Insurance Claim Summaries

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

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• Outcome: paid in full / negotiated settlement / denial upheld / withdrawn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; only name and description are 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