In Financial Services Cloud Insurance, most claims are created through a guided FNOL OmniScript that calls the createUpdateClaim service. You can also work the claim directly from its record. The flow below covers what an admin or adjuster touches to get a claim from first notice to an open coverage with a reserve.
- Capture the loss through FNOL
Have the claimant complete the First Notice of Loss OmniScript. It collects the policy, loss date, damaged property, and injured parties, then passes a claimJson payload to createUpdateClaim, which builds the Claim and its related records.
- Confirm the claim record
Open the resulting Claim. Check the claim number, linked Insurance Policy, claim type, loss date, loss description, and status. Fix anything the intake form got wrong before adjusters start working it.
- Add participants and items
Verify the Claim Participants carry the right roles (Claimant, Insured, and any third parties) and that Claim Item records describe each damaged asset or covered service.
- Open a claim coverage with a reserve
On the Financials tab, choose Open Coverage. Set the claimant, involved item, insured item, and coverage, then enter the loss reserve. The platform creates the Claim Coverage and a reserve adjustment record automatically.
The active policy the loss is filed against. The claim cannot validate coverage without it.
The kind of claim, such as auto, home, or life. It drives routing and which coverages apply.
When the loss occurred. Used to confirm the policy was in force and to start lifecycle timers.
The lifecycle stage, from submitted through closure, that tells everyone where the claim stands.
The estimated amount set aside on a coverage. Entering it creates the Claim Coverage and its first reserve adjustment record.
- Standardize Loss Type and Cause of Loss as picklists. Free text on these fields makes audit and reporting almost impossible.
- Deduplicate FNOL submissions across channels. The same loss reported by phone and by app can create two claims and operational chaos.
- Treat reserve changes as auditable events. The adjustment records are what make the numbers defensible, so do not bypass them with raw field edits.