Triage a new insurance claim and decide on SIU referral

Help me triage a newly reported insurance claim. Line and policy type: [e.g. "personal auto", "homeowners", "workers' comp", "commercial property"] First notice of loss details: [date reported, date of loss, what happened, who reported it, injuries, damage description] Policy facts: [effective dates, recent changes or new policy, coverages and limits, prior claims] Information gathered so far: [statements, photos, police or fire report, estimates] My authority level: [reserve and settlement authority] Jurisdiction: [STATE/COUNTRY] Give me: 1. Coverage questions to resolve (e.g. was the policy in force, is the cause of loss covered, any exclusions or conditions in play), each with what I need to answer it. 2. A suggested complexity tier (fast-track / standard / complex) with the reason. 3. An initial reserve approach: what drives the estimate and what is unknown. Do not give a dollar figure unless I provide the inputs. 4. A next-steps plan with deadlines, including regulatory acknowledgment and decision timelines to [CONFIRM for my state]. 5. A fraud indicator check: list any recognized red flags present (e.g. loss soon after inception or coverage increase, inconsistent statements, reluctance to provide documents, prior similar claims). For each, the objective fact that triggered it. 6. A recommendation on whether to refer to the special investigations unit (SIU), with a draft referral summary if yes. Rules: indicators are reasons to investigate, not proof of fraud. Keep the claimant contact neutral and do not delay payment of undisputed amounts. Use only facts I provide; mark gaps [CONFIRM]. Follow our claims guidelines and state fraud reporting requirements.