SNEK POLICY
Every Insurance Denial Needs an Explanation
A denial should be understandable, reviewable, and connected to the actual policy.
Explain the decision
A denial should identify the relevant policy language, the factual reason, the evidence relied upon, what additional information could change the result, and how the customer can appeal.
Human review
Automated systems may assist with claims, but a significant denial affecting health, a home, livelihood, or another major financial interest should have meaningful human review available. ‘The computer said no’ is not an appeals process.
FULL POLICY DETAILS
The longer version
Why SNEK thinks this
A denial that simply says no leaves the customer unable to correct an error, challenge a bad interpretation, or even understand what part of the contract is in dispute. SNEK wants denial decisions to be specific enough that another human can actually review them.
How it would work
A denial should identify the relevant policy language, the factual basis, the important evidence relied upon, what information could change the decision, the appeal route, and the applicable deadlines. For significant claims involving health, housing, livelihood, or another major interest, a meaningful human review should be available even when software was used in the initial decision.
Where SNEK leaves room
Automation can help process routine claims. SNEK’s objection is to automation becoming unaccountable authority. The amount of explanation and review can scale with the importance and complexity of the claim, but the customer should always know why the insurer said no.
Related SNEK policies
A Policyholder Bill of Rights • Bad-Faith Insurance Denials Should Become Expensive