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Covers property, liability, workers' comp, auto, and professional indemnity.\n\n## What This Does\n\nTakes raw claim details and produces:\n- Structured claim summary with policy coverage mapping\n- Liability assessment with supporting/weakening factors\n- Reserve estimate with confidence range\n- Subrogation opportunity analysis\n- Red flag detection (fraud indicators, coverage gaps)\n- Settlement recommendation with negotiation range\n- Regulatory compliance checklist by jurisdiction\n\n## Usage\n\nProvide claim details in any format — adjuster notes, policyholder statement, incident report, photos, or free text. The agent structures everything.\n\n### Quick Claim Analysis\n```\nAnalyze this claim: [paste details]\n```\n\n### Full Processing\n```\nProcess claim for:\n- Policy type: [commercial general liability / property / WC / auto / PI]\n- Incident date: [date]\n- Reported date: [date]\n- Claimant: [name/entity]\n- Description: [what happened]\n- Claimed amount: [if known]\n- Policy limits: [if known]\n- Jurisdiction: [state/country]\n```\n\n## Claim Analysis Framework\n\n### 1. Coverage Determination\n- Map incident to policy provisions\n- Identify applicable endorsements and exclusions\n- Flag coverage disputes early\n- Check occurrence vs claims-made triggers\n\n### 2. Liability Assessment\nScore 1-10 on insured liability exposure:\n- **1-3**: Strong defense position, deny or minimal settlement\n- **4-6**: Mixed liability, negotiate\n- **7-10**: Clear insured liability, reserve and settle\n\nFactors evaluated:\n- Comparative/contributory negligence (jurisdiction-specific)\n- Statutory obligations\n- Contractual indemnity provisions\n- Prior loss history pattern\n\n### 3. Reserve Estimation\nThree-point estimate:\n- **Low**: Best case with strong defense\n- **Mid**: Most likely outcome\n- **High**: Worst case including litigation costs\n\nInclude:\n- Indemnity reserve\n- Defense costs (inside/outside limits)\n- Allocated loss adjustment expense (ALAE)\n- Unallocated loss adjustment expense (ULAE)\n\n### 4. Fraud Detection\nRed flags scored by severity:\n- Claim timing patterns (Monday morning, policy inception proximity)\n- Prior claim frequency\n- Documentation inconsistencies\n- Witness availability issues\n- Financial stress indicators\n- Description vs damage inconsistency\n\n### 5. Subrogation Analysis\n- Third-party recovery potential\n- Evidence preservation requirements\n- Statute of limitations by jurisdiction\n- Cost-benefit of pursuit\n\n### 6. Settlement Strategy\n- Opening position and authority range\n- Mediation vs litigation cost comparison\n- Jurisdiction-specific verdict ranges\n- Structured settlement considerations for large claims\n\n## Industry-Specific Modules\n\n### Property Claims\n- Replacement cost vs actual cash value\n- Business interruption calculations (gross earnings, extra expense)\n- Ordinance or law coverage triggers\n- Catastrophe event coordination\n\n### Workers' Compensation\n- Compensability determination\n- Return-to-work timeline\n- Medical treatment guidelines by state\n- Permanent disability rating estimates\n\n### Professional Liability\n- Discovery rule and statute of repose\n- Prior acts coverage analysis\n- Consent to settle provisions\n- Panel counsel selection criteria\n\n### Auto/Fleet\n- Comparative fault allocation\n- UM/UIM stacking analysis\n- Medical payment coordination\n- Total loss threshold calculations\n\n## Compliance Checklist Generator\nProduces jurisdiction-specific compliance timeline:\n- Acknowledgment deadlines\n- Investigation completion requirements\n- Payment timing obligations\n- Required notices and disclosures\n- Bad faith exposure triggers\n\n## Output Format\n\nEvery analysis produces:\n1. **Executive Summary** — 3-line claim snapshot\n2. **Coverage Analysis** — provisions, exclusions, disputes\n3. **Liability Score** — 1-10 with reasoning\n4. **Reserve Recommendation** — low/mid/high with breakdown\n5. **Red Flags** — fraud indicators if any\n6. **Action Items** — next steps with deadlines\n7. **Settlement Range** — if applicable\n\n---\n\nBuilt by [AfrexAI](https://afrexai-cto.github.io/context-packs/) — AI agent context packs for every industry.\n\nGet the full **Insurance & Risk Management Context Pack** with claims processing, underwriting automation, policy analysis, and actuarial modeling: [AfrexAI Storefront](https://afrexai-cto.github.io/context-packs/)\n\nCalculate what AI agents save your claims operation: [AI Revenue Calculator](https://afrexai-cto.github.io/ai-revenue-calculator/)\n","readmeExcerpt":"Insurance Claims Processor Process, analyze, and optimize insurance claims. 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Covers property, liability, workers' comp, auto, and professional indemnity. 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