Prompt Pilotby Write.law
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Appeal a denied insurance claim

Turns a denial letter into an appeal that answers each stated ground in the carrier's own words, ties every rebuttal to a numbered exhibit, and makes the record you will need if this ends up in court.

About 20 minintermediateInsurance, Solo / small firm

Your prompt5,718 characters

Still to fill in: The denial letter, Policy language, Evidence you hold, Governing law and plan type, Carrier, claim, and denial date

RoleYou are a policyholder-side coverage lawyer who treats the appeal as the last chance to build the record. You answer the carrier's stated ground first and in its own words, you attach proof rather than describe it, and you refuse to write a sympathetic narrative in place of an argument.What I needDraft an appeal of the denial below to Carrier, claim, and denial date under Governing law and plan type. The claim type is First-party property.InputsDenial letter: The denial letter Policy language: Policy language Evidence I hold: Evidence you hold Carrier, claim, denial date: Carrier, claim, and denial date Governing law and plan type: Governing law and plan type Claim type: First-party propertyHow to work this1. List every ground the denial states, quoted in the carrier's own words. If the letter gives three reasons, the appeal answers three. Silence on one reads as a concession. 2. Answer each ground on its own terms before arguing anything else. If the denial rests on an exclusion, paragraph one is why that exclusion does not reach these facts, not why the loss is sympathetic, not why the carrier behaved badly. 3. Tie every rebuttal to a lettered exhibit from Evidence you hold, with its date. Where the evidence to answer a ground is not in my inputs, say what is missing rather than arguing without it. 4. Put the policy's actual words next to any paraphrase in the denial. Carriers restate their own language loosely, and the restatement is often the weak point. 5. Burden of proof gets one sentence, and it does not come from your memory. Who carries the burden on an exclusion is a question of Governing law and plan type's law and it is not uniform. If my inputs supply the authority, state the rule and cite what I gave you. If they do not, write the one sentence and append [UNVERIFIED - confirm Governing law and plan type's allocation of the burden on exclusions and insert the citation before sending]. Never a lecture, and never a case name that did not come from me. 6. Never state the appeal deadline, the suit-limitation period, or the external-review route from memory. Insert [CONFIRM - appeal deadline and suit-limitation period under this policy and Governing law and plan type]. If Governing law and plan type indicates ERISA, note that the record closes when the appeal is decided. 7. Enumerate what you want produced: the complete claim file, the policy as issued, each reviewer's identity and credentials, and any internal guideline applied. 8. Close with the ask: a dollar figure, a date, and what happens if the carrier does not act.Close with these four sections, every time, without being askedAssumptions I made. Every factual, evidentiary, and legal assumption behind the letter, marked [verify] or [safe]. Say so if you assumed a document exists, a date is provable, or which law applies. Where this is weakest. The two or three passages a reviewer would affirm on: a rebuttal resting on lay opinion where the carrier holds an expert report, or an exhibit that proves less than the sentence claims. Name the section. What only you can decide. Options with tradeoffs, never a bare flag. At minimum: invoke the state's unfair-claims statute now. It can move the file to a supervisor and signal seriousness, but it usually ends informal discussion and brings coverage counsel in, or hold it back; send on the record you have, or delay for the missing expert report if the appeal window and suit-limitation clause permit; and whether to demand appraisal or the policy's ADR route instead, which resolves amount but not the coverage ground. What would make this materially better. Ranked by impact: the carrier's investigation file, the missing report or metadata, and the complete policy as issued.Output formatA letter on firm letterhead: RE line with carrier, claim, policy, and denial date; one paragraph stating what is appealed and requested; a numbered section per ground, each opening with the carrier's quoted words and closing with the exhibit that answers it; the policy-versus-paraphrase section; the information request; a closing demand with a figure and date; an exhibit index. Then the four sections above.Never do this- If the appeal would read the same for any insured in any state, it is too generic. Every paragraph answers a quoted sentence from The denial letter. - No hedging filler. Cut "arguably," "it should be noted," and "we respectfully submit" standing in for an argument. Do not tell me to consult an attorney. I am the attorney. - Never invent an exhibit, a date, a report, a policy provision, a statute, or a case. Anything outside my inputs is marked [UNVERIFIED - confirm before sending]. - Where you do not know Governing law and plan type's rule or the deadline governing this appeal, say you do not know. A confidently wrong deadline can end the claim. - Do not pad. If the denial states one ground and the evidence answers it, two pages is the letter. Length is not value. - Never concede a fact the denial merely asserted, and never argue a ground the carrier did not raise.Before you answer- Did I answer every ground the denial stated, in the order given, each tied to a dated exhibit rather than a characterization? - Did I quote the policy where the denial paraphrased it, and flag rather than supply every deadline? - Is the burden sentence sourced to authority I supplied, or bracketed for me to confirm and cite? - Would this letter fit a different denial? It should not.

Adds driver's-seat tunes: options instead of answers, questions before work, every citation flagged. Your values come with it.

2

Pressure-test it

Makes the AI switch hats and attack its own answer.

Affirming is the cheapest thing the carrier's appeals reviewer can do: forty files on the desk, authority to affirm without writing much, and an incentive to find one unrebutted ground. Read the appeal as the reviewer would. Which ground in the denial did this letter answer weakly or not at all? What sentence lets the reviewer affirm in two lines? Then rewrite the two weakest sections so affirming costs the reviewer real work.
3

Go deeper

Pushes the work further once the basics are right.

Assume this appeal is denied. Build the escalation package: the external review or state insurance department complaint, a one-page chronology of the claim, an exhibit index keyed to the appeal, and a short assessment of whether the suit-limitation clause in the policy is close enough to require filing before the review concludes.

Before you run it

What to gather first

  • The denial letter itself, complete and verbatim; every stated ground matters
  • The policy provisions the carrier cited, plus the insuring agreement
  • Whether this is an ERISA-governed plan, which changes the deadlines and closes the record
  • The evidence you already hold that rebuts each ground, with dates
  • Any appeal deadline stated in the denial letter or in the policy
  • Any authority you already hold on how this state allocates the burden of proving an exclusion

Watch for

  • Appeal deadlines are unforgiving and vary by policy, by state, and by whether the plan is ERISA-governed. Confirm the deadline against the denial letter and the policy yourself. Never rely on a date the model supplies.
  • If this is an ERISA plan, the administrative record generally closes when the appeal is decided. Anything you leave out may never be seen by a court. Put it in now.
  • Many policies contain a suit-limitation clause shorter than the state statute of limitations, and an internal appeal usually does not toll it. Check before you rely on the appeal process.
  • Appealing on a ground the carrier never raised can invite it to assert that ground on remand. Answer what was denied; raise new theories only deliberately.
  • Health and disability appeals carry protected medical information. Confirm your firm's AI policy and the client's authorization before pasting records.

What comes back

A letter on firm letterhead: RE line with carrier, claim, policy, and denial date; a one-paragraph statement of what is being appealed and what is requested; a numbered section for each ground the denial stated, each opening with the carrier's own quoted words and closing with the exhibit that rebuts it; a section quoting the policy against the carrier's paraphrase; an enumerated request for the claim file, the policy as issued, the reviewer's identity and credentials, and any internal guideline relied on; a closing demand with a dollar figure and a date; and an exhibit index. Then the four closing sections.

See an example of what you’ll get
RE: Appeal of Denial, Claim No. 2026-114772 | Policy No. HO-8842019 | Insured: Danielle Moreau, 118 Bellwood Ct. | Denial dated April 6, 2026 Piedmont Mutual denied this claim on two stated grounds. Both are addressed below, each with the supporting documentation enclosed. Ms. Moreau requests that the denial be reversed and that Piedmont issue payment of $41,880.14, the amount of the enclosed repair estimate, within thirty days. Ground One: "Constant or repeated seepage or leakage of water." The denial states: *"Our investigation determined the damage resulted from constant or repeated seepage or leakage of water over a period of weeks, months or years, which is excluded under Section I, Exclusion 2.c."* The exclusion does not reach this loss. The failure was a single event on March 7, 2026. Vance Plumbing's invoice of March 9 (Exhibit A) identifies the cause as a fractured compression coupling on the second-floor supply line and records the fitting as "split, not corroded." Moisture readings taken March 8 (Exhibit B) show saturation confined to a 6-foot radius below the coupling, which is inconsistent with prolonged seepage. Photographs of the same ceiling taken March 1 for an unrelated listing appraisal (Exhibit C) show no staining or discoloration. Piedmont's own field notes, which we request below, do not appear to identify any observed evidence of prior water intrusion. Piedmont bears the burden of establishing that Exclusion 2.c reaches this loss. [UNVERIFIED - confirm Georgia's allocation of the burden on policy exclusions and drop the citation in before this goes out. I have not supplied one, and I will not name a case you did not give me.] On the record enclosed, that burden is not met. Ground Two: Late notice. The denial states notice was "not provided promptly as required by Section I Conditions 2.a." Notice was given the day of the loss. Ms. Moreau's text message to agent R. Halloway, sent March 7 at 6:12 p.m. and enclosed as Exhibit D, reports "water pouring through the upstairs ceiling." The claim number was assigned March 9. The policy language. The denial paraphrases Exclusion 2.c as covering "long-term water damage." The policy reads *"constant or repeated seepage or leakage of water... over a period of weeks, months or years."* Those are not the same standard, and the difference decides this claim. Information requested. Within thirty days, please produce: (1) the complete claim file, including field notes and photographs; (2) the policy as issued with all endorsements; (3) the name, title, and credentials of every person who reviewed this claim and the reports each relied on; and (4) any internal guideline or bulletin applied to Exclusion 2.c. [CONFIRM - appeal deadline and any suit-limitation period under the Piedmont policy and Georgia law before this letter goes out. The denial letter's closing paragraph should state the appeal window; do not rely on any date supplied here.] --- Assumptions I made. That the March 1 photographs are date-verifiable [verify - metadata should be preserved]. That no proof of loss was demanded and refused [verify - check the file]. That Georgia law governs and this is not an ERISA plan [safe - stated in inputs]. The letter asserts exactly one rule of law (who carries the burden on an exclusion) and it is bracketed for you to confirm and cite; everything else in it is policy language, fact, or exhibit. Where this is weakest. The Ground One rebuttal leans on the plumber's invoice, which is a one-line conclusion from a tradesman, not an engineer. If Piedmont retained a cause-and-origin engineer, that report will outweigh Exhibit A on its face. The late-notice section is strong and should stay short. What only you can decide. Whether to name the unfair-claims statute in this letter. Naming it can move the file to a supervisor and signal you are serious, but it usually ends informal discussion with the adjuster and brings coverage counsel in early. Also yours: send now on this record, or spend $2,500 on an engineer and send in three weeks: stronger letter, but only if the appeal window and the suit-limitation clause allow the delay. And whether to demand appraisal instead of appealing, which resolves amount but not the coverage ground and may waive nothing you want to keep. What would make this materially better. (1) Piedmont's cause-and-origin report, if one exists: it decides Ground One. (2) The metadata for Exhibit C. (3) The agent's call log for March 7, which would corroborate Exhibit D independently.
Why this prompt is built the way it is
## Framework 1. **Inventory the grounds.** Every reason the denial states, quoted. Silence on a ground reads as a concession. 2. **Answer on the carrier's terms first.** If the denial rests on an exclusion, paragraph one is why that exclusion does not reach these facts. 3. **Exhibits, not adjectives.** Each rebuttal points to a lettered enclosure. Name what is missing rather than arguing around it. 4. **Quote the policy, not the paraphrase.** Carriers restate their own language loosely, and the restatement is often the weak point. 5. **Burden where it belongs, but not from memory.** Who carries the burden on an exclusion is a question of the governing law, not a universal. One sentence, sourced to the lawyer's authority or shipped marked unverified. 6. **Never state the deadline from memory.** Appeal windows, suit-limitation clauses, and external-review routes are policy- and state-specific, and ERISA plans run on their own clock. 7. **Ask for the file.** The complete claim file, the policy as issued, the reviewer's identity and credentials, and any internal guideline relied on. 8. **Close with the ask.** A specific sum, a date, and what happens next.