Sample Ltd Claim Denial Letter Template


Case Manager
CIGNA Disability Management Solutions
Routing D212
12225 Greenville Avenue
Dallas TX 75243
Telephone 800.352.0611
April 11, 2002
Ext 5643
Facsimile 860.731.3211
Policy Keys:
Account Name:
Life Insurance Company of North America
Dear Ms.:
This letter is in reference to your Long Term Disability claim. As you know, we have been
investigating your claim for disability benefits and a determination has been reached.
To be eligible for disability benefits, you must satisfy the policy provisions defined as follows:
Disability Definition
“An Insured will be considered Disabled if because of Injury or Sickness, he is unable to perform
all the essential duties of his occupation."
After Monthly Benefits have been payable for 24 months, an Employee will be considered
Disabled only if he cannot actively work in any “substantially gainful occupation” for which he is
qualified or may reasonably become qualified by reason of his education, training or experience.
“Substantial gainful occupation” means one which provides the income required to support the
standard of living reasonably approximating the standard maintained prior to the disability.”
Medical data evaluated
We based our decision to deny your claim for benefits upon policy language and all documents
contained in your claim file, viewed as a whole. According to the information provided by your
physician, you have been released to return to work full-time.
We requested and received medical information from Dr._______. On 02/20/98 your doctor
states that you had gained 10 pounds, still had intermittent diarrhea related to gastrectomy. Your
ENT evaluation was negative with a question of reflux.
Also Dr. _______stated that he saw you on 12/10/98 for an operative procedure. On that date he
states that there is no evidence of persisting ulceration or mass in the esophagus and absolutely no
mucosal abnormalities seen anywhere in the esophagus or in the visualized portion of the


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