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