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.

1. 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.)

1. 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.

1. 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.

1. 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.)

1. 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.