Summarise a claim file and the policy for a coverage review
Key facts
- Human involvement
- YellowClose supervision
- How AI is used
- Build a chronology of notice, proof of loss, investigation steps, reservation, and denial, and pin each event to the letter in the file. Quote the policy clause the letter relies on. Do not give a coverage opinion.
- What the lawyer must review
- State claims-handling standards govern. The NAIC model requires, where it is enacted and its frequency test is met, a reasonably prompt acknowledgment, a prompt investigation, and a coverage decision within a reasonable time after the investigation. California Insurance Code § 790.03 contains its own list, including misrepresentation of policy provisions to claimants. You decide whether the file meets the enacted statute. Keep the claim file out of a public tool (Model Rule 1.6).
- Written for / version
- United States versionUS
Who does what
| Role | What they do |
|---|---|
| Assistance | Potential support includes preparing preliminary structure or wording and summarising source material. Confirm the tool’s capability and permitted scope. |
| Lawyer | Set the scope, supervise the work closely, verify every part relied on, resolve omissions and exceptions, and approve the exact output. |
Checklist
- Verify the applicable jurisdiction and the version of each relevant law, rule or instrument in force at the material time.
- Confirm the output against the client’s instructions and the complete relevant source material, including omissions or contradictions.
- Resolve exceptions and record the responsible lawyer’s approval of the exact output and intended use.
Forms and precedents for this task
| Form or precedent | Kind | AI use | Summary |
|---|---|---|---|
| Response to a reservation of rights or disclaimer | Letter | AI use Yellow | The insured's response to an insurer's reservation of rights or denial. |
Signed-in accounts can read the full text of each one. All precedents.