Insurance Analyst

What this skill does

# Insurance Analyst

Comprehensive insurance analysis system designed for insurance professionals, risk managers, business owners, and individuals navigating complex insurance decisions. This skill provides policy comparison, coverage gap analysis, claims evaluation, risk assessment, and insurance purchasing guidance across personal and commercial insurance lines.

The Insurance Analyst excels at breaking down policy language into understandable terms, identifying coverage gaps and overlaps, evaluating claims scenarios, comparing policies and pricing, assessing business and personal risk exposures, and recommending appropriate coverage levels and deductibles. It's valuable for insurance agents, brokers, risk managers, CFOs, and consumers making informed insurance decisions.

**Important Disclaimer:** This skill provides educational information and analytical frameworks about insurance. It does NOT constitute insurance advice, legal advice, or a substitute for working with licensed insurance professionals. Insurance is highly regulated, state-specific, and contract-based. Always work with licensed insurance agents/brokers and legal counsel for specific coverage recommendations, policy interpretation, and claims guidance.

## Core Workflows

### Workflow 1: Policy Analysis & Coverage Review

**Purpose:** Thoroughly understand insurance policies, identify coverage, exclusions, limitations, and gaps.

**Policy Components:**

**1. Declarations Page ("Dec Page")**
- Named insured (who is covered)
- Policy period (effective dates)
- Coverages purchased and limits
- Deductibles
- Premium amount
- Property/vehicles/locations covered
- **Read this first** - Quick summary of what you bought

**2. Insuring Agreement**
- What the insurer promises to cover
- Triggering events that activate coverage
- Scope of protection
- Basic obligations of insurer and insured

**3. Definitions**
- Key terms used throughout policy
- Often surprisingly limiting
- Example: "Property damage" may exclude certain types of damage
- **Always read definitions** - They control interpretation

**4. Coverages**
- Detailed description of what's covered
- Sub-limits (coverage within coverage)
- Extensions (additional coverages)
- **Example (Homeowners):**
  - Coverage A: Dwelling
  - Coverage B: Other structures
  - Coverage C: Personal property
  - Coverage D: Loss of use
  - Coverage E: Personal liability
  - Coverage F: Medical payments

**5. Exclusions**
- What is NOT covered
- **Most important section** - Exclusions eliminate coverage
- Common exclusions: Intentional acts, war, nuclear, wear and tear, earth movement, flood
- Can be broad (entire category) or specific

**6. Conditions**
- Obligations and procedures
- Duties after loss (notification, cooperation, proof of loss)
- Cancellation provisions
- How disputes are resolved
- **Failure to comply can void coverage**

**7. Endorsements**
- Modifications to base policy
- Can add, remove, or clarify coverage
- May increase or decrease premium
- Read carefully - can significantly change coverage

**Policy Analysis Framework:**

**Step 1: Identify Coverage Triggers**
- What event must occur for coverage to apply?
- "Occurrence" vs. "Claims-made" (liability insurance)
- "All risk" vs. "Named peril" (property insurance)
- Timing requirements (when did event occur vs. when reported?)

**Step 2: Determine Coverage Scope**
- Who is covered? (named insured, family, employees, etc.)
- What is covered? (types of property, types of liability)
- Where is coverage provided? (geographic limitations)
- When does coverage apply? (policy period, retroactive dates)
- How much coverage? (limits, sub-limits, deductibles)

**Step 3: Identify Exclusions**
- What categories of loss are excluded?
- Are there exceptions to exclusions (coverage buy-back)?
- Do any endorsements modify exclusions?

**Step 4: Understand Conditions**
- Notification requirements (how quickly must you report?)
- Cooperation obligations
- Other insurance provisions (how policy coordinates with other policies)
- Duties after loss

**Step 5: Calculate Net Coverage**
- Policy limit
- Less: Deductible
- Less: Depreciation (if applicable - ACV vs. RCV)
- Less: Sub-limits for specific property/perils
- Less: Prior claims against policy (if aggregate limit)
- = Available coverage

**Common Policy Types:**

**Personal Lines:**
- **Homeowners (HO-3):** Dwelling all-risk, personal property named peril
- **Renters (HO-4):** Personal property and liability
- **Condo (HO-6):** Personal property, improvements, liability
- **Auto:** Liability, collision, comprehensive, uninsured motorist
- **Umbrella:** Excess liability over underlying auto/home
- **Life:** Term, whole life, universal life
- **Disability:** Income replacement if unable to work
- **Health:** Medical expenses, deductibles, copays, out-of-pocket max

**Commercial Lines:**
- **General Liability (CGL):** Third-party bodily injury and property damage
- **Professional Liability (E&O):** Errors, omissions, negligence in services
- **Property:** Building and contents, business income
- **Workers' Compensation:** Employee injury and illness
- **Commercial Auto:** Vehicles used for business
- **Cyber Liability:** Data breaches, cyber attacks, privacy violations
- **Directors & Officers (D&O):** Protection for company leadership
- **Employment Practices Liability (EPLI):** Employment-related claims

**Deliverables:**
- Policy summary document (plain English)
- Coverage checklist (what's covered, what's not)
- Exclusions analysis
- Coverage gap identification
- Recommendations for additional or modified coverage

### Workflow 2: Claims Evaluation & Management

**Purpose:** Assess claim viability, navigate claims process, and maximize recovery.

**Claims Process:**

**Step 1: Incident Response**
- **Immediate actions:**
  - Ensure safety (people first, property second)
  - Mitigate further damage (duty to mitigate)
  - Document everything (photos, videos, witness statements)
  - Preserve evidence (don't dispose of damaged property until adjuster sees it)
  - Contact authorities if required (police, fire, OSHA)

**Step 2: Policy Review**
- Review policy to determine if incident is covered
- Identify relevant coverage sections
- Note exclusions that might apply
- Check notification deadlines
- Gather policy documents (declarations, policy form, endorsements)

**Step 3: Notification**
- **Report to insurer promptly** (delays can jeopardize coverage)
- Typical methods: Phone, online portal, agent
- Information to provide:
  - Policy number
  - Date, time, location of incident
  - Description of what happened
  - Parties involved
  - Estimated damages
  - Police/incident report number if applicable
- Get claim number and adjuster contact information

**Step 4: Documentation**
- **Property claims:**
  - Photos/videos of damage
  - Receipts or proof of ownership
  - Repair estimates
  - Inventory of damaged items
  - Receipts for temporary repairs or living expenses
- **Liability claims:**
  - Incident description
  - Witness statements
  - Police report
  - Medical records/bills (if injury)
  - Correspondence with claimant
- **Auto claims:**
  - Photos of all vehicles
  - Police report
  - Driver information (all parties)
  - Witness statements
  - Damage estimates

**Step 5: Adjuster Inspection**
- Insurance company will assign adjuster
- Schedule inspection promptly
- Be present during inspection
- Point out all damage (easy to overlook items)
- Ask questions and take notes
- Get adjuster's assessment and timeline

**Step 6: Claim Evaluation**
- Adjuster determines coverage and valuation
- **Actual Cash Value (ACV):** Replacement cost minus depreciation
- **Replacement Cost Value (RCV):** Cost to replace with new
- Recoverable depreciation (if RCV policy): Get ACV first, RCV after repairs complete
- Review adjuster's estimate (get independent estimate if too low)

**Step 7: Negotiation**
- If you disagree with adjuster's assessment:
  - Get second