What is the necessary step when an adjuster decides to deny a claim?

When an adjuster decides to deny a claim, the proper course of action is to inform the claimant in writing, accompanied by a detailed explanation. This is essential for several reasons. First, providing a written notification establishes a formal record of the decision, which is critical for both legal and procedural transparency. A written communication allows the claimant to clearly understand the basis of the denial, including the reasons behind the decision, which promotes trust and clarity in the claims process.

Additionally, a fully explained denial helps to ensure that the claimant is aware of their rights, including the option to appeal the decision or provide additional information that may justify a different outcome. Clear communication in this manner is also a best practice, as it mitigates misunderstandings and provides a roadmap for the claimant should they wish to contest the denial. This kind of thorough documentation aligns with regulatory requirements and industry standards in handling claims.