Sample Insurance Supplement Letter
This template shows the structure and format of a professional insurance supplement request. Use it as a reference when preparing your own supplement to recover omitted scope, pricing discrepancies, or recoverable depreciation.
What this sample includes: Claim reference, property details, original vs. supplement amounts, line-by-line itemization (10–15 items), and supporting documentation references. Dollar amounts are illustrative ($8,000–$15,000 range).
Tip: Use "Save as PDF" in the print dialog to download a PDF version.
Claims Department
Acme Property & Casualty Insurance Company
P.O. Box 12000
Chicago, IL 60601
To Whom It May Concern:
I am writing to request a supplemental payment for claim number CCP-2025-847293, regarding property damage at 428 Oak Ridge Drive, #204, Springfield, IL 62701. Your company’s initial estimate of $12,450.00 does not reflect the full scope of damage identified by my contractor and documented in the attached materials.
I respectfully request the following supplemental amounts be added to my claim settlement:
| # | Category / Item | Description | Amount |
|---|---|---|---|
| 1 | Roof Replacement – O&P | Overhead & profit (10% + 10%) per policy for multi-trade repair | $1,847.00 |
| 2 | Decking Replacement | Additional 4 sheets required; initial scope shorted 120 sq ft | $486.00 |
| 3 | Drip Edge | Full perimeter drip edge; omitted from original estimate | $312.00 |
| 4 | Ridge Vent | Ridge vent replacement; linear footage understated | $428.00 |
| 5 | Interior Drywall | Ceiling repair in 2 bedrooms; water damage from roof leak | $780.00 |
| 6 | Paint – Bedrooms | Paint & primer for repaired ceiling areas | $345.00 |
| 7 | Gutter Realignment | Gutter adjustment post-roof replacement | $195.00 |
| 8 | Ice & Water Shield | Valley & eave coverage per local code; omitted | $624.00 |
| 9 | Flashing – Chimney | Step flashing & counter-flashing; scope incomplete | $428.00 |
| 10 | Labor – Roofing | Market rate adjustment; carrier rate below local prevailing | $892.00 |
| 11 | Permit & Inspections | Municipal permit and final inspection fees | $285.00 |
| 12 | Debris Removal | Dump fees for roofing debris; initial allowance insufficient | $185.00 |
| SUPPLEMENT REQUEST TOTAL | $8,796.00 | ||
Supporting Documentation Attached:
- Contractor estimate and line-item breakdown
- Photographs of damage and omitted items
- Local building code requirements
- Market rate documentation for labor
I request that you process this supplement within 14 business days and issue payment for the full supplemental amount. Please contact me if you need any additional documentation.
Sincerely,
Jane M. Henderson
Policyholder
Usage Instructions
- Replace all placeholder names, addresses, claim numbers, and dollar amounts with your own information.
- Ensure each line item is supported by your contractor estimate, photos, or other documentation.
- Send via certified mail with return receipt and keep a copy for your records.
- Follow up in writing if you do not receive a response within your stated timeframe.
Customization Guidance
- Adjust line items based on your actual scope deficiencies; include only items you can substantiate.
- Reference specific policy sections (e.g., O&P, code upgrades) where applicable.
- Consider attaching a contractor estimate or Xactimate-compatible summary if available.
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