Claims status updates
When to use it
Section titled “When to use it”- You are an insurer or an MGA and claimants keep calling to ask "where is my claim?"
- Your claims officers already know the status of each claim, but nobody tells the customer.
- You want claims that stall to be noticed, not forgotten.
Where the data comes from
Section titled “Where the data comes from”| How | What |
|---|---|
| A form people fill in | The Report a claim form and the Upload documents form this playbook creates. Put the claim link on your website and in your WhatsApp replies. |
| A form your staff fill in | The Claim update form your claims officers fill in each time a claim changes status, matched by phone. This is the no-code way. |
| Events from your app or website (needs a developer) | Or, with the app option, your claims system sends a claim-submitted event and a status-changed event with a status property. |
What it sets up
Section titled “What it sets up”| Kind | Name | What it does | Lands |
|---|---|---|---|
| Team | Claims officers | Handles document reviews, declined-claim calls and stuck claims. | Empty |
| Form | Report a claim | The claim form (the no-code way in). Claim details stay on the form; messages never repeat them. | Draft, not published |
| Form | Claim update | Staff-only form where a claims officer records each status change. Matched to the claimant by phone. | Draft, not published |
| Form | Upload documents | A short form for claimants to upload the documents asked for. Documents go only through this form. | Draft, not published |
| Segment | Claim under review, no update | Under review with no status change for a while. | Ready |
| Template | Claim received (SMS) | Acknowledgement with what happens next. | Ready |
| Template | Documents needed (SMS) | Secure upload link when documents are needed. | Ready |
| Template | Documents reminder (SMS) | Reminder when documents are still outstanding. | Ready |
| Template | Claim under review (SMS) | Status message: the claim is being reviewed. | Ready |
| Template | Claim approved (SMS) | Status message: approved. No amounts. | Ready |
| Template | Claim paid (SMS) | Status message: paid. No amounts. | Ready |
| Template | Claim declined (SMS) | Status message: declined. Respectful, no reasons, offers a call. | Ready |
| Template | Documents received (SMS) | Acknowledgement when documents are uploaded. | Ready |
| Follow-up | Claim 1: submitted | A new claim gets an acknowledgement that says what happens next. | Off |
| Follow-up | Claim 1: submitted | A new claim gets an acknowledgement that says what happens next. | Off |
| Follow-up | Claim 2: documents needed | Documents needed: the upload link, then a reminder if the status is unchanged. | Off |
| Follow-up | Claim 2: documents needed | Documents needed: the upload link, then a reminder if the status is unchanged. | Off |
| Follow-up | Claim 3: under review | Under review: a short status message. | Off |
| Follow-up | Claim 3: under review | Under review: a short status message. | Off |
| Follow-up | Claim 4: approved | Approved: a status message with no amount. | Off |
| Follow-up | Claim 4: approved | Approved: a status message with no amount. | Off |
| Follow-up | Claim 5: paid | Paid: a status message with no amount. | Off |
| Follow-up | Claim 5: paid | Paid: a status message with no amount. | Off |
| Follow-up | Claim 6: declined | Declined: a respectful message with no reason, and a call task. | Off |
| Follow-up | Claim 6: declined | Declined: a respectful message with no reason, and a call task. | Off |
| Follow-up | Claim 7: documents received | Uploaded documents get an acknowledgement and a review task for the claims team. | Off |
| Follow-up | Claim 8: stuck claim | Daily run over "claim under review, no update": a task for a claims officer, at most once a week. | Off |
The questions it asks
Section titled “The questions it asks”| # | Question | Default | Fills in |
|---|---|---|---|
| 1 | What should messages call your company? | none, must answer | org_name |
| 2 | How do claim updates reach Origamy? Choose form (no code: a claim form and a staff update form) or app (your claims system sends events). | form | claims_source |
| 3 | Which team handles claims and the calls this playbook creates? (claims officers, one person is fine) | Claims officers | claims_team |
| 4 | Which number should claimants call about their claim? | ‹workspace phone› | claims_phone |
| 5 | After how many days under review with no update should a claims officer be asked to look? | 7 | stuck_days |
Other settings
Section titled “Other settings”These have defaults. Change any that don’t fit.
| Setting | Default | Key |
|---|---|---|
| Event your system sends when a claim is submitted | claim.submitted | submitted_event |
| Event your system sends when a claim's status changes (with a status property) | claim.status_changed | status_event |
| Claim types on the claim form | Motor, Home, Travel, Business | claim_types |
| Days to wait for documents before the reminder | 3 | docs_remind_days |
| Days after which a stuck claim is no longer raised | 90 | stuck_stop_days |
| Hours the claims team has to make a call | 24 | call_due_hours |
| Daily run time for the stuck-claim check | 09:00 | send_time |
| Default phone country on the forms | ‹workspace country› | default_country |
| Time zone for the daily run | ‹workspace timezone› | timezone |
| Greeting when a first name is missing | there | greeting_fallback |
Timings
Section titled “Timings”- A new claim gets an acknowledgement SMS straight away.
- Each status change sends its message straight away, and saves the status and the time on the claimant.
- Documents needed: the upload link goes at once. If the status is still documents needed 3 days later, a reminder goes.
- Documents uploaded through the form get an SMS straight away and a review task for Claims officers.
- Every day at 09:00 (‹workspace timezone›), claims under review with no update for 7 days (and less than 90 days) create a task for Claims officers, due in 24 hours. Each claim is raised at most once a week.
Channels
Section titled “Channels”| Channel | Needed for | Before it can send |
|---|---|---|
| sms | Every message to claimants | An SMS provider, or Origamy managed SMS after business verification (KYC). |
What you need to do
Section titled “What you need to do”- With the form option: publish the Report a claim, Claim update and Upload documents forms. Officers fill in Claim update, with the claimant's phone number, every time a status changes: documents needed, under review, approved, paid or declined. With the app option: send claim.submitted and claim.status_changed with a status property that is one of documents_needed, under_review, approved, paid or declined.
- Never leave the status blank, and use only the five statuses. The stuck-claim check and the documents reminder read the status, so a wrong value means a missed message.
- Never put an amount, a policy number, a claim reference or the reason for a decline in a message. Messages say only what changed and who to call. Decline reasons are given by a claims officer, in writing or on the phone, under your regulator's rules.
- Tell claimants, on the claim form and in your branch, that documents go only through the upload form and that you will never ask for a PIN, password or code. No message here asks for one.
- Add people to the Claims officers team. A task assigned to an empty team reaches nobody. Limit who can open submitted forms, because claim forms and uploads hold personal documents.
- Connect an SMS provider or finish business verification, switch the follow-ups on, and test each status with your own phone and a fake claim.
- The Claim update form is the whole system with the form option, so make it quick: the officer enters the claimant’s phone number, picks one of five statuses and is done. Bookmark it on every claims desk. If your claims system can send events, choose the app option instead and send the status as a property, using exactly the same five values.
- Upload links beat WhatsApp photos and email attachments for documents, because uploads land in one place and the claimant knows where to send them. Say on the claim form that documents go only through the upload form and that you never ask for a PIN, password or code, since claims scams are common.
- Keep every message short and free of amounts, policy numbers, claim references and decline reasons. A decline is hard news: the SMS is respectful and the claims officer’s call, which the playbook creates, is where the reason is explained under your insurance regulator’s rules.
- Many claimants in Nigeria and elsewhere get paid by bank transfer or mobile money, which can take a day or two to show. The paid message says so, and tells them whom to call, which cuts “where is my money?” calls.
This playbook is synthesized: no customer has run it with us yet. If you build it, tell us what you changed, and we’ll replace it with the real version.
Copilot eval
Section titled “Copilot eval”The request used to test the copilot on this playbook (a live eval):
We're an insurer. Our claims officers will record each claim's status on a form: documents needed, under review, approved, paid or declined. Text the claimant the right message for each status. For documents needed, include a link to upload documents and send a reminder three days later if the status hasn't changed. If a claim sits under review for 7 days with no update, give our claims team a task. Acknowledge every new claim with what happens next. Never put an amount or a policy number in a message.
It passes when every piece is a valid draft and everything lands off, with at least: form, segment, workflow, message_template. It must never use: amount, policy number.