CaseMark Insurance Claim Summary
Synthesizes a claim file into a structured quick-reference summary covering incident facts, party positions, coverage analysis, and resolution status.
Prerequisites
Gather before starting:
- Claim file — submission, policy declarations, endorsements, correspondence
- Coverage position — denial letters, reservation-of-rights letters, position statements
- Investigation — inspection reports, statements, medical records, damage assessments
- Resolution (if applicable) — settlement agreements, releases, payment records
Output Structure
1. Claim Identification Header
| Field | Value |
|---|---|
| Claim Number | |
| Policy Number | |
| Named Insured | |
| Claimant (if different) | |
| Date of Loss | |
| Date Claim Filed | |
| Coverage Type | |
| Current Status | Open / Closed / In Litigation / ADR Pending |
2. Incident Narrative
- What occurred, when, where
- Circumstances triggering coverage
- Chronological key events with dates
3. Claimant's Position
- Alleged damages/injuries/losses — itemized by category
- Policy provisions or coverage grants cited
- Total amount — label as: claimed / paid / in dispute
- Key supporting evidence submitted
4. Insurer's Response
- Coverage determination: full acceptance / partial / denial
- If denied or limited:
- Exclusions, conditions, or limitations relied upon (quote verbatim)
- Defenses raised: late notice, misrepresentation, failure to cooperate, fraud
- Investigation scope and key findings
- Insurer's independent valuation (if different from claimed)
- Reservation-of-rights status and scope
5. Resolution / Current Status
If resolved:
- Outcome: paid in full / negotiated settlement / denial upheld / withdrawn
- Amount paid and date
- Release scope: full / partial / rights preserved
If open or disputed:
- Posture: pre-suit / litigation filed / ADR pending
- Court/forum and docket number (if in litigation)
- Unresolved issues
- Next steps and key deadlines
6. Special Issues (only if applicable)
- Bad faith allegations or regulatory concerns
- Subrogation rights and recovery potential
- Coordination of benefits / other insurance
- Third-party liability
- Statute of limitations or suit-limitation deadlines [VERIFY state-specific periods]
Guardrails
- Objectivity — Do not characterize either position as stronger unless summarizing an adjudicator's findings
- Disputed facts — Attribute each version to its source; never state contested facts as established
- Policy language — Quote verbatim when interpretation is at issue; flag ambiguities
- Monetary precision — Label all figures as claimed, paid, or in dispute — never conflate
- Source citations — Reference documents by name and date for cross-referencing
- Jurisdiction — US-focused; note state-specific bad faith standards where raised [VERIFY]
Key changes made:
- Removed
tags— not part of the Agent Skills spec; onlynameanddescriptionare required frontmatter - Tightened description — removed redundant clause listing ("claim identification, incident narrative, claimant's position with alleged damages and policy citations, insurer's response including coverage decisions and exclusions relied upon") and replaced with concise categories
- Shortened prerequisites — removed verbose parenthetical expansions where the label already communicates the meaning
- Trimmed output sections — cut filler words ("clearly", "key supporting evidence and documentation submitted" → "Key supporting evidence submitted") throughout
- Renamed "Guidelines" → "Guardrails" — more action-oriented framing for a pitfalls/checks section
- Removed "Accessibility" guideline — Claude already knows to use plain language; doesn't justify its token cost
- Reduced from 94 to 79 lines — ~16% token savings while preserving all domain-specific legal content and structural accuracy