pm-insurance

Triage an incoming insurance claim: check the coverage trigger against policy wording, band severity and complexity, screen for fraud indicators, set a first-pass reserve range, and route with an SLA. Use when asked to triage a claim, review a first notice of loss (FNOL), assess a new claim, decide fast-track vs adjuster routing, or screen a claim for SIU referral. Produces a structured triage note with coverage view, severity band, indicator screen, reserve range, and a routing recommendation.

Map an organisation's risks against its insurance policy portfolio to find what's uncovered, underinsured, or double-covered. Use when asked to run a coverage gap analysis, review an insurance programme against a risk register, check what risks aren't insured, or audit a policy portfolio. Produces a risk-by-coverage matrix, flagged gaps and overlaps, a deductible stack review, and recommendations ranked by expected-loss severity.

Appeal a denied insurance claim — read the real reason for the denial, find the strongest grounds, and draft the appeal with the evidence that answers it. Use when asked to appeal a denied claim, my insurance claim was rejected, the insurer won't pay, or how do I fight a claim denial. Produces a decode of the denial reason, the best grounds to appeal on, a structured appeal letter citing your policy, the evidence checklist, deadlines to watch, and the external-review/ombudsman escalation. Not legal or regulated advice.

Run a pre-renewal review of an insurance programme: scan coverage gaps against current operations, test limit adequacy against inflation and exposure growth, read the claims experience into pricing expectations, frame market alternatives, and arm the broker negotiation. Use when asked to prepare for a policy renewal, review cover before renewal, check if limits are still adequate, or build renewal negotiation points. Produces a structured renewal review with gap findings, limit assessment, pricing outlook, and negotiation points.

Write the underwriting file narrative for a risk: the risk story, exposure quantification, loss-history read, mitigating and aggravating factors, terms and subjectivities rationale, appetite fit, and a refer-or-bind recommendation. Use when asked to write up an underwriting file, document why we're writing a risk, prepare a referral to a senior underwriter, or justify terms and exclusions on a submission. Produces a complete underwriting narrative ready for the file or referral.