pf-claims-summary v1.1

AI-assisted claims document generator with deep domain knowledge for independent adjusters and small TPAs. Turn adjuster field notes into professional claims narratives, reserve memos, status reports, diary entries, and subrogation checklists compliant with NAIC Model #900 and state prompt payment laws — in minutes, included with your subscription.

Alternative to: Guidewire ClaimCenter ($50,000+/yr), Duck Creek Claims ($30,000+/yr), Snapsheet ($12,000+/yr)

Installation

Download the pf-claims-summary.plugin file
Open Claude Desktop and navigate to Settings > Plugins
Click Install Plugin and select the downloaded .plugin file
The plugin will be installed and available immediately

Note: All data stays local on your machine. No external API calls or cloud storage required.

Commands

/claims:claims-check — name: claims-check
/claims:claims-diary — name: claims-diary
/claims:claims-intake — name: claims-intake
/claims:claims-narrative — name: claims-narrative
/claims:claims-pipeline — name: claims-pipeline
/claims:claims-reserve — name: claims-reserve
/claims:claims-setup — name: claims-setup
/claims:claims-status — name: claims-status
/claims:claims-subrogation — name: claims-subrogation

Important: All documents generated by this plugin are drafts intended as starting points. Insurance documents, analyses, and recommendations must be reviewed by a licensed insurance professional before use with clients or carriers. This plugin does not provide insurance advice.

What It Does

Command	Output	Description
`/claims:claims-setup`	`.claims/config.json`	Initialize workspace and adjuster settings
`/claims:claims-intake [claim-id]`	`processing/claim-{id}.json`	Parse adjuster notes into structured claim data per NAIC Model #900 §4
`/claims:claims-narrative [claim-id]`	`outbound/narrative-{id}.docx`	Professional claims narrative with 5 sections, NAIC Model #900 compliance
`/claims:claims-reserve [claim-id]`	`outbound/reserve-memo-{id}.docx`	Reserve recommendation memo with SSAP No. 55 & ASOP No. 43 methodology
`/claims:claims-status [claim-id]`	`outbound/status-{id}.docx`	Status report with state prompt payment law deadline tracking
`/claims:claims-diary [claim-id]`	`outbound/diary-{id}-{date}.docx`	Diary entry with regulatory deadline tracking and NAIC investigation milestones
`/claims:claims-subrogation [claim-id]`	`outbound/subrogation-{id}.docx`	Subrogation checklist with Made Whole Doctrine and state lien statute guidance
`/claims:claims-pipeline [claim-id]`	All 5 docs	Full pipeline: intake → all documents
`/claims:claims-check [claim-id]`	Status display	Check which pipeline stages are complete

Quick Start

Set up your workspace (run once):
```
/claims:claims-setup
```
Follow the prompts to enter your name, carrier, and working directory.
Enter a claim (conversational or from notes file):
```
/claims:claims-intake CLM-2026-0042
```
Generate all documents:
```
/claims:claims-pipeline CLM-2026-0042
```

Or generate individual documents:

/claims:claims-narrative CLM-2026-0042
/claims:claims-reserve CLM-2026-0042
/claims:claims-status CLM-2026-0042
/claims:claims-subrogation CLM-2026-0042

Workspace Structure

After setup, your working directory will contain:

inbound/          Drop adjuster notes here (TXT, DOCX, PDF)
processing/       Structured claim JSON files (auto-created)
outbound/         Generated DOCX documents (your deliverables)
archive/          Archived/versioned claim files
.claims/
  config.json     Adjuster settings and disclaimer text
  logs/           Per-claim processing logs

Supported Coverage Types

Bodily Injury
Property Damage
Collision
Comprehensive
Med Pay
UM/UIM (Uninsured/Underinsured Motorist)
GL (General Liability)
Workers Comp

AI-Powered Features

Claim Intake with Regulatory Compliance: Converts adjuster notes into structured JSON per NAIC Model #900 §4(a) prompt investigation requirement, with Colossus/Mitchell BI severity classification and NICB fraud indicator awareness
Reserve Estimation per SSAP No. 55 & ASOP No. 43: Generates preliminary reserve estimates using case reserve methodology, Loss Development Factors (LDF), and industry benchmarks (Colossus/Mitchell, ISO CP 00 10, state WC fee schedules)
Claims Narrative with Professional Standards: Synthesizes claim data into professional DOCX narratives following AIC/CPCU standards with coverage summary, loss facts, liability assessment per comparative negligence law, investigation status per NAIC timeline, and next steps per professional practice
Investigation Milestone Tracking with State Timelines: Tracks NAIC Model #900 milestones and state-specific prompt payment law deadlines (CA 40 days, TX 60 days, FL 90 days per first notice)
Subrogation Analysis with Legal Framework: Identifies third-party recovery opportunities per Made Whole Doctrine, anti-subrogation rules, state WC lien statutes (NY WCL §29, CA Labor Code §3852), comparative negligence impact, and AFI arbitration procedures
Regulatory Diary Entries with Deadline Tracking: Generates diary entries documenting NAIC Model #900 compliance against state-specific prompt payment law timelines, with automatic deadline status reporting
Coverage-Specific Guidance: Applies NAIC Model #900, state UCPA variations, ACORD form compliance, ISO policy forms, IICRC standards, and professional adjuster best practices per coverage type (Auto, Property, GL, Workers Comp)

Estimated Cost per Use

Disclaimer: Token estimates are approximate and based on typical usage patterns measured from skill prompt sizes. Actual costs vary with input data size, conversation length, and complexity. Estimates use Claude Sonnet 4.6 pricing ($3/1M input, $15/1M output). Cowork and Claude Desktop subscription users (Pro/Max/Team) are not charged per-token — these estimates apply only to direct Anthropic API usage. Running stages individually in fresh sessions uses fewer input tokens than running the full pipeline sequentially, because pipeline mode accumulates conversation history across stages.

Per skill (run individually in a fresh session):

Stage	Skill Prompt	User Input	Total Input	Output	Est. Cost
claims-intake	~5.0K	~800	~8.6K	~5.0K	~$0.10
claims-reserve	~5.4K	~800	~8.9K	~5.4K	~$0.11
claims-diary	~4.9K	~800	~8.4K	~4.9K	~$0.10
claims-narrative	~4.9K	~800	~8.4K	~4.9K	~$0.10
claims-subrogation	~5.8K	~800	~9.4K	~5.8K	~$0.12
Standalone total			~43.7K	~26.0K	~$0.52

Full pipeline (all stages in one session — context accumulates):

Stage	Base Input	+ History	Total Input	Output	Est. Cost
claims-intake	~8.7K	0	~8.7K	~5.0K	~$0.10
claims-reserve	~9.1K	~5.8K	~14.9K	~5.4K	~$0.13
claims-diary	~8.5K	~12.0K	~20.6K	~4.9K	~$0.13
claims-narrative	~8.6K	~17.7K	~26.3K	~4.9K	~$0.15
claims-subrogation	~9.5K	~23.4K	~32.9K	~5.8K	~$0.19
Pipeline total			~103.3K	~26.0K	~$0.70

Running the full pipeline once typically costs $0.49–$0.91 in API tokens (Claude Sonnet 4.6).

Known Limitations

No real-time claims system integration: Documents generated here are standalone DOCX files — they are not automatically synced to Guidewire, Duck Creek, or any other claims management system. Manual entry into your CMS is required.
No persistent database: Claim data is stored as local JSON files in processing/. If the workspace folder is deleted or moved, claim data is lost. Back up your workspace regularly.
No multi-user collaboration: This plugin works for a single adjuster in a single workspace. It does not support shared team access, concurrent editing, or user role management.
Reserve amounts are AI estimates: All reserve figures generated by /claims:claims-reserve are preliminary estimates requiring supervisor review and approval before booking. They are not actuarially determined.
No e-signatures: The supervisor approval block in reserve memos provides a signature line but does not support digital/electronic signature capture.
No persistent scheduling or diary: Projected close dates and outstanding item due dates are recorded in status reports but are not tracked in any scheduling system. Manual follow-up required.
PDF and DOCX notes extraction: Notes files in DOCX format are parsed using python-docx (which captures table cells). PDF files should be converted to TXT for best results. Scanned/image PDFs are not supported.

Dependencies

python3 (3.8+): System dependency
python-docx (0.8.11+): Installed automatically by claims-setup

Version History

See CHANGELOG.md for version history.

Support

Generated by Plugin Factory v0.7.3. This plugin is for use with Claude Cowork mode.

Important Disclaimers

AI-Generated Content: This plugin uses AI (LLM) technology which can produce inaccurate or incomplete outputs. All content should be treated as a starting point and reviewed for accuracy before use.
Not Professional Advice: Outputs do not constitute legal, financial, tax, medical, or other professional advice. Consult qualified professionals before making decisions based on generated content.
No Compliance Guarantee: References to industry standards, regulations, or guidelines are for informational purposes only. This plugin does not guarantee compliance with any law or regulation. Users are responsible for verifying all outputs meet their specific regulatory requirements.
No Endorsement or Affiliation: Mention of third-party products, standards, or organizations does not imply endorsement, partnership, or certification by those entities.
Not Medical or Health Advice: Health and medical-related outputs are not a substitute for professional medical advice, diagnosis, or treatment. Always consult a licensed healthcare provider for health-related decisions.

Claims Summary