How to see where benefit claims are decided
Map a benefit claims assessment as a flowchart, then count claims through its decisions and show them as a Sankey diagram. A process-level view, not advice on any individual claim.
A claim passes through a few decisions before it reaches a decision file: is the evidence enough, and is the assessment ready. This guide draws that process and then counts claims through it.
The short version
- Draw the assessment as decisions with named exits before counting.
- Count claims, once each, for one period, including those that go round more than once.
- A wide No branch at a decision shows where claims loop back.
- Show the counts as a Sankey diagram and keep the flowchart beside it for explanation.
A claims process is a set of decisions you can count
A public benefit or entitlement claim is opened, checked for coverage, assessed and sent for approval. Between the first step and the last there are two points where a claim can go back: when the evidence is not sufficient, and when the assessment is not ready for decision. Drawn as a flowchart, those points are easy to see. Counted, they show where claims spend their time.
The example is an 11-step assessment process. Its decisions are "Evidence sufficient?" and "Assessment ready for decision?". The branch from the first goes back to "Request and verify additional evidence", and the second to "Refer dispute, complexity or specialist question". Counting claims on each branch for one period gives a Sankey diagram like /sankey/benefits-claims-processing.
This guide is about the process, not about any individual claim. It gives no advice on eligibility or on how to claim, and the figures you use should come from your own case records.
A claim assessment, built in stages
Eleven steps and two decisions. Each decision is where a Sankey would show claims continuing or going back.
Opening and evidence
The process starts at "Open registered claim", then "Review coverage and reported loss" and "Identify documents and assessment needs". "Evidence sufficient?" sends No to "Request and verify additional evidence", which returns to the document step. That return is the first loop to count.
Assessment and estimate
With sufficient evidence the claim reaches "Assess cause, extent and relevant terms" and "Estimate supported loss or benefit". "Assessment ready for decision?" sends No to "Refer dispute, complexity or specialist question", which returns to the estimate. A second loop, a second count.
Recommendation and approval
A claim that is ready goes to "Record assessment and recommendation" and ends at "Send decision file for approval". The number of claims that arrive here, against those that went round either loop, is what the Sankey shows.
How it works
Draw the assessment with its decisions
Include the two points where a claim can go back, and name every exit.
Pick a period and a unit
Count claims opened in one period. Decide whether a reopened claim is the same claim, and say so.
Count claims through each exit
For each decision, count how many claims took each branch, including those that went round more than once.
Draw the counts as a Sankey diagram
Use the stages and decisions as nodes and the exits as flows. Check that what enters each node equals what leaves it.
Read the loops first
The widest return branch shows where claims wait. Read a sample of those files to find the reason before changing anything.
Mistakes to avoid
Counting each pass as a new claim
A claim that returns for evidence is still one claim. Count it once and record the loop as a flow.
Hiding claims that never reach a decision
Withdrawn or closed claims belong in the diagram as their own outcome.
Using the picture to judge individuals
The diagram describes a process in aggregate. Do not use small counts to identify or assess a person.
Open the claim assessment flowchart
Open the template, adapt the decisions to your process and count the exits.
Related guides
Frequently asked questions
Does this tell me whether a claim will succeed?
No. It is a way of looking at how a process works in aggregate. It gives no view on any individual claim.
Where do the numbers come from?
From your own case records for a stated period. The editor draws what you enter and does not read your systems.
Can I add an outcome such as refused?
Yes. Add a node for each outcome and a flow from the decision to it. Check that the node still balances.