Expedited Insurance Appeal Request Letter

Build an urgent appeal request letter that explains medical harm from delays and lists supporting attachments.

Expedited appeal letter details

All fields are optional. Use clear urgency language to speed up review.

Status message placeholder

Policyholder Name

Address

Phone / Email

Insurance Company

Policy Number

Claim Number

Date of Denial

Medical Urgency Explanation

Treating Provider Name

Requested Resolution

Generates a formal letter emphasizing urgency and attachments.

🔒 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.