Practice area
Insurance LawInsurance law
Define the intended work in Insurance Law, confirm the applicable requirements and select a task to plan the necessary review.
Key facts
- Tasks covered
- 24
- Tasks with a step-by-step checklist
- 4
- Local differences
- 3 jurisdictions where this area changes
Jurisdiction
Tasks
GreenLawyer reviewYellowClose supervisionRedLawyer-led
| Task | How AI is used | Human involvement | What the lawyer must review |
|---|---|---|---|
| Review the policy wording and draft a coverage advice table | Extract insuring clauses, exclusions, conditions, notification and limits into a table mapped to the notified facts, with clause references and open questions. | YellowClose supervision |
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| Draft claims-handling advice from the policy and the claim file | From the claim correspondence and the policy, draft an advice outline (notification, prejudice, reservation of rights, next steps) with document cites. | YellowClose supervision |
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| Draft an ombudsman or external-dispute submission | Structure an ombudsman or external-dispute submission from the claim chronology, with a list of published determinations cited for you to check. | YellowClose supervision |
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| Draft AFCA submissions and responses from the claim chronology | Structure an AFCA submission from the claim chronology, draft narrative sections, and list published AFCA determinations cited for you to check. | YellowClose supervision |
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| Draft policy endorsements and exclusion wording from the underwriting brief | On the lawyer's instructions, assist with the endorsement or exclusion clause, working from the underwriter's brief, the base wording it amends and the schedule, and keeping to the defined terms the policy already carries. Check the settled clause back against the insuring clause, the definitions, the conditions, the other exclusions, the limits, sub-limits and deductible, and list every overlap, broken cross-reference and gap in cover the new wording creates. | YellowClose supervision | The lawyer settles the operative words, because an ambiguity in an exclusion is read against the insurer. Confirm the clause carries out the underwriting instruction and nothing more, that it uses the policy's own defined terms and leaves no conflict or unintended grant of cover elsewhere in the wording, and that the effective date, policy number and any premium adjustment are right. Check it against the Insurance Contracts Act requirements that bear on it, including the duty to clearly inform the insured of an unusual term and the limits on relying on an act or omission, the unfair contract terms regime for consumer and small business cover, and the reinsurance and target market position the endorsement may disturb. |
| Map subrogation and contribution rights from the policy and the loss file | From the policy, settlement and third-party documents, table possible recovery targets, waivers of subrogation and other-insurance clauses. | YellowClose supervision |
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| Draft pleadings in a coverage or indemnity dispute | The lawyer drafts the statement of claim, defence, reply, cross-claim or particulars, and the tool writes no part of it — no draft, no first draft, no suggested paragraphs. Working from the policy wording, the coverage table and the claim file, the tool indexes the grounds the lawyer has chosen — for example an exclusion, breach of condition, non-disclosure or late notification — with the policy clause and the claim-file reference beside each material fact, and lists any allegation with no source on the file or in the lawyer's instructions rather than filling the gap. It does not propose or formulate an allegation of fraud or dishonest non-disclosure; where the file holds material that might bear on one, it points to the document and leaves the allegation to the lawyer. On the lawyer's own draft it compares the draft against the coverage table and against the pleading served by the other side, and lists the allegations the draft does not answer and the grounds in the table the draft does not plead, without supplying the words. | RedLawyer-led | The lawyer drafts the pleading and settles every allegation, admission and non-admission personally: an allegation not traversed is deemed admitted on filing, an admission needs leave to withdraw, and a ground of denial not pleaded — an exclusion, breach of condition, non-disclosure, late notification — may not be available later. Verify every policy clause, limit and date against the policy and the claim file, and calculate the limitation period personally. Where the rules require the pleading to be verified by affidavit, the verification is the deponent's own sworn statement — the allegations it verifies must be in the lawyer's and the client's own words and nothing generative goes into the verification itself. Before filing, comply with the chosen forum's rules on disclosing AI use and certifying the document, and sign the pleading and the reasonable-prospects certification personally; in a forum that instead requires a proper basis certification for each material allegation, denial and non-admission, that certification is the lawyer's own to sign. |
| Draft expert instructions for a loss assessor, engineer or actuary | Take the questions and the assumed facts the lawyer has settled and set them out in a working table for the lawyer's own use, with the policy clause and the claim-file page beside each one, quoted from the file rather than composed, and list the source material the assessor, engineer or actuary has not yet been given. The lawyer writes the letter of instruction and any schedule that goes out with it. On the draft report, table the expert's assumptions and opinions against the letter as sent, with page cites, and flag anything outside the instructed scope, any question in the letter the report does not answer, and any departure from the expert code that applies. | RedLawyer-led | The lawyer writes the letter of instruction and settles every assumed fact in it. Check each question against the coverage issue actually in dispute, confirm each assumed fact has a source in the claim file, and treat the instructions as material that will be read by others: serving the report and relying on it will ordinarily waive privilege over the instructions and over the material the expert referred to or relied on in forming the opinion, so treat the letter as material the other side and the court will see; a report obtained and never served, or served and not relied on, does not by itself waive privilege in the instructions. The expert's duty is to the court, so confirm which expert code applies in the forum, or applies by the terms of the brief where the matter is not yet in court, before relying on the tool's scope and code flags. |
| Map the insurer's conduct, licensing and claims-code obligations | From the client's claims process and policies, table candidate conduct, licensing and claims-code obligations with a list of current instruments to check. | YellowClose supervision |
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| Map the insurer's ASIC, APRA, GI Code and Privacy Act claims-handling obligations | From the client's claims process and policies, table obligations under ASIC RG 271, the GI Code, APRA CPS 230 and Privacy Act APPs, listing current instruments to check. | YellowClose supervision |
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| Build a non-disclosure or misrepresentation table from application and claim | Compare the application answers with later facts on the claim file and table possible non-disclosure or misrepresentation issues with document cites. | YellowClose supervision |
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| Build a non-disclosure or misrepresentation table under the Insurance Contracts Act | Compare the application answers with later facts on the claim file and table possible non-disclosure or misrepresentation issues under the ICA, with document cites. | YellowClose supervision |
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| List AI-use risk points in the client's claims or underwriting process | From the client's process description, list discrimination, explainability, disclosure and claims-handling risk points and questions for the vendor. | YellowClose supervision |
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| List AI-use risk points in claims or underwriting against CPS 230, RG 271 and Privacy Act | From the client's process description, list discrimination, explainability, disclosure and claims-handling risks against CPS 230, RG 271 and the Privacy Act, with vendor questions. | YellowClose supervision |
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| Review a reinsurance treaty and extract the claims-cooperation clauses | Extract attachment, exclusions, claims-cooperation, follow-the-settlements/fortunes and aggregation clauses into a table with clause references. | YellowClose supervision |
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| Draft a settlement deed and release for an insurance claim | From the agreed heads, draft a deed covering payment, release, confidentiality, subrogation and any coverage reservation. | YellowClose supervision |
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| Draft a coverage-position letter from the approved issues table | Turn the lawyer-approved coverage table into a first-draft position letter (indemnify / reserve / decline) with policy cites and information requests. | YellowClose supervision |
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| Build a notification and prejudice chronology from the claim correspondence | From the policy's notification clause and the correspondence, table when the insured knew, when notice was given, and any alleged prejudice, with document cites. | YellowClose supervision |
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| Compare the claim narrative with the contemporaneous documents | Compare the insured's claim form and statements with incident records, contracts and correspondence; list inconsistencies and missing attachments. | YellowClose supervision |
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| Extract other-insurance, allocation and deductible mechanics across a programme | From the tower or programme wordings, table limits, deductibles, drop-down, other-insurance and drop-in clauses with conflicts flagged. | GreenLawyer review |
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| Summarise a claims file and policy for a coverage review | Extract facts, dates and policy terms into a coverage memo outline. | YellowClose supervision | Lawyer forms the coverage view. |
| Analyse claims-handling records for AI-driven decisions | Identify where automated tools affected the claim decision. | YellowClose supervision | Lawyer assesses duty of utmost good faith and GICOP. |
| Build a chronology of a contested insurance claim | Create a dated chronology from emails and reports. | GreenLawyer review | Verify against documents. |
| Review policy wording for AI-related exclusions | Flag silent AI and cyber exclusions. | YellowClose supervision | Lawyer interprets. |
| Draft IDR response to a complainant | Draft a response citing policy terms. | RedLawyer-led | Lawyer settles; AFCA rules apply. |
| Review insurer claims-handling AI against the AI joint statement | Gap-analyse. | YellowClose supervision | Lawyer advises. |
| Summarise expert reports in an insurance claim | Summarise. | GreenLawyer review | Verify. |
| Draft a policy for a firm's AI use on insurer panel work | Draft. | GreenLawyer review | Approve. |
Firm-wide obligations
| Obligation | What it covers |
|---|---|
| Trust accounting & handling client money | Checks that apply across files. |
| Costs, billing & litigation funding | Checks that apply across files. |
| Client-facing & access-to-justice AI tools | Checks that apply across files. |
| Incoming evidence — deepfakes & synthetic documents | Checks that apply across files. |
| AI decision systems | Checks that apply across files. |
| Confidentiality & client information | Checks that apply across files. |
| AML/CTF — the practice as a reporting entity | Checks that apply across files. |
What changes in Australia
| Topic | What changes |
|---|---|
| Scope | Policy drafting and interpretation under the Insurance Contracts Act 1984 (Cth) (ICA), claims handling, coverage disputes, subrogation, professional indemnity and reinsurance. |
| Regulation | Compliance under the ASIC Act, the Life Insurance Act 1995 and APRA's prudential standards. |
| Deadlines | Claims and litigation work has tight deadlines, jurisdiction-specific procedure and AFCA or court filing duties. Errors cost money or cause prejudice. |
| Insurers' own AI | Advice on insurers' AI in underwriting, claims triage and fraud detection engages CPS 230, ICA s.13 and Privacy Act APP 1.7 automated-decision disclosure (from 10 December 2026). |
What changes in New Zealand
| Topic | What changes |
|---|---|
| Disputes | No AFCA. Disputes go to industry dispute-resolution schemes and the courts. |
| Tribunal | The Canterbury Earthquakes Insurance Tribunal is listed in the Courts of New Zealand GenAI guidelines. |
| Injury claims | Check any personal-injury component against ACC cover. |
- Courts of New Zealand: GenAI guidelines — Lawyers (7 December 2023) · 2026-09-23
- Accident Compensation Act 2001 · 2026-09-23
- Community Law: Overview of the ACC scheme · 2026-09-23
What changes in United States
Known here as: Insurance law
| Topic | What changes |
|---|---|
| Governing law | Insurance regulation is mainly state (McCarran-Ferguson), with some federal overlays. Policy interpretation is state contract and insurance-code law. |
| Checking | Formal Opinion 512: verify coverage citations and wording against the actual policy. |
Precedents for this area
- Internal dispute resolution complaint to an insurer about a declined or underpaid claim (Letter, AI use Yellow). A complaint letter to a general insurer's internal dispute resolution team challenging a declined or underpaid claim: the decision, the facts, why it is wrong under the policy and the Insurance Contracts Act, the Code standards engaged, the remedy and the documents requested.
- AFCA complaint about an insurance claim: lodgement and preparation guide (Form, AI use Yellow). A guide to lodging an insurance complaint with the Australian Financial Complaints Authority through its online process: eligibility, time limits, what to include, the stages of AFCA's process and how to prepare the evidence.
- Coverage advice memorandum (insuring clause, exclusions, conditions, non-disclosure and section 54) (Memo, AI use Yellow). An original structure for a coverage advice under Australian law: the question, short answer, facts and policy terms, then a step-by-step analysis of cover, exclusions, conditions and notification, disclosure and misrepresentation, section 54, good faith, quantum and next steps.
- Reservation of rights letter from an insurer (specific, timely and fair) (Letter, AI use Yellow). An original reservation of rights letter for an insurer that identifies the specific policy provisions and facts in question, explains what the insurer will do meanwhile, sets out the insured's rights under the Code and the Act, and asks for the information needed to decide.
- Checklist: AI in insurance claims handling — automated decisions, explanations and synthetic-evidence fraud (Checklist, AI use Yellow). A compliance checklist for insurers and their advisers on AI in claims: inventory, human review of adverse outcomes, reasons, fairness, privacy and automated-decision transparency from 10 December 2026, and fair handling of suspected AI-fabricated invoices, photos and documents.
- Memo: reviewing professional indemnity, cyber and D&O wordings for AI exclusions and "silent AI" exposure (Memo, AI use Yellow). An original memo structure for reviewing a client's PI, cyber and D&O programme for how it treats AI-related losses: express AI exclusions, silent AI, definitions, sub-limits, notification and disclosure, with a findings table and recommendations for renewal.
All precedents for Insurance Law. Signed-in accounts can read the full text.