---
name: subrogation-referral
source: https://app.decimal.ai/s/subrogation-referral@1/SKILL.md
source_sha256: f954cc52b5da
---

# Subrogation referral screen

You are handed a loss the carrier has already paid (or reserved) on the first-party
side. Decide whether the carrier should pursue recovery from a third party. Return
exactly one decision — **REFER** or **WAIVE** — plus one reason.

Run the gates **in this order**. The moment a gate fails, stop and **WAIVE** with that
gate's reason — do not keep screening. **REFER** only if the loss clears every gate.

## Gates (in order)

1. **Liable third party.** Is there an identifiable party — other than the insured —
   whose fault caused the loss? Single-vehicle accidents, weather/hail, fire with no
   cause, and losses where the insured is 100% at fault have no target. If none →
   WAIVE `no-liable-third-party`.

2. **Anti-subrogation bar.** A carrier cannot subrogate against its own insured. If the
   would-be target is the named insured, an additional insured, a co-insured, or any
   party covered under the *same* policy, the claim is barred → WAIVE `anti-subrogation`.
   (This bars intra-policy targets even when they are clearly at fault.)

3. **Collectibility.** Can the target actually pay? A judgment-proof, uninsured,
   unidentified (e.g. unidentified hit-and-run), bankrupt, or untraceable target yields
   nothing. If not collectible → WAIVE `not-collectible`.

4. **Statute of limitations.** Is the underlying tort still within its limitations
   period? If the deadline for the underlying claim has already passed → WAIVE
   `time-barred`. Do not refer a claim you can no longer file.

5. **Made-whole priority.** By default the insured must be made whole for the entire
   loss — including deductible and any uncovered amounts — before the carrier keeps
   recovery. If the insured is still short *and* the recoverable pool is too small to
   make them whole first, the carrier's right is subordinate → WAIVE `not-made-whole`.
   If the pool is large enough to make the insured whole *and* leave a net for the
   carrier, this gate passes. (A valid priority-of-reimbursement clause can override
   this default; absent that, apply made-whole.)

6. **Dollar threshold.** Would net recovery clear the cost of pursuing it? Compare the
   paid/reserved amount against the referral floor (default **$2,500** net exposure) and
   the estimated cost to pursue. Below the floor, or where pursuit costs exceed expected
   recovery → WAIVE `below-threshold`.

If all six gates pass → **REFER**, naming the recoverable basis (the liable party and
the theory — negligence, product defect, premises liability, etc.).

## Output

One line: the decision, the reason code, and a short basis.

- `REFER — rear driver negligent, insured, $8,000 paid, within SOL, insured made whole`
- `WAIVE anti-subrogation — target is a co-insured on the same auto policy`
- `WAIVE not-collectible — unidentified hit-and-run, no traceable target`

## Notes

- Waive on the **first** failing gate; the earliest failure is the reason. Do not list
  every gate — one decision, one reason.
- "Reserved but not yet paid" losses are still screenable; use the reserve as the
  exposure figure for the threshold gate.
- Comparative-fault losses can still refer for the third party's share — the insured's
  partial fault reduces recovery but does not by itself bar it.