When a life insurance claim is denied, families are often told they can “appeal” the decision. What insurers do not explain is that the appeal letter is not a formality. It is the most important legal document in the entire claim process.
A properly written appeal letter can force reversal of a wrongful denial. A poorly written one can permanently destroy the claim.
At LifeInsuranceAttorney.com, our practice focuses exclusively on denied and delayed life insurance claims. We draft appeal letters that function as legal briefs, not emotional pleas. These appeals are designed to overturn denials or, if necessary, position the case for litigation.
Why the Appeal Letter Matters More Than People Realize
An appeal letter is often the last opportunity to control the narrative of the claim. Once it is submitted, everything the insurer considers going forward is filtered through that document.
Insurers rely on appeal letters to determine whether a beneficiary understands the policy, the law, and the weaknesses in the denial. If the appeal is weak, insurers are far less likely to reverse course.
In certain policies, including federal and employer governed plans, the appeal may be the only chance to challenge the denial at all.
Step One: Full Policy and Denial Analysis
Before a single word is written, a lawyer conducts a complete review of the claim file.
This includes analyzing:
• The full policy, endorsements, and riders
• The original application and underwriting materials
• The insurer’s denial letter and stated rationale
• The timing of death relative to contestability provisions
• Any exclusions relied upon by the insurer
We pay particular attention to language involving misrepresentation, exclusions, lapse provisions, and conditions that insurers often misapply.
Many denials fail because insurers rely on internal guidelines rather than actual policy language. Identifying that mismatch is critical.
Step Two: Evidence Control and Documentation Strategy
A lawyer does not simply attach documents. Evidence is curated and framed to support specific legal arguments.
Depending on the denial, this may include:
• Medical records and physician statements
• Prescription history with contextual explanation
• Autopsy or toxicology reports
• Premium payment history and lapse notices
• Agent communications and application assistance records
The goal is not volume. The goal is relevance. Insurers often deny claims because beneficiaries overwhelm the file with unfocused records that inadvertently support the insurer’s position.
Step Three: Legal Framing and Standards of Review
An appeal letter written by a lawyer applies the correct legal standards to the insurer’s denial.
This includes addressing:
• Whether an alleged omission was material
• Whether intent to mislead can be proven
• Whether the condition existed or was diagnosable at the time of application
• Whether the alleged issue had any connection to the cause of death
• Whether policy language is ambiguous and must be construed in favor of coverage
For employer provided policies governed by ERISA, the appeal must be especially precise. Courts often limit later lawsuits to the administrative record created during the appeal.
For federal employee policies governed by FEGLI, the appeal process is even more unforgiving. In many cases, there is only one appeal. Any mistake can be fatal to the claim.
Step Four: Drafting the Appeal Letter Itself
A lawyer written appeal letter is structured like a legal argument, not a personal letter.
It typically includes:
• Identification of the policy, insured, and beneficiary
• A clear statement disputing the denial
• A point by point rebuttal of the insurer’s stated reasons
• Citations to policy language supporting coverage
• Legal arguments grounded in statute and case law
• Controlled presentation of supporting evidence
The tone is professional, assertive, and precise. Emotional language is avoided. Insurers respond to legal exposure, not sympathy.
Step Five: Strategic Follow Up and Negotiation
Submitting the appeal is not the end of the process. It is the beginning of negotiation.
After submission, our attorneys communicate directly with the insurer’s claims department or legal counsel. Many denials are reversed at this stage once insurers realize the appeal was prepared for litigation.
If the appeal is denied, the letter becomes the foundation of a lawsuit. Every argument preserved matters.
Why DIY Appeals Often Fail
Many beneficiaries unknowingly sabotage their claims by submitting appeals on their own.
Common mistakes include:
• Admitting facts the insurer must prove
• Conceding materiality without realizing it
• Submitting irrelevant or damaging records
• Missing procedural deadlines
• Triggering a one shot appeal prematurely
Once submitted, these errors cannot be undone.
Special Warning for Federal and Employer Policies
If the policy is governed by FEGLI, ERISA, or a union or government employer plan, do not submit anything on your own.
In many of these cases:
• You get one appeal
• Informal letters count as formal appeals
• New evidence may be barred later
• Courts defer heavily to the administrative record
One wrong submission can permanently bar recovery.
Final Perspective
A life insurance appeal letter is not paperwork. It is a legal instrument that determines whether a denial stands or collapses.
Insurers know immediately whether an appeal was written by a lawyer who understands life insurance law. When they see that level of precision, many denials do not survive.
If your life insurance claim has been denied, do not guess. Do not explain. Do not apologize.
Get legal control of the appeal before the insurer locks the file forever.