Insurance Appeal Letter Template

INSURANCE APPEAL LETTER SENT VIA CERTIFIED MAIL [Your Name] [Mailing Address] [City, State, ZIP Code] [Phone Number] [Email Address] [Date] [Insurance Company Name] [Appeals Department or Claims Department] [Mailing Address] [City, State, ZIP Code] Re: Appeal of Insurance Decision Policy Number: [POLICY NUMBER] Claim Number: [CLAIM NUMBER] Date of Loss/Service: [DATE] Denial or Decision Date: [DATE] To Whom It May Concern: I am writing to appeal the decision regarding the claim listed above. SUMMARY OF DECISION BEING APPEALED: On [DATE], I received notice that the claim was: [ ] Denied [ ] Partially denied [ ] Underpaid [ ] Closed without full review [ ] Delayed without adequate explanation [ ] Other: [DESCRIBE] The stated reason for the decision was: [Quote or summarize the insurance company's reason.] BASIS FOR APPEAL: I disagree with the decision for the following reasons: 1. [Explain the first reason, referencing policy language or facts.] 2. [Explain the second reason, referencing documents or evidence.] 3. [Explain any additional reason.] SUPPORTING INFORMATION: I am enclosing or referencing the following documents: [ ] Copy of denial or decision letter [ ] Policy declarations page [ ] Relevant policy language [ ] Medical records, repair estimates, invoices, or receipts [ ] Photos or damage documentation [ ] Letter from provider, contractor, adjuster, or expert [ ] Prior claim correspondence [ ] Other: [DOCUMENTS] REQUESTED OUTCOME: I request that the insurance company: [ ] Reverse the denial and approve the claim [ ] Pay the remaining claim amount of $[AMOUNT] [ ] Reopen the claim for additional review [ ] Provide a written explanation with policy citations [ ] Schedule a supplemental inspection or review [ ] Other: [REQUEST] DEADLINE FOR RESPONSE: Please provide a written response no later than [DATE]. If additional information is needed, please identify exactly what is missing and where it should be sent. PRESERVATION OF RIGHTS: This appeal is submitted to preserve my rights under the policy and applicable procedures. Nothing in this letter waives any rights, remedies, deadlines, or claims. Please confirm receipt of this appeal and include the claim number on all future correspondence. Sincerely, [Your Signature] [Your Printed Name] --- ENCLOSURES: [List documents enclosed] --- SENDER RECORD: Certified Mail Number: ______________________________ Date Mailed: ________________________________________ Appeal Deadline: ___________________________________ Response Deadline: _________________________________