Appraisal and Umpire Demand (Policyholder)
Policyholder Demand for Appraisal and Umpire Selection
[DATE]
Via [METHOD REQUIRED BY POLICY OR SELECTED DELIVERY METHOD]
[INSURER NAME]
[CLAIMS DEPARTMENT OR DESIGNATED RECIPIENT]
[ADDRESS OR EMAIL]
Re: Demand for appraisal of Claim [CLAIM NUMBER]
| Loss detail | Information |
|---|---|
| Named insured | [FULL LEGAL NAME] |
| Policy number and period | [NUMBER]; [START DATE] to [END DATE] |
| Property and state | [PROPERTY ADDRESS]; [STATE] |
| Date and description of loss | [__/__/____]; [LOSS DESCRIPTION] |
| Claim number | [NUMBER] |
| Appraisal provision | [POLICY SECTION AND PAGE] |
Dear [CLAIMS REPRESENTATIVE]:
I am the [NAMED INSURED / AUTHORIZED REPRESENTATIVE] for the identified claim. Under the appraisal provision at [POLICY SECTION AND PAGE], I demand appraisal of the disputed [ACTUAL CASH VALUE / REPLACEMENT COST / AMOUNT OF LOSS / OTHER POLICY-DEFINED MEASURE] for [IDENTIFIED PROPERTY OR DAMAGE ITEMS]. The relevant policy language states:
[QUOTE THE ACTUAL APPRAISAL PROVISION, INCLUDING APPOINTMENT, UMPIRE, COST AND AWARD TERMS.]
Amount in dispute
On [__/__/____], the insurer stated its valuation of [IDENTIFIED ITEM OR SCOPE] as $[AMOUNT], as shown in [CLAIM LETTER OR ESTIMATE, DATE]. My valuation for the same item or scope is $[AMOUNT], as shown in [ESTIMATE OR SUPPORT, DATE]. The disputed items and amounts are:
| Item or scope | Insurer's figure | Insured's figure | Supporting record |
|---|---|---|---|
| [ITEM 1] | $[AMOUNT] | $[AMOUNT] | [EXHIBIT/PAGE] |
| [ITEM 2] | $[AMOUNT] | $[AMOUNT] | [EXHIBIT/PAGE] |
| [ITEM 3] | $[AMOUNT] | $[AMOUNT] | [EXHIBIT/PAGE] |
I request an appraisal determination within the scope of [QUOTED POLICY PROVISION AND APPLICABLE LAW]. This demand does not ask the appraisers or umpire to decide a separate coverage or policy-interpretation issue unless the applicable policy and law assign that issue to them. I reserve my positions on any issue outside the appraisal panel's authority.
Appraiser and umpire
I designate [APPRAISER NAME], [FIRM], [PHONE], [EMAIL], as my appraiser under [POLICY PROVISION]. [STATE THE APPLICABLE QUALIFICATION STANDARD AND THE ACTUAL FACTS BEARING ON THE APPOINTEE'S QUALIFICATIONS, COMPENSATION AND RELATIONSHIPS.] The appraiser has [ACCEPTED / WILL CONFIRM] the appointment.
Please identify the insurer's appraiser and provide contact details by [DATE CALCULATED UNDER POLICY OR APPLICABLE LAW]. Under the policy procedure, the appraisers should select an umpire [STATE THE ACTUAL TRIGGER AND TIME, IF ANY]. If they cannot agree, I request that the parties follow [QUOTE THE POLICY'S UMPIRE-SELECTION PROCEDURE OR STATE THE PROPOSED PROCESS SUBJECT TO AGREEMENT]. My proposed candidate, if the policy permits a party proposal, is [NAME AND QUALIFICATIONS / NONE AT THIS TIME].
Please direct your written response to [NAME, ADDRESS, EMAIL] and identify any disagreement with the stated scope or procedure. Nothing in this letter releases or settles any claim, defense, coverage position, or remedy; any effect of appraisal and any available remedy remain governed by the policy and applicable law.
Respectfully submitted,
[SIGNATURE]
[PRINTED NAME AND CAPACITY]
[MAILING ADDRESS]
[EMAIL AND PHONE]
Date: [__/__/____]
Enclosures: [INSURER ESTIMATE OR LETTER]; [INSURED ESTIMATE]; [RELEVANT POLICY EXCERPT]; [OTHER IDENTIFIED RECORD]
About this template
- Last updated
- September 26, 2026
- Jurisdiction
- All states
- Category
- Insurance Law
Legal authority
- Applicable insurance policy appraisal clause, Section [SECTION/PAGE]
- Applicable state appraisal law, if any, to be selected for the loss
Insurance law covers the rights of policyholders against insurance companies that deny claims, delay payment, or undervalue losses. Demand letters, proof of loss forms, and bad-faith complaints all have their own state-specific deadlines and format requirements. Carefully written insurance paperwork puts the claim on the record, triggers the insurer's legal obligations, and preserves the right to recover extra damages if the insurer behaves badly.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
The statutes this template relies on are listed under Legal authority.
N.C. Gen. Stat. § 58-44-16(f)(14) (state-specific example only) (checked September 26, 2026): "If the insured and this insurer fail to agree as to the actual cash value or the amount of loss, then, on the written demand of either, each shall select a competent and disinterested appraiser and notify the other of the appraiser selected within 20 days after the demand."
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