"Insurance Claim Denial Letter Template"

An Insurance Claim Denial Letter is a document that insurance companies can use when they would like to notify their policyholders that the services they requested are not covered by their insurance policy. The purpose of the letter is to provide policyholders with reasons why their claim was denied.

With this letter, insurance companies can provide their policyholders with information about what kind of evidence they need to review their decision. An Insurance Claim Denial Letter sample can be downloaded below.

Generally, these types of letters also provide policyholders with the requirements that the policyholders should follow if they want to appeal the insurance company's decision they have received. If an individual has received this kind of letter from their insurance company and they disagree with their decision, they can respond to it with an Insurance Claim Denial Appeal Letter.

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How to Write an Insurance Claim Denial Letter?

Writing an Insurance Claim Denial Letter can be a time-consuming process that requires a lot of preparation. Commonly, this kind of letter can contain the following parts:

  1. Information About the Addressee. You can start your denial letter by stating who is supposed to receive it. Usually, the recipient of the letter is a policyholder, therefore, you should state their name and address.
  2. Information About the Sender. Here, you can designate the name of the insurance company and address. Some insurance companies prefer to print their letter on their unique blank with their logo and contact information on it. If the insurance company you represent has developed such kinds of blanks, then you should use them for your correspondence on behalf of the company.
  3. The Date. Every letter must include the date when it was issued. It will designate that its content is valid and current.
  4. Introduction. In this part of the letter, you can state the reason for writing and refer to the claim made by the policyholder.
  5. Claim Denial Details. This is the biggest part of the letter and can be divided into several sections:
    • Policyholders should be provided with a motivated response dedicated to the reason why their claim has been denied. This section can also include references to insurance and medical documents, quotations from those documents, and other details;
    • The insurance claim should also include terms on which the policyholder can appeal the decision they received. Before requesting the insurance company to review their decision the policyholder can look for a sample Appeal Letter for Insurance Claim Denial to get an idea on what to include into such kinds of letters.
  6. Conclusion. At the end of the document, the representative of the insurance company should put their signature to confirm that everything stated in it is true and correct. Additionally, they should indicate their name, department, and contact details so the policyholder will know whom to contact in case they have any questions.

Still looking for a particular template? Take a look at the related templates and samples below:

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Insurance Claim Denial Letter
From: ___________________________
To:______________________________
Sender’s Name
Claimant's Name
_________________________________
_________________________________
_________________________________
_________________________________
Sender’s Address
Claimant's Address
_________________________________
_________________________________
City, State, ZIP Code
City, State, ZIP Code
_________________________________
_________________________________
Date
Date
_________________________________
_________________________________
SSN
Account Name
_________________________________
_________________________________
Policy Keys
Company
Dear ______________________________,
Claimant's Name
This letter is in reference to your ____________________________________ claim. As you
know, we have been investigating your claim for ____________________________ benefits
and a determination has been reached.
To be eligible for ____________________________________ benefits, you must satisfy the
policy provisions defined as follows:
1. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
©
TEMPLATEROLLER.COM
Insurance Claim Denial Letter
From: ___________________________
To:______________________________
Sender’s Name
Claimant's Name
_________________________________
_________________________________
_________________________________
_________________________________
Sender’s Address
Claimant's Address
_________________________________
_________________________________
City, State, ZIP Code
City, State, ZIP Code
_________________________________
_________________________________
Date
Date
_________________________________
_________________________________
SSN
Account Name
_________________________________
_________________________________
Policy Keys
Company
Dear ______________________________,
Claimant's Name
This letter is in reference to your ____________________________________ claim. As you
know, we have been investigating your claim for ____________________________ benefits
and a determination has been reached.
To be eligible for ____________________________________ benefits, you must satisfy the
policy provisions defined as follows:
1. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
©
TEMPLATEROLLER.COM
3. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Sincerely,
_______________________________
Sender’s Name
_______________________________
Sender’s Signature
©
TEMPLATEROLLER.COM
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