insurance-claim-summaries

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.

11 stars

Best use case

insurance-claim-summaries is best used when you need a repeatable AI agent workflow instead of a one-off prompt.

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.

Teams using insurance-claim-summaries should expect a more consistent output, faster repeated execution, less prompt rewriting.

When to use this skill

  • You want a reusable workflow that can be run more than once with consistent structure.

When not to use this skill

  • You only need a quick one-off answer and do not need a reusable workflow.
  • You cannot install or maintain the underlying files, dependencies, or repository context.

Installation

Claude Code / Cursor / Codex

$curl -o ~/.claude/skills/insurance-claim-summaries/SKILL.md --create-dirs "https://raw.githubusercontent.com/CaseMark/skills/main/skills/legal/insurance-claim-summaries/SKILL.md"

Manual Installation

  1. Download SKILL.md from GitHub
  2. Place it in .claude/skills/insurance-claim-summaries/SKILL.md inside your project
  3. Restart your AI agent — it will auto-discover the skill

How insurance-claim-summaries Compares

Feature / Agentinsurance-claim-summariesStandard Approach
Platform SupportNot specifiedLimited / Varies
Context Awareness High Baseline
Installation ComplexityUnknownN/A

Frequently Asked Questions

What does this skill do?

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.

Where can I find the source code?

You can find the source code on GitHub using the link provided at the top of the page.

SKILL.md Source

# 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; 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

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