Appealing Life, Health Insurance & Disability Claim Denials
Prepare a Timely and Effective Appeal of your Denied Life, Health Insurance or Disability Claim
If your short or long term disability claim has been denied or terminated, or if your request for pre-authorization of a medical procedure or treatment has been denied by your health insurance plan (or if coverage has been denied even though the treatment was pre-authorized), then you are likely facing the prospect of some sort of appeal or claim review process. Unfortunately, many claimants rush to file their appeal on the theory that the sooner the appeal is filed, the quicker the insurance company will reverse its decision and pay badly needed medical, life insurance, or disability benefits. Claimants may be forgiven for having this perception, because as they read their insurance companies’ claim denial letters, they may be struck by glaring mistakes, sloppy reasoning, or significant omissions. Pointing out such obvious errors should lead the health, life or disability insurance company to quickly approve their claims, right?
Not necessarily. It is our lawyers’ experience that such quickfire appeals are just as quickly rejected, typically on the ground that the claimant has added nothing new in terms of actual medical or occupational evidence. Because you, the claimant, generally have the affirmative legal burden to substantiate your entitlement to benefits, it is imperative that your appeal contain not only a critique of your insurance company’s claim denial, but as much medical and occupational evidence as possible to demonstrate your disability, or the medical necessity of your proposed treatment, hospitalization, medication, or surgical procedure. While it is certainly important to observe all appeal deadlines, it is our lawyers’ experience that a targeted and well-supported appeal is the most effective way to win approval of your disability claim, or coverage for a disputed life insurance or health insurance benefit.
In order to maximize the effectiveness of your life, health, or disability insurance appeal, it is important to know what kind of coverage you have, and the appeal rights that may be available to you. The following pages from our website may be helpful in this regard:
- Do you have ERISA benefits and appeal rights, or individual health, life or disability insurance? It is important to know whether your life, health or disability insurance coverage is is provided through a plan that is governed by the federal Employee Retirement Income Security Act, commonly referred to as ERISA, or is a privately purchased individual insurance policy that is governed solely by state law.
- If my life, health, or disability benefit is provided through an ERISA plan, how can I prepare an effective appeal? If your coverage is provided through an ERISA plan, our lawyers have compiled some guidelines for making the most of your appeal and appeal rights.
- What does it mean if my ERISA plan is self-funded or self-insured? Special rules apply to self-funded ERISA plans, so it is important for you to know whether your life, health insurance, or disability coverage is provided through such a plan.
- What appeal rights to I have if I privately purchased an individual life, health or disability insurance policy? If you’ve purchased your own insurance coverage, it will typically be governed by the law of the state in which it was purchased or delivered. Our attorneys discuss some of the rules that apply to New York life, health, and disability insurance policies.
- What is an external appeal, and is there any advantage to external review if I’ve received a health insurance claim denial? New York, and some other states, provide external review rights for some kinds of health insurance coverage denial. Our lawyers explain when you are entitled to an external appeal, and discuss the relative advantages of pursuing such external review.
- When should I get a lawyer involved in my ERISA appeal, or in a dispute over my private life, health or disability insurance claim? Consulting with an attorney who is experienced in ERISA and insurance law can offer significant advantages and help you to avoid costly mistakes.
Mark Scherzer Law :: ERISA Health Insurance Claim Appeals :: Short and Long Term Disability Claim Appeals
New York ERISA Life, Health and Disability Insurance Lawyers (including New York County, Bronx County, Kings County, Richmond County, Queens County, Rockland County, Westchester County, Nassau County, Suffolk County, Orange County, Putnam County, Sullivan County, Ulster County, Dutchess County, Delaware County, Greene County, Columbia County, Albany County, Rennselaer County, Clinton County, Jefferson County, Oneida County, Schenectady County, Otswego County, Saratoga County and St. Lawrence County)