Short Term Disability Appeal Letter (Free Sample)
Use this sample short term disability appeal letter as a template for your formal appeal letter.
Last updated on September 19th, 2021
Sample Short Term Disability Appeal Letter
Name of Claimant
Insurance or other Number of Claimant
Address of Claimant
City, State, Zip Code
DATE
Name of Insurance Company
Address of Insurance Company
City, State, Zip Code
Dear Sir / Madam,
I am writing this letter to appeal your decision to deny me short term disability benefits. My case number is NUMBER. Enclosed is a copy of the denial letter, and, as you can see, the claim was denied because all of the medical documents were not included with the application. I believe this is a wrong decision and have enclosed medical records to prove that I cannot attend work for six months.
As it clearly states in the medical records and in the letters from my surgeon and physiotherapist, I have suffered two broken legs in an automobile accident, and the physiotherapist recommends six months of exercises to help me walk properly again.
I have enclosed all of my medical records with this letter including the subsequent report that states how long it will take me to fully recover.
I would like you to reconsider my case and approve my short term disability claim as I have maintained my insurance premium payments regularly since I bought the policy on DATE.
If you have any questions or concerns, I can be reached at 555-123-4567 or at [email protected]. Thank you for your attention to this matter.
Sincerely,
Claimant’s Signature
Claimant’s Name Printed
List of Enclosures
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