Insurance Claim Summary

# 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- Outcome: paid in full / negotiated settlement / denial upheld / withdrawn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]

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**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