Free letter template
Insurance claim appeal letter
Use the appeal address in the denial letter. Attach your evidence as extra pages.
Recommended: Certified + return receipt ($17.99)Appeals have deadlines; the return receipt proves the insurer received yours.
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Re: Appeal of claim [Claim number]
To [Insurer] Appeals Department: I appeal the denial dated [Date of denial] of claim [Claim number] under policy [Policy or member ID]. [Why the decision is wrong] Please reconsider and pay the claim. I also request a copy of all documents, records and criteria used in deciding my claim. Sincerely, [Your name]
When to use this letter
- Your health, auto, home or other claim was denied or underpaid
Where to send it
The appeals address in the denial letter.
Tips before you mail it
- Health plans: file within 180 days of the denial.
- Keep copies of everything you send.
The full template text
Re: Appeal of claim {{claimNo}}
To {{insurer}} Appeals Department:
I appeal the denial dated {{denialDate}} of claim {{claimNo}} under policy {{policyNo}}.
{{reasons}}
Please reconsider and pay the claim. I also request a copy of all documents, records and criteria used in deciding my claim.
Sincerely,
{{signature}}Text in {{double braces}} is filled in from the form above. This is a general template, not legal advice.