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

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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

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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

2

Refer to any documents that will help substantiate your position.

Example Sentences

Example Phrases

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

Example Phrases