Date:
Your Name
Your Address
City, State ZIP Code
Insurance Company Name
Attn: Claims Department
Insurance Company Address
City, State ZIP Code
RE: Disability Insurance Claim Appeal
Policy Number:
Claim Number:
Dear Claims Reviewer,
I am writing to formally appeal the decision to deny my disability insurance claim. I respectfully request a review of my claim based on the information provided below.
Explanation of Appeal:
Supporting Medical Information:
Enclosed Documents:
Thank you for your attention to this matter. I look forward to your prompt response. If you need additional information, please contact me.
Sincerely,

Your Name