Insurance Claim Denial Letter

From: ___________________________ Sender’s Name

_________________________________ _________________________________ Sender’s Address

_________________________________ City, State, ZIP Code

_________________________________ Date

_________________________________ SSN

_________________________________ Policy Keys

Dear ______________________________, Claimant's Name

To:______________________________ Claimant's Name

_________________________________ _________________________________ Claimant's Address

_________________________________ City, State, ZIP Code

_________________________________ Date

_________________________________ Account Name

_________________________________ Company

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. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

3. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

4. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

5. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Sincerely,

_______________________________

Sender’s Name

_______________________________

Sender’s Signature