How to Read a Denial Letter

How to Read a Denial Letter (Unum, MetLife, Cigna, Aetna, Guardian)

Receiving a disability denial letter from your insurer is frustrating and overwhelming. Companies like Unum, MetLife, Cigna, Aetna, and Guardian often use complex legal and medical language to discourage appeals. But these letters are not the final word — they’re a roadmap showing what evidence you’ll need to overturn the decision.

This guide breaks down how to read a denial letter, what to look for, and how to identify mistakes insurers commonly make.

Anatomy of a Denial Letter

Most denial letters contain these key sections:

1. Claim Information — Policy number, claim number, and date of filing.
2. Reason for Denial — The insurer’s stated basis for rejecting your claim.
3. Policy Provisions Cited — The exact section of the insurance contract the company is relying on.
4. Medical Evidence Summary — The insurer’s review of your medical records.
5. Appeal Rights & Deadlines — Your right to appeal and the timeframe (often 180 days) to submit.

Key Provisions & Exclusions to Watch

When reading your letter, pay attention to:

• Definition of Disability: Many policies change definitions after 24 months — from “own occupation” (your specific job) to “any occupation” (any job you could perform).

• Pre-Existing Condition Exclusions: Insurers may argue your disability is related to a condition treated before coverage began.

• Mental/Nervous Limitations: Many policies cap mental health claims at 24 months.

• Objective Evidence Requirements: Some letters claim you lack “objective medical evidence” even for conditions that don’t show up on scans.

Spotting Errors & Misstatements

Insurers often:

• Cherry-pick medical records — citing minor improvements while ignoring serious ongoing limitations.

• Rely on file reviews instead of exams — where their doctor never meets you.

• Misquote your job duties — using generic job descriptions rather than the actual demands of your position.

• Overstate policy exclusions — applying them more broadly than the contract allows.

If you find inconsistencies between what your doctor reported and what the denial letter claims, that’s a red flag.

Common Phrases & What They Really Mean

• “Insufficient objective evidence” → The insurer wants more test results, even if your condition (like chronic pain or migraines) doesn’t always show up on scans.

• “Your condition does not prevent you from performing sedentary work” → They are redefining your job to minimize physical demands.

• “Based on our medical review…” → Their doctor likely never examined you in person.

• “You failed to meet the policy definition of disability” → They are applying a narrow or shifting definition (own vs. any occupation).

Call to Action

Call 1-800-CANT-WORK — Free Denial Letter Review
If you’ve received a denial from Unum, MetLife, Cigna, Aetna, or Guardian, don’t accept it at face value. Our attorneys will review your letter, identify errors, and build the strongest possible appeal.