Claim denial appeal template
A denial is a decision with a reason attached. This is the letter that answers the reason and asks the insurer to look again.
The short version
A denial is a decision, and decisions have reasons you can answer
An insurer that declines a claim generally has to tell you why, in writing, and generally names the part of the policy it is relying on. That reason is the whole subject of an appeal.1
Asking for reconsideration is not a formality you have to exhaust before anything else is available. It is the cheapest route on the list, it is the only one that can be resolved by the people who already have your file, and it produces the written record every route after it depends on.
Before you write anything
Get the denial in writing, and read what it actually says
If you have been told over the phone, ask for it in writing and wait for it. The letter below quotes the reason back, and a reason you are working from memory is a reason the insurer can say it never gave.
Read the letter itself for two things: the reason, and the provision. Those are different. “There is no cover for this” is a reason; the clause the insurer says removes the cover is the provision. An appeal that answers the first without naming the second is arguing with a summary.
Read your policy for the periods too. A proof-of-loss window, an internal appeal period and the provision limiting how long you have to bring a suit are all in there, and they are not the same in every policy.
What it contains
Five things, and the third is the one you are actually writing
The decision, quoted
The date of the denial and the reason it gave, in the insurer's own words. A paraphrase is a different reason, and an appeal against a different reason is not an appeal.
The provision it rests on
A denial commonly cites a policy provision. Naming it back is what turns the argument from whether the outcome feels right into whether that clause reaches these facts.
What the reason does not account for
The one thing the appeal is about. Something the decision did not have, did not address, or got wrong on the facts, stated plainly and supported by what is enclosed.
A request for the file
The documents and information the decision was based on, and the full text of the provision cited. A denial is a conclusion drawn from a file, and arguing with a conclusion you have not seen the basis for is guesswork.
A date for the answer
A written reply by a date you set. If the decision stands, an insurer that puts the reason in writing has given you what every route after this one needs.
What it cannot do
An appeal asks the same company to change its mind, and the clock does not wait
Everybody who looks at your appeal works for the organization that denied the claim. Appealing is still worth doing: a decision made on an incomplete file is a decision that changes when the file changes. But it is also why you set a date and hold to it.
The periods in your policy generally keep running while an appeal is considered. Three rounds of internal review can use up the window for the routes that do not depend on the insurer agreeing with you: a complaint to your state insurance regulator, and past that a court. Appeal, and watch the dates while you do.
The template
Fill in the brackets and send it
Two of the brackets are quotations rather than descriptions: the reason your denial letter gave, and the provision it cited. Copy them across word for word.
To [Insurer name],
Claim number: [Claim number] Policy number: [Policy number] Date of loss: [Date of loss] Your denial letter dated: [Date]
The decision I am appealing
Your letter of [Date] declined this claim. The reason it gave was: [Quote the reason your denial letter gave].
The provision it relied on was: [The policy provision your letter cited, if it cited one]. I am asking you to reconsider that decision, and this letter answers that reason.
What that reason does not account for
[What that reason does not account for, in your own words]
I enclose the following in support of that: [List what you are enclosing].
What I am asking you to send me
Please send me the documents and information the decision was based on, the complete text of the provision cited above, and a description of your internal appeal or reconsideration procedure, including any period within which I have to use it.
What I am asking you to do
Please reconsider the decision and reply in writing by [Response deadline]. If the decision stands, please say so in writing and state the reason and the provision it rests on, so that I can take it further.
Yours sincerely, [Your name]
Send it the way you would want to prove later that you sent it.2 If it comes to a court instead, your state’s page has the small claims limit where you are.
The other two
If the claim was accepted and the number is the problem
An insurer that accepts the claim and offers a figure you think is too low has not denied anything, and this letter is the wrong one. For a vehicle that was written off, most auto policies carry their own provision for settling a disagreement about the amount. The appraisal demand invokes it.
For a car that was repaired and is worth less than it was, the diminished value demand is a claim carried on evidence, usually against the at-fault driver’s insurer rather than your own.
Disclosures
- 1.Satisfy is not a law firm, does not provide legal advice, and is not a licensed insurance adjuster. This page describes what an appeal of a declined claim generally contains and provides a blank letter. Whether a policy provision applies to a particular loss is determined by that policy and by the law of the state, and nothing here says that any denial was wrong.
- 2.Any period within which an insurer must respond, within which an internal appeal must be brought, and within which a suit must be filed is set by the policy and by state law. Nothing on this page states a deadline, a figure or an entitlement.