If a contract provision causes a denial of coverage, what must the insurer provide to the claimant?

When a contract provision leads to a denial of coverage, the insurer is required to provide a clear explanation that references the exact provision within the policy that justifies the denial. This requirement ensures that the claimant understands the specific reasons behind the decision, allowing them to assess their options and possibly challenge the decision if they believe it is unwarranted.

Providing an explanation that directly cites the relevant policy provision promotes transparency and helps the claimant recognize what terms or conditions were not met, which is crucial for any further actions they may want to take regarding their coverage or for seeking alternative solutions. This practice aligns with the principles of fairness and accountability in the insurance process, reinforcing the insurer's obligation to communicate effectively with policyholders.