Sample Appeal Letter For Short Term Disability
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 firstname.lastname@example.org. Thank you for your attention to this matter.
List of Enclosures