Complain About an Unfair Insurance Payment or Settlement • Letter Templates and Guide

How to write this letter:

1Give all the relevant facts concerning the claim.
2Refer to any documents that will help substantiate your position.
3Include a specific request for action you feel will correct the situation. Explain anything you intend to do to resolve the problem, but to not threaten legal action until negotiation has failed.
4Close the letter with an expression of hope or confidence.

Tips

If you feel that a settlement, proposed or given, is less than you deserve, this letter may be one way to get it changed. Be sure to include documentation that will support your claim. If the company seems unwilling to work with you, or refuses to consider your appeal, you can send the same information in an appeal to the agency that regulates the insurance industry in your state. Remember to communicate facts, not anger or frustration, and don't insult the insurance company. You may handle other complaints to or about an insurance company in the same way.

Example Letter #1

Copied!

I have just received your letter informing me that my insurance policy will not cover my daughter's surgery because you consider the surgery to be "elective" and we did not obtain authorization in advance. It never entered my mind that anyone would consider surgery that would prevent her paralysis and eventual death by suffocation to be "elective." Surely someone made a mistake in writing us this letter, or in defining what is "elective."

I trust you have copies of her medical records in your possession. If not, I will have the neurosurgeon send them to you. I request that you review her case to see that her condition clearly was "life-threatening" and therefore not "elective."

She now has a chance to lead a relatively normal life, for which we are grateful. To say we have no claim to insurance coverage for her surgery is to add severe insult to injury. I am confident that you will agree once you have seen the documentation. I will await your response before taking other action.

Example Letter #2

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After the fire at my Springfield residence, three independent contractors, including your own adjuster, estimated the damages to my home to be about $25,000. Therefore, I am sure you can imagine my dismay when I received your settlement of $14,000 for my losses on policy #5555, which should cover 100% of the damages.

In case this discrepancy is the result of a simple oversight, I am resubmitting copies of the estimates I sent to you a month ago, including your own adjuster's statement of the damage. Please send me the correct amount as soon as possible, so I can complete the repairs. I hope to hear from you soon.

Example Letter #3

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I just received a bill from Springfield Hospital indicating that Doe Insurance paid only $300 of a $1,300 bill, because the charges are larger than the "usual and customary." I called every hospital within a 40-mile radius and found that my bill would have been at least as large at every one of those hospitals. I have enclosed a copy of my original claim, a list of the hospitals I called, and a copy of my most recent bill that reflects your underpayment. Please look at my case again. I am sure that you will agree to pay my entire bill.

Example Letter #4

Copied!

I received your check in the amount of $860 as your settlement for the hail damage to the awning behind my home. Your letter indicated that this was the depreciated value of the five-year-old awning that was destroyed.

I am enclosing a copy of my last premium statement. You will note that I pay a "replacement value" surcharge. I have paid this surcharge for the past ten years, on the understanding that I would be paid replacement, rather than depreciated, value on any claim.

I assume that the incorrect payment was an oversight, and request that you send me a check for the difference as soon as possible. If you feel I am mistaken, or if you need any additional information, please call me at 555-5555.

Write Your Letter Step-by-Step

1

Give all the relevant facts concerning the claim.

Example Sentences

I was quite upset when I received a letter from your claims department informing me that your company would not pay for my wife's ulcer surgery, performed on January 3. According to Ms. Jane Doe, the adjuster who evaluated my claim, the surgery was unnecessary and therefore not covered by our policy. I am writing concerning claim # 123. The amount that your adjusters have set for the damage Hurricane John did to my house is unacceptably low. I cannot possibly repair the damage to my roof and home for the amount your company has offered. Even if I were to do the work myself, the materials alone would cost almost $300 more than your estimate. Enclosed you will find the check you sent me on June 3, for repairs to my car. Based on the three different estimates submitted, your check falls nearly $300 short of the cost of the repairs. Several months ago I submitted a claim for my hospital stay from March 3 through March 7, when I was hospitalized for a severe liver infection. Your company refused to pay for the surgery and hospitalization, claiming that I did not take appropriate steps to prevent the illness. When I discussed the matter with my agent, he avoided any direct answers on how this decision was reached. I have found everyone else in the company equally evasive. I was very surprised to receive notice from your office that my automobile insurance has been cancelled. Surely there must be a mistake. I have had a policy with your company for fifteen years, and have had only one claim to replace a broken windshield. I am a nondrinker and am the only driver of the car. I can hardly be considered a high risk driver.

Example Phrases

according to the adjuster according to the Blue Book am returning your check for am most dissatisfied with amount was far below based on the three different estimates can hardly be considered cannot possible repair the damage for claimed that I did not take appropriate steps to enclosed you will find grossly inaccurate estimate have paid extra for this additional coverage is completely nonfunctional is worth far more than market value is materials alone would cost must surely be a mistake please review the enclosed documents policy states that provided me with an estimate of settlement amount is unacceptably low several quotes from different specifically requested the increased coverage the cost of the repairs will be the car's value is closer to the amount your adjusters have set the cost of materials alone is was not informed that was very surprised to receive would not cover the costs of would not even pay for was shocked to learn your company refused to your proposed settlement is your estimate is too low

2

Refer to any documents that will help substantiate your position.

Example Sentences

Enclosed you will find a copy of a letter from my doctor stating that I was in his office for my regular checkup just two months before the condition became apparent, and that I was asymptomatic at that time. I am including copies of the four estimates I obtained for repairing the damage to my car. Two of the estimates are from shops you recommended. All of the estimates by far exceed the $150 that you sent me. With this letter I am including estimates from three independent contractors. They have inspected the damage to my house, and their estimates vary between $1,500 and $1,750. With this letter you will find a copy of a notice from your regional office, dated May 1, stating that your company will not pay the medical bills for treatment of my liver infection. You will also find copies of letters I sent to that office about this situation, as well as a letter from my doctor stating that the infection was undetectable at my last check up, only one month before my hospitalization. This is the third time I am sending you copies of the receipts you requested to verify my purchase of a home security system.

Example Phrases

a photocopy of all of the estimates am including copies of as you can see from the enclosed at the onset of the problem contract does not state copies of all of the documents which verify copies of the three estimates enclosed you will find evidence demonstrates that for your records had no way of anticipating have fulfilled my obligations have appraised it at much more than have had the damage inspected by have done my share of letter from my doctor stating not an unreasonable request policy states quite clearly that received from the shops you recommended sent copies of these same documents to the notice I received from the receipts you requested their estimates vary between

3

Include a specific request for action you feel will correct the situation. Explain anything you intend to do to resolve the problem, but to not threaten legal action until negotiation has failed.

Example Sentences

I would appreciate it very much if your company would send someone out to look at the damage for themselves. I am confident you will reevaluate the amount of your payment. If you will refer to your own records, you will find that my driving record is virtually spotless. I await your explanation and reconsideration. I trust that the information I have provided will be sufficient to justify payment for my wife's hospital stay. If you continue to ignore my request, I shall pursue legal action. I would like you to arbitrate a settlement between me and the local insurance office in the case of my surgery and hospital stay. I would like your company to take into consideration the estimates I have provided and reevaluate your settlement offer. If you continue to deny the fact that your offer is unacceptably low, I will take my case to the State Insurance Commission. Please consider this evidence before denying my claim. If we cannot reach a reasonable settlement, I will cancel all existing policies and lodge a complaint with the Better Business Bureau. If I do not receive a fair offer from your company within two weeks, I will initiate a suit in small claims court to recover my losses.

Example Phrases

am confident that await your explanation of based on both estimates before denying my claim check your records check the Blue Book value compare your estimate with the other expect adequate compensation for expect you to reevaluate expect full reimbursement of expect to hear from you within fulfill your obligations have no desire to pursue legal action, but if I do not receive if you continue to ignore if you do not respond if we cannot come to some agreement kindly reconsider your leaves me with no alternative to lodge a complaint with look over the information I have provided merits a reevaluation of must demand that you must involve the State Insurance Commission need another opinion offer a reasonable settlement reassess your offer reconsider the amount of your payment reevaluate in the light of request that you request a full investigation into shall pursue legal action should be taken into consideration should justify payment of trust that the information will help you to will simply cancel all my other policies will take my case to would like you to arbitrate a settlement would like your company to would appreciate your cooperation

4

Close the letter with an expression of hope or confidence.

Example Sentences

I trust that your firm will make every effort to settle this issue. Thank you in advance for your consideration. Thank you for your help. I will appreciate your immediate attention to this matter. I hope to hear from you soon. Please contact me as soon as possible. I am sure we can work out a solution that will be mutually agreeable. Thank you for addressing my concerns. Thank you.

Example Phrases

am sure we can work out a fair settlement as soon as possible eager to get on with the repairs eager to settle this issue for your immediate attention to for your cooperation for your assistance for addressing my concerns hope to hear from you soon if you need any further information kindly make every effort to look forward to mutually agreeable solution once the facts are brought to light settle this issue thank you for to meeting your claims adjuster to your expediting payment of this claim trust that this can be cleared up soon trust that once you have will appreciate your immediate attention to with all the facts in hand

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