What action is required from an adjuster when a claim is denied?

When a claim is denied, it is essential for the adjuster to send written confirmation of the denial. This action serves several important purposes in the claims process. First, it provides a clear and formal record of the denial, which is crucial for both the policyholder and the insurer. Written communication helps prevent misunderstandings and ensures that there is documentation showing the reasons for the denial.

Additionally, confirmation in writing allows the insured party to understand the specific grounds upon which their claim was denied. This transparency is key for maintaining trust in the insurance process and helps the policyholder to consider their options moving forward, which might include submitting additional evidence or appealing the decision.

Providing a verbal explanation, although useful for immediate discussions, doesn’t fulfill the regulatory requirements and fails to create an official documentation trail, which is why it is not sufficient on its own. Immediate payment of the denied claim would contradict the decision made, and re-assessing the claim automatically could lead to inconsistencies and confusion, as claims should be individually reviewed before any determination is made. Thus, sending written confirmation aligns with best practices in claims management and regulatory compliance.