Sample Appeal Letter for Short Term Disability [Free]

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Sample Appeal Letter For Short Term Disability

Katherine Brunswick
900 Valley View
San Francisco, CA, 94104

October 14, 2022

ABC Insurance Company
4980 – 15th Street
San Francisco, CA, 94108

Dear Sir / Madam,

I am writing this letter to appeal your decision to deny me short term disability benefits. My case number is 09-0945-000. 

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 585-123-4597 or at Thank you for your attention to this matter.


Katherine Brunswick
List of Enclosures

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