If you have received a denial letter after applying for a long-term disability claim, it can be difficult to know what to do next. Disability claim denials are quite common, and you have a few options when it comes to pursuing an appeal.
Internal Long-Term Disability Appeal
An internal appeal is essentially a request that the insurance company look over your claim again and reevaluate their initial decision.
Situations where an internal appeal is likely the best options include:
Need for Medical Clarification
If your claim was denied because the insurance company requires some form of clarification from your healthcare provider, an internal appeal is usually effective once you supply the requested clarification.
Missed Medical Appointment
If you have missed a doctor’s appointment or treatment session, an internal appeal may result in your favor as long as you attend a medical appointment to make up for the one that you missed.
External Long-Term Disability Appeal
When you make an external appeal, this means that you are involving a third party outside of the insurance company. Depending on the nature of your case, it may be heard by an informal tribunal or by the Court. If you want to claim damages for past benefits owing, punitive damages, and/or compensation for mental stress, you will need to file a lawsuit in the courts. If you win or settle your court case, the insurance company will be obligated to pay for your legal fees.
Situations where an internal appeal is likely the best options include:
Medical Exam Done by Company Doctor
If your medical examination was conducted by the insurance company’s doctor, it is unlikely that the company will change its initial decision, even if you supply them with medical evidence from an unbiased healthcare practitioner.
The Insurance Company Denies That You are Receiving Medical Care
If your claim is denied because the insurance company says that they don’t believe that you are receiving medical care, they are unlikely to change their stance unless a third party decision-maker is brought in.
Your Claim is Denied on a Technicality
Insurance companies that deny your claim on a technicality such as a missed deadline or a pre-existing medical condition are unlikely to come up with a different decision upon reevaluation, so an external appeal is recommended in this situation.
Get Help from a Lawyer
If your long-term disability claim has been denied and you are interested in filing an appeal, get in touch with the lawyers at Hoogbruin & Company today for advice on whether to choose an internal or external appeal and get assistance with your next steps.