Submit Claim Request

Claimant Appeal Request Form

If your claim was denied and you have received an Explanation of Benefits from us explaining why it was denied, you have the option to appeal our decision. You must submit your appeal in writing and include supporting documentation. You may use this form to appeal a coverage decision or you can request an appeal by following the appeal procedure outlined in your certificate of coverage.

Important Note: If your Explanation of Benefits indicates that your claim was closed due to lack of supporting documentation (medical records, etc.), you DO NOT need to file an appeal. Instead, upload the requested documentation via the “Submit Additional Documents” button on the SafetyWing Customer Portal page.