When a life insurance claim is denied, the denial letter rarely tells the full story. The insurer may cite medical records, underwriting concerns, or an “investigation” without showing you what it actually reviewed.
That missing information is often sitting in the claim file.
If you ask for the right documents early, you can expose cherry picking, shifting rationales, and gaps in the insurer’s proof. You also avoid appealing blind.
This post gives you a practical claim file request checklist you can use immediately.
What “claim file” really means
Insurers use the term “claim file” loosely. Many beneficiaries receive only a handful of documents, usually the denial letter and a couple attachments. That is not the real file.
The full claim file is everything the insurer collected, generated, relied on, and discussed internally while deciding whether to pay.
You want the complete record, not a curated packet.
When to request the file
Request it as soon as a denial arrives, and also whenever a claim is stuck in prolonged “review.”
Do not wait until the end of an appeal window to ask. Some insurers delay production. Others send partial files in waves.
If the claim is under an ERISA governed group policy, the timing is even more important because the administrative record is often the universe of evidence later.
How to request it so you get more than a partial dump
Use plain, direct language and demand a complete copy of the claim file and all documents relevant to the claim decision.
Ask for native format where possible for logs and metadata. Ask for everything the insurer “considered, relied upon, generated, reviewed, or obtained” in connection with the claim.
Also ask for an index of the file. An index makes it harder for the insurer to pretend missing items do not exist.
Claim file request checklist
Below are the categories that most often contain the leverage in a denied case.
A) Core policy and claim documents
The full policy, including all forms, riders, endorsements, and amendments
The certificate of coverage and summary plan description if group coverage
The application and all supplements
Any evidence of insurability forms and the approval or rejection decision
All beneficiary designation forms, change forms, and acknowledgment letters
The complete claim submission packet you provided
The insurer’s proof of loss requirements and any correspondence about “missing” items
B) The denial and the insurer’s decision trail
The denial letter and any internal drafts
All internal claim notes, adjuster logs, diary entries, and activity logs
Claim handling guidelines, playbooks, and internal procedures used for this claim
A list of every reason for denial considered, even if not stated in the letter
Any escalation notes to a supervisor, committee, or legal unit
All reservation of rights letters and coverage position letters
C) Medical record ordering and cherry picking evidence
A list of all providers and facilities from which records were requested
All medical records actually received, including attachments and enclosures
The vendor order forms or request parameters used to obtain records
Search terms, date ranges, and limitations used in record retrieval
Any audit trail showing what was requested versus what was produced
The insurer’s medical chronology or summary, if created
D) Medical reviews and expert opinions
Any nurse reviewer notes and summaries
Any physician review reports, including peer reviews
The questions posed to the medical reviewer
The materials provided to the reviewer
Any communications with the reviewer, including emails or portal messages
Credential information for reviewers if maintained in the file
E) Underwriting and post claim underwriting materials
The complete underwriting file for the policy issuance
Underwriting guidelines in effect at the time of application
Underwriting worksheets and risk classification documents
Any contestability review memos
Any post claim underwriting notes and recommendations
Any misrepresentation or rescission committee notes
Any rating or decline rationale that was considered
F) Database, third party, and investigative materials
MIB inquiry results and supporting documentation
Pharmacy database results and queries
Motor vehicle report if used
Credit based or financial underwriting reports if used
Social media or internet investigation materials if referenced
Surveillance reports or investigator summaries if obtained
Recorded statements, interview summaries, and transcripts if any exist
G) Communications that often reveal the real rationale
All emails between claims and underwriting
All emails between claims and legal
All emails with third party vendors
All letters sent to and from you and other beneficiaries
Phone call logs and call summaries
Any internal messaging notes that explain why the denial was chosen
H) ERISA specific items if the policy is employer provided
The full administrative record and a statement confirming it is complete
All documents “relevant” to the claim under ERISA standards
The plan document, not just a certificate
The claims and appeals procedure document
Deadlines applied and how they were calculated
Any internal appeal unit notes and decision logs
What to look for when the file arrives
Do a fast triage first.
Compare the denial letter citations to what is actually in the file. Are the referenced records complete or excerpted?
Check whether there are claim notes on dates when you called or emailed. Missing entries often signal gaps or editing.
Look for new rationales not stated in the denial letter. Those often appear in internal notes first.
Identify vendor involvement. If a vendor did the record collection or medical review, you will often find boilerplate language and narrow search scopes.
Red flags that the insurer produced an incomplete file
No internal notes or logs, only external correspondence
No underwriting file, only the application
Medical records appear selective, missing follow up and specialist notes
No communications with vendors, only the final vendor report
No index and no certification that the record is complete
References to documents you did not receive, such as “see attached” with nothing attached
If you see these, respond in writing and request the missing categories explicitly.
Why this checklist helps an appeal
An appeal works best when it answers the insurer’s actual rationale, not the public facing version. The claim file shows what the insurer truly relied on.
If you are forced to guess, you will either submit too little and leave holes, or submit too much and give the insurer more material to twist. The claim file reduces that risk.
The takeaway
A denial letter is a summary. The claim file is the case.
When you request the full claim file using a detailed checklist, you increase the odds of exposing cherry picked evidence, unsupported conclusions, and procedural shortcuts. That often changes the trajectory of the appeal, and it positions the case better if litigation becomes necessary.
Quick copy and paste request language
Subject: Request for Complete Claim File and Index
I request a complete copy of the claim file and all documents relevant to the claim and the denial decision, including all materials considered, reviewed, relied upon, or generated in connection with the claim. Please include the policy and all forms and riders, the full underwriting file, all claim notes and activity logs, all medical records obtained, all vendor reports and communications, all internal communications regarding the claim, and an index identifying every document in the file. If this is an ERISA governed claim, please treat this as a request for the complete administrative record and all relevant documents.
Please provide the file electronically and confirm in writing that the production is complete.