Insurance Claim Denial Appeal Exhibit Checklist
Every document you need to appeal a denied health, auto, home, or disability insurance claim.
What's Inside
- Denial letter with specific reason codes
- Insurance policy — relevant coverage sections
- Medical records or doctor's letters of medical necessity
- Repair estimates, contractor bids, or replacement costs
- Photos of damage, injuries, or conditions
- + 2 more sections
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Why Use This Checklist?
Match your evidence directly to the reason codes in the denial letter
Track internal and external appeal deadlines separately
Know when you have grounds to escalate to your state insurance commissioner
Build the record you'd need if the case becomes a bad faith lawsuit
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Insurance Claims Exhibit Checklist FAQ
How do I appeal a denied insurance claim?
Start by reading the denial letter carefully — it must cite specific policy language and give you appeal rights. For health insurance under ERISA, the insurer must explain the denial in writing per 29 U.S.C. § 1133. Gather evidence that directly addresses the stated reason, then file an internal appeal. If that fails, most states offer an external review by an independent reviewer.
What is the difference between an internal and external appeal?
An internal appeal goes back to the insurance company for reconsideration, usually by a different reviewer. An external appeal goes to an independent third party — required by the ACA for health plans. You typically must exhaust internal appeals first, though some states let you skip straight to external review for urgent claims.
When should I file a complaint with the state insurance commissioner?
File a complaint when the insurer misses deadlines, fails to explain the denial in writing, ignores your appeal, or acts in bad faith. The complaint doesn't replace your appeal — do both. Many states have online complaint portals, and commissioners can pressure insurers to reconsider.