Complain About an Unfair Insurance Payment or Settlement

Example Letter #1


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


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


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


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.

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