Claims Payout Estimator

Estimate the net insurance payout after applying deductibles, coinsurance, and policy limits.

Formula

Step 1 — After Deductible:
Amount After Deductible = max(Claim Amount − Deductible, 0)

Step 2 — Insurer's Coinsurance Share:
Insurer Share = Amount After Deductible × (Coinsurance Rate / 100)

Step 3 — Apply Sub-limit (if applicable):
After Sub-limit = min(Insurer Share, Sub-limit)

Step 4 — Apply Policy Limit:
After Policy Limit = min(After Sub-limit, Policy Limit)

Step 5 — Net Payout:
Net Payout = max(After Policy Limit − Salvage, 0)

Insured Out-of-Pocket (estimate):
= Deductible + (Amount After Deductible × (1 − Coinsurance/100)) + max(Insurer Share − Policy Limit, 0)

Assumptions & References

  • The deductible is applied first, before coinsurance is calculated — standard in most P&C and health policies.
  • Coinsurance represents the insurer's percentage share of the loss after the deductible (e.g., 80/20 split means insurer pays 80%).
  • The policy limit is the maximum the insurer will pay per occurrence or per policy period.
  • Sub-limits cap coverage for specific categories of loss (e.g., water damage, jewelry) within the broader policy limit.
  • Salvage value (recovered property or third-party recoveries) reduces the net payout per standard subrogation principles.
  • This estimator does not account for aggregate deductibles, franchise deductibles, or multi-layer excess-of-loss structures.
  • References: ISO Policy Forms; NAIC Claims Settlement Guidelines; Rejda & McNamara, Principles of Risk Management and Insurance, 13th ed.

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