Insurance Appeal Letter Sample with Example in Pdf & Word

An Insurance Appeal Letter is a written communication that a policyholder or beneficiary sends to an insurance company to formally request a review or reconsideration of a decision made by the insurance company regarding a claim, coverage, or policy issue.  

The purpose of this letter is to present additional information, provide clarification, or dispute a decision that the policyholder believes to be incorrect or unfair. Insurance appeal letters are commonly used in situations where a claim has been denied, coverage has been terminated, or the policyholder disagrees with the terms of their policy.  

Sample Insurance Appeal Letter with Example [Word Editable]

Here are the key components and purposes of an Appeal Letter for Insurance Company: 

1. Identification of the Policyholder:

• The letter typically begins with the policyholder's personal information, including their name, policy number, contact details, and the date the letter is written. 

2. Date:

• The date is included for reference. 

3. Salutation:

• A formal salutation, such as "Dear [Insurance Company Name] Claims Department," is used to address the recipient. 

4. Explanation of the Appeal:

• The main body of the letter provides a detailed explanation of the reasons for the appeal. Common reasons for insurance appeals include: 
• Claim Denial: Explaining why the policyholder believes their claim should be approved and presenting any additional evidence or documentation that supports their case. 
• Coverage Termination: Requesting a review of the decision to terminate coverage and providing reasons for why the policyholder believes the coverage should continue. 
• Disputed Policy Terms: Addressing disagreements or misunderstandings regarding policy terms, coverage limits, exclusions, or premium amounts. 

5. Supporting Documentation:

• The policyholder should include any relevant supporting documents to strengthen their appeal. This may include medical records, bills, photographs, repair estimates, or any other evidence that supports their position. 

6. Request for Specific Action:

• The Reconsideration Insurance Appeal Letter Template should clearly state the desired outcome of the appeal, whether it's the approval of a claim, the reinstatement of coverage, or a clarification of policy terms. 

7. Professional and Respectful Tone:

• The letter should maintain a professional and respectful tone throughout, addressing the insurance company with courtesy and clarity. 

8. Contact Information:

• The policyholder provides their contact information, including an email address and phone number, for any follow-up communication or questions from the insurance company. 

9. Signature:

• The letter is signed by the policyholder to confirm its authenticity. 

10. Deadline for Response: - Some insurance companies may specify a deadline for submitting appeals, so it's essential to adhere to any such deadlines.
11. Follow-Up: - After submitting the appeal letter, the policyholder should follow up with the insurance company to ensure that their request is being reviewed and to provide any additional information or documentation if requested.