Insurance Policy Analyzer
When a client has a potential claim and needs to determine whether their insurance policy provides coverage.
Coverage disputes turn on language most people never read closely until a claim hits. Whether a loss is covered, excluded, or sits in a gray area depends on how the insuring agreement, definitions, exclusions, and conditions interact, and on whether the policy is occurrence-based or claims-made. A disciplined coverage analysis maps that architecture against the actual facts so you can advise the insured on whether, and how, to pursue the claim.
This is detailed, structure-heavy work that Claude handles well. Provide the policy type, the insured, and the situation giving rise to the claim, and it walks the insuring agreement, parses the key defined terms, tests each exclusion against the facts, checks the conditions and limits, and offers a preliminary coverage assessment with next steps. For coverage counsel, it is a cost-effective way to build the first draft of a coverage position quickly.
A coverage opinion carries real consequences, so the output is a starting point, not a conclusion. Endorsements override printed forms, jurisdiction-specific insurance law shapes interpretation, and the facts often need development, all of which require your judgment. Verify every quoted provision against the full policy, including all endorsements, before relying on the analysis. It is attorney work product to refine, not legal advice.
The Prompt
Analyze the following insurance policy: Policy type: [e.g., CGL, D&O, E&O, cyber, property] Insured: [NAME] Claim or potential claim: [DESCRIBE THE SITUATION GIVING RISE TO A CLAIM] Analyze: 1. Insuring agreement — what is covered, and what triggers coverage (occurrence vs. claims-made) 2. Key definitions — how are "occurrence," "claim," "damages," and "insured" defined? 3. Coverage territory and period 4. Exclusions — list each exclusion and assess whether it applies to this claim 5. Conditions — notice requirements, cooperation duties, voluntary payment restrictions 6. Limits and deductibles — per occurrence, aggregate, defense costs inside or outside limits 7. Additional insured provisions 8. Subrogation rights 9. Coverage determination — is this claim likely covered, excluded, or in a gray area? 10. Recommended next steps for the insured Policy: [PASTE POLICY TEXT]
Example Output
A coverage analysis identifying the relevant insuring agreement, applicable exclusions, and a coverage opinion with risk assessment.
Illustrative example — names, figures, and facts are fictional.
INSURANCE COVERAGE ANALYSIS Policy: Commercial General Liability (CGL), occurrence-based Insured: Brightline Contracting LLC Claim: Third party (homeowner) alleges water damage from defective roofing work completed 14 months ago. 1. INSURING AGREEMENT — Coverage A (bodily injury / property damage) Trigger: "property damage" caused by an "occurrence" during the policy period. Resulting water damage to the home (vs. the defective work itself) likely qualifies as property damage. 2. KEY DEFINITIONS "Occurrence" = accident, including continuous exposure. Faulty workmanship causing resulting damage may be an occurrence in many jurisdictions, FACT/LAW dependent. 3. EXCLUSIONS — assessment vs. this claim j(5)/(6) "Your Work" — likely BARS the cost to repair the defective roof itself. Resulting damage to other property — may fall OUTSIDE the your-work exclusion (potentially covered). "Subsidence"/"Mold" endorsement — CHECK; if water led to mold, a mold exclusion could limit recovery. 4. CONDITIONS Notice: "as soon as practicable." 14-month delay raises a late-notice question, assess prejudice under applicable state law. Voluntary payments: insured should make no repairs/admissions without insurer consent. 5. LIMITS / DEDUCTIBLE $1M per occurrence / $2M aggregate; defense costs outside limits. SIR of $5,000 applies. 6. PRELIMINARY COVERAGE DETERMINATION: GRAY AREA. Resulting water damage is potentially covered; the defective work itself is likely excluded. Outcome turns on the occurrence question and the late-notice analysis. 7. RECOMMENDED NEXT STEPS - Tender the claim immediately and request a coverage position in writing. - Obtain the complete policy with ALL endorsements; confirm occurrence vs. claims-made. - Develop facts on when damage was discovered to address late notice. Note: Parties, figures, and provisions are illustrative. Verify against the full policy and applicable state law before issuing any coverage advice.
Tips
- •Always check whether the policy is occurrence-based or claims-made — the trigger analysis differs completely.
- •Look at the definitions section first — insurers narrow coverage through definitions more than exclusions.
- •Check for endorsements that modify the base policy — they often override the printed form.
Frequently Asked Questions
When should I use the insurance policy analyzer?
Use it when a client faces a potential or actual claim and you need to assess whether their policy responds. It is well suited to first-pass coverage analysis across CGL, D&O, E&O, cyber, and property policies, and to organizing the insuring agreement, exclusions, and conditions before you form a coverage position or draft a tender letter.
Can this replace a formal coverage opinion from an attorney?
No. The analysis is a first-pass aid; the coverage opinion and the responsibility for it remain with you. Coverage outcomes hinge on endorsements, jurisdiction-specific insurance law, and developed facts, all matters of attorney judgment. Confirm every cited provision against the complete policy and the controlling law before advising the insured.
How do I get the most reliable analysis?
Identify the policy type, the insured, and the specific facts giving rise to the claim, then paste the entire policy including the declarations and every endorsement, since endorsements frequently override the printed form. Note whether coverage is occurrence-based or claims-made; the trigger analysis differs completely, and flag the jurisdiction so interpretive rules can be considered.
Is it ethical to put a client's insurance policy and claim facts into AI?
Handle it with care. Model Rule 1.6 and ABA Formal Opinion 512 require protecting client confidences and understanding a tool's data practices. Avoid entering privileged claim details or client identifiers into consumer AI without adequate confidentiality safeguards; favor an enterprise or zero-retention configuration and obtain informed client consent where the sensitivity warrants it.
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