How to Run a Claims Assessment Workflow That Closes Fraud Gaps and Satisfies the IRA

Who This Is For

You manage claims at an insurance company — motor, property, or medical. Assessors visit sites, submit assessment reports, and recommend settlements. Approvals happen informally — sometimes over WhatsApp, sometimes by email, rarely with a structured sign-off chain. An IRA examination is coming, or one has recently flagged your claims documentation as inconsistent. You know the current process has gaps. The question is what to do about it before the next examination.

What You Can Achieve

• Every claim requires a documented site visit with photo evidence before any assessment data can be entered — assessors who skip visits create a visible, immediate workflow gap
• The complete assessment record — site photos, police abstract, full assessment report, approver decision — is captured in one structured, sequential workflow rather than scattered across inboxes
• IRA examiners reviewing your claims records find complete, sequential documentation for every settled claim — organized by assessor, approver role, and settlement amount
• Senior approver review is a documented, timestamped step attributed to a named individual — not a WhatsApp message that may or may not still exist
• Claims processing time drops when the workflow is clear and sequential — assessors know exactly what's required, and nothing gets stuck waiting for missing documentation to be chased
• Fraud patterns surface through the audit trail: assessors who consistently approve without complete site evidence, or who show unusual settlement amount patterns, become visible

The Hakiki Workflow

1. 1
   Claim Reference & Policy Number Text

   Enter claim reference number and policy number — ties the assessment to the policy record

2. 2
   Site Visit Conducted Boolean

   Confirm physical site visit has been conducted — MANDATORY. This step must be YES before any assessment data can be entered

3. 3
   Damage / Loss Photos File Upload

   Upload minimum 4 photos of damage or loss at the site — taken during the physical visit. Required

4. 4
   Police Abstract File Upload

   Upload police abstract — required for motor accident, theft, and burglary claims

5. 5
   Estimated Repair / Replacement Cost Text

   Enter assessor's estimated cost (KES) — supported by quotes or valuation evidence

6. 6
   Pre-Existing Damage Noted Boolean

   Record whether any pre-existing damage was observed at the site that is unrelated to the claimed incident

7. 7
   Pre-Existing Damage Notes Text

   Describe pre-existing damage in detail — required if previous step is YES, used in settlement calculation

8. 8
   Assessment Report Upload File Upload

   Upload completed assessment report — required before assessor recommendation is recorded

9. 9
   Assessor Recommendation Single Select

   Select: Approve / Decline / Investigate Further — with assessor ID and timestamp

10. 10
    Senior Approver Review Boolean

    Senior approver confirms they have reviewed the assessment record and recommendation

11. 11
    Senior Approver Concurrence Boolean

    Senior approver concurs with assessor recommendation — or documents the basis for override

12. 12
    Final Decision Single Select

    Select: Approved / Declined / Referred to Legal — recorded by senior approver with role ID

13. 13
    Settlement Amount Text

    Enter approved settlement amount (KES) — matches the authorized decision

14. 14
    Payment Authorized Boolean

    Finance confirms payment is authorized against the approved settlement — final gate before disbursement

HAKIKI Features Used