Insurance Denial Appeal letter template

Template preview

[DATE]

[RECIPIENT NAME]
[RECIPIENT ADDRESS]

Re: Formal Appeal of Denied Claim #[CLAIM NUMBER], Policy #[POLICY NUMBER] — $[AMOUNT DISPUTED] in Dispute

Dear Appeals Department:

I am formally appealing your denial of the above claim. Your stated reason — "[DENIAL REASON]" — is not supported by my policy terms or the facts of this claim.

Facts:
[FACTS]

Requested resolution:
[DESIRED OUTCOME]

Please treat this as a formal appeal under my policy's internal appeal process and applicable law, including ERISA where my coverage is employer-sponsored, and my state's unfair claims settlement practices act and bad-faith statutes. I request a written determination within the timeframe required by law, along with the complete claim file and the specific policy provisions relied upon for denial.

If this claim is not resolved fairly, I am prepared to file a complaint with the state insurance commissioner and to pursue a bad-faith claim.

Sincerely,

[USER FULL NAME]
[USER ADDRESS]

Bracketed fields are filled in automatically from your answers, then rewritten by AI into a professional letter in your own voice.

What you'll need

• • Recipient
• • Recipient address
• • Your name
• • Your address
• • Policy number
• • Claim number
• • Denial reason
• • Amount disputed
• • Facts
• • Desired outcome