Response Letter to Denial of Insurance Claim

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									This document sets forth a response letter to an insurance carrier who has denied
insurance coverage to the policyholder. The letter asks the insurance carrier to review
additional documentation and reconsider allowing coverage to the claim. This template
letter allows for customization and the user should insert all applicable facts and
attached the appropriate documentation regarding the policyholder’s request for
reconsideration. This document should be used by insurance policy holders who have
had claims denied under their current policy.
                    ___________ [Instruction: Insert Policy Holder Name]
                        ___________ [Instruction: Insert Address 1]
                        ___________ [Instruction: Insert Address 2]

                                                          ___________ [Instruction: Insert Date]

___________ [Instruction: Insert Insurance Carrier Name]
___________ [Instruction: Insert Address 1]
___________ [Instruction: Insert Address 2]
Attn: ___________ [Instruction: Insert Name of Person Who Signed The Denial Letter]

      Re:    Insurance Policy # ___________ [Instruction: Insert Number] – Claim #
___________ [Instruction: Insert Number] – Denial of Claim

Dear ___________ [Instruction: Insert Name of Person Who Signed The Denial Letter:

       On or around ___________ [Instruction: Insert Date], I filed the above-referenced
claim regarding ___________ [Instruction: Insert Reason For Claim].

        I recently received a letter dated ___________ [Instruction: Insert Date], indicating that
the claim has been denied because “___________.” [Instruction: Insert Quote from Letter
about why claim was denied]

       I disagree with this decision and believe if you had all of the necessary information at the
time of your initial review, you would have come to a different conclusion. Accordingly, I ask
you please review the following enclosed additional documentation, all of which supports the
approval and processing of my claim.

             (1) ___________ [Instruction: Insert Name of Supporting Document 1]
             (2) ___________ [Instruction: Insert Name of Supporting Document 2]
             (3) ___________ [Instruction: Insert Name of Supporting Document 3]

       Based on this additional information, I am asking that you reconsider your previous
decision and allow coverage. Please feel free to contact me if you will require further additional

       I appreciate your assistance with this matter and look forward to your response.

                                      Very truly yours,

                                      [Instruction: Sign]

                                      _____________       [Instruction:   Insert   Policy   Holder

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