Facing a denied insurance claim can be frustrating. Fortunately, you have the right to appeal. A well-written letter of appeal for reconsideration can significantly increase your chances of overturning the denial. This article provides 14 sample letters you can adapt to your specific situation to present a clear and compelling case for why your claim should be approved.
Remember to always keep copies of all correspondence, include your policy number and claim number in every letter, and be polite and professional in your tone. Highlight any new information or evidence that supports your claim. Understanding the reason for the denial is crucial for addressing the specific concerns raised by the insurance company. Tailor your letter to directly counter those concerns with factual evidence and clear explanations.
Sample Letter 1: Initial Appeal for Reconsideration
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to appeal the denial of my claim, #[Claim Number], under policy #[Policy Number], which I received on [Date of Denial]. I respectfully request a reconsideration of this decision.
[Briefly explain the reason for your claim and the original denial.]
I believe the denial was based on [Explain why you believe the denial was incorrect]. I am enclosing [List any supporting documents you are including, e.g., medical records, repair estimates].
I kindly request you to review my claim again with the attached documentation. Thank you for your time and consideration.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 2: Appealing Based on Doctor’s Opinion
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number] – Supporting Doctor’s Opinion
Dear Sir/Madam,
I am writing to appeal the denial of my claim, #[Claim Number], under policy #[Policy Number]. I received the denial notice on [Date of Denial]. This appeal is supported by the professional medical opinion of my doctor, [Doctor’s Name].
As you know, my claim is for [briefly describe the reason for the claim – e.g., medical treatment following an accident]. Your denial cited [state the reason for the denial, e.g., the treatment was not medically necessary].
However, I have now included a letter from [Doctor’s Name] that clearly explains why the treatment *was* medically necessary in my case. [Doctor’s Name] outlines [briefly summarize the doctor’s explanation].
I urge you to reconsider my claim in light of this crucial new information. Thank you for your time and attention to this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 3: Appealing Due to Policy Misinterpretation
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number] – Misinterpretation of Policy Terms
Dear Sir/Madam,
I am writing to appeal the denial of claim #[Claim Number] under policy #[Policy Number], which I received on [Date of Denial]. I believe the denial is based on a misinterpretation of the terms and conditions of my insurance policy.
The denial letter stated that [State the reason given for denial, referring to the specific clause in the policy]. However, [Explain why you believe the insurance company’s interpretation is incorrect. Refer to specific wording in the policy to support your interpretation. Quote the relevant clause if possible].
I respectfully request that you review my claim again, considering the proper interpretation of the policy language as I have outlined above. I am confident that a fair review will result in the approval of my claim.
Thank you for your time and attention to this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 4: Requesting Further Clarification on Denial
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Request for Clarification – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing in response to the denial of my claim, #[Claim Number], under policy #[Policy Number], received on [Date of Denial]. While I understand the claim was denied, I require further clarification on the specific reasons for the denial.
The denial letter stated [Quote the reason given in the denial letter, if possible]. However, I need more specific information to understand the basis of this decision. Could you please provide details regarding [Specifically request clarification on the vague parts of the denial. For example: “the specific policy exclusion that applies,” or “the deficiencies in the documentation I submitted”].
Once I receive this clarification, I will be in a better position to address your concerns and provide any additional information needed to support my claim. Thank you for your assistance in this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 5: Appealing After Providing Additional Evidence
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number] – With Additional Evidence
Dear Sir/Madam,
I am writing to appeal the denial of my claim, #[Claim Number], under policy #[Policy Number], which I received on [Date of Denial]. Since the initial denial, I have obtained additional evidence that I believe strengthens my claim.
Your initial denial was based on [State the reason for the initial denial]. To address this, I am now providing [Describe the new evidence you are providing, e.g., “a police report,” “witness statements,” “additional medical records”]. These documents clearly demonstrate [Explain how the new evidence supports your claim and addresses the reason for the initial denial].
I respectfully request that you review my claim again, taking into account this new evidence. I am confident that this will lead to a positive reconsideration.
Thank you for your time and attention to this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 6: Appealing for Loss of Income Claim
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number] – Loss of Income Claim
Dear Sir/Madam,
I am writing to appeal the denial of my loss of income claim, #[Claim Number], under policy #[Policy Number], which I received on [Date of Denial]. The claim relates to income lost due to [briefly explain the reason for the loss of income – e.g., injury sustained in a car accident].
The denial letter stated [Explain the reason given for the denial, e.g., insufficient proof of lost income, or that the injury was not severe enough to warrant time off work]. However, I have provided [Mention the documentation you provided, e.g., pay stubs, doctor’s notes].
I am also including [List *additional* documents you are now providing to support your claim, e.g., a letter from your employer confirming your absence and lost wages, a more detailed doctor’s note explaining the extent of your injuries]. These documents clearly demonstrate the significant financial impact this incident has had on me.
I respectfully request that you reconsider my claim in light of this additional information.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 7: Appealing to a Higher Authority Within the Company
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Name of Supervisor/Manager]
[Title of Supervisor/Manager]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number] – Escalation of Appeal
Dear [Mr./Ms./Mx. Last Name],
I am writing to you as a supervisor/manager to appeal the denial of my claim, #[Claim Number], under policy #[Policy Number]. I previously submitted an appeal to [Name of Previous Contact Person, if known], which was unfortunately unsuccessful. I believe the denial remains unwarranted.
[Briefly summarize the reason for your claim and the original denial]. I have already submitted [Mention the key documents you previously submitted].
Despite this, my appeal was denied due to [State the reason for the denial from the previous appeal]. I am confident that a further review by you will demonstrate the validity of my claim. I am available to provide any further information you may require.
Thank you for your time and attention to this important matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 8: Requesting Internal Review
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Request for Internal Review – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to formally request an internal review of the denial of my claim, #[Claim Number], under policy #[Policy Number], which I received on [Date of Denial]. I believe the denial was made in error and warrants further investigation by an independent reviewer within your company.
My claim is for [Briefly describe the nature of your claim]. The denial was based on [State the reason for the denial as given by the insurance company].
I respectfully request that this matter be reviewed by a senior claims adjuster or a dedicated internal review board to ensure impartiality and a thorough re-evaluation of all relevant information.
Thank you for your time and consideration.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 9: Threatening Legal Action (Use with Caution)
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Formal Notice – Intent to Pursue Legal Action – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
This letter serves as formal notification of my intent to pursue legal action regarding the wrongful denial of my claim, #[Claim Number], under policy #[Policy Number], which I received on [Date of Denial].
I have made multiple attempts to appeal this denial, providing all necessary documentation and clarification to support my claim. Despite this, my claim remains unfairly denied.
Unless I receive written confirmation of the approval of my claim within [Number] days, I will have no alternative but to consult with legal counsel and initiate legal proceedings to recover the full amount of my claim, as well as any associated legal fees and damages.
Sincerely,
[Your Signature]
[Your Typed Name]
*Disclaimer: Consider consulting with a lawyer before sending a letter threatening legal action.*
Sample Letter 10: Appeal After Receiving a Partial Payment
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Full Payment – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to appeal the partial payment I received for claim #[Claim Number] under policy #[Policy Number]. While I appreciate the partial payment, it does not fully cover the losses incurred as a result of [Briefly explain the reason for your claim – e.g., the damage to my vehicle].
The partial payment of [Amount Received] is insufficient because [Explain why the amount is insufficient. Be specific. E.g., “it does not cover the full cost of repairs as estimated by [Name of Repair Shop] (Estimate attached),” or “it does not account for the depreciation of my damaged property”].
I am requesting a full and fair settlement of my claim, consistent with the terms and conditions of my insurance policy. I look forward to your prompt response and a resolution to this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 11: Appealing Due to Unreasonable Delays
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Complaint Regarding Unreasonable Delay – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to express my serious concern regarding the unreasonable delay in processing my claim, #[Claim Number], under policy #[Policy Number]. I originally submitted my claim on [Date of Initial Claim Submission], and despite numerous inquiries, I have yet to receive a final decision.
This delay is causing me significant hardship, as [Explain the negative impact of the delay. E.g., “I am unable to repair my vehicle,” or “I am incurring significant medical expenses without reimbursement”].
I urge you to expedite the processing of my claim and provide me with a clear timeline for resolution. If I do not receive a satisfactory response within [Number] days, I will be forced to consider further action.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 12: Appealing Due to Lack of Communication
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Complaint Regarding Lack of Communication – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to express my dissatisfaction with the lack of communication I have received regarding my claim, #[Claim Number], under policy #[Policy Number]. Since submitting my claim on [Date of Initial Claim Submission], I have received minimal updates on its status.
I have attempted to contact your office on [List dates and methods of contact – e.g., “by phone on [Date],” “via email on [Date]”], but have received either no response or unhelpful replies. This lack of communication is unacceptable and causes me significant anxiety.
I request that you immediately assign a dedicated representative to handle my claim and provide me with regular updates on its progress. I expect to receive a response within [Number] business days.
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 13: Appealing a Denied Life Insurance Claim
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Appeal for Reconsideration – Life Insurance Claim # [Claim Number] – Policy # [Policy Number] – Deceased: [Deceased’s Name]
Dear Sir/Madam,
I am writing to appeal the denial of my life insurance claim, #[Claim Number], under policy #[Policy Number], for the deceased [Deceased’s Name]. I received the denial notice on [Date of Denial]. As the beneficiary of this policy, I respectfully request a reconsideration of your decision.
The reason stated for the denial was [State the reason for the denial. This is critical to address specifically. For example, “the insured failed to disclose a pre-existing condition,” or “the death was ruled a suicide”].
I believe this denial is incorrect because [Explain why the denial is incorrect. Provide specific counter-arguments and supporting evidence. For example, “I have medical records demonstrating that the alleged pre-existing condition was properly managed and unrelated to the cause of death,” or “I have evidence to suggest that the death was accidental”]. I am enclosing [List the specific documents you are including, e.g., death certificate, medical records, police report, witness statements].
I urge you to review this matter carefully and approve my claim promptly. The loss of [Deceased’s Name] has been devastating, and the life insurance benefits are crucial for [Explain the purpose of the benefits – e.g., providing for dependents, settling debts].
Sincerely,
[Your Signature]
[Your Typed Name]
Sample Letter 14: Second Appeal After Initial Appeal Was Denied
[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Second Appeal for Reconsideration – Claim # [Claim Number] – Policy # [Policy Number]
Dear Sir/Madam,
I am writing to submit a second appeal for the denial of my claim, #[Claim Number], under policy #[Policy Number]. I previously appealed this denial on [Date of First Appeal], and I received a response upholding the denial on [Date of Denial of First Appeal].
Since my initial appeal, I have [Describe any new actions you have taken or new information you have obtained to support your claim. For example: “obtained a second opinion from a different doctor,” or “found additional documentation proving my loss”]. I am now including [List the new documents you are providing].
The original denial was based on [Restate the reason for the original denial]. I maintain that this denial is incorrect, and I urge you to reconsider my claim in light of the new information I am providing. I am prepared to pursue all available avenues to ensure my claim is fairly reviewed and approved.
Thank you for your attention to this matter.
Sincerely,
[Your Signature]
[Your Typed Name]
Conclusion
Appealing a denied insurance claim requires a persistent and well-documented approach. These sample letters provide a starting point for crafting compelling arguments. Remember to personalize each letter with the specifics of your situation, and always maintain a professional and respectful tone. By presenting your case clearly and thoroughly, you significantly increase your chances of a successful appeal.
