Dispute Unfair Insurance Claims: Letter Examples & Templates for a Successful Appeal
Letter #1: Unfair Denial of Coverage for Daughter's Surgery
I am disputing your denial of coverage for my daughter's surgery, categorized as "elective." This surgery was necessary to prevent paralysis and potential death. I urge you to review her medical records, which clearly indicate a life-threatening condition. I request a reconsideration of your decision and coverage for the surgery.
Letter #2: Underpayment of Home Insurance Claim
I am requesting a review of my home insurance claim, policy #[policy number]. Three independent contractors, including your adjuster, estimated the damages at $25,000. However, I received a settlement of $14,000. I have resubmitted the estimates and request the correct amount be paid.
Letter #3: Underpayment for Hospital Bill Due to "Usual and Customary" Charges
Doe Insurance underpaid my [hospital name] bill, claiming the charges exceeded "usual and customary" rates. My research indicates otherwise. I have enclosed supporting documents and request you re-evaluate my claim and pay the full bill amount.
Letter #4: Incorrect Payment for Hail Damage Claim Based on Depreciated Value
I received a payment of [amount] for hail damage to my awning, based on depreciated value. However, my policy includes a "replacement value" surcharge, which I have paid for [number] years. I request a revised payment reflecting the replacement value of the awning.
Letter #5: Denied Claim for Car Accident Due to Preexisting Condition
My car accident claim was denied due to a pre-existing condition, despite medical documentation confirming the accident aggravated the condition. I urge you to review the evidence and reconsider your decision. I am entitled to coverage for the medical expenses resulting from the accident.
Letter #6: Delayed Processing of Disability Insurance Claim
My disability claim has been pending for an unreasonable amount of time, causing financial hardship. I have submitted all required documentation and followed up multiple times, but have received no updates. I request an immediate resolution and prompt payment of my benefits.
Letter #7: Denied Life Insurance Claim Due to Misrepresentation Allegations
My life insurance claim was denied based on allegations of misrepresentation on my application. I believe this decision is in error, as I answered all questions truthfully and to the best of my knowledge. I request a review of my case and a reversal of your decision.
Letter #8: Low Settlement Offer for Property Damage Claim
The settlement offer for my property damage claim is significantly lower than the actual cost of repairs. I have obtained multiple estimates from reputable contractors, which support my claim. I request a fair and reasonable settlement that reflects the true cost of restoring my property.
Letter #9: Denial of Coverage for Medical Procedure Due to Lack of Pre-authorization
My claim for a medically necessary procedure was denied due to lack of pre-authorization. However, my doctor explained that the urgency of the situation did not allow for pre-authorization. I request an exception and coverage for this essential procedure.
Letter #10: Unfair Denial of Business Interruption Insurance Claim
My business interruption insurance claim was denied despite the forced closure of my business due to [reason]. The policy clearly covers such situations, and I have provided ample documentation to support my claim. I request a thorough review and reversal of your decision.
Expert Tips
- Clearly state the reason for your dispute, including policy details and claim numbers.
- Provide evidence to support your claim, such as medical records, repair estimates, or police reports.
- Cite relevant policy terms or legal provisions if applicable.
- Request a specific resolution, such as reconsideration of the decision, increased payment, or coverage approval.
- Maintain a professional and assertive tone throughout the letter.
Write Unique and Personalized Letters: A Step-by-Step Guide
Follow these simple steps to write your own complaint letter effectively:
Sample 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.
Key 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
Sample 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.
Key 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
Sample 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.
Key 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
Sample 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.
Key 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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