Overview

When a serious illness, hospitalization, or caregiving crisis prevents you from filing or paying taxes on time, the IRS may waive penalties through a penalty abatement. Relief commonly rests on “reasonable cause” — proof that circumstances beyond your control made compliance impossible — or on administrative programs such as first-time abatement or disaster-related relief. The IRS explains these options on its Penalty Relief page and in guidance for Form 843 (Claim for Refund and Request for Abatement) (IRS.gov).

In my 15 years working with clients on tax relief, medical emergencies are a frequent and compelling cause for abatement when documented clearly. Below I’ll walk you through eligibility, documentation, step-by-step submission, common pitfalls, and what to do if the IRS denies your request.

(See also: The Basics of Penalty Abatement: Reasonable Cause vs Administrative Waivers and Penalty Abatement Request Letter.)

Who usually qualifies?

Taxpayers who may qualify include:

  • Individuals hospitalized or incapacitated during a filing or payment window.
  • Caregivers whose responsibilities directly prevented timely tax action.
  • Taxpayers whose medical emergency created sudden financial inability to pay without clear prior noncompliance.

Qualification is fact-specific. The IRS looks for a direct link between the medical event and the missed obligation, plus supporting documentation and a history of prior compliance. If you had a long record of late filings before the medical event, relief is less likely.

What forms of relief apply to medical emergencies?

  • Reasonable cause abatement: The primary route. You must show that circumstances beyond your control prevented compliance and that you acted reasonably once able.
  • First-Time Abatement (FTA): If you otherwise meet the FTA criteria (usually no prior penalties for three tax years and current filing/payment of the tax), you may be eligible regardless of cause. Learn more about First-Time Penalty Abatement on our site.
  • Administrative waivers & disaster relief: The IRS occasionally issues relief after disasters or public health events (e.g., COVID-related relief); these can apply if your area or situation was covered by an IRS announcement.

Authoritative resources: IRS Penalty Relief and About Form 843 (IRS.gov).

Key evidence to include (checklist)

  • A clear timeline of events: dates you were hospitalized, incapacitated, or caring for someone and the specific dates you missed filing or payment deadlines.
  • Medical records or hospital discharge summaries showing diagnosis, treatment dates, and incapacity.
  • A letter from the treating physician or hospital that confirms the patient’s condition and ability to participate in tax matters (signed and on letterhead when possible).
  • Proof of prior compliance (copies of prior-year tax returns, proof of previously timely payments or filings).
  • Documentation of any attempts to comply (mailed return receipts, e-file confirmation, bank records showing attempted payment, communications with tax professionals).
  • If a caregiver cared for someone else, documentation of the care relationship and how duties prevented tax compliance.
  • Financial statements showing inability to pay if the medical emergency caused a sudden loss of income.

Tip from practice: organize these documents in chronological order with a one-page executive summary at the front that lists the enclosed items and states the relief requested.

How to prepare a persuasive reasonable cause letter

A reasonable cause letter is the centerpiece of most medical-emergency abatement requests. Structure it like this:

  1. Header: Your name, SSN (or ITIN), tax year(s), and IRS notice number if you have one.
  2. One-line request: “I am requesting penalty abatement for [penalty type] for [tax year] due to a medical emergency occurring on [date(s)].”
  3. Chronology: Short bullet timeline of the event and steps you took (or could not take) because of the emergency.
  4. Evidence summary: List key documents you are submitting (medical records, hospital letters, payment attempts, prior-year compliance proof).
  5. Explanation: Briefly explain how the emergency directly prevented filing or payment (be specific — e.g., “patient was unconscious from X date to Y date and under sedation until Z, preventing execution of tax filings”).
  6. Closing: State the relief requested and add a professional sign-off with contact information.

Include copies (never originals) of supporting documents.

Example anchor links: see our sample guidance in the Penalty Abatement Request Letter article for templates and wording tips.

Where and how to submit the request

  • Mail: If you received an IRS notice, mail your letter and copies to the address on the notice. Many abatement requests are submitted by mail with supporting evidence.
  • Form 843: Use Form 843 when seeking an abatement of certain civil penalties or to claim a refund — but check the form instructions, because not all penalty types are claimable via Form 843 (IRS, About Form 843).
  • Phone: For simple issues, you can call the number on your IRS notice. Representatives can annotate your account, but they often will still require a written submission for verification.
  • Representative: A tax pro with a signed power of attorney (Form 2848) can present your case and communicate with the IRS on your behalf.

Note: There currently is no general online portal to submit a full penalty-abatement packet (as of 2025); most complete requests go by mail or through a representative.

Typical timeline and what to expect

  • Acknowledgment: The IRS may not send an immediate acknowledgment. Expect initial correspondence or account annotation within 30–90 days.
  • Decision: Many routine cases are resolved in 45–90 days; complex cases with appeals or requests for more evidence can take longer.
  • If denied: The IRS will send a denial letter explaining why. You can then file an appeal through the IRS Office of Appeals or request assistance from the Taxpayer Advocate Service if you face a significant hardship or unreasonable delay (taxpayeradvocate.irs.gov).

If the IRS denies the request

  1. Carefully read the denial to identify the reason.
  2. Gather any missing evidence and correct factual gaps.
  3. File an appeal with IRS Appeals following the instructions in the denial letter. Appeals typically require a written protest for larger amounts or a completed Form 13711 (Small Case Request) for smaller cases.
  4. Consider the Taxpayer Advocate Service if the denial produces financial hardship or you encounter systemic delays.

In practice, a targeted supplemental submission that fills gaps (for example, a physician’s note specifically stating inability to sign documents) will succeed in many cases on reconsideration.

Common mistakes to avoid

  • Sending vague or generic letters without dates and specific evidence.
  • Assuming “medical” alone is enough; the IRS needs a direct link between the health event and missed tax action.
  • Waiting until collections start or penalties snowball — file early once you can document the event.
  • Submitting originals; always send copies and keep the originals safe.

Practical tips from my practice

  • Prepare an executive summary page that gives the IRS a quick case snapshot. Examiners read many packets; a concise summary helps.
  • Use dated, signed statements wherever possible (doctor statements, hospital discharge summaries).
  • If you can pay some or all tax while waiting for abatement, do so — interest generally continues to accrue even if penalties are abated.
  • If overwhelmed, hire a tax pro. The cost of professional help is often lower than the penalties you can recover.

Frequently asked questions

Q: Can I use Form 843 for any penalty?
A: No. Form 843 covers many—but not all—penalties and refund claims. Always check the Form 843 instructions and the IRS Penalty Relief guidance (IRS.gov).

Q: How long will the IRS take to respond?
A: Typical decisions take 45–90 days, but complex cases or appeals can take longer.

Q: Will interest stop while the IRS considers my abatement?
A: Generally interest on unpaid tax continues to accrue even if penalties are abated.

Q: Can an authorized representative file for me?
A: Yes. A licensed practitioner with Form 2848 (Power of Attorney) can represent you. This is often faster and improves the chance your packet is correctly routed.

Related resources on FinHelp

Authoritative sources

Professional disclaimer

This article is educational and based on general principles and my 15 years of experience helping taxpayers with penalty relief. It is not personalized tax advice. For guidance specific to your situation, consult a qualified tax professional or attorney and verify current IRS procedures before filing.

If you’d like, I can provide a one-page reasonable cause letter template you can download and adapt for your situation.