Organize Your Insurance Denial Appeal Evidence
Your insurer denied the claim. Now you need the denial letter, policy language, medical records, and supporting documentation in a single appeal packet that an adjuster, independent reviewer, or judge can actually follow.
- ERISA (29 U.S.C. section 1133) requires group health plan denials to include the specific reasons for denial and a description of the appeal process.
- Group health plan enrollees have at least 180 days after receiving a denial to file an internal appeal under ERISA regulations.
- The Affordable Care Act section 2719 gives policyholders the right to an independent external review after exhausting internal appeals.
- Internal appeal decisions must be completed within 30 days for pre-service claims and 60 days for post-service claims under federal rules.
- Over 40 states have enacted their own external review laws that apply to state-regulated individual and small-group health plans.
- Most state unfair claims settlement practices acts require insurers to provide a written explanation when denying a property or auto claim.
- ExhibitPrep processes all documents in the browser -- medical records, policy documents, and financial information are never uploaded to external servers.
Preview free -- pay only when you download. $4.99 per session.
For policyholders and insurance professionals
For policyholders fighting denials
The denial letter arrived. The clock is ticking on your appeal deadline. You need your evidence organized before the insurer or review board looks at it.
- Put the denial letter, policy language, and medical records into numbered exhibits
- Include your doctor's letter of medical necessity alongside the insurer's denial
- Build an appeal packet with a table of contents for the reviewer
- Keep medical records and claim details private on your own device
For insurance attorneys and public adjusters
Twelve open claims, each with a stack of denial letters, adjuster notes, and supporting documents. You need exhibit organization that keeps pace with your caseload.
- Batch stamp denial files, medical records, and policy excerpts in one session
- Create combined appeal binders with table of contents for external review
- Prepare exhibit packets for bad faith litigation and appraisal proceedings
- Keep exhibit formatting consistent across cases and claim types
Insurance Claim Appeal Evidence Types
Denial letter and policy sections
- Written denial with reason codes
- Policy declarations page
- Coverage sections and exclusions
- Explanation of Benefits (EOB)
Medical records and repair estimates
- Treatment records by provider
- Doctor's letter of medical necessity
- Contractor or body shop repair estimates
- Lab results and diagnostic imaging
Adjuster correspondence
- Emails and letters with the adjuster
- Phone call notes and summaries
- Claim submission acknowledgments
- Requests for additional information
Photos and documentation
- Property damage photos (before and after)
- Vehicle damage photographs
- Inspection and appraisal reports
- Receipts and proof of loss forms
Appeal documentation
- Formal appeal letter
- Peer-reviewed studies or clinical guidelines
- Independent medical opinion letters
- External review request forms
Claim submission records
- Original claim submission with date stamp
- Proof of timely filing
- Prior authorization records
- Claim timeline and status history
Medical records, claim details, and financial documents stay on your device
ExhibitPrep runs entirely in your browser. Denial letters, policy documents, medical records, repair estimates, adjuster correspondence -- none of it leaves your computer. No server upload, no cloud storage, no third-party access. That matters when you are working with sensitive health information and financial records.
When you might not need ExhibitPrep
If you have a simple auto claim with one denial letter and one repair estimate, you probably don't need exhibit stamps. But if your insurer denied a health claim and you need the denial letter, policy language, treating physician's letter, lab results, and peer-reviewed studies in a single appeal packet, numbered exhibits keep the reviewer from getting lost.
Appeal deadlines are strict
The denial letter includes a deadline. Miss it, and you lose your right to appeal.
- ERISA plans give 180 days for internal appeals, but some plans set shorter deadlines
- External review requests typically must be filed within 4 months of the internal denial
- Property and auto claims often have shorter appeal windows set by state law
- Gathering medical records from multiple providers takes time -- start early
Free insurance claim exhibit checklist
Covers denial letters, policy documents, medical records, repair estimates, adjuster correspondence, and appeal forms. Track which documents you have and which you still need.
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Insurance claim denial appeal FAQ
What documents do I need for an insurance claim denial appeal?
An insurance denial appeal typically requires the written denial letter with specific reason codes, the relevant policy coverage sections and exclusions, supporting evidence such as medical records or repair estimates, any correspondence with the insurer or adjuster, and a formal appeal letter. For ERISA-governed health plans, 29 U.S.C. section 1133 requires the insurer to provide a written denial with specific reasons and a description of the appeal process.
What is the ERISA appeal process for denied health insurance claims?
Under ERISA (29 U.S.C. section 1133), group health plans must give you at least 180 days to file an internal appeal after a denial. The plan must complete its review within 30 days for pre-service claims or 60 days for post-service claims. If the internal appeal is denied, the Affordable Care Act (ACA section 2719) gives you the right to an external review by an independent review organization. You must exhaust internal appeals before requesting external review in most states.
Are medical records and claim documents safe in ExhibitPrep?
Yes. ExhibitPrep processes all files in your browser. Medical records, claim details, policy documents, and financial information are never uploaded to any server. Your files stay on your device from upload through download.
How should I organize exhibits for a health insurance denial appeal?
Start with the denial letter as Exhibit 1, followed by the relevant policy sections showing coverage. Then include medical records organized by provider or date, the treating physician's letter of medical necessity, any peer-reviewed studies or clinical guidelines supporting the treatment, and your formal appeal letter. Number exhibits sequentially and include a table of contents so the reviewer can locate specific documents without flipping through the entire packet.
Can I use ExhibitPrep for property or auto insurance claim disputes?
Yes. Upload the denial letter, policy declarations page, photos of damage, repair estimates from contractors or body shops, adjuster inspection reports, and any correspondence. ExhibitPrep stamps them with sequential exhibit numbers and can combine everything into a single PDF binder for the insurer, appraisal panel, or court.
What is an external review for a denied insurance claim?
Under ACA section 2719, if your internal appeal is denied, you can request an external review by an independent review organization (IRO) that has no financial relationship with your insurer. The IRO reviews your medical records, the plan's coverage terms, and relevant clinical evidence, then issues a binding decision. Over 40 states have external review laws, and the federal process applies to self-insured ERISA plans.
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