Coverage question reply prompt: free ChatGPT template
Updated · By Robert Breen
Use this when a client writes "is this covered?" about something that just happened: water in the basement, a cracked windshield, a stolen trailer. The honest answer from an agency is rarely yes or no. It's what the policy shows, who decides, and what to do next. This prompt builds that answer from facts you supply, so the reply is useful today without making a coverage decision only the insurance company can make.
Have a professional review it. This prompt helps you draft, not decide coverage. Only the policy, the carrier and a licensed agent can confirm coverage, payments or rates, so have a licensed professional review the reply before it goes out.
The prompt
Copy it into ChatGPT (or Claude, Gemini or Copilot) and replace every [BLANK] with your own details. It uses the four parts from Prompt Writing 101: Role, Context, Task and Format.
Role: You are [AGENT] at [AGENCY], an independent insurance agency, answering a client who asks if a loss is covered. Context: What the client's policy documents show: [POLICY FACTS]. Agency rules and next steps: [AGENCY RULES]. Only the insurance company decides coverage, after a claim is reported and reviewed. Never write that something is or isn't covered, and never estimate a payment. Task: Reply: acknowledge what happened, explain what their policy lists that relates to it (limits and deductibles exactly as given), say the insurance company makes the coverage decision, and give the next step from our rules. Format: Under 180 words, calm and kind, no subject line. Answer the coverage question honestly in the first two sentences: what the policy shows and who decides. Sign as [AGENT]. Here is the client's email: [CLIENT EMAIL]
Fill in the blanks
[AGENT]- Your name as the client knows you.
[AGENCY]- Your agency's name.
[POLICY FACTS]- What the declarations page and forms list that relates to this loss: the coverage or endorsement name, limit and deductible, quoted exactly. Write "Nothing listed" if you found nothing.
[AGENCY RULES]- How claims get reported (you do it, or the client calls the carrier), plus your standard guidance, such as taking photos before cleanup.
[CLIENT EMAIL]- The client's message, with policy numbers and personal details removed.
Example, filled in
A made-up example from the free lesson Reply Faster to Claim-Status Emails: ChatGPT for Independent Insurance Agencies. Stonebridge Insurance Agency is the made-up agency in the insurance Reply Faster lesson. A different client, Ellen, emails after her sump pump fails in a storm.
Role: You are Tom at Stonebridge Insurance Agency, an independent insurance agency, answering a client who asks if a loss is covered. Context: What the client's policy documents show: Harbor Mutual homeowners policy; the declarations page lists a water backup and sump discharge endorsement, $10,000 limit; all-perils deductible $1,000. Agency rules and next steps: we can report the claim today, or she can call Harbor Mutual's claim line. Our standard guidance: photos and video before cleanup, keep damaged items until the adjuster says otherwise, keep cleanup receipts. Whether to hire a cleanup company before the adjuster visits is the adjuster's call; we'll ask when we report it. Only the insurance company decides coverage, after a claim is reported and reviewed. Never write that something is or isn't covered, and never estimate a payment. Task: Reply: acknowledge what happened, explain what their policy lists that relates to it (limits and deductibles exactly as given), say the insurance company makes the coverage decision, and give the next step from our rules. Format: Under 180 words, calm and kind, no subject line. Answer the coverage question honestly in the first two sentences: what the policy shows and who decides. Sign as Tom. Here is the client's email: Hi Tom, our sump pump died in Tuesday's storm and there's two inches of water in the finished basement. Carpet and a couch are soaked. Am I covered? Should I call a cleanup company now or wait? Ellen
What a good answer looks like
- An honest direct answer up top: "Your policy lists a water backup endorsement with a $10,000 limit; Harbor Mutual decides whether this loss is covered once it's reported."
- Limit and deductible quoted exactly, with no math about what she'd get.
- A next step with a time: Tom reports it today, or Ellen calls the claim line.
- The cleanup question routed to the adjuster, as your rules say, instead of answered by the AI.
How to check it before you use it
An AI draft can sound right and still say something you never told it. Use the habit from the Reply Faster lesson: check every promise, name, date and number against what you gave it before anything goes out.
- Check every promise: ask for a table of each claim and the policy fact or rule behind it. Any sentence that implies a coverage decision fails.
- Search for "covered," "you're protected," "should be paid," "no problem." Rewrite each as what the policy lists and who decides.
- Confirm the endorsement name, limit and deductible against the actual declarations page and forms.
- If the email mentions an injury or someone blaming the client, stop and handle it personally.
Why this prompt works
Left alone, a model answers "am I covered?" with a cheerful yes because that's what the client hopes to hear. The Format line forces the honest answer into the first two sentences, and the Context names the one sentence the model may never write. That's a guardrail stated in plain words.
Practice it in the free lesson
Reply Faster to Claim-Status Emails: ChatGPT for Independent Insurance Agencies: A client with an open auto claim wants a payment date, a rental and a promise about her rate. Give ChatGPT the thread and your agency's facts, catch what it shouldn't promise, and send an honest reply from Gmail. You do every step yourself in a practice copy of ChatGPT, and nothing touches your real accounts.
Also useful: Reply Faster: Turn a Messy Customer Email Thread into a Clear, Friendly Reply
Terms used here
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Frequently asked questions
- Why not say it's covered when it obviously is?
- Because the carrier decides after it reviews the claim, and conditions or exclusions can apply that aren't on the declarations page. A written "you're covered" that turns out wrong can become an errors and omissions problem for the agency.