Skip to main content

​
How it works

Screenshot2026 03 06at12 17 07PM
Claims Review is a full coverage analysis for an active claim — written from the agent’s perspective. It tells you whether the policy covers the loss, what the policy requires the insured to do next, and where any ambiguities or risks lie. It’s designed to help agents manage a new claim with confidence, not to adjust the claim, but to understand the coverage picture completely before the process moves forward.
1

Upload claim documents

Upload the documents that describe the claim — first notice of loss, claim forms, incident reports, damage assessments, police reports, or any combination of these.
2

Upload policy documents

Upload the policy documents that may respond to the claim — declarations pages, policy forms, and endorsements. The more complete the policy file, the more precise the coverage analysis.
If multiple policies may respond to the claim (for example, a primary GL and an umbrella), upload all of them. Cara will map the coverage layers and address how each policy applies.
3

Upload the original application (optional)

Optionally upload the original application or supporting documents from binding. This enables Cara to run a misrepresentation analysis — comparing what was stated at application against what the claim reveals about the insured’s actual operations.
If no application is uploaded, Cara will still run the misrepresentation analysis using risk information extracted from the policy schedules themselves. She’ll note that the analysis is limited without the full application, but she won’t skip it.
4

Review the coverage analysis

The output is a structured report with a key conclusion at the top of each section and supporting detail available in expandable dropdowns — keeping the report scannable while preserving the full detail for anyone who needs it.The report includes:
  • Executive Summary — Bottom-line coverage determination and the 3–5 most important action items
  • Claim Summary — A table capturing date of loss, type, named insured, claimant, claimed amount, policy number, period, line of business, and coverage trigger
  • Coverage Analysis — Whether the coverage trigger is satisfied, whether the insuring agreement applies, which exclusions are relevant, and how endorsements affect the outcome. Includes jurisdiction-specific case law research with full citations.
  • Coverage Determination — A clear per-policy conclusion: 🟢 Likely Covered, 🟡 Ambiguous, or 🔴 Not Covered — with the reasoning behind each
  • Misrepresentation Analysis — A field-by-field comparison of what was represented at application against what the claim and web research reveal, with an overall risk rating
  • E&O Risk Assessment — An honest review of the agency’s professional liability exposure on this claim, including whether the placement was appropriate and whether coverage gaps were documented
  • Next Steps — The most urgent action in plain language, followed by a full step-by-step list of what the insured needs to do and when
Cara specifically searches for exceptions to every exclusion that might apply. When an exclusion is relevant, she looks for endorsement carve-backs, exceptions within the exclusion language, and case law that has narrowed the exclusion’s scope. The answer is often in an exception to the exclusion, not the exclusion itself.
Jurisdictional rules matter for coverage outcomes. Contra proferentem, the reasonable expectations doctrine, and anti-concurrent causation rules all apply differently by state. Cara researches these and flags them when they’re relevant to the claim.
5

Next steps

From here, you can:
  • Ask Cara follow-up questions about specific exclusions, endorsements, or coverage determinations
  • Request a plain-language summary to share with the insured
  • Use the next steps section as a checklist for managing the claim process
  • Run Loss Run Analysis if the claim context reveals a broader pattern worth addressing at renewal

​
Tips for best results

  • Upload all endorsements, not just the dec page. Coverage outcomes frequently depend on endorsement language — a carve-back that restores coverage can be buried in an endorsement that isn’t obvious from the declarations page alone.
  • For claims-made policies, upload the full policy period history if possible. Retroactive dates and prior acts exclusions are common sources of coverage disputes on professional lines claims.
  • The misrepresentation analysis always runs. Even without an application, Cara extracts risk information from the policy schedules and uses it as the baseline. This section is for the agency’s awareness — it is internal, not written for the client.