SAMPLE · FICTIONAL LETTER
Jordan Avery
[Street address] · [City], FL [ZIP]
[phone] · [email]
17 October 2026
Example Pet Insurance Company
Attn: Claims Appeals
[Address / appeals email from denial letter]
Re: Written appeal of claim denial
Policyholder: Jordan Avery · Pet: Maple (canine, DOB 03/2019)
Policy no.: EPI-0000-0000 (sample) · Claim no.: CLM-0000000 (sample)
Date of denial letter: 25 September 2026 · Amount claimed: $2,860.00
Dear Appeals Team,
I am writing to appeal your decision of 25 September 2026 to deny the above claim as a pre-existing condition under Section 7(b) of my policy. I ask you to reconsider and pay the claim under the terms of the policy. My reasons are set out below, and every point refers to a dated record enclosed with this letter.
1. The decision — Your letter says the claim was denied because a "skin mass [was] documented prior to policy effective date." I understand this refers to the note from Maple's wellness examination at Cedar Animal Clinic on 10 November 2025 (Enclosure C, page 2).
2. The policy definition — Section 7(b) defines a pre-existing condition as a condition for which, before the policy effective date or during a waiting period, "a veterinarian provided medical advice; the pet received previous treatment; or, based on information from verifiable sources, the pet had signs or symptoms directly related to the condition for which a claim is being made" (Enclosure B, page 6). Policy effective 1 February 2026; illness waiting period ended 15 February 2026.
3. The condition claimed is a different condition — 10 Nov 2025: ~1 cm soft movable mass LEFT lateral chest wall; FNA consistent with lipoma; plan monitor (Encl. C p.2). 20 Jul 2026: raised reddened nodule RIGHT hind leg / lateral thigh (Encl. D). 22 Jul 2026: cytology consistent with mast cell tumour. 5 Aug 2026: excision; histopathology cutaneous mast cell tumour (Encl. E). Left chest lipoma re-checked unchanged; not part of this claim. Different tumour types, locations, lab results.
4. No signs of the claimed condition before coverage — Complete Cedar records 2019–present (Encl. C) show no right hind leg nodule / mast cell findings before 20 Jul 2026.
5. Veterinarian's opinion — Dr. Lee signed statement (Encl. F): lipoma not medically related to the mast cell tumour; no signs of MCT before 20 Jul 2026.
6. Burden of proof — Florida §627.71545 provides the insurer has the burden of proving a preexisting exclusion applies. The denial identifies a different mass, not signs directly related to the MCT before 15 Feb 2026.
7. What I am asking for — (1) reverse denial and process $2,860 under normal terms; (2) if upheld, specify records/reasoning and next review level + deadline; (3) copy of complete claim file.
Submitted within the time limit. Please confirm receipt.
Sincerely, Jordan Avery
Enclosures A–H as in Conversion brief 04 (denial, policy, records, July visits, surgery/histo, vet statement, invoices, timeline).
- A — Denial letter
- B — Policy
- C — Complete veterinary records
- D — July visits
- E — Surgery and histopathology
- F — Veterinarian statement
- G — Invoices
- H — Medical timeline