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What Can You Do If Your Insurance Claim Is Denied?

What Can You Do If Your Insurance Claim Is Denied?


Denied Insurance Claim

If your disability claim has been denied, you will likely be given the opportunity to “appeal” the decision by providing additional information for the insurance company to review. In our experience, while there is a small possibility that an appeal will reverse the decision, in most cases, it simply further delays the matter, with many more months of no payments being made and creating further frustration and financial pressure on you. 

GOOD ADVICE:

  • Discuss your claim with an experienced disability lawyer so that at least you know what your options are and can consider what action to take. 
  • The biggest reason to bypass the insurance company “appeal process” is to push the matter forward to more senior people in the insurance company who are experienced at dealing with disputed claims, rather than continuing to try and persuade the lower level claims manager. 
  • By proceeding with legal action, you are forcing the insurance company to take your claim more seriously. 
  • Do not give vague or inconclusive medical information
  • Doctors are often frustrated by the need to repeatedly provide supportive medical information and are often offended by the insurance company’s refusal to accept their opinions. Remember your doctor is mostly busy with attending to the needs of their patients’ health care and they often don’t have the time to get engaged in a substantive way with the insurance company process.

What Documents Do Insurance Companies Want For A Medical Disability Appeal?

If your claim has been denied and you are now appealing, your insurance company has likely requested additional information to support the claim.  Often, they will not even consider your appeal unless you provide them “fresh evidence”.  As part of your original application you and your doctor would have filled out forms and it is also common that your primary physician’s clinical notes and records were provided.  

On appeal you will need to submit;

  • Up to date clinical records.
  • Records from any hospital or specialists.
  • Copies of diagnostic tests, scans, x-rays and bloodwork.
  • A narrative report from your specialist or primary physician is often the best evidence on appeal.  That report should contain not just your diagnosis and that physician’s opinion on your disability but also a thorough treatment of your symptoms, how they affect your functionality both in and out of the workplace, the treatment you are undertaking and, if available, your prognosis into the future.  

5 MISTAKES TO AVOID:

1. Exaggerating Your Symptoms:

The denial rate for disability claims among the private and public sector has received considerable publicity. In an effort to jump start your claim, or give it some extra punch, there could be a temptation to exaggerate the symptoms of your disability on the claim form. You may have had your disability for some time and fear that your claims adjuster will not understand why you cannot work. Your pain may be intermittent, and you may fear that the insurance company will not understand that this prevents you from working. Exaggerating your symptoms can ultimately lead to your claim being denied. It is important to remember that your claims adjuster and your insurance company have years of experience handling disability claims, and they are eager to weed out what they consider “invalid” claims. Exaggerating your symptoms could result in your claim reaching the “invalid” file.

2. Understanding Your Disability:

It is very important that your doctor conduct a thorough medical examination and refer you to the appropriate specialist. Your doctor should be the one to make an assessment of your disability and provide specific information about why you cannot work. With this in mind, it is crucial that any medical information you give to your insurance company be complete and accurate. You may be tempted to understate your disability in the hopes that a smaller claim may prompt your insurance company to start disability payments. However, any information you provide about your disability will be used to make a decision on your claim, so that information should be accurate and supported by your doctor’s findings.

3. Waiting Too Long To Hire A Lawyer:

The value of seeking the help of a lawyer experienced in the area of disability law cannot be overemphasized.Many claimants feel overwhelmed, as most of their energy is spent trying to overcome their disability. It is understandable that the work involved in filing a disability claim might come much further down on your priority list. Waiting too long to involve a lawyer in your claim may make the process even longer and more drawn out. It is always better to find an experienced lawyer and involve them at an early stage. In addition to moving your claim along more smoothly, a lawyer can also advise you on other resources that are open to you. 

4. Failing To Put Faith In Your Lawyer:

Most experienced lawyers welcome the input and active participation of their client. However, a claimant who fails to give their lawyer room to maneuver in order to successfully follow your claim will ultimately run into trouble. It is important to appreciate the value of an experienced lawyer when it comes to following a disability claim through to resolution. A good lawyer can add that experience and make the process easier for you only if you put faith in your lawyer and allow them to do what they do best.

5. Giving In:

If you cannot work due to a disability and have already gone through the arduous claims process only to find your claim is denied, you may feel you are ready to admit defeat. As we’ve already seen, many disability claims are denied when first submitted. Individuals with no experience with disability claims can, understandably, feel intimidated by large insurance companies and overwhelmed by their claims process. Many experienced lawyers acknowledge that these feelings are a strong indicator that it is a good time to find a lawyer. A lawyer who has experience with disability claims can help level the playing field. The bottom line is that you shouldn’t give up. Perseverance may yield results. If you feel you cannot do it alone, seek help from one of our experienced disability lawyers here at Share Lawyers. 

REMEMBER! Appeals are often unsuccessful and can take many months.  As such, if your claim has been denied we would encourage you to seek legal advice as soon as possible. 

Most disability insurers will give you a right to appeal a denial. We at Share lawyers would recommend that you contact one of our experienced lawyers before appealing. There are certain time limits to sue that may impact your ability to get your long-term disability benefits.

Has your long-term disability claim been denied? Contact Share Lawyers and put our experience to work for you.

We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.
 
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This searchable database contains information about disability, critical illness and life insurance claims, and what you can do if you are denied or cut off of your benefits. It is a collection of the most common questions we receive from our clients. General answers have been provided by our lawyers.