How to Nicely Deny a Claim to Your Client


It's understandable that an insurance claimant would be upset by the circumstances that caused the claimant to file the claim. Unfortunately, sometimes a claimant wants his insurance to cover something that his policy does not cover, and the claims adjuster must deny the claim. The last thing the adjuster wants is to further upset the client, but she must find a way to tell the client that she cannot approve the claim. If you find yourself in this situation, slowing down and taking the time to listen empathetically to the client helps soften the blow of your denial of his claim.

Listen to the client's concerns and description of the situation. Rather than immediately denying the claim, repeat or paraphrase what the client tells you so that he knows you are listening to him. Ask the client questions about his claim to clarify the issue.

Wait until you have exhausted all possibilities before denying a claim. Tell the client that you are unsure whether insurance will cover his claim, but continue asking questions to see if there is any way that you can help the client. Make suggestions regarding possible solutions for the client. Refer the client to other services that can help as necessary. For example, if the client's policy does not cover repairs to his vehicle, refer him to a low-cost mechanic or body shop for an estimate before denying the claim.

Refrain from making it personal. Never use sarcasm or ridicule a client, regardless of how crazy his attempted claim may be. Instead, blame your supervisors or the insurance forms the client uses if you have to deny a claim. For example, you might say, "Unfortunately, your policy doesn't cover that. If it were up to me I would definitely do this for you, but my supervisor won't allow it."

Close the call by making another appropriate referral for the client. In addition to suggesting low-cost services that might meet the client's needs, suggest upgrading the policy so that in the future, claims of this nature will be covered. For example, if a client's auto insurance policy doesn't cover renting a vehicle while his vehicle is being repaired after an accident, suggest adding such coverage.

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