# Claims, disputes and exceptions

> Claims, disputes and exceptions: Sumarity workflows across industries. Cases that need a decision with reasons: a claim, a dispute, a failed payment.

Source: https://www.sumarity.ai/processes/claims-disputes/

Process 

# Claims, disputes and exceptions

Cases that need a decision with reasons: a claim, a dispute, a failed payment. The judgement is the category and the action; the evidence is the policy, the rules and the record.

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Workflows

## 15 workflows, 10 industries.

Cross-checked: 9 · Proven by code: 3 · Checked by the outcome: 2 · Vetoed by code: 1

### Finance and accounting

### Customer deductions and short-pay disputes

Valid deduction (promotion, damage) or not

Proven by code

### Banking and payments

### Payment exceptions and investigations

Why a payment failed or is queried; the action

Proven by code

### Card disputes and chargebacks

Network reason code; evidence enough to fight

Cross-checked

### Customer complaints handling (UK FCA)

Complaint category, redress due

Cross-checked

### Wealth, asset management and fund administration

### Trade settlement fails

Why it failed; the fix

Cross-checked

### Insurance

### First notice of loss triage

Claim type, severity, fast track or adjuster

Cross-checked

### Claim coverage check against policy wording

Covered, excluded, limits

Cross-checked

### Subrogation and recovery identification

Whether a third party is liable

Checked by the outcome

### Healthcare

### Claim denial management and appeals

Denial reason, appealable, evidence

Checked by the outcome

### Manufacturing and supply chain

### Quality non-conformance triage

Defect category, severity, supplier

Cross-checked

### Warranty claim validation

In warranty, covered failure, parts

Proven by code

### Retail, hospitality and consumer

### Returns and refund review

Policy met; abuse indicators

Vetoed by code

### Logistics and transport

### Carrier damage and loss claims

Liability, amount, evidence

Cross-checked

### Telecoms

### Billing dispute resolution

Valid dispute; credit due

Cross-checked

### Public sector

### Benefit claim verification

Evidence supports eligibility

Cross-checked  

## Your version of it. On your data.

Start from the closest workflow and describe your differences.

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