Claim status self-service that answers “where is my claim?” from the real file, and hands every judgment to the adjuster
Fewer status calls to adjusters, and the same true answer at any hour.
See one case, screen by screen ↓It lets a policyholder see where their claim stands and get answers to their questions without calling the adjuster. Claim Status Self-Service shows the claim as a tracker — Reported, Inspected, Estimate, Payment — drawn live from the claim file, and names the one thing each stage is waiting for and who has it.
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A policyholder with a flooded kitchen does not know what a claim goes through. The claim system holds a status code — “Est. pending — PH” — and she sees nothing, or a portal that says “In progress”. So she calls: to ask where it stands, when the contractor can start, how the deductible applies and why the check will be smaller than the estimate.
Each call lands on the desk adjuster who should be writing estimates, and the answer depends on who picks up. Depreciation holdback and the deductible get explained a different way every time, and a wrong promise becomes a complaint. Worse, the one thing the claim is waiting for — often a document from the customer herself — goes unnamed until the next call, while the 15-day response clock and the 30-day status letter keep running.
Estimated split for one desk adjuster’s week, in hours, by hand and with the solution.
Six agents keep the tracker true to the claim file, answer with sources and hand every judgment to the adjuster.
A supply line under Alicia Brennan’s kitchen sink burst on 26 September. Sixteen days later the claim is waiting on her contractor’s estimate — and neither of her two phone calls told her so. Here is what happens next, screen by screen, in the working solution.
After work, Alicia opens her claim page. Reported and Inspected are ticked off; the marker sits on Estimate, which names the one thing it is waiting for: her contractor’s estimate, asked for on 5 Oct, 7 days ago — with an upload button right there. Her payment line reads “3 business days after the estimate is agreed”.
“Everything else is done. Upload Oakmere’s estimate here and Tomás Reyes, your adjuster, will compare it with our inspection within 2 business days.”
She asks how her deductible applies. The answer comes from her policy declarations and the payment record: $1,500, once, from the repair payment — the $3,840.00 paid to Dry Ridge Water Restoration went out in full. Then she asks whether Halverton will pay for a hotel while the kitchen is out. That is a coverage question, so it is not answered: it goes to her adjuster in her own words.
“That’s a decision for Tomás Reyes, your adjuster … He’ll reply by Wed 14 Oct, 5 p.m., here and by text. Keep receipts for any extra costs from today.”
Alicia uploads Oakmere Builders & Restoration estimate OBR-2610-118 from her phone — 4 pages. The checks run in front of her: it is for her claim and her address, both on page 1; all 23 lines read and the $18,642.37 total adds up; the contractor licence is active. The original file is kept with its fingerprint.
The Document checker never accepts or approves a document — a mismatched claim or address is held for a person.
Compared with the inspection of 1 Oct: 21 lines match and 2 differ — base cabinets at 14 ft against the inspection’s 12 ft, and the countertop replaced rather than reset. The Estimate stage now reads “With Tomás · by Wed 14 Oct”, and a payment date appears: Thu 15 Oct, if he agrees by Wednesday.
“Received tonight at 19:46: 21 of its 23 lines match our inspection; Tomás decides the other 2 by Wed 14 Oct, 5 p.m., and you’ll get a text.”
Tomás’s task list has Alicia’s estimate to compare and her hotel question at the top, each with the time she was promised. The hotel task carries her exact words and the file context: kitchen unusable for about 5 working days per Oakmere, bedrooms and bathrooms unaffected, Coverage D loss of use $97,200. Self-service answered 418 questions on his region’s claims today; these came to him because they need judgment.
“0 past a promised time · 0 near day 15”
The claim file’s run log shows each step with its time: the tracker opened, the deductible answered from the declarations and payment record in 5.8 s, the hotel question classified as coverage under guideline G-3, the 15-day response clock started, the upload’s fingerprint kept, the 23 lines matched with photos IMG_0412 and IMG_0420–0423 attached.
From the run log: “15-day response clock started (10 CCR §2695.5(b)) · day 1 of 15”.
Side by side, line by line. Inspection photo IMG_0412 shows the base cabinet run at 14 ft 1 in where the sketch said 12 ft — Tomás agrees 14 LF, +$596.40. Photos IMG_0420–0423 show no damage to the quartz slab, so he keeps detach and reset, with a supplement if it cracks on removal. Agreed: $17,500.52.
The Estimate comparer lists each difference with the photo or measurement behind it. It never agrees a price or changes the inspection estimate.
Alicia gets a text, and her tracker shows Payment: $17,500.52 agreed, less $2,214.60 held for depreciation until the repairs are done, less the $1,500 deductible — $13,785.92, by check to her and Sierra Gate Home Loans, mailed Thursday 15 Oct. Oakmere can start the repairs now.
“Why is my lender on it?” sits on the Payment stage, answered from the mortgage clause of her policy.
Grace sees all 2,192 open property claims in the Sacramento region by who has the next move: the customer, contractors, adjusters, payments and others such as lenders, public adjusters and the city — each with the one item and the days waiting. Henry Osei’s signed proof of loss is at 16 days, reminded 3 times, with an adjuster call due. Alicia’s claim has moved to payments.
In the week of 5–11 Oct adjusters took 501 status calls against a July average of 1,284. Self-service answered 3,146 of 3,358 questions and handed 212 to adjusters, each with the customer’s words; 41% were asked between 18:00 and 08:00. All three clocks — answer within 15 days, reply by the promised time, written status every 30 days — stand at 100%.
The same claim, seen by the five people around it — what their week looked like, and what it looks like now.
Six agents keep the tracker true to the claim file, answer with sources and hand every judgment to the adjuster.
Keeps each claim’s stage, dates and the one item it is waiting on current from the claim system, and turns status codes into plain words the customer understands.
Answers the policyholder’s question in plain words from the live claim file, the policy and the approved message guidelines, with a source on each fact.
Reads what the customer uploads — estimates, photos, receipts, proofs of loss — and checks the claim, the address, the type and that totals add up.
Lines up a contractor’s estimate with the inspection estimate and lists each difference with the photo or measurement behind it.
Turns a question that needs judgment into an adjuster task with the customer’s own words, the file context and a reply-by time — and tells the customer who and when.
Writes every question, answer, upload and reminder to the claim’s contact log, sends the reminders set in Settings and counts the 15-day and 30-day clocks.
Decides coverage and amounts; agrees estimates. The agents propose; a named person decides.
Policyholders ask about their own claim on the page, by text or on the phone line; adjusters and supervisors ask about claims, questions and clocks. Every answer is drawn from the file and cites its source.
How does my deductible apply?
Your deductible is $1,500, and it comes off once for this claim — from the repair payment, not from each bill. The $3,840.00 we paid Dry Ridge Water Restoration on 6 Oct was paid in full, with nothing taken off.
Why would the payment be less than the estimate?
Your policy pays the repairs in two parts. First, the agreed estimate less depreciation — an allowance for the age and wear of what’s being replaced — and less your $1,500 deductible. When the work is finished and Oakmere sends the final invoice, we pay the depreciation we held back, up to the full agreed amount.
Why did Alicia Brennan’s hotel question come to me?
Because it is a coverage question. Guideline G-3 says whether a cost is covered is always the adjuster’s decision unless it is already on the file. She was told you will reply by Wed 14 Oct, 5 p.m.; the 15-day clock is on day 1.
Are we inside the 15-day response clock on every claim?
Yes. Last week all 3,358 questions were answered or replied to well inside 15 days; of the 212 handed to adjusters, 209 were replied to by the promised time and 3 are still open, inside time. 118 undecided claims got their 30-day written status on time.
13 screens from the working solution, on its sample data. Pick one to see it large.
Stages, waiting items, clocks, reminders, channels and handover are settings — set for your claim types and your states.
| Setting | Default | Choose from |
|---|---|---|
| Stages the customer sees · homeowners water | Reported · Inspected · Estimate · Payment | Per claim type — fire, wind and hail add Contents; auto physical damage has its own repair-shop stages |
| Waiting items and their wording | “We need your contractor’s estimate” · Upload | Each item with the customer’s action: upload, sign on the page, or the lender’s number |
| Answer any question that expects a response | 15 calendar days | 10 CCR §2695.5(b) — the outer limit |
| Reply promise for handed questions | 2 business days | Shown to the customer as a date and time |
| Written status while undecided | Every 30 calendar days | 10 CCR §2695.7(c)(1) |
| Reminders when a claim waits on the customer | Text on day 3 and day 7; adjuster call on day 10 | No texts in quiet hours, 21:00 – 08:00, customer’s local time |
| Channels and languages | Policyholder page, two-way text, phone status line | Signed in, or claim number + ZIP + date of birth · English, Spanish |
| Handover when the adjuster is out | To the supervisor | Declared catastrophe, off by default: when on, handed questions go to the catastrophe team |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample claims data · “target” = the design goal, measured in the live solution · “estimated” = our estimate · “typical” = published figures (SwiftCase, “Beyond ‘Where’s My Claim?’”, Oct 2025 — status enquiries 30–50% of inbound volume, 4–6 minutes per call). California regulations 10 CCR §2695.5(b) and §2695.7(c)(1) are named as context. People, companies, claims and policies named on this page are fictional — characters and sample data in the working solution.
It lets a policyholder see where their claim stands and get answers to their questions without calling the adjuster. Claim Status Self-Service shows the claim as a tracker — Reported, Inspected, Estimate, Payment — drawn live from the claim file, and names the one thing each stage is waiting for and who has it.
The Claim file reader turns the claim system’s status code into the customer’s stage and the waiting item — for example “Waiting on you: your contractor’s estimate”. The Question answerer then answers in plain words from the live claim file, the policy and the approved message guidelines, with a source on each fact.
No. Coverage, amounts not yet agreed, exceptions, complaints and attorney or public adjuster mentions always go to the adjuster. The Handover writer turns the question into a task with the customer’s own words and a reply-by time, and the customer is told who will reply and when.
Reserves, internal notes, fraud or subrogation activity and anyone else’s data. Guideline G-11 keeps them out of every answer, and the Claim file reader never shows them on the tracker.
The customer uploads it from the Estimate stage. The Document checker confirms the claim and address, reads every line and checks the total; the Estimate comparer lines it up with the inspection and lists each difference with its photo or measurement. The adjuster agrees or keeps each difference, and the tracker moves to Payment.
The policyholder page — signed in, or with claim number, ZIP and date of birth — two-way text from the claim’s number, and a phone status line with spoken answers. Answers and texts can be in English and Spanish.
Yes. The Contact logger logs every question, answer, upload and reminder and counts the clocks set in Settings — in the working solution, California’s 15-day response limit (10 CCR §2695.5(b)), the 30-day written status (§2695.7(c)(1)) and a 2-business-day reply promise for handed questions.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your claim stages, waiting items, message guidelines and a sample of open claims — and it goes live once every quality gate has passed. We will walk you through it on your own claims first.
A coverage position on day one, every answer tied to the policy wording.
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1-min demoWe’ll run Claim Status Self-Service on a sample of your own open claims and the questions your customers ask.