The denial letter arrived by registered mail at a small retail business in Alberta, addressed to the owner and stamped with the insurer's claims department return address. The letter ran 3 pages and informed the retailer that the theft claim submitted 6 weeks earlier had been denied in full. The insurer cited 3 separate grounds for the denial, each rooted in specific policy provisions, and concluded that no payment would be made under the commercial property policy.
The underlying claim arose from a break-in at the retail premises that had occurred approximately 2 months before the denial letter arrived. The retailer discovered the loss upon opening the store one morning and immediately reported the incident to police and to the insurance broker. The claim submitted through the broker sought recovery for stolen inventory and cash, with supporting documentation including police reports, inventory records, and point-of-sale data. The total amount claimed was in the range that, after legal fees, would yield a net recovery of approximately $27,000 if paid at 75 percent of the claimed value.
The insurer assigned an adjuster who conducted an investigation over several weeks. The adjuster interviewed the retailer, reviewed the documentation provided, and examined the physical premises. At the conclusion of the investigation, the insurer issued the written denial setting out the 3 grounds. One of the grounds invoked a dishonesty exclusion in the policy. The denial letter provided specific citations to policy language and stated that the insurer considered the matter closed.
The retailer did not respond immediately. Approximately 4 months passed between the date the denial letter arrived and the date the retailer engaged a coverage lawyer to review the file. By the time the lawyer was retained, roughly 17 percent of the applicable 2-year limitation period had elapsed. The lawyer's retainer covered analysis of the denial grounds, preparation of a formal response, and negotiation with the insurer.
The response the lawyer prepared was sent by registered mail to the insurer, with copies to the broker and to the insurer's claims manager. The response addressed each of the 3 denial grounds in sequence and requested that the insurer reconsider within 30 days. Within 3 weeks of sending the response, the insurer shifted from maintaining the denial to engaging in settlement discussions. The claim ultimately settled at 75 percent of the amount originally claimed, with the retailer's net recovery after legal fees being approximately $27,000.