Tutorial for “Complain About an Unfair Insurance Payment or Settlement”

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.

Steps

1. Give all the relevant facts concerning the claim.

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.

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.

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.

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.

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.

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.

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.

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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