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Insurance Letter Response Tool
Procedural tool for preparing structured responses to insurance letters. Not a chatbot. Not a negotiation tool. Not legal advice.
Tool will refuse to generate output for fraud investigations, EUO requests, reservation of rights, or attorney involvement.
What is the Insurance Letter Response Tool?
This is a procedural, risk-aware tool that prepares structured correspondence outlines in response to insurance carrier letters. It is NOT a chatbot, NOT a negotiation tool, and NOT a legal advisor.
The tool uses fixed playbooks with predetermined sections and strict line limits. It classifies your letter, detects the phase, evaluates risk, and either prepares a procedural outline or refuses output with explanation.
How This Tool is Different
NOT a Chatbot
Does not accept free-form narratives or "tell your story" inputs. Uses structured classification only.
NOT a Negotiation Tool
Does not argue, persuade, or advocate. Prepares factual, procedural correspondence only.
NOT Legal Advice
Does not interpret policy language or provide coverage advice. Procedural outlines only.
NOT Always Available
Intentionally refuses output in dangerous scenarios requiring professional representation.
Tool Characteristics
🔒
Risk-Aware
Evaluates every letter for dangerous scenarios. Refuses output when attorney required.
📋
Scope-Limited
Fixed playbooks with 20-30 line maximum. No free-form generation.
⚙️
Procedural
Deterministic, structured outlines. No negotiation, no persuasion, no strategy.
🎯
Classification-Based
Requires structured input. Classifies claim type, party type, and letter phase.
How the Tool Works
1
Upload & Classify
Upload letter and provide structured classification (claim type, party type, context, amount).
2
Phase Detection
Tool scans letter text for phase patterns (denial, information request, EUO, fraud, etc.).
3
Risk Evaluation
Tool applies hard-stop guardrails. Checks for fraud, EUO, attorney involvement, etc.
✓
Generate Outline (if safe)
If no hard stops triggered, tool prepares procedural correspondence outline.
⛔
Refuse (if dangerous)
If hard stop triggered, tool refuses output and explains why attorney required.
⚠️ Important: This tool does NOT accept free-form narratives. Do not "tell your story" or provide explanations. Structured classification only.
When the Tool Will Refuse Output
⛔ HARD STOP CONDITIONS
- Fraud investigations – Any mention of fraud, misrepresentation, or false statements
- Examination Under Oath (EUO) – EUO requests require attorney representation
- Recorded statement requests – Recorded statements can be used against you
- Reservation of rights letters – Coverage is being questioned
- Attorney involvement – Any mention of attorneys, legal counsel, or litigation
- Bad faith allegations – Complex legal issues requiring attorney expertise
- Commercial claims over $25,000 – High-value commercial claims require professional representation
- Personal claims over $50,000 – High-value claims should be reviewed by attorney
- Unknown phase – If tool cannot determine letter type, manual review required
When a hard stop is triggered, tool will explain why it cannot assist and recommend professional representation. This is intentional.
Insurance Letter Response Tool vs. Alternatives
| ChatGPT / AI Chatbots | Attorney | This Tool | |
|---|---|---|---|
| Risk Guardrails | None | Professional judgment | Hard stops enforced |
| Output Type | Free-form generation | Custom legal strategy | Fixed playbooks only |
| Scope | Unlimited | Full representation | Procedural only |
| Cost | $0-$20/month | $1,000+ or 10-20% of payout | $19 one-time |
Use the Insurance Letter Response Tool
Upload your insurance letter to receive procedural correspondence preparation. Tool may refuse output if attorney representation required.
Upload Insurer Letter