---
title: "Summarise a claim file and the policy for a coverage review"
url: "https://ailawframework.com/practice/insurance-law/summarise-a-claims-file-and-policy-for-a-coverage-review/united-states"
type: "task_jurisdiction_version"
site: "AI Law Framework"
id: "A22-B7-1-US"
practice_area: "Insurance Law"
tier: "yellow"
lawyer_review: "required"
jurisdictions: ["US"]
last_reviewed: "2026-10-22"
---

# Summarise a claim file and the policy for a coverage review

> 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.

Canonical page: https://ailawframework.com/practice/insurance-law/summarise-a-claims-file-and-policy-for-a-coverage-review/united-states  
Last reviewed: 2026-10-22

Site index for agents: https://ailawframework.com/llms.txt

## Key facts

| Fact | Value |
| --- | --- |
| Practice area | [Insurance Law](https://ailawframework.com/practice/insurance-law.md) |
| Human involvement | Yellow: Lawyer and AI draft together |
| 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 | United States |
| Applies to | [Summarise a claims file and policy for a coverage review](https://ailawframework.com/practice/insurance-law/summarise-a-claims-file-and-policy-for-a-coverage-review.md) |

## Checking plan

- What the AI does: 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.
- Basis: Checked against the linked sources on 22 October 2026. Confirm the current instrument before reliance.

## Notes

- The model Act's 15-calendar-day rule is for providing claim forms after a request, and only in a state that has enacted it.
- McCarran-Ferguson, 15 U.S.C. § 1012, is why the state's insurance code controls over a general federal statute.

## Sources

- [NAIC Unfair Claims Settlement Practices Act, model MO-900](https://content.naic.org/sites/default/files/model-law-900.pdf) (checked 2026-10-22)
- [California Insurance Code § 790.03, unfair methods of competition and unfair acts](https://california.public.law/codes/ca_ins_code_section_790.03) (checked 2026-10-22)
- [ABA Model Rule 1.6, Confidentiality of Information](https://www.americanbar.org/groups/professional_responsibility/publications/model_rules_of_professional_conduct/rule_1_6_confidentiality_of_information/) (checked 2026-10-22)

## Forms and precedents for this task

| Form or precedent | Kind | AI level | Summary |
| --- | --- | --- | --- |
| [Response to a reservation of rights or disclaimer](https://ailawframework.com/precedents/insurance-law/us-reservation-of-rights-response.md) | Letter | Yellow | The insured's response to an insurer's reservation of rights or denial. It asks the insurer to identify the provisions it relies on.… |

Signed-in accounts can read the full text of each one.

*Practice guidance for planning and review. Confirm current primary sources and the requirements of the actual matter. This is general information, not legal advice.*