The shape of every subrogation question

Domain guide

Subrogation is the carrier's right to recover what it paid its insured from the party that caused the loss. Every subrogation claim, in any line of business, answers the same three questions in the same order. The engine evaluates them in that order too, and the brief reports them in that order.

1. Is there a payment to recover? Coverage must respond and the loss must exceed the deductible. No payment, no subrogation, whatever the facts say about fault. The engine still identifies the theory and keeps it in the trace, so the analysis is not lost; it simply cannot refer.
2. Is there a responsible party, and on what theory? A party with the right role must be on the roster, and the facts that establish the theory must be stated. Each theory names its facts. A roster alone proves nothing.
3. Does anything defeat the theory? Gates and defenses: the state's fault rule, a waiver of subrogation, a limitation period, immunity, a natural event, lost evidence. Each is a record with a class: a routine verification adds a condition, a material defense changes what the adjuster does next.

The four status words

Every fact arrives with a status, and the difference between the four decides the answer more often than the facts themselves.

stated

The carrier said it. A rule may act on it.

not_stated

The carrier looked and found nothing. A waiver marked not stated means the contract was read and has no waiver: the defense does not fire.

not_returned

Nobody looked. The field was left out. A defense that needs it stays open and the brief carries a verification item.

not_extractable

A document was read and the fact could not be read from it. Document path only.

The engine never infers one fact from another. An adverse demand does not make the insured at fault. A weather word in a narrative is not an act of God. A party next door is not a cause. If the carrier did not state it, it is not there.

What a determination looks like

A theory ends in one of three states. Confirmed: the roster and the facts carry it. Indeterminate: a fact it needs was not supplied, and the brief names the field. Excluded: a fact it needs is stated the wrong way, or a defense bars it, and the brief names the reason.

The referral follows the strongest theory: refer, refer with conditions, investigate, or no referral, each with a closed reason code. Conditions carry a class. A routine condition is something to verify before demand. A material condition changes the posture: lost evidence, a natural event that may have been the sole cause, a notice deadline the engine cannot compute.

Money, deadlines, and what would change it

Money is shown in heads and never estimated: stated, computed from stated inputs, pending on rate and limit, excluded, or indeterminate. Two recovery figures appear: the base, and the legally recoverable amount, which stays pending until the fault share is known. Deadlines appear only for causes on the thesis, each with its anchor date shown. The last section of every brief, what would change it, lists the facts that would move the answer. Read it first when you are testing: it is where the engine tells you whether your claim said what you thought it said.

Where to go next

Property subrogation

Attribution carries most theories; contracts and two clocks defeat them.

Auto subrogation

Fault facts carry the driver theory; employment facts carry the rest.

Situations that change the answer

Uninsured parties, hit-and-run, no-fault states, waivers, act of God, repose, adverse demands.

Authoring a test claim

Five habits that make a claim that tests something.