Insurance claim letters: how does it work?

It often happens that your insurer refuses compensation or delays in granting it to you. It is not necessarily a question of ill will on his part, it may simply be a question, for example, of a misunderstanding of the incident or of an error. Find out examples insurance claim letters!

The complaint letter intervenes in this situation to ask the insurer to review its position in the light of the elements that you bring in the mail. It also helps to formalize your disagreement.

Before writing your letter, check your contract (general conditions and special conditions) carefully to make sure that the insured’s refusal is unfounded and that you are not a case of exclusion. The insurance relationship is subject to the principles of contract law and insurance law.

In the letter, you must prove that you have respected the procedure, the deadlines for declaring a claim and in particular that the damage is not intentional (case of exclusion).

Send your mail by registered mail with acknowledgment of receipt. This will serve as proof in the event of a dispute with the insurer. The statute of limitations is 2 years so don’t delay too long.

What should you do if the insurer doesn’t want to pay your claim?

If after you send an email and an official registered letter (with a receipt), but there is no reply from the insurance company, then you can do this via:

Use legal advise to solve these problems

One thing you can do is file a civil lawsuit against the insurance company. However, before filing a civil suit, you must first file a summons. If the subpoena is ignored by the insurance, then you can file a lawsuit at the District Court. However, some of you may be lazy to send subpoenas, are involved in suing, let alone go back and forth to the District Court, then you can contact your lawyer.

Use insurance arbitration or mediator to hear your case

Arbitration is an alternative to going to court over a business dispute. Instead, a neutral third party is recruited to settle the dispute. When it comes to arbitration, you have many choices.  When it comes to insurance disputes, arbitration can be disadvantageous for policyholders. Too often, the process is skewed in favor of the insurance company. Increasingly, insurance policy arbitration provisions contain language not only limiting a policyholder’s rights, but also eviscerating established legal protections, both statutory and under common law.

File a complaint about your insurance company

Contact your insurance agent.
Appeal to an executive at the insurance company.
Ask a third party such as an ombudsman to mediate your dispute.
File a complaint with the state department of insurance, which regulates insurance activity and insurer compliance with state laws and regulations.
Seek arbitration if that is an option in your policy.
File a legal claim against the insurer in court.

Example Insurance Claim Letters

This inscurance claim letter can be adapted for all types of contract: auto insurance, home insurance, multi-risk pro etc.

Letter to complain about Insurer’s Rejection or Delay of Claim

Last name First Name
Address
City, Postal Code
Tel. No.
Company name of the insurer or manager
Address
Done at (City) on (Date).

Registered letter with acknowledgment of receipt

Subject: Complaint (indicate here the subject of your complaint and the nature of the contract concerned)

Dear,

The purpose of this letter is to request full reimbursement. Following the claim number (indicate the claim number), I have taken note of your decision informing me of your refusal to compensate me.

Insured under contract no. (Indicate your contract number), and in accordance with the special conditions of my contract, I should nevertheless benefit from your part of the damages. Consequently, I ask you to modify your decision, and to proceed to the compensation which is due to me, and this within a reasonable time.

I remain at your disposal to provide you with any element you deem necessary.

Thank you for your kind attention and looking forward to hearing from you soon.

Signature

Example health insurance claim letter 

From:
Patient name
Patien Address
Patient DOB: XX-XX-XXXX
Policy Number: XXXXXXXXXX

To:
Blue Health Insurance Inc.
42 Broadway #12
New York, NY 123123

New York, April 10, 2021

To whom it may concern,

I am writing to request reimbursement for covered services I received through ABC Private Clinic LLC, which operates as a cash-only practice.

The services of ABC Private Clinic LLC are very cost effective. In New York, a hospital birth with no interventions costs approximately $ 14,000 to $18,000. The cost of my homebirth was much less, and the care I received was much more time intensive and thorough.

Please also bear in mind that my labor included the complication of premature rupture of membranes (PROM) at X:XX PM on DAY, DATE. Our baby was born at X:XX PM on DAY, DATE – nearly 45 hours later. Management of PROM often includes admission to hospital with increased duration of stay, administration of antibiotics, induction of labor, and cesarean section at 24 hours after rupture. This would most likely create expenses exceeding $35,000. However, due to the evidence based care and careful management of Believe Midwifery Services, I was able to remain at home and safely deliver our baby, infection free, nearly 45 hours after rupture, for 1/6 of the cost.

I am seeking reimbursement for my out of pocket maternity expenses totaling $5903.00.

I am enclosing the invoice from BABC Private Clinic LLC as well as a claim outlining services we received.

Thank you in advance for your cooperation. I’d be happy to answer any further questions and can be reached at: (XXX) XXX-XXXX

Sincerely,

Your Name

enclosures: ABC Private Clinic LLC Invoice, Claim outline

Personal Property Claim Settlement Letter

(Date)

(Name of adjuster or highest ranking ins. co. employee)
(Name of insurance co.)
(Address)

Re: Claim Number: ____________
Date of Loss: ____________
Name of Insured:_______________________
Address of Insured Property:_________________________________

Dear _____________,

The purpose of this letter is to request full reimbursement for my family’s personal property that was destroyed (date of loss). The total value of the items that were deemed a total loss is $ ———–. As you know, we have answered every request for information from (insurance company). We have made the property available for inspection multiple times and cooperated fully in providing documentation of our losses.

We understand that (name of insurance company)’s policy is to hold back full payment until after we replace each item and submit receipts. We have every intention of replacing all the items in our home to restore it as it was prior to (date of loss). Our personal belongings were in (very good to excellent) condition at the time of the loss, and we have pictures to prove that (insurance company) has applied excessive depreciation in calculating the actual cash value of our property.

We are anxious to put this painful experience behind us, get back into our home and restore our household. Having to continually submit receipts to your company and wait for full reimbursement for every purchase we make over the next year seems unfairly time-consuming and emotionally painful.

We are asking (insurance company) to make a fair settlement offer on our personal property claim in the amount of the reasonable replacement value of our complete inventory list, less what we’ve already received. Please give this request full consideration and respond no later than (proposed date).

I look forward to (insurance company)’s timely response. Thank you for your anticipated cooperation in this matter.

Sincerely,

Your Name
Mailing Address

Insurance claim letters

[Senders Name]
[Address line]
[State, ZIP Code]
[Letter Date]
[Recipients Name]
[Address line]
[State, ZIP Code]
[Subject: Normally bold, summarizes the intention of the letter] -Optional-

Dear [Recipients Name],

I am writing to file a claim on the car insurance I have with you, as I need it to cover the costs of the repair of my Chevrolet Volt which was damaged during the last hurricane.

Throughout the duration of the storm, I parked my car in the garage of my house to protect it from all the natural elements, however, because of the intensity of the wind and rain; the roof of my garage was blown off. Subsequently, tree branches and other storm debris caused significant damage to the exterior of the car.

I have attached the repair estimates made by three different car companies. The highest estimate is priced at $5,480 while the lowest is at $4,295. All details are included.

I would like to thank you in advance for your prompt assistance regarding this matter. I would like to have the repairs done as soon as possible and would greatly appreciate your cooperation. Thank you very much.

Sincerely,

[Senders Name]
[Senders Title] -Optional-

[Enclosures: number] – Optional –
cc: [Name of copy recipient] – Optional –