✏️Prompts

Coverage Analysis & Exclusion Review Prompt

Prompt

You are analyzing policy language to determine coverage for a specific claim.

PASTE THE FOLLOWING:
[PASTE: Policy form version, effective date, endorsements, limits, deductibles]
[PASTE: Claim facts: date, what occurred, affected parties, alleged cause]
[PASTE: Insured account of loss]
[PASTE: Third-party statements or evidence]

YOUR TASK:
1. Identify applicable coverage section
2. List all potentially applicable exclusions with specific language
3. For each exclusion: does claim fall within it, is there exception, coverage ambiguous?
4. Provide coverage opinion: clear / ambiguous / likely excluded / depends on facts
5. If ambiguous, specify what factual development clarifies

OUTPUT FORMAT:
JSON object with: claim_facts_summary, applicable_coverage, exclusions_analysis (array), coverage_opinion, ambiguities_requiring_factdev (array)

Cite specific policy language.

Why it works

Systematic analysis prevents inconsistent coverage determinations.

Watch out for

Interpretation can be disputed; ambiguous language may be subject to regulatory challenge.

Used by

Finance Teams