Policy Workflow Design

Design the end-to-end workflow for insurance policy submission, underwriting, binding, issuance, and endorsement. Produces a workflow specification and system integration requirements suitable for automation build.

Scope Definition

Confirm which workflow components are in scope before designing:

• New business intake (submission form design)
• Underwriting routing and review
• Quote generation and delivery
• Bind workflow
• Policy issuance and delivery
• Endorsement workflow (mid-term changes)
• Cancellation workflow (separate or included)

Lines of business in scope: [Personal auto / Commercial auto / Homeowners / Commercial property / GL / Professional liability / Workers comp / Other]

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Component 1: New Business Intake

Submission form design:

Define required fields by line of business. Group into sections that mirror ACORD form structure so data maps cleanly to carrier systems.

Section	Fields	Required?	Source of Truth
Applicant information	Full name, DOB, SSN/EIN, address, contact	Required	Applicant entry
Risk information	[LOB-specific: vehicle VIN, property address, business description]	Required	Applicant entry
Prior insurance	Current carrier, policy #, expiration date, reason for shopping	Required for most carriers	Applicant entry
Loss history	Claims in past 3–5 years (dates, types, amounts)	Required	Applicant entry + CLUE pull
Requested coverage	Coverage types, limits, deductibles	Required	Agent selection
Signatures	Applicant signature, agent certification	Required	E-signature

ACORD form mapping:

LOB	ACORD Form	Fields Mapped
Personal lines	ACORD 80	All personal auto fields
Commercial lines	ACORD 125	Commercial applicant info
Property	ACORD 140	Property details
GL	ACORD 126	General liability

Document collection at intake:

Document	Required For	Collection Method	Validation
Prior dec page	All renewals and transfers	Upload	Policy number matches; not expired
MVR authorization	Personal and commercial auto	E-signature	Signed before MVR pull
Loss runs	Commercial lines (3–5 years)	Upload or carrier request	Signed by prior carrier
Photo inspection	Property over $[X]	Upload or inspection order	4-point completed

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Component 2: Underwriting Routing

Risk appetite rules (work with client underwriting team to define):

Rule	Condition	Action
Auto-decline	[e.g., >2 at-fault accidents in 3 years]	Decline with adverse action notice
Refer to underwriter	[e.g., prior lapse >60 days]	Route to UW queue with flagged reason
Straight-through quote	[e.g., preferred risk, no adverse factors]	Auto-quote, agent notification
MGA/carrier referral	[e.g., risk outside standard appetite]	Route to E&S market workflow

Referral queue design:

Field	Description
Submission ID	Unique ID for tracking
LOB and risk type	For routing to correct underwriter
Flag reason	Which rule triggered the referral
Priority	Standard / Rush (binding deadline approaching)
Assigned underwriter	Auto-assigned by LOB and territory
SLA	Response required within [N] business hours
Escalation trigger	Unreviewed after [N] hours → supervisor notification

Declination workflow:

1. System flags submission for decline
2. Licensed underwriter (never automated system alone) reviews and confirms
3. Adverse action notice generated — includes: specific reason(s), right to dispute, date
4. Notice delivered to applicant within state DOI time requirement
5. Notice copy stored in compliance file with delivery confirmation
6. Producer notified of declination

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Component 3: Quote Generation

Rating system integration:

Carrier / Rating Engine	Connection Method	Data Format	Rate Return Format
[Carrier 1]	API / Rater	JSON / XML	Quoted premium + tier
[Carrier 2]

Quote workflow:

1. Submission passes underwriting routing (either auto-approved or UW approved)
2. System submits rating data to configured carriers/raters
3. Responses collected; quotes ranked by premium (and optionally by coverage quality)
4. Quote comparison generated (side-by-side coverage and premium)
5. Agent reviews quotes and selects recommendation
6. Quote document generated for client presentation
7. Quote delivered to client (email / portal)

Quote document required elements:

• Quoted premium (annual and monthly if payment plan available)
• Coverage summary (limits and deductibles)
• Carrier name and AM Best rating
• Quote expiration date
• Payment options
• Next steps (how to bind)

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Component 4: Bind Workflow

Bind authority rules:

Bind Type	Authority Level	Approval Required
Preferred risk within appetite	Agent bind authority	None — auto-bind
Standard risk	Agency bind authority	Agency principal approval if over $[X] premium
Referral risk	Carrier/MGA bind authority	Carrier written approval before binding
E&S / surplus lines	Surplus lines bind authority	Diligent search documentation + affidavit

Bind workflow steps:

1. Client confirms coverage selection (written or documented phone acknowledgment)
2. First premium payment collected (check, ACH, or credit card — confirm carrier acceptance)
3. Premium finance agreement executed if applicable
4. Binder issued to insured — must include: insured name, carrier, effective date, LOB, limits, policy number (or pending)
5. Evidence of insurance (EOI/certificate) issued if required by lienholder or additional insured
6. Carrier system submission:
   • AMS → carrier portal (automated submission) OR
   • AMS → ACORD XML → carrier API OR
   • Manual carrier portal entry (legacy carriers)
7. Carrier confirmation received and stored
8. Agent and insured notified of bind confirmation

Surplus lines bind checklist:

• Diligent search documented (minimum [N] admitted declinations per state law)
• Surplus lines broker license confirmed active
• Premium tax calculated and stamping fee included
• Stamping office affidavit prepared
• Disclosure notice to insured signed (risk not covered by state guaranty fund)

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Component 5: Policy Issuance

Issuance workflow:

1. Carrier issues policy (typically 1–10 business days post-bind depending on carrier)
2. Policy document received from carrier
3. Policy data reconciled against AMS:
   • Effective date matches bind confirmation
   • Coverage limits and deductibles match quote
   • Named insured(s) correct
   • Additional interests / lienholders correct
4. Discrepancies flagged for agent review and correction
5. Policy document stored in document management system linked to AMS client record
6. Policy delivered to insured:
   • Email with PDF attachment (with delivery confirmation tracking)
   • Portal upload if insured has portal access
   • Mailed copy if required by state law or insured preference
7. Agent notification of successful issuance
8. Billing confirmed (direct bill carrier vs. agency bill)
9. Policy tickler set for renewal (90 days before expiration)

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Component 6: Endorsement Workflow

Endorsement intake:

Change Type	Intake Method	Processing Path
Driver add/remove	Online form or phone	Automated if within appetite; referral if adverse
Vehicle add/remove	Online form or phone	Automated for standard; referral for high-value or specialty
Address change	Online form or phone	Automated for most; referral if rate territory impact
Coverage change	Agent-initiated	Agent submits to carrier; audit trail required
Named insured change	Agent + carrier approval	Carrier-specific process; may require new application

Endorsement processing:

1. Change request received (channel logged for E&O file)
2. Change type classified (in-appetite automatic vs. referral)
3. Premium impact calculated (return premium or additional premium)
4. Client acknowledgment of premium change (required before processing)
5. Endorsement submitted to carrier
6. Endorsement document received and reconciled
7. AMS updated with endorsement effective date and premium change
8. Endorsement confirmation sent to insured with updated coverage summary
9. E&O documentation: request logged with date, requestor, change made, confirmation

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Output Format

Deliver two artifacts:

1. Workflow Diagram Specification — For each component in scope, a step-by-step process narrative with decision branches, actor at each step (system / agent / underwriter / insured / carrier), and system interactions

2. System Integration Requirements — For each system integration point:

   • Integration purpose
   • Source system and destination system
   • Data transferred (field list)
   • Connection method (API / file exchange / manual)
   • Authentication requirements
   • Error handling and retry logic
   • SLA / timeout requirements