메뉴
保险理赔纠纷维权辅助分析。当保险顾问的客户被保险公司拒赔时使用。逐条拆解拒赔理由、匹配保险法依据、规划维权路径，生成申诉函/投诉书/证据清单。 涵盖健康险（医疗险/重疾险）六大拒赔场景：未如实告知、等待期出险、既往症、免责条款、疾病定义争议、其他争议。 定位为保险专业咨询辅助工具，非法律执业服务。
기본적으로 소스를 먼저 확인하는 Prompt가 선택됩니다. 직접 명령으로 전환하거나 로컬 사본을 다운로드할 수도 있습니다.
설치 여부를 결정하기 전에 SKILL.md와 SkillsMP에 표시된 보조 파일을 읽어 보세요.
Codex 또는 Claude로 설치 이 Prompt를 복사해 Codex, Claude 또는 다른 어시스턴트에 붙여 넣으면 Skill 페이지를 검토하고 설치를 진행할 수 있습니다.
직접 명령은 검토 Prompt를 거치지 않습니다. 실행하기 전에 소스를 확인하세요.
npx skills add https://github.com/sujian666666com-glitch/kk-skill --skill insurance-claim-appeal명령은 한 줄로 유지됩니다. 복사하기 전에 가로로 스크롤해 전체 내용을 확인하세요.
로컬 사본을 원하시나요? SkillsMP에서 현재 제공할 수 있는 파일을 다운로드하세요.
Discover and filter 15,330 The Graph subgraphs by domain, network, protocol type, or natural language goal. Each result includes an x402 query URL — $0.01 USDC on Base per call, no API key required.
Audit and reduce AI agent runtime spend in dollars. Use for AI costs, agent spend, token waste, runtime attribution, detector coverage, and FinOps. Works with OpenClaw, Hermes, QM, Claude Code, Cursor, and generic event ingest.
Use this skill whenever the user is troubleshooting a VMware/vSphere problem — a reported error, an exception, a log dump, a slow or failed VM, a host that went sideways — and needs help locating the root cause. It is the diagnostic brain of the VMware family: it drives a systematic investigation, pulls the right signals from the other skills, correlates events into one timeline, ranks root-cause hypotheses, and tells you what to check next even when you don't know where to start. Always use this skill for "diagnose this VMware issue", "why is my VM slow", "troubleshoot this vSphere error", "what does this log mean", "help me figure out what broke" when the context is explicitly VMware/vSphere/ESXi/NSX. It is READ-ONLY: it never changes anything. Do NOT use it to execute fixes — single fixes go to vmware-aiops, multi-step gated remediation goes to vmware-pilot. Do NOT use it for routine inventory or health checks with no problem to solve — use vmware-monitor.
SOC 직업 분류 기준
SKILL.md 표시 중
| name | insurance-claim-appeal |
| version | 1.0.0 |
| description | 保险理赔纠纷维权辅助分析。当保险顾问的客户被保险公司拒赔时使用。逐条拆解拒赔理由、匹配保险法依据、规划维权路径，生成申诉函/投诉书/证据清单。 涵盖健康险（医疗险/重疾险）六大拒赔场景：未如实告知、等待期出险、既往症、免责条款、疾病定义争议、其他争议。 定位为保险专业咨询辅助工具，非法律执业服务。 |
| category | legal-finance |
| tags | ["保险理赔","维权申诉","法律分析"] |
| triggers | ["拒赔","理赔纠纷","保险拒赔分析","理赔申诉","被保险公司拒赔","理赔维权","重疾险拒赔","医疗险拒赔","怎么应对拒赔","保险理赔被拒"] |
| author | 小包总 |
| agent_created | true |
本技能为保险顾问（代理人/经纪人）提供结构化的理赔拒赔案件分析流程。核心价值：将一份拒赔通知书 + 保单条款 + 病历材料，转化为可执行的维权方案。
用户身份：大童保险服务保险代理人（小包总），从业8年，中介平台，可跨公司比较产品。主业健康险（医疗险+重疾险），专注非标体客户。
按以下五步流程执行，不可跳过步骤。
从用户提供的材料中提取以下关键信息。信息不完整时，逐项向用户确认。
必收信息：
选收信息（根据拒赔类型）：
references/rejection_scenarios.md 提供了六大常见拒赔场景的分析框架。根据本案的拒赔理由，加载对应的场景章节，逐条拆解：
输出格式：
## 拒赔通知拆解
### 拒赔理由一：[理由原文]
- 依据条款：[条款编号和原文]
- 条款性质：[免责条款/一般条款/...]
- 存在的问题：[逐条指出]
- 反驳依据：[法律/条款/事实]
- 应对策略：[一句话总结]
加载 references/appeal_paths.md，按以下顺序排列维权路径：
对每条路径给出：
加载 assets/evidence_checklist.md，标记：
根据维权策略和用户需求，生成以下一项或多项：
assets/appeal_letter_template.md，填充案件具体内容assets/complaint_letter_template.mdassets/evidence_checklist.md 生成定制版references/legal_basis.md 汇总了核心法条。在分析中引用法条时：
加载 references/compliance.md，严格遵守：
最终输出应包含：
一、案件信息摘要
二、拒赔通知拆解（逐条分析）
三、维权路径建议（按优先级排列，含操作步骤）
四、证据材料清单（已有/待获取）
五、交付物（申诉函/投诉书/证据清单）
六、重要提示（含合规声明）
references/rejection_scenarios.md — 六类常见拒赔场景分析框架references/legal_basis.md — 核心法律条文和适用策略references/appeal_paths.md — 维权路径全景和操作流程references/compliance.md — 合规边界和输出规范assets/appeal_letter_template.md — 理赔申诉函模板assets/complaint_letter_template.md — 12378投诉申请书模板assets/evidence_checklist.md — 理赔维权证据清单