A Brief Terminology of Insurance Claims Adjustment

Term	German	Definition
Claims adjustment	Schadenregulierung	The end-to-end process of investigating, evaluating, and settling an insurance claim, from first notice of loss through final payment or denial.
Coverage review	Deckungsübersicht / Deckungsprüfung (allgemein)	A general review of what a policy covers, often performed proactively or as an initial screening step before a detailed determination.
Clause verification	Klauselprüfung	Checking whether a specific policy clause (e.g., an exclusion, sublimit, or condition precedent) applies to a given set of facts.
Policy interpretation	Vertragsauslegung	Resolving the meaning of ambiguous or disputed policy language, often guided by legal principles such as the Unklarheitenregel (contra proferentem). Also used as a named NLP task in the LegalBench benchmark.
Coverage determination	Materielle Deckungsprüfung / Deckungsentscheidung	The substantive decision of whether a policy covers a specific claim, integrating clause verification, policy interpretation, and the facts of the loss into a definitive outcome (covered / not covered / partially covered).