Insurance claim rejected? Well I hope you didn’t fail composition in school, because now you’ll need to file an appeal. And since the average insurer has less empathy than bacteria, you’d better have Martin-Luther-King-Levels of persuasiveness. Insurers are experts at poking holes in arguments, especially written ones. So before your fire off that e-mail or letter, check out the pointers in this article:
1. Get Straight to the Point
The opening paragraph should not be a rant on how enraged you are, why you’re disappointed, how accurate you are with a sniper rifle, etc. There’s room for that, but it’s at the closing of the appeal.
The opening needs to be instantly relevant, because that’s when you have the insurer’s full attention. And you want to include the following straight away:
- A short sentence about your claim and why it was rejected
- A summary (maybe like this set of bullet points) on why you are appealing
- What you expect the insurance company to do (e.g. full pay out? Partial? Send you an apology? etc.)
Ideally, you all that in a single opening paragraph, in 100 words or less. Especially verbose (wordy) letters cause readers to start “skimming”. When your insurer does that, they might miss details.
2. Get Supporting Documents
Don’t just write “according to my doctor / dentist / mechanic…” If you have a supporting statement from a professional, get it directly from them and include it in your appeal.
Most doctors only charge a small fee to write a supporting statement, and some family doctors don’t charge at all. If possible, get a referral (and subsequently a letter) from a specialist. This is typically used for late injury claims. Say, for example, you got whiplash from an accident. But you didn’t notice till after you made your claim. You’d then require a doctor’s letter, stating your current condition is due to the same accident.
If you’re dealing with car insurance, ask the mechanics for detailed receipts or invoices. You might also visit more than one approved mechanic, and request quotations from them. This is especially handy when disputing repair prices.
3. Mention If Family Members Also Have Policies
If your other family members have policies from the same insurer, you should mention it. Don’t devote a whole paragraph to it, just slip it in a sentence, like this:
- …which especially concerns me, as my wife also has a policy from you
- …and is also a concern to my immediate family, all of whom buy policies from you
- As all of my family (wife and three children) have policies under you…
Most insurers dislike the prospect of losing several policies (your whole family) at once. But whatever you do, never phrase this as a direct threat. Insurers are
at least 50% human too, and dig in their heels.
4. Name Names
Before you were told to file an appeal, you probably had phone conversations with your insurer. During the pauses in which you thought up creative new vulgarities, you may have gotten some employee names.
Be sure to mention those names when writing your appeal. First, this prevents the notorious “ping pong” effect. If you write that “I spoke to Melanie and was told file an appeal”, you won’t get an e-mail saying “You have the wrong department, please call Melanie at XYZ”.
The second reason to prevent backtracking. Picture this conversation:
You: “But you said I could get a partial pay out!”
Insurer: “We did? Who in here said that?”
You: “That…that person I spoke to on Tuesday.”
Insurer: “Dunno who that was, dunno what you’re talking about. Ha ha! Problem bro?”
5. Mention the Follow-Up
Prompt the insurer for a follow-up. The easiest way to do this is to write: “I hope I can get a response by next week. Otherwise, I will follow up within the next X days.” Make it apparent that you’re harder to shake than a meth habit, and twice as troublesome. This will warrant some much needed attention, as you’re competing with a towering pile of appeals.
And if the insurer doesn’t follow up, you now have a record of it. In the event of legal dispute, you can prove the insurer was reluctant to communicate with you “despite your best efforts”.
6. Explain How It Saves Them Money
This trick usually works for medical insurance: Explain how covering the cost of your procedure can save your insurer money. It’s easier than you think!
They don’t want to pay for your inhaler? Fine, they can pay your hospital bills when you next have an asthma attack. Don’t want to pay for dental surgery? Sure, but it could mean a root canal they’re paying for one day. The idea is that, by not helping you get the equipment or procedure you need, the insurer could end up paying even more in the long run.
As with point 3, don’t make it a direct threat. Simply remark that it’s “mutually beneficial” for them to cover it, and have your doctor offer a cost comparison.
Still Worried About Good Insurance?
Get a good insurer, and you won’t have to do any of this. Do some research when getting insurance; don’t just pick from the companies that call you first. For car insurance, visit MoneySmart. Just enter your car details on the main page, and this free site will find you the cheapest and most reliable auto-insurers. You can also speak to their insurance experts, who can give you further advice.
Have you ever written an insurance appeal? Comment and let us know how it went!
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Tags: Life Insurance