Insurance claims denied or underpaid

Disability denial organizer

Use this page to put a denied or stopped disability claim in order. Fill it in on screen or print it and write on it. What you type stays in this browser on this device; nothing is sent to us or anyone else.

Start with the first section: the deadline to appeal is the one thing that can't wait. Blank spaces are fine.

The denial letter

The letter that denied or stopped your benefits. The time to appeal is counted from the day it reached you.

Date printed on the letter

Day the letter reached you

Insurer, plan name and claim number

The appeal deadline, in the letter's own words

The reasons the letter gives, one per line

What the letter says would help your claim

Your policy and plan papers

The policy or certificate, and the summary plan description (the booklet that explains the plan and how to claim).

What I have, and where it is

What I asked my employer or the insurer for, and when

How the policy defines disability, and when that definition changes

The claim file

Everything the insurer relied on, considered or created in deciding your claim. You can ask for a copy.

Date I asked for the claim file

Date it arrived

Reports from the insurer's own doctors or job experts

Medical records

Everyone who has treated you for the conditions that stopped you working.

Doctors, clinics, therapists and hospitals, with dates

Tests and imaging, with dates

Medications and side effects

What my doctors say I can't do

Records I have asked for, and when

Letters and calls with the insurer

Everything that went back and forth, in date order.

Letters and emails from the insurer, with dates

What I sent the insurer, with dates

Phone calls: date, who I spoke to, what they said

Your dated timeline

The dates that tell the story of the claim. Rough dates are fine.

Last day at work

Date the claim was filed

Date benefits started, if they did

Date benefits were denied or stopped

Date and what happened

Social Security disability

A separate claim, but the insurer may ask about it.

Applied? Dates, and any decision

Your questions

What worries you most, and what you would like to ask a lawyer.

What worries me most

Questions I want to ask