For Insurance Claims Adjusters ·
What you'll accomplish
By the end of this guide, you'll have a reliable workflow for using Claude to research coverage questions — analyzing policy language, understanding exclusion interpretations, and building your coverage position before you make the coverage determination or write your letter. What used to take 30-60 minutes of reading and research takes 5-10 minutes.
What you'll need
Before asking Claude anything, you need the exact policy language. Do not paraphrase — AI coverage analysis is only as good as the text you provide.
Find the relevant provisions in the policy:
Copy the exact text — not a summary of it.
What you should see: A text block with the exact policy language, including any defined terms.
Go to claude.ai, start a new conversation. Set the context:
I am an insurance claims adjuster researching a coverage question. I'll provide policy language and claim facts. Help me analyze how the policy language applies. Important: This is for research and professional analysis only. Always note if information is uncertain or requires verification with legal counsel.
Structure your input clearly:
POLICY LANGUAGE:
[Paste exact policy text — insuring agreement, exclusion, and relevant definitions]
CLAIM FACTS:
[Describe what happened: date, who, what, where, how]
COVERAGE QUESTION:
[Specific question — e.g., "Does the water damage exclusion apply to this sudden pipe burst?" or "Is the claimant an insured under the policy?"]
After providing context, type:
Please analyze this coverage question. Provide:
1. How the policy language applies to these facts (step by step)
2. The arguments in favor of coverage
3. The arguments against coverage
4. Any ambiguity in the policy language that could affect the outcome
5. What additional facts I should try to establish to strengthen the coverage position
6. Whether there are any standard industry interpretations of this type of provision I should be aware of
What you should see: A structured analysis covering both sides of the coverage argument, with specific references to the policy language you provided.
Coverage research is iterative. Use follow-up questions to explore:
What you should see: More specific responses that build on the initial analysis, helping you anticipate counterarguments from a public adjuster or attorney.
For a straight exclusion analysis:
Does this policy exclusion apply to these facts? Policy exclusion: [paste]. Facts: [describe]. Analyze both sides and tell me what's most defensible.
For a coverage position memo:
Based on this policy language and these claim facts, draft a brief coverage analysis memo (1 page) that I can put in the claim file. The memo should explain the coverage question, the relevant policy language, the analysis, and our coverage position. Policy: [paste]. Facts: [describe]. Position: [coverage / no coverage / under reservation].
For understanding concurrent causation:
This claim involves two causes of loss: [covered cause] and [excluded cause]. The damage was caused by both. How does the "concurrent causation" doctrine generally work in insurance coverage analysis, and what policy language would support or defeat coverage in this situation? Policy language: [paste concurrent causation or anti-concurrent causation clause if present].
For a complex insured-status question:
Is [person] an insured under this policy? Policy definition of insured: [paste]. Relevant facts about this person: [describe relationship to named insured, age, residency, etc.]. Analyze whether they qualify as an insured and what additional facts matter.