To make this letter as effective as possible, please consider these points first:
- Gather Your Documents: Collect all relevant paperwork. This includes your policy declarations page, the denial letter (if you received one), any photos or repair estimates, and a log of every call you’ve made to the company (date, time, person’s name, and what was discussed).
- Choose Your Path: The template has two main sections in the middle. You will choose the one that fits your situation—either the section for a Claim Denial or the one for an Unreasonable Delay. You will delete the one you don’t need.
- Fill in the Blanks: Carefully replace all the bracketed information [like this] with your specific details.
- Keep it Professional: The letter is designed to be firm and professional, not emotional. Stick to the facts. This approach is much more effective.
- Send it Certified Mail: This is the most critical step! Send the letter via USPS Certified Mail with a Return Receipt. This costs a few extra dollars but gives you legal proof that the insurance company received your letter and on what date. This is invaluable if you need to escalate the issue later.
- Keep a Copy: Make a complete copy of the signed letter and all the documents you send for your own records.
Template Letter to Insurance Company
[Your Name] [Your Street Address] [Your City, State, Zip Code] [Your Phone Number] [Your Email Address]
[Date]
[Claims Adjuster’s Name, if known] [Insurance Company Name] [Claims Department Address] [City, State, Zip Code]
Subject: Formal Request for Re-evaluation of Claim Number: [Your Claim Number] | Policy Number: [Your Policy Number]
Dear [Mr./Ms./Mx. Last Name of Adjuster or “Claims Department”],
I am writing to you today regarding the insurance claim I filed under my [Type of Policy, e.g., Homeowners, Auto] policy, number [Your Policy Number], for a loss that occurred on [Date of Loss].
The purpose of this letter is to formally request a comprehensive re-evaluation of your company’s position on this matter and to express my concerns regarding the handling of my claim thus far.
(Choose the section below that applies to your situation and delete the other one)
[SECTION FOR A CLAIM DENIAL]
On [Date you received denial], I received a letter from you stating that my claim has been denied. The reason cited for this denial was [Quote the specific reason for denial from their letter, e.g., “that the damage was caused by flooding, which is not a covered peril.”]
I believe this denial is incorrect and is not consistent with the terms of my policy. I would like to draw your attention to [Mention a specific section of your policy if you know it, or a specific piece of evidence, e.g., “the enclosed report from engineer John Smith, which states the damage was caused by a burst pipe, a covered event,” or “the language on page 12, section B of my policy which appears to cover this situation.”]
To resolve this, I formally request that you provide me with the following within 30 days:
- A complete copy of the specific policy language, including all relevant clauses and exclusions, that your company is using to justify this denial.
- A detailed explanation of how that language applies to the specific facts of my claim.
- A re-evaluation of my claim in light of the enclosed documents: [List the new documents you are providing, e.g., “the independent contractor’s report,” “additional photographs of the damage,” etc.].
[SECTION FOR UNREASONABLE DELAY]
My claim was filed on [Date you filed claim], and it has now been [Number of days/weeks/months] without a resolution. The progress on my claim has been unacceptably slow, and communication from your office has been minimal.
I have made several attempts to get a status update. My records show I contacted your office on the following dates: [List dates of calls or emails, e.g., October 5, October 15, October 28]. Despite these attempts, I have not received a clear explanation for the delay or a timeline for when my claim will be resolved.
Under the terms of my policy and state regulations, I am entitled to a prompt and fair settlement of my claim. This extended delay has caused significant hardship for my family.
I formally request a complete written update on the status of my claim within 15 business days of your receipt of this letter. This update should include a detailed explanation for the delay, the name of the supervisor managing my case, and a definitive timeline for when I can expect a decision.
(The rest of the letter applies to both situations)
I have enclosed copies of the following documents to support my claim and this request:
- [List all documents you are including, e.g., The original claim form]
- [e.g., Photos of the damage]
- [e.g., Repair estimates from licensed contractors]
- [e.g., The denial letter dated XX/XX/XXXX]
I trust that we can resolve this matter amicably and promptly. I have been a loyal policyholder with your company for [Number] years and expect to be treated fairly and in accordance with the terms of my policy.
If I do not receive a substantive response within the timeframe requested above, I will be left with no alternative but to escalate this matter by filing a formal complaint with the [Your State’s Name] Department of Insurance.
I look forward to your prompt reply.
Sincerely,
(Your Signature)
[Your Printed Name]
Enclosures: [List the number of documents enclosed, e.g., (4)]
What to Expect After You Send the Letter
- The insurance company will likely assign your file to a different adjuster or a supervisor for review.
- The 15 or 30-day deadline you set creates a sense of urgency and a clear timeline for you to follow up on.
- If they call you, be polite, take detailed notes, and then follow up with a brief email summarizing what was discussed to maintain a paper trail.
