By Gary Blake, Director
The Communication Workshop
In the mind of the customer, insurance companies often take on the persona of a corporate Big Brother whose only message to him is "We deny your claim!" This is just one reason why a claims professional's denial letters must set a professional tone: definite but not overbearing; concise but not brusque; specific but not exhaustive.
As a writing consultant who presents Claims Writing seminars at insurance companies across the United States, I am often shocked at the carelessness and lack of organization evident in most of the denial letters I read. These letters suffer from a number of flaws, but the chief ones are wordiness, failure to come to the point, and inappropriate tone. Among the other problems common throughout the industry are: failure to write out dates, use of hedgy language, and incorrect format.
Better denial letters not only give you and your company a sharper, more professional image, but they help keep customers. So, training yourself to write better denial letters is not a matter of displaying editorial erudition, it's literally money in the bank.
This article presents an actual denial letter (only the names and other identifying features have been changed). In this letter, there are at least a half dozen problems. And it is typical of the hundreds of claims letter an adjuster ( or examiner, SIU professional, underwriter or loss control professional) may write every year. And that's just one \employee. If hundreds or even thousands of adjusters at a company perpetuate these mistakes, thousands of hours and millions of dollars in productivity can disappear silently. By reviewing these letters, you'll gain insight into your own strengths and weaknesses in the gentle art of saying "No"to your customer:
Remember when we were kids and we used to see those cartoons with the caption: "What's wrong with this picture?" We might find five or ten inconsistencies and then be surprised to find that there were a handful more that we didn't see. The same may be true of this letter: how many major and minor problems did you spot as you tried to make the letters smoother, sharper, more concise, better organized and more "reader-friendly" in general?
There are several things that catch my eye. First, the capital letters in the inside address. This letter was mailed in a window envelope and therefore tries to satisfy postal requirements (all capital letters) as well as seem like a personal message. If you must live with this "serving of two masters," it isn't a major problem, but recognize that the caps do set an impersonal tone.
As for the "RE" line, I would only shove it to the right side of the letter if it became rather long (say, 4 lines or more). My reason for moving it over would be so that the reader didn't perceive it as a "blockade" between himself or herself and the opening lines of the letter. When a RE line becomes 8, 9, or 10 lines, it is easy to get so caught up in the details that we are practically exhausted before we come to the actual letter!
By the way, spelling out dates is a good idea: it helps the reader perceive the date faster than by using numerals.
The salutation, "Dear Ms. Gorman," requires a colon, not a comma, which would be appropriate if you were addressing her by her first name. The closing, "Respectfully," is also bothersome: do you think that by dragging out this solemn, stodgy closing that you are convincing the reader that you were not being frivolous in your denial? I find that "respectfully" adds too somber a tone; I prefer "Sincerely."
Cut Extra Words
The first paragraph of this letter takes two wordy sentences to say what could be captured in one:
"Enclosed are January 21, 1998, medical bills from Dr. Curran."
After all, the date of loss is in the "RE" line.
The second paragraph could also be cut drastically to read:
"In your Acme policy, please refer to page three, Part II
(Medical Expense Coverage), first column, top of page:"
Test your skill at paring down the following wordy series of sentences taken from another denial letter:
The Acme USA claims office has received a claim you filed under your Homeowner’s Policy. The claim involves the theft of your mother’s ring. Your mother is currently in a nursing home in East Tine. Her ring was apparently stolen from her while she was at the nursing home.
I revised it to read: "We have received a claim you filed under your homeowner's policy regarding the theft of your mother's ring while she was in a nursing home in East Tine."
The wording of this letter occasionally lapses into ambiguity that make the reader work harder than necessary. For example, in the fourth paragraph, the writer writes: "We will consider medical bills for care until 1-16-98, and since the medical bills that were sent to us are after that date, we cannot give them consideration."
For added precision, I would change that sentence to read "...since the medical bills were sent to us by your doctor for treatment received after that date, we cannot make any payment." While that last phrase may sound negative, it is more honest than the euphemistic phrase "give them consideration."
The denial letter I quoted from regarding the lost ring ends stodgily and with hedging: "Acme USA will not be able to reimburse you or your mother for her lost or stolen ring. If you have any further questions in regards to this matter, please to contact the undersigned during normal business hours"
If you don't see at least five problems in those sentences alone, you may need to brush up your letter own letter writing skills!
How about writing: "Since your mother does not meet the definition of an insured person, Acme USA will not reimburse you or your mother for her ring If you have any further questions regarding this matter, please call me at ______________." Throwing in "normal business hours" sounds patronizing (even though I know certain claimants do call at odd hours). Wean yourself away from phrases like "call the undersigned" (you are the undersigned) and "in regard to" (use "regarding") or "Do not hesitate to contact me" (a cliche; write: "please call me").
Get To The Point
There is a wonderful scene in The Godfather in which the Godfather's lawyer is dining with the Hollywood Producer. The producer says something that makes the lawyer get up and request to be taken to the airport. When the producer asks what's wrong, the lawyer says that he must talk with the Godfather because the Don "likes to get bad news quickly."
Most customers, managers, and other human beings also, if asked, would like to get bad news quickly. So, why is that so many claims adjusters are trained to slip the denial in just before the end of the letter? Maybe you feel you are "softening up the claimant"? Perhaps you visualize the claimant reading the opening paragraph, ripping up the letter, and tossing it! Maybe you feel you're being polite. Or being rational, by first detailing the claim. I believe that you need to reveal the main news early in the letter -- even if it's bad news. Therefore, I would have liked this letter's first paragraph to have given forth with the "bad news" sentence beginning : "Since these bills were for treatment received after that date..."
Denial letters can be brisk, straightforward, and concise; they need not be overly humble. They must state facts, avoid euphemisms, and show concern. They must come to the point and they must be persuasive. Maybe it's time you took a hard look at the letters your department is sending out --to claimants as well as to physicians, attorneys, and insurance commissioners, and see if it's time for a major overhaul of form letters before the next batch hit the mail.
GARY BLAKE presents on-site seminars in "Effective Business Writing for Claims Professionals" at claims departments across the United States. Blake, director of the Port Washington, NY-based Communication Workshop, is the author of The Elements of Business Writing (Macmillan), now in its 23rd printing. His web site is www.writingworkshop.com. Next month in Claims, Dr. Blake will discuss the art of writing to opposing attorneys.