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Communicating With Your Insurance Company--The Right Way
By James E. Wilson Jr., Lawyer If you suffer a loss, notify your insurance company immediately. Failure to give timely notice of a claim may result in denial of the claim. Your insurance policy may contain a telephone number to report a loss, or call your insurance agent for the telephone number of a claim representative. Keep notes of the date and time of all your calls, with whom you spoke, and what was said. When you provide information about the claim, state the facts objectively. Do not whine. Be absolutely honest. Do not exaggerate. If you do not know something, or if you are estimating, say so. The policy may be void if you provide false information or conceal relevant information. Strictly follow the instructions given by your company. Complete and return forms provided by the company as soon as possible, and keep a copy. Ask the claim representative for help in completing the paperwork. You paid for this service. If you do not understand something, ask the company to explain. To insure an accurate record, communicate in writing, and ask the company to respond in writing. The law requires the insurance company reply within 20 working days after receipt of a communication from you which suggests a response is expected. Keep a copy of all letters and papers you send and receive. If you talk with a company representative, keep detailed notes, including the date, time, and substance of the conversation, and then send a letter to the company confirming the conversation. Keep your notes and a copy of the confirming letter. You have a duty to cooperate with the reasonable requests of your company. Failure to cooperate may result in a denial of the claim. The insurance company is entitled to learn what you know about the claim, and the identity of witnesses so it can decide what obligations it has. The insurance company has a right to see damaged property, to examine records relevant to the claim, and to take your statement. When writing to the insurance company, include the date of the letter, the name and title of the adjuster, the claim number, the date of loss, and your mailing address. Be sure to keep a copy of your letters, and keep the letters you receive. Be professional, courteous, brief, and absolutely honest. For example, a letter requesting information about a decision not to pay chiropractic bills on the grounds the care was not medically necessary might read: The enclosed Explanation of Benefits says my chiropractic treatment is not medically necessary. This has come as quite a surprise since I was told by a licensed provider I needed the care. I bought my policy for protection, peace of mind, and security. I bought it from Superhonest Insurance Company because I trusted its integrity in honoring its slogan, "We'll make things right." Now that I need my benefits it appears there will be difficulty getting the bills paid. I hope my trust was not misplaced. For the sake of my peace of mind, and to get this resolved promptly, please provide the name and contact information for whoever made this determination, and the facts used. Your prompt written response will be of great benefit to me because the prospect of my having to pay bills I thought were covered by my policy is most distressing.A letter confirming a telephone conversation might read: Thank you for your call today. You said my policy does not cover the full amount of my hospital bill. That came as quite a shock as I paid extra for the best hospitalization coverage, and my agent told me I have full coverage. The possibility of a heart attack is exactly why I bought my policy - protection, peace of mind, and security. I bought Superhonest Insurance because of its advertised integrity. I do not have the funds to pay these bills. Please reevaluate my claim and mail me your conclusion as soon as possible. If you feel you are not being treated fairly, do not act unprofessionally or discourteously toward the claim representative or your agent. If you have questions or concerns please call me. I am here to help. |