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Claim denial explanation email prompt: free ChatGPT template

Customer emailsInsuranceWorks in ChatGPT, Claude, Gemini and Copilot

Updated · By Robert Breen

Use this when a client forwards a denial letter from the carrier and asks what it means. This prompt explains, in plain words, the reason the carrier gave, the policy wording it quotes, any deadline and the options the letter lists, such as asking for a review or sending more information.

You didn't make the decision and can't reverse it. The email says so kindly, offers a call and never promises that an appeal will work.

Have a professional review it. This prompt helps you draft, not decide coverage. Only the policy, the carrier and a licensed agent can confirm coverage, payments or rates, so have a licensed professional review the reply before it goes out.

The prompt

Copy it into ChatGPT (or Claude, Gemini or Copilot) and replace every [BLANK] with your own details. It uses the four parts from Prompt Writing 101: Role, Context, Task and Format.

Role: You are an agent at [AGENCY] writing to a client whose claim was denied by [CARRIER].
Context: The client is [CLIENT]. The claim is [CLAIM]. Key wording from the carrier's denial letter, including the stated reason and any policy section it quotes: [DENIAL LETTER]. Options and deadlines the letter lists: [OPTIONS]. What I can offer: [AGENCY HELP].
Task: Write a kind, clear email that explains the denial in plain words. Say what the carrier decided and why, quoting the policy section exactly as the letter does. List the options and deadlines exactly as stated. Say the carrier made the decision and our agency can't change it, then say how we can help. Do not judge whether the denial is correct, interpret the policy beyond the letter or predict any review or appeal.
Format: Plain text email, under 220 words, with short paragraphs: what was decided, why, your options, how we can help. No emoji. No subject line if it's a reply.

Fill in the blanks

[AGENCY]
Your agency's name.
[CARRIER]
The insurance company that issued the denial.
[CLIENT]
The client's name.
[CLAIM]
The claim number and what happened, in a sentence.
[DENIAL LETTER]
The reason and the quoted policy language, copied word for word from the letter.
[OPTIONS]
What the letter says the client can do and by when, copied exactly.
[AGENCY HELP]
What you will actually do, such as a call to review the policy together or contacting the adjuster with questions.

Example, filled in

A made-up example from the free lesson Reply Faster to Claim-Status Emails: ChatGPT for Independent Insurance Agencies. Stonebridge Insurance Agency is the made-up independent agency from the claim-status lesson, where Tom works with the carrier Harbor Mutual. In this made-up scenario, a homeowners client's water claim was denied, and she forwards the letter. The client, claim and policy wording are invented.

Role: You are an agent at Stonebridge Insurance Agency writing to a client whose claim was denied by Harbor Mutual.
Context: The client is Ellen Brooks. The claim is HM-4479310, water in her finished basement after heavy rain on September 12. Key wording from the carrier's denial letter, including the stated reason and any policy section it quotes: the claim is denied because the damage was caused by surface water entering through a foundation wall, and the letter quotes Section I Exclusions, "We do not cover loss caused by flood, surface water, waves or overflow of a body of water." Options and deadlines the letter lists: she may send additional information, such as a contractor's report on the cause, within 60 days of the letter date of September 30, and ask the adjuster Rachel Moore to reconsider. What I can offer: a call this week to go over her policy and the letter together, and help sending any new information to Rachel.
Task: Write a kind, clear email that explains the denial in plain words. Say what the carrier decided and why, quoting the policy section exactly as the letter does. List the options and deadlines exactly as stated. Say the carrier made the decision and our agency can't change it, then say how we can help. Do not judge whether the denial is correct, interpret the policy beyond the letter or predict any review or appeal.
Format: Plain text email, under 220 words, with short paragraphs: what was decided, why, your options, how we can help. No emoji. No subject line if it's a reply.

What a good answer looks like

  • The exclusion is quoted word for word, in quotation marks, with its section name.
  • The 60-day window and the September 30 letter date appear exactly as the letter gives them.
  • A plain sentence that Harbor Mutual made the decision and the agency can't overturn it.
  • An offer of a call and help sending a contractor's report, with no hint that it will change the outcome.

How to check it before you use it

An AI draft can sound right and still say something you never told it. Use the habit from the Reply Faster lesson: check every promise, name, date and number against what you gave it before anything goes out.

  • Read the denial letter yourself and compare every quote and date in the email.
  • Delete any line that sounds like an opinion on the denial, such as "this seems unfair" or "this should be covered".
  • Have a licensed agent read the email before it goes out.

Practice it in the free lesson

Reply Faster to Claim-Status Emails: ChatGPT for Independent Insurance Agencies: A client with an open auto claim wants a payment date, a rental and a promise about her rate. Give ChatGPT the thread and your agency's facts, catch what it shouldn't promise, and send an honest reply from Gmail. You do every step yourself in a practice copy of ChatGPT, and nothing touches your real accounts.

Start the free lesson

Also useful: Prompt Writing 101: Role, Context, Task, Format

Terms used here

Claims adjusterDeclarations pageLegal information vs legal advice

More customer emails prompts

All free prompt templates · AI glossary