What Evidence Do I Need to Appeal a Denied Insurance Claim?

The difference between a successful appeal and a failed one often comes down to a single factor: the quality and completeness of the evidence you submit. Insurers look for any gap in your documentation to maintain their denial. Your job is to close every gap.

This guide covers exactly what evidence you need, organised by claim type and appeal stage.

The Core Evidence Package (All Claims)

Regardless of what type of claim was denied, every appeal should include this foundational set:

1. The denial letter

Keep the original denial letter. It tells you the exact reason the insurer gave for rejecting your claim — and that reason is the target of your appeal. If the letter is vague or uses general language, you have grounds to request a more specific explanation.

2. Your insurance policy document

You need to know exactly what your policy says — and what it does not say. Locate the relevant section that the insurer is relying on to deny you (an exclusion clause, a waiting period definition, a "medically necessary" standard). Read it carefully. Ambiguous policy language generally favours the policyholder under the legal principle of contra proferentem.

3. Proof of premium payments

A simple but sometimes overlooked point: evidence that your policy was active and premiums were paid up to date at the time of the claim.

4. Chronological correspondence record

Compile all emails, letters, call logs, and notes relating to your claim. Dates matter — especially if you need to demonstrate that an insurer missed a regulatory deadline for responding.

5. Your original claim submission

A copy of the claim form and everything you submitted with it. If the insurer is claiming you failed to provide required documentation, this shows what you actually sent.

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Evidence by Claim Type

Health and Medical Claims

For "not medically necessary" denials:

• A letter from your treating doctor specifically addressing the medical necessity of the treatment, referencing clinical guidelines (e.g., NICE guidelines in the UK, MOH guidelines in Singapore, Medicare Benefits Schedule in Australia)
• Any specialist referral letters
• Relevant diagnostic test results (blood tests, imaging, biopsies)
• Published clinical guidelines or peer-reviewed evidence supporting the treatment
• Evidence of previous unsuccessful conservative treatments (to show the claimed treatment was a necessary next step)

For pre-existing condition denials:

• Medical records showing the timeline of your condition — particularly evidence that you were not symptomatic or diagnosed at the time the policy was taken out
• A statutory declaration from you and your doctor if necessary
• Evidence of any medical disclosures you made when applying for the policy

For prior authorisation denials:

• Evidence that your treating physician attempted to obtain prior authorisation, or that the urgency of the situation made it impractical
• Any communications with the insurer about the treatment before it occurred

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Life Insurance Claims

For contestability period denials (alleged non-disclosure):

• Evidence that the information in question was either disclosed on the original application or was not material to the underwriting decision
• Medical records from the relevant period showing the full picture of your health history
• Expert medical evidence on whether the non-disclosed condition was related to the cause of death

For cause of death disputes:

• Death certificate
• Coroner's report (if applicable)
• Post-mortem results
• Treating physician's statement

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Travel Insurance Claims

For trip cancellation denials:

• Medical certificates from your doctor confirming you were unfit to travel (with dates)
• Any relevant documentation of the covered event (flight cancellation notices, natural disaster declarations, etc.)
• Proof of bookings and costs incurred

For medical expense claims while abroad:

• Original receipts for all medical expenses
• Hospital admission and discharge paperwork
• Treating doctor's diagnosis and treatment records
• Evidence that you sought treatment at the first available opportunity

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Income Protection and Disability Claims

These are among the most documentation-intensive claim types:

• Comprehensive medical records spanning the period of disability
• Treating specialist's detailed clinical assessment of functional capacity
• Evidence of ongoing treatment and therapy
• Independent medical examination (IME) records if provided by the insurer (and your response to their findings)
• Employment records showing your occupation and income at the time of the claim
• If the insurer has commissioned their own IME, consider obtaining your own independent opinion

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Strengthening Your Evidence

Get a tailored doctor's letter

A generic "patient was sick" letter will not move the needle. Ask your doctor to write a letter specifically addressing the insurer's stated reason for denial — referencing the clinical guidelines, explaining why the treatment was necessary, and (if applicable) why the condition was not pre-existing.

Request the insurer's full file

In many jurisdictions (including the UK, Australia, and Singapore), you have the right to request all documents the insurer holds about your claim, including any internal assessments, IME reports they commissioned, and claims handler notes. This can reveal the actual reason behind the denial — which may differ from the stated reason.

Address every point in the denial letter

Your appeal should directly respond to each specific ground of denial cited by the insurer. Don't just submit new evidence — explain why each piece of evidence addresses each ground of denial.

Know your deadline

Evidence submitted after the appeal deadline may not be considered. Check your policy and local regulations for the applicable window. For time-sensitive claims (e.g., urgent medical procedures), the deadline for expedited external review may be as short as 24–72 hours.

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A Note on Organising Your Evidence

Insurers receive many appeals. A clearly organised submission — with a cover letter explaining the structure, numbered attachments, and a clear cross-reference between your arguments and your evidence — is far more likely to be carefully considered than an unstructured bundle.

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