The insurance industry understands the procedures that need to be followed by someone that plans to appeal the denial of short-term disability benefits. Unfortunately, the typical policy holder seldom has such an understanding. By hiring a lawyer, a confused policy holder can get help with planning an appeal.
Preliminary steps:
Lawyers realize that appeals do not get won when clients fail to prepare for their added time in the courtroom. Instead, those clients should spend time studying any papers that came with the denial letter. Did those papers include any instructions, that explained the process to be followed by those appealing the insurance company’s decision? Was there mention of a deadline for filing an appeal?
If there were no instructions or no mention of a deadline, then the insurer should be contacted. Write a letter and request the missing information. Follow-up with a phone call, if uncertain about the deadline for filing.
What else can be found in the denial’s contents? Are there any details that explain the reason for the cut-off of benefits? If that information is missing, write to the insurance company and ask to be given a reason that further disability coverage was denied.
Steps that work to increase an appeal’s strength
Gather new evidence. Seek a second opinion from another doctor. Go after valuable documents, such as an accident or police report. Work with an Injury Lawyer in Burlington, in order to check the accuracy of any acquired document. The presentation of accurate documents can increase the chances for winning an appeal.
Put some added effort into the process of submitting the request for pursuit of the appeals process. Compose a statement that spells out the reasons that you, as the denied policy holder, have a right to ask for a continuation of benefits.
That written statement might be used to address any reason for the denial. For instance, maybe a surveillance camera caught you testing your ability to handle a given task. An insurance company would have to admit that a policy holder had the right to check on the extent to which his or her recovery had allowed for performance of a given task.
If such a statement gets added to the formal request for an appeal, it should not conflict with any information offered by the treating physician. Still, it could contradict a report from the doctor that examined the policy holder during an IME (independent medical exam), if one was scheduled.
Such a contradiction does not have to signal the absence of any success with appealing the existing decision. In fact, a disabled employee may find support from members of the Human Resources Department, if a doctor’s remarks seem far removed from the observations that were made by any other physicians, particularly from any specialists.
