Insurance Benefit Exclusion Challenge Letter PDF

Prepare a formal appeal letter contesting a denial based on benefit exclusion language.

Appeal letter inputs

Fill in any details you want included in the benefit exclusion appeal.

Policyholder Name

Address

Insurance Company

Policy Number

Claim Number

Denial Date

Exclusion Cited by Insurer

Reason Exclusion Should Not Apply

Requested Resolution

Download the letter and attach evidence before sending.

🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)

Non-Negotiable Guardrails

Do not modify global layout, header, footer, ads, analytics, or shared components
Do not import @/components/ui/select or any unverified shadcn components
Use native HTML inputs only
Row add/remove buttons must be plain <button>
No date math, no parsing, no calculations
PDF builders must return Promise<Uint8Array>
Always create Blobs using bytesToPdfBlob(bytes) from lib/pdf/bytes.ts
Never include null in React-PDF style arrays
No refactors
Tool may only break itself

Processing stays in your browser. PDFs generate locally—no uploads or accounts.
Downloads use a secure PDF blob helper (no raw array buffers or workers required).
Review details before sending; nothing here is legal advice or a substitute for local forms.