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Jack Dawson
312, Church Lane, 25 Apt.
Meridian, MS 39301, USA
Phone: 555-143-532-001
Email: [email protected]
Date of Birth: 14th June, 1979
21st June, 2013

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Dear Sir/Madam, *(if the name is unknown)

I am writing this letter to request reconsideration of the decision of my disability insurance claim denial. Please be advised that my financial status is to a significant extent dependent on the successful solution of this case.

A review of the information may be helpful; therefore, allow me to briefly repeat the facts which have prompted me to write you this letter of appeal. I was suffering from a cognitive disorder starting from the year 1993. This disease is neither terminal, nor socially intolerable; however, in my case it delivered me a number of uncomfortable situations, including temporary difficulties in the understanding of the speech of other people, and of written text. I have every reason to believe the cognitive disorder developed as a result of a head trauma, which I received in 1992 while working on the Mississippi River, Port Franco (the head injury was supported with documented evidence—see Appendix 1). However, the Insurance Fund refused to issue me disability insurance, referring to the fact that the necessary paperwork was not filed by my doctor in an appropriate way.

Considering this, I consulted with my doctor and lawyer; we have revised all the documents which I needed to submit in order to get the insurance, and now I can provide you with the correctly filed notarized paperwork (Appendix 2).

Therefore, I ask you to reconsider your decision about my disability insurance claim denial. If you have any questions that may expedite this request, please call me at 555-143-532-001. Thank you for your attention to this matter.


Jack Dawson

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