag potential duplicate FNOLs against the same policy, incident or party.

UK FCA Insurance Conduct of Business Sourcebook rules on prompt, fair and transparent claims handling.

FCA Consumer Duty principles requiring good outcomes, clear communication and avoidance of foreseeable harm.

Financial Ombudsman Service guidance on what constitutes a fair claim outcome in the UK.

UK trade-standard vehicle valuation references used to price write-offs and trade-in values.

Empirical distributions of past claim severities by line of business, used to set adequate reserves.

UK Insurance Fraud Bureau and Cifas shared intelligence on suspected fraud rings, identities and devices.

Arbitration Forums (US) agreements that resolve subrogation disputes between member insurers without litigation.

Operational playbooks describing the carrier's preferred handling steps by claim type and severity.

Tolerances and rules used to validate repair estimates against benchmarks before approval.

Internal procedure to qualify a new loss notification: completeness, eligibility and routing.

Curated catalog of fraud indicators (red flags) used to score and route suspect claims.

Carrier's structured decision tree allocating fault between parties based on circumstances of loss.

Playbooks defining how medical invoices are reviewed for medical necessity, coding and pricing.

Internal thresholds defining acceptable customer-satisfaction scores and when to trigger remediation.

UK Judicial College Guidelines giving bracketed compensation ranges for personal-injury awards.

Court precedents applicable to the claim's jurisdiction that influence litigation strategy and quantum.

Per–line of business actuarial guidelines on reserving methodology and adequacy testing.

Local road and traffic regulations used to determine fault in motor accidents.

French law granting near-automatic indemnification to non-driver victims of motor bodily-injury accidents.

Evidence-based clinical guidelines used to assess appropriateness, duration and cost of treatment.

US NAIC standards governing loss-reserve estimation and statutory reporting.

Alerts from the National Insurance Crime Bureau and US state fraud bureaus on emerging fraud schemes.

UK actuarial tables used to capitalize future loss of earnings and care in personal-injury claims.

Standardized catalogs of part numbers, prices and labor times for repair-cost estimation.

Historical bodily-injury claims with comparable diagnoses, used to benchmark severity and outcomes.

Past closed claims with comparable facts, used to benchmark a fair settlement range.

Lessons from prior claims where missing evidence drove cycle-time overruns or reopens.

Outcomes of comparable past claims by settlement vs. litigation route, used to inform strategy.

Retrospective comparison of triage decisions against the actual complexity of past claims.

Repository of historical fraud cases used to train detection and benchmark new suspect claims.

Past claims with similar accident dynamics, used as analogs to assess liability.

Prior coverage disputes with similar wording or facts that shaped the carrier's interpretation.

Past claims with comparable damage scopes, used to validate estimates and reserve setting.

Past claims with similar severity drivers, used to anchor reserves and reserve adequacy reviews.

Closed claims where subrogation or salvage recovery succeeded, informing eligibility scoring.

Past claims showing vendor recovery results (salvage, deductibles, supplier credits).

Recovery negotiations with prior third parties or insurers, used to anticipate counter-offers.

Repository of every active policy wording and endorsement, the source of truth for coverage interpretation.

Standardized recovery process and demand letter templates per claim type and jurisdiction.

Controlled vocabularies used to classify causes, perils and coverages consistently across claims.

Registry of regulatory and contractual deadlines (acknowledgment, decision, payment) per jurisdiction.

Mandatory disclosures the insurer must provide to claimants and authorities at each step of the claim.

Per-LOB checklist of documents required to evaluate, settle and close a claim.

Reference prices from salvage markets used to estimate recoverable salvage value on totaled assets.

Matrix defining who can authorize settlements at which monetary thresholds and complexity levels.

Scoring rules used to estimate a claim's severity and exposure at first notice for triage.

EU Solvency II rules governing the calculation of best-estimate technical provisions and risk margin.

Approved templates for full and partial releases and discharges executed at settlement.

US state-specific rules allocating damages between parties based on relative fault.

US state insurance code provisions that mandate minimum coverages and coverage interpretations.

US state laws imposing deadlines and penalties for late claim acknowledgment, decision or payment.

US state statutes prohibiting specific unfair conduct in the handling and settlement of claims.

Registry of limitation periods that constrain when subrogation or recovery actions can be brought.

Decision tree determining whether a claim is eligible for subrogation and against whom.

UK Supreme Court precedents (notably Arnold v Britton) governing how insurance policy wording is construed.

Underwriting reference clarifying intended coverage scope behind ambiguous policy clauses.

US vehicle valuation references (NADA, Kelley Blue Book) used to settle total-loss auto claims.

Internal policy defining how vulnerable customers are identified, supported and prioritized.

Sanctions and watchlists screened against involved parties before payment or settlement.

US state workers' compensation fee schedules and procedural rules controlling medical billing.