| name | insurance-claim-summaries |
| title | Insurance Claim Summary |
| description | Generates structured summaries of U.S. insurance claim files covering identification, incident narrative, party positions, coverage analysis, and resolution status. Use when synthesizing claim files for adjusters, legal counsel, or claims managers during pre-filing review, discovery, or settlement preparation. Trigger keywords: claim summary, insurance claim, coverage summary, adjuster summary, coverage denial, reservation of rights. |
| author | CaseMark |
| author_url | https://github.com/CaseMark/skills/tree/main/skills/legal/insurance-claim-summaries |
| license | Apache-2.0 |
| version | 0.1.0 |
| execution_mode | open |
| jurisdiction | us |
| practice | insurance |
| language | en |
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- Outcome: paid in full / negotiated settlement / denial upheld / withdrawn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
