| Review theme | Question to investigate | Evidence that helps |
|---|---|---|
| “They called it pre-existing” | Which prior sign or record did the insurer cite, and how does the policy define the exclusion? | The decision letter, relevant clinical timeline and exact clause. |
| “They paid less than the percentage advertised” | Which charges were eligible, how was the deductible applied, and did a limit intervene? | An itemized invoice and settlement calculation. |
| “It took too long” | Was the file complete, when were records requested, and which step remained open? | A dated submission and correspondence timeline. |
These examples are hypothetical themes, not allegations about a named company. They keep the inquiry focused on something that can be checked. A reviewer may not publish private medical or policy records, so an unanswered question is an evidence limit, not proof the complaint is wrong.