Supplemental Insurance Claim Letter
[Your name, or your business's legal name]
[Mailing address]
[Phone] | [Email]
[Date of this letter]
Sent by [certified mail, return receipt requested, or email to the claims address on your claim] [Keep proof of the date you sent it.]
[Adjuster's name], [Adjuster's title]
[Insurance company name]
[Claims department mailing address]
Re: Supplemental claim and request for additional payment
Named insured: [Name exactly as it appears on the declarations page]
Policy number: [Policy number]
Claim number: [Claim number]
Date of loss: [Date of loss]
Insured property or vehicle: [Property address, or vehicle year, make, model and VIN]
Paid to date: [$ total paid, with payment dates]
Dear [Adjuster's name]:
[Insurance company name] accepted coverage for this loss on [date coverage was accepted] and has paid [$ paid to date]. The documented cost to [repair / replace] the covered damage is [$ documented cost], which leaves [$ gap] unpaid. I am submitting this supplemental claim and ask you to revise your estimate and pay the difference.
1. Where the claim stands
Your estimate: [$ amount], dated [date], prepared by [adjuster or firm], [estimate or file number]
Our estimate or invoices: [$ amount] from [contractor, shop, or vendor], dated [date]
Deductible applied: [$ amount]
Depreciation withheld: [$ amount] [If the policy pays replacement cost, check what it requires before withheld depreciation is paid, such as proof that repairs are finished.]
Payments received: [$ amount on date, check or transfer number]
2. Items missing from or underpaid in your estimate
No. | Item | Your estimate | Our estimate or invoice | Difference | Why it should be paid |
|---|---|---|---|---|---|
1 | [Room or area, and item or trade] | [$ amount, or "not included"] | [$ amount] | [$ difference] | [Reason, Exhibit letter] |
2 | [Item] | [$ amount] | [$ amount] | [$ difference] | [Reason, Exhibit letter] |
3 | [Item] | [$ amount] | [$ amount] | [$ difference] | [Reason, Exhibit letter] |
Total difference | [$ total] |
[The Line-by-Line Payment Comparison sheet holds every line. Copy only the lines in dispute here. Common gaps are items left out of the scope, lower measurements or quantities, unit prices below local costs, code upgrade work, overhead and profit, and sales tax.]
3. Damage found during repairs
[Describe any covered damage found after your inspection: what it is, where, when it was found, and who found it. Delete this section if none.]
This damage was found on [date found] and photographed before it was covered up (Exhibit [letter]). If you want to reinspect before the work is closed in, please contact me by [date] at [phone or email].
4. Evidence enclosed
Exhibit A: Your estimate dated [date] and your payment letters
Exhibit B: [Contractor, shop, or vendor] estimate dated [date]
Exhibit C: Invoices and receipts for work completed
Exhibit D: [Number] photos, including damage found during repairs, taken on [dates]
Exhibit E: [Code requirement, permit, manufacturer instruction, or local price quote that supports a line]
Exhibit F: Line-by-Line Payment Comparison
5. What I am asking for
Revise your estimate to include the items in section 2 and pay a supplemental amount of [$ amount].
Pay the withheld depreciation of [$ amount], now that repairs are complete (Exhibit C). [Delete if not applicable.]
For any line you do not pay in full, explain in writing the policy provision or pricing source for the lower amount.
If you need anything else to decide, tell me in writing exactly what it is.
6. Response requested
Please respond in writing by [response date]. [Choose a date that fits your state's claim handling time limits. Some states also set a deadline for filing a supplemental claim, counted from the date of loss. These rules vary by state.]
I also ask that [Insurance company name] handle this supplemental claim within the time limits set by [state] law. [Cite a specific statute or regulation only after you have checked it.]
This letter is a supplemental claim and a request for payment. Nothing in it waives any of my rights under the policy or the law, including any appraisal provision the policy contains.
Please send all communication about this claim to [email or mailing address].
Sincerely,
[Signature]
[Printed name]
[Title, if writing for a business]
[Business name, if any]
Enclosures: Exhibits A to [last exhibit letter]
cc: [Your contractor, and your insurance agent or broker, if any]
Notes for you, delete before sending:
Many policies have an "Appraisal" condition for disagreements about the amount of loss. Usually each side picks an appraiser and the two pick an umpire. Read your policy's own wording for who pays, the time limits, and what the result decides. This template does not recommend using it or not.
If the insurer does not pay or answer, other options include a complaint to your state insurance department, a licensed public adjuster, or a lawyer. Each has different costs and limits. This template does not recommend one.
This template is a drafting aid, not legal advice.