Appeal Letter: Disability Insurance Claim Denied

I am writing to formally appeal the denial of my [short-term / long-term] disability claim, reference number [Claim Number]. I have been disabled since [Date] due to [Diagnosis] and meet the plan's definition of disability as documented by my treating physician.

I have been under the continuous care of [Provider Name] since [Date]. My diagnosis of [Condition] results in the following functional limitations that prevent me from performing [own occupation / any occupation]: [specific limitations]. I am enclosing updated medical records, a treating physician statement, and functional capacity documentation.

The denial states [reason]. I dispute this finding because [specific rebuttal]. My treating physician, who has directly examined and treated me over [duration], is better positioned to evaluate my functional capacity than a records-only review by the insurer's contracted physician.

I request a full and fair review of all evidence, including the enclosed updated medical documentation. Under ERISA, I have the right to a full and fair review, to review all documents relied upon in making the decision, and to present evidence and testimony. Please provide the complete claim file within the statutory deadline.