Our attorneys can help you avoid a disability claim denial or a refusal to provide health insurance coverage by reviewing your employee benefit or insurance policy documents, calling your attention to applicable benefit provisions and limitations, and alerting you to key issues that should be addressed as you prepare to submit your short or long term disability claim or your pre-authorization request for medical benefits coverage.
Perhaps you have been struggling at work with multiple sclerosis, HIV, back pain from degenerative disc disease, myasthenia gravis, chronic fatigue syndrome, Lyme disease, Parkinson’s disease or another chronic disease, and are feeling that it is time to consider going on a disability leave. Or perhaps you’re already on a short term disability leave, and are considering whether to file a claim for long term disability benefits. Or perhaps a family member is in the hospital, recuperating from an accident, and the treating physician believes he or she would benefit from a transfer to a rehabilitation facility, or should be discharged to home only if private duty nursing or home health care can be arranged. Or perhaps you have exhausted standard cancer chemotherapy, and your oncologist is recommending a new drug, or a treatment that is part of a clinical trial.Our lawyers can draw on their legal understanding of your insurance coverage and their experience dealing with claim administrators, to help you make your best case for coverage right from the start. It may be imperative to get updated medical records, supporting letters from treating physicians, occupational descriptions, published medical literature addressing your illness or treatment, or other sorts of evidence to substantiate your disability claim or request for health insurance pre-authorization.
Many of our clients rightly feel that after working many years and paying for their medical or disability insurance, getting coverage for their disability or medical care shouldn’t be a struggle. The reality of the modern “managed care” environment, however, means that no claim is presumed valid and each one is carefully scrutinized to determine that coverage is appropriate and fully substantiated. If a disability claim or request for medical coverage is incompletely documented, or if the evidence suggests that a particular policy exception or limitation should apply (even if remotely), the claim administrator may deny the claim or delay its approval, pending further investigation. This can leave you in a difficult position, awaiting the outcome of an extended investigation (while your benefits are delayed or withheld) or forcing you to pursue an appeal to obtain coverage.
We believe that careful preparation can help to speed the processing of your claim and to avoid improper claim denials. By sitting down with you, reviewing your plan or insurance policy documents, and discussing some of your medical and occupational history, we can help guide you towards making a strong and persuasive claim right from the start.
Remember, the best defense is a good offense.
Mark Scherzer Law :: Disability Claim Preparation :: Health Insurance Coverage Assistance
New York Lawyers (including Nassau County, Suffolk County, Rockland County, Westchester County, Orange County and Putnam County)