Insurance Demand Letter

An insurance demand letter is from someone owed money by an insurance company due to a claim. This is usually from an event causing monetary damage or injury, such as an accident, with the claimant seeking a settlement.

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Last updated July 22nd, 2025

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An insurance demand letter is from someone owed money by an insurance company due to a claim. This is usually from an event causing monetary damage or injury, such as an accident, with the claimant seeking a settlement.

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Key Features

  • Statement of Purpose. Directly calls upon the insurance provider to uphold the policy through compensation for losses.
  • Specifically Defines Damages. Formally documents an itemized list of financial losses that must be compensated.
  • Presents Legal Basis. Describes how the insurance provider disregarded fair dealing and good faith practices.
  • Demands Specific Relief. Explicitly and formally states the exact dollar amount expected.
  • Sets Deadline For Response. Names a specific date when relief is to be delivered.

How to Remedy (6 steps)

1. Gather and Organize Your Medical Records and Insurance Policy

Research your rights according to the law, your specific circumstances, and the terms of your insurance policy. Prepare such items for presentation. For example;
  • Denial Letter or EOB (Explanation of Benefits)
  • Insurance Policy
  • Medical Bills, Records, Prescriptions
  • Doctor Letters, Referrals, and Support
  • Log of All Communications with the Insurer

2. Seek an Internal Resolution

Contact the insurer’s claims or appeals department and request a correction, as well as a written explanation (if none was provided with the denial).

3. File A Formal Appeal

Appeal the decision in writing according to the insurer’s internal appeal process (often a federal requirement applied to ACA (Affordable Care Act) compliant plans).

4. Send an Insurance Demand Letter

If the appeal is denied as well, then develop a demand letter imposing a 10-30 day deadline to respond or remedy the situation. Include clear evidence to support your statements.

5. Response and Negotiation

Present more evidence if unsatisfied with the response (e.g., denial or partial payment). Consider contacting a state regulator for possible assistance.

6. External Appeal

Should the issue remain unresolved, then seek an independent external medical review (free in most states) or pursue this issue with:

  • A civil lawsuit for acting in bad faith or a contract breach
  • Small claims court for smaller amounts
  • The appropriate State Insurance Department
  • Department of Labor (for employer plans)

Sample

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INSURANCE POLICY DEMAND LETTER

[CLAIMANT’S NAME]
[STREET ADDRESS]
[CITY, STATE ZIP CODE]
[PHONE NUMBER]
[E-MAIL]

Date: [DATE]

[INSURANCE COMPANY NAME]
[INSURER STREET ADDRESS]
[INSURER CITY, STATE ZIP CODE]
[INSURER E-MAIL]

Re: Breach of [INSURANCE POLICY TITLE/TIER AND NUMBER]

Dear [INSURANCE AGENT NAME],

This letter serves as formal notice regarding your breach of policy [POLICY TITLE/TIER AND NUMBER] dated [POLICY DATE] for [POLICY HOLDER NAME] during the period of [INSURANCE COVERAGE DATES].

As of the date of this notice, you have failed to perform the following obligations: [DESCRIBE BREACH].

Therefore, to satisfy this breach of policy, this letter demands that you cure the issue with the following actions: [DESCRIBE HOW TO CURE COVERAGE FAILURE].

This demand must be handled within [#] days of receiving this letter. If you do not cure this breach within this time, I reserve the right to pursue all available legal remedies, including filing a lawsuit for damages, without further notice.

I prefer to resolve this matter amicably and encourage you to contact me as soon as possible to confirm your intention to comply.

Sincerely,

_______________________

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