Insurance Appeal Deadline Extension Request Letter

Build a letter asking for more time to appeal a denial when records are missing, you were hospitalized, or other good cause applies.

Request more time to appeal

All fields are optional. Explain the good cause reasons for needing extra time to appeal.

Status message placeholder

Policyholder Name

Address

Insurance Company

Policy Number

Member ID

Claim Number

Denial Date

Current Appeal Deadline

Reason for Extension

Requested New Deadline / Extra Days

Evidence Attached

Generates a deadline extension request with space for good cause explanations.

🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)

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.