I am writing to formally appeal the decision regarding my workers’ compensation claim, claim number
.
On , I was injured while performing my job duties as a at .
I filed a claim for workers’ compensation benefits, which was denied on .
I believe this decision was made in error. The reasons given for the denial were:
In support of my appeal, I have attached the following documentation:
I respectfully request that you review my case in light of this information. Please let me know if you require any additional information.