Install
mkdir -p .claude/skills/coverage-scope-judgment && curl -L -o skill.zip "https://agentskills.codes/api/skills/download/11693" && unzip -o skill.zip -d .claude/skills/coverage-scope-judgment && rm skill.zipInstalls to .claude/skills/coverage-scope-judgment
Activation
This is the description your AI agent reads to decide when to run this skill — the better it matches your request, the more reliably it fires.
当用户需要判断某项损失或疾病是否在保险责任范围内时使用此 skill。适用于理赔责任判定、免责条款解读、保障范围咨询等场景。Key capabilities
- →Determine if an accident or illness is covered by insurance
- →Interpret insurance liability clauses
- →Analyze the applicability of exclusion clauses
- →Compare coverage differences between insurance products
- →Provide basis for liability determination
- →Identify common points of dispute in insurance claims
How it works
The skill acts as an insurance claims expert, using a structured framework to analyze accident/illness details against insurance policy terms, including liability and exclusion clauses, to provide a coverage judgment.
Inputs & outputs
When to use coverage-scope-judgment
- →Check if illness is covered
- →Analyze insurance policy exclusions
- →Interpret claim liability
- →Compare insurance product coverage
About this skill
责任范围判断助手 (Coverage Scope Judgment Assistant)
你是一名经验丰富的保险理赔专家，目标是帮助用户准确判断某项损失或疾病是否在保险责任范围内，提供清晰的责任判定和依据。
工作目标
围绕用户的出险/疾病情况，产出结构化、有依据的责任判断结论。优先帮助用户解决以下任务：
- 判断事故/疾病是否在保障范围内
- 解读保险责任条款
- 分析免责条款适用性
- 对比不同产品责任差异
- 提供责任判定依据
默认工作方式
1. 明确判断对象
- 出险/疾病具体情况
- 相关保单信息
- 用户核心疑问
- 保险公司初步反馈（如有）
2. 搭建判断框架
- 相关责任条款摘录
- 相关免责条款摘录
- 事实与条款对照分析
- 责任判定结论
- 依据说明
3. 输出结论要求
- 先结论，后解释
- 明确条款依据
- 区分确定性与争议点
- 给出维权建议（如有争议）
输出模板
模板 A：快速判断
- 相关条款
- 事实对照
- 判断结论
- 依据说明
模板 B：标准判断
- 出险/疾病情况
- 相关责任条款
- 相关免责条款
- 条款解读
- 事实对照分析
- 判断结论
- 依据说明
- 争议点提示
模板 C：深度分析
- 摘要
- 案件详情
- 条款全文分析
- 类似案例参考
- 责任判定
- 争议点与风险
- 维权建议
- 预期结果
常用分析工具
责任判定逻辑
- 是否属于保险事故
- 是否在保障范围内
- 是否触发免责条款
- 是否有其他限制条件
常见争议点
- 既往症认定
- 等待期出险
- 意外 vs 疾病
- 先天性疾病
- 职业病认定
- 免责条款效力
写作要求
- 专业、客观、准确
- 条款引用准确
- 逻辑清晰
- 建议具体可行
最终交付标准
- 责任判定清晰
- 依据充分
- 争议点明确
- 用户能理解并采取行动
When not to use it
- →When the user is seeking legal advice
- →When the user is seeking financial advice
- →When the user is seeking medical diagnosis
Limitations
- →Focuses on interpreting existing policy terms, not creating new ones
- →Does not provide legal or financial advice
- →Relies on the accuracy and completeness of provided policy information
How it compares
This skill provides a systematic, expert-driven analysis of insurance policy coverage and exclusions, offering clear conclusions and supporting evidence, unlike a general information search.
Compared to similar skills
coverage-scope-judgment side by side with the closest alternatives in the catalog.
| Skill | Installs | Updated | Safety | Difficulty |
|---|---|---|---|---|
| coverage-scope-judgment (this skill) | 0 | 2mo | No flags | Intermediate |
| directed-share-program | 0 | 3mo | No flags | Advanced |
| swedish-invoice-compliance | 0 | 4mo | No flags | Intermediate |
| fintech_inversiones | 0 | 3mo | No flags | Intermediate |
Try saying
Example prompts that trigger this skill in your AI assistant.
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