How to Appeal an Insurance Company’s Decision? A Step-by-Step Guide

Receiving an insurance company’s decision that is difficult to agree with is more common than you might think. An underestimated compensation amount, a refusal to pay, or the omission of part of a claim can be frustrating, but it is important to remember one thing: the insurance company’s position is not final. Every customer has the right to appeal, and a well-prepared appeal often leads to a change in the decision or a more favorable recalculation of the benefit. In this guide, I show you step by step how to effectively challenge an insurance company’s decision — from analyzing the documents and preparing arguments to submitting an appeal and exploring further options. This will make the entire process simpler, more organized and, above all, genuinely increase your chances of obtaining the compensation you are entitled to.

Appeal vs. Complaint – Why Does the Name Matter?

In practice, customers most often use the term “appeal against an insurance company’s decision.” From a formal point of view, such a letter is treated as a complaint. This distinction is important because it is the complaint procedure that triggers specific statutory obligations on the part of the insurance company.

After a complaint is submitted, the insurance company has 30 days to respond. In particularly complex cases, this period may be extended to a maximum of 60 days — with an obligation to inform the customer of the reasons for the delay. Moreover, failure to respond within the statutory deadline means that the complaint is deemed accepted in accordance with the customer’s request.

At Sagarto, we place particular emphasis on timely and transparent responses because we know that clear communication is the foundation of trust.

When Is It Worth Filing an Appeal?

It is worth considering an appeal whenever there are doubts about whether the decision is correct. This most often applies when:

• the amount of compensation appears to be underestimated,
• part of the damage has been omitted,
• the decision is based on incomplete documentation,
• a provision of the insurance terms and conditions has been applied which, in the customer’s opinion, should not apply,
• payment of the benefit has been refused despite the conditions of the insurance contract being met.

It is worth emphasizing that dissatisfaction alone is not sufficient grounds for an effective appeal. The key is to present specific arguments and evidence.

How to Appeal an Insurance Company’s Decision – Step-by-Step Procedure

1. Thorough Analysis of the Decision

The first and most important step is to read the decision carefully. You should pay attention not only to the amount of the benefit, but above all to the reasoning. This is where you will find information about the legal grounds and contractual provisions on which the decision was based.

At Sagarto, every decision includes a factual explanation and a reference to the terms of the contract. This is precisely the section that should serve as the starting point for any potential appeal.

2. Gathering Evidence

The effectiveness of an appeal largely depends on the quality of the evidence presented. In motor vehicle claims, this often includes additional repair estimates, quotes from local repair shops, repair invoices or documents relating to the rental of a replacement vehicle. In property damage claims, photographs, repair estimates and expert opinions are important.

In life and health insurance claims, medical documentation and a precise reference to the definitions of benefits contained in the insurance terms and conditions play a key role. The consistency between the actual circumstances and the contractual definition determines whether the payment is justified.

3. Preparing the Appeal Letter

A well-prepared appeal should be factual and specific. It should include the claim number, policy number and date of the decision. Most importantly, however, you should formulate a clear request — for example, specifying the exact amount of additional compensation you are seeking.

Many appeals are ineffective because they contain general statements without specifying what the customer actually expects. Instead of writing “I request that the case be reconsidered,” it is better to write “I request that the benefit be increased to PLN 14,800.”

Here you will find a ready-made appeal letter template that can be used as a basis for preparing your own complaint.

4. Submitting the Complaint and Monitoring the Deadline

A complaint can be submitted in writing or electronically. Regardless of the form, you should always keep proof that it was submitted. This allows you to monitor the response deadline.

From the moment the complaint is effectively submitted, the statutory 30-day period begins to run. If this deadline is exceeded, the customer may invoke the effect of the complaint being deemed accepted.

What If the Decision Is Upheld?

If the decision is upheld after reconsideration, the customer may pursue further remedies — including amicable proceedings or court proceedings. In practice, however, many cases can be resolved already at the internal complaint review stage, particularly when the customer provides additional evidence.

The Most Common Mistakes When Filing an Appeal

Appealing an insurance company’s decision is a process that requires care and an understanding of the applicable procedures. Below are the most common mistakes that people filing appeals should avoid:

Lack of knowledge of the insurance policy terms: Not knowing the provisions of the insurance contract, such as the scope of coverage, exclusions of liability or claims reporting procedures, may lead to an unjustified appeal.

Insufficient documentation: Appeals are often submitted without appropriate evidence, such as photographs, medical certificates, invoices or other documents supporting the validity of the claim. It is important to attach all documents supporting your arguments.

Emotional tone of the letter: Appeals should be factual and professional. An emotional or aggressive tone may harm the case, so it is better to focus on facts and arguments.

Failure to refer to specific provisions: It is worth referring to specific provisions of the insurance policy and legal regulations that support your position. This increases the chances of a positive outcome.

Unclear arguments: An appeal should be clear and understandable. You should explain precisely why the insurance company’s decision is unlawful or unjustified.

Submitting the appeal late: Insurance companies often have a specified period for submitting appeals. Failure to meet the deadline may result in losing the opportunity to pursue your rights further.

Ignoring previous communication: It is important to include previous correspondence with the insurance company in the appeal and, where appropriate, point out any unjustified or incorrect information that was provided.

Being unprepared for a response: Sometimes an insurance company may request additional information or documents. It is important to be prepared for this and respond promptly to such requests.

Failure to consult a lawyer or advisor: People filing appeals often do not seek professional assistance, which can lead to mistakes in their arguments. It is worth consulting a lawyer specializing in insurance matters.

Incorrect contact details: It is important that all personal and contact details are current and correct in order to avoid communication problems.

Avoiding these mistakes increases the chances of successfully appealing an insurance company’s decision and achieving a satisfactory outcome.

How to Write an Appeal – What Should the Letter Contain?

An appeal against an insurance company’s decision is usually a short but specific letter. It should contain the parties’ details, case identifiers, a clearly formulated request (e.g. higher compensation) and a factual justification supported by evidence.

What the Appeal Must Contain

An appeal should normally include:

• the place and date on which the letter was prepared.
• the insurance company’s details (full name, registered office address and, where applicable, department/branch).
• the insured/injured person’s details: first name, surname, correspondence address, telephone number and e-mail address.
• the policy number and claim number (and sometimes also the decision number).
• an indication of the decision you disagree with (decision date, reference number and a brief quotation of its content).
• a clear statement of your request, e.g. “I request that the compensation be increased to PLN …” or “I request that the decision be changed and compensation paid.”
• the bank account number to which the benefit should be paid.
• justification — an explanation of why the decision is incorrect, with reference to specific items in the repair estimate, valuation or insurance terms and conditions.
• a list of attachments (e.g. “attachments: repair estimate, vehicle photographs, expert opinion”).
• a handwritten signature (for a paper letter) or a qualified/electronic signature if required by the applicable form.

How to Write the Justification?

The justification does not have to be long, but it should be specific and based on facts. In practice:

• state exactly what you disagree with, e.g. “I disagree with the accepted labor rate of PLN … per hour and with the classification of certain parts as used.”
• provide facts and figures, e.g. the higher actual repair cost shown on an invoice, the repair shop’s price list or an independent expert’s valuation.
• attach evidence:

• a repair estimate from the repair shop, invoices and receipts.
• medical documentation (in cases involving health impairment), medical certificates and rehabilitation records.
• photographs of the damage, witness statements and other documents confirming your version of events.

Example sentence: “The labor rate of PLN 80 per hour applied by you is not consistent with market rates — I am attaching a repair estimate from a workshop where the rate is PLN 150 gross, which corresponds to the average rates in my region.”

Form and Method of Submission

• You can submit an appeal in writing (by registered mail with confirmation of receipt), electronically (if the insurance company allows this form) or orally for the record at a branch, although written form is the safest option.
• Address it to the insurance company (often to the management board or complaints department) and keep proof of sending/receipt.

An appeal against an insurance company’s decision is an element of the procedure designed to ensure that the customer has a full opportunity to have the decision reviewed. At Sagarto, we treat complaints as a natural part of the service process and analyze each case individually.

If you have doubts about a decision — prepare a factual, well-documented appeal. Use our letter template and remember: the most important elements are specific arguments, evidence and a clearly defined request.

Transparency, timeliness and responsibility — these are the foundations of Sagarto’s operations.