Your insurance provider has denied giving you compensation for your disability claim; now what? Dealing with disability insurance companies leads to frustration, discouragement, and confusion. In reality, the process is more complex for an average person leaving them feeling overwhelmed.
Firstly, it is important that you have acquired your shoer or long-term disability policy via your employment, ERISA, a federal law that applies to your claim. It means you should follow certain rules when filing for benefits or appealing for a claim denial. Ince you miss the deadline, you will be foreclosed from pursuing the claim further.
Things you need to understand before appealing a short or long-term disability claim
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Identify the denial reason.
It is time to review the denial letter. When an insurance company denies your claim, they send you a detailed reason for the denial. Review the company’s reason for denial to determine what you need to address the appeal.
The letter will contain the basic information on filing an appeal and the deadlines for your appeal. Claimants generally have 180 days to submit the administrative appeal. Failing to submit within the deadline can result in losing the ability to seek benefits in court.
Sometimes, the insurance company will twist information or ignore relevant information. When you review the denial letter and have questions in mind, you should contact an attorney to tackle step two.
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Review the disability plan document.
It is essential to understand the disability definition contained in your policy. In your appeal, you should mention why you meet the disability definition. Also, your treatment experts and providers should be aware of the definition when preparing statements of forms to support your disability claim.
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Obtain the insurance company’s claim file.
You can receive a complete copy of the insurance company’s claim file. You have to ask for the claim in writing. Your claim should contain information related to the claim, surveillance videos, in-house medical reviews, medical evidence, and the insurance company’s claim guidelines.
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Preparing the administrative appeal of the disability insurance claim denial
It is crucial for you to know that when you prepare documents for your administrative appeal, you are eventually preparing for court review. If the insurance company holds its claim denial after the review of the appeal and a lawsuit is filed, the only information the court will view is the information submitted before the final denial.
