When to Use This Template

An appeal letter is your first formal response when your insurance company has denied your claim or offered less than you believe you're owed. Unlike a bad faith demand letter, an appeal is part of the normal claims process and gives the insurer a chance to reconsider their decision.

Claim Denial

Your claim was denied entirely, and you believe it should be covered under your policy.

Partial Denial

Some portions of your claim were denied while others were approved.

Underpayment

The settlement offer is significantly below the actual value of your loss.

Coverage Dispute

The insurer claims your loss isn't covered, but you believe it is.

💡 Appeal vs. Demand Letter

Use an appeal letter first to give the insurer a chance to correct their decision through normal channels. If the appeal is denied and you believe the insurer acted in bad faith, then consider sending a demand letter. Appeals are less adversarial and often more effective for straightforward disputes.

🐻 California Note

California insurers must respond to your appeal within specific timeframes. Under Cal. Code Regs. tit. 10, Section 2695.7, insurers generally have 40 days from receiving your proof of claim to accept or deny it. For health insurance appeals, California has additional protections:

The Template

Copy this template and replace all bracketed placeholders with your specific information. Customize the middle sections based on your specific denial reason and evidence.

Claim Appeal Letter
[YOUR NAME] [YOUR ADDRESS] [CITY, STATE ZIP] [YOUR EMAIL] [YOUR PHONE] [DATE] VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED [INSURANCE COMPANY NAME] Appeals Department [APPEALS DEPARTMENT ADDRESS] [CITY, STATE ZIP] Re: Appeal of Claim Denial / Underpayment Policy Number: [POLICY NUMBER] Claim Number: [CLAIM NUMBER] Date of Loss: [DATE OF LOSS] Date of Denial: [DATE OF DENIAL LETTER] Insured: [YOUR NAME / POLICYHOLDER NAME] Dear Appeals Department: I am writing to formally appeal the [denial / partial denial / underpayment] of my insurance claim, as communicated in your letter dated [DATE OF DENIAL LETTER]. After reviewing the denial and my policy, I believe this decision was made in error, and I respectfully request that you reconsider. SUMMARY OF MY CLAIM On [DATE OF LOSS], I experienced [BRIEF DESCRIPTION OF LOSS - e.g., "water damage to my home when a pipe burst in my kitchen" or "a motor vehicle accident that totaled my vehicle"]. I filed a claim with [INSURANCE COMPANY NAME] on [DATE CLAIM FILED]. The total value of my claim is $[TOTAL CLAIM VALUE], which includes: - [ITEM/CATEGORY 1]: $[AMOUNT] - [ITEM/CATEGORY 2]: $[AMOUNT] - [ITEM/CATEGORY 3]: $[AMOUNT] [ADD OR REMOVE ITEMS AS NEEDED] YOUR STATED REASON FOR DENIAL In your denial letter, you stated that my claim was [denied / underpaid] because: "[QUOTE THE EXACT LANGUAGE FROM THE DENIAL LETTER]" WHY THE DENIAL IS INCORRECT I respectfully disagree with this determination for the following reasons: [CUSTOMIZE THIS SECTION BASED ON YOUR SPECIFIC SITUATION. SOME EXAMPLES:] 1. MY LOSS IS COVERED UNDER THE POLICY Your denial letter cites [EXCLUSION OR LIMITATION CITED]. However, this [exclusion / limitation] does not apply to my claim because [EXPLAIN WHY - e.g., "the damage was caused by a sudden and accidental discharge of water, which is explicitly covered under Coverage A of my policy"]. My policy, at page [PAGE NUMBER], states: "[QUOTE RELEVANT POLICY LANGUAGE THAT SUPPORTS YOUR CLAIM]." This language clearly covers my loss because [EXPLAIN HOW THE POLICY LANGUAGE APPLIES TO YOUR FACTS]. 2. THE FACTS DO NOT SUPPORT THE DENIAL Your denial appears to be based on [INCORRECT FACTUAL ASSUMPTION]. However, the actual facts are [CORRECT FACTS]. I have enclosed [DESCRIPTION OF EVIDENCE - e.g., "photographs," "contractor estimates," "medical records," "police report"] that demonstrate this. 3. YOUR VALUATION IS INCORRECT [IF APPEALING AN UNDERPAYMENT:] Your offer of $[AMOUNT OFFERED] significantly undervalues my loss. The actual replacement cost / repair cost / fair market value is $[ACTUAL VALUE], as demonstrated by the enclosed [ESTIMATES / APPRAISALS / COMPARABLE SALES / OTHER DOCUMENTATION]. Specifically: - [ITEM 1]: You valued at $[THEIR VALUE], actual value is $[ACTUAL VALUE] - [ITEM 2]: You valued at $[THEIR VALUE], actual value is $[ACTUAL VALUE] [ADD ADDITIONAL ITEMS AS NEEDED] SUPPORTING DOCUMENTATION I am enclosing the following documents in support of this appeal: 1. [DOCUMENT 1 - e.g., "Copy of denial letter dated [DATE]"] 2. [DOCUMENT 2 - e.g., "Relevant pages from my insurance policy"] 3. [DOCUMENT 3 - e.g., "Photographs of the damage"] 4. [DOCUMENT 4 - e.g., "Repair estimate from [CONTRACTOR NAME]"] 5. [DOCUMENT 5 - e.g., "Medical records from [PROVIDER]"] [ADD OR REMOVE DOCUMENTS AS NEEDED] REQUEST Based on the above, I respectfully request that [INSURANCE COMPANY NAME]: 1. Reverse the denial and approve my claim in full; OR 2. Increase the settlement offer to $[AMOUNT REQUESTED] to reflect the actual value of my loss. I also request a written explanation if you maintain the denial, including the specific policy provisions you are relying upon and how the facts of my claim support your interpretation. Please respond to this appeal within [30] days. If I do not receive a satisfactory response, I will [pursue additional remedies, including filing a complaint with the [STATE] Department of Insurance and/or seeking legal counsel]. Thank you for your prompt attention to this matter. Please direct all communications to me at the address above. Sincerely, [YOUR SIGNATURE] [YOUR NAME (printed)] Enclosures: [NUMBER] documents as listed above

Customization Tips

Address the Specific Denial Reason

Don't just generally argue that you should be covered. Read the denial letter carefully and address their specific stated reason. If they cite an exclusion, explain why it doesn't apply. If they question the value, provide competing evidence.

Quote Your Policy

Find the specific policy language that supports your position and quote it directly. Reference the page number. Insurance companies sometimes deny claims hoping policyholders won't read the actual policy language.

Organize Your Evidence

Number your enclosures and reference them by number in your letter. Make it easy for the reviewer to find and review your supporting documents. Consider creating a summary table if you have many items to dispute.

💡 Pro Tip: Get Additional Evidence

If your initial claim lacked documentation, use the appeal as an opportunity to strengthen your case. Get additional estimates, expert opinions, photographs, or other evidence that wasn't included originally. New evidence can change the outcome.

What to Include vs. Exclude

Include

Exclude

⚠️ Watch Your Deadlines

Most insurance policies and state laws have deadlines for filing appeals. Check your denial letter and policy for any stated deadline. If you miss the appeal window, you may lose important rights. For health insurance, federal law (ERISA) and state laws often have strict timelines. Don't wait until the last minute.

After You Send

  1. Track your deadline. Note when you sent the letter and when you expect a response.
  2. Follow up if needed. If you don't receive acknowledgment within 2 weeks, call to confirm receipt.
  3. Document everything. Keep records of all communications, including phone calls (note date, time, who you spoke with, what was said).
  4. Know your next steps. If the appeal is denied, consider: requesting a supervisor review, filing a DOI complaint, sending a bad faith demand letter, or consulting with an attorney.

Need Help With Your Appeal?

A well-crafted appeal can make the difference between a denied claim and a successful outcome. I can review your denial, analyze your policy, and draft a compelling appeal tailored to your specific situation.

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