Insurance External Review Request Letter PDF

Generate a late-stage external review request letter with all contact and claim details in a formal PDF.

Policyholder Name

Phone / Email

Address

Insurance Company

Policy Number

Claim Number

Date of Final Internal Denial

Reviewer / Agency

Requested Outcome

Reason for External Review

All fields are optional. No validation or calculations run here.

Generate a formal letter plus attachments checklist.

🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)

Non-Negotiable Guardrails

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

Safety notes

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.