Appealing a Disability Denial with Private Insurance

It is stressful enough to have to deal with all the medical issues and stress of a disability of any type. On top of handling your recovery, rehabilitation and the ever challenging financial consequences of an injury or illness you may also find that you have to deal with a disability denial. Private insurers do have to follow specific laws with regards to how they evaluate and approve or deny your claim and they don't have the option to make arbitrary decisions. Unfortunately, for many individuals dealing with private insurance companies the denial is as far as the insured ever goes. There are options for appeal and the first step is working with a disability attorney that can represent your interests.

Disability denial can happen for a number of reasons. In some cases inaccurately completed applications or lack of documentation can be easy to correct. However, once denied, it may be more difficult to win an appeal if you try doing it on your own. An attorney can review your paperwork and work with you on getting additional medical documentation to support your claim. This may mean going back to your original physician or working with a specialist or expert in the area of your particular disability. Since an attorney that is familiar with insurance claims and denials has the insight into what specific information the insurer requires to approve the claim they can be invaluable. In addition they can consult with the physician or specialist to ensure that the doctor understands that the language he or she must use to satisfy the insurance company.

The doctor or specialist cannot alter existing language in your medical file, but they can provide clarification and additional medical information about the impact of your disability on your future employment options. Most doctors aren't aware of the language that the insurance company is looking for, so this really helpful for all involved. The attorney cannot tell the doctor what to report and the doctor will accurately report the disability and its impact.

Typically an attorney representing a claimant in a disability denial with a private insurance company will attempt to first correct the problem by providing the documentation required. The insurance company must notify the claimant of the reason for the denial, which is the starting point for the appeal. In most states and in most denial appeals there will be a requirement for an attempt to resolve the conflict using and alternative dispute resolution format. This may include mediation, which is an informal discussion using a neutral third party, a trained mediator, to try to come to a mutually agreeable settlement. In many cases a satisfactory benefit is determined in mediation which prevents the cost and time of a formal lawsuit.

Arbitration can also be used with a denial. Arbitration is more formal in nature than mediation and includes an arbitrator hearing both sides and making a determination on settlement. In most situations both parties, the claimant and the insurance company, have to agree to the decision of the arbitrator. Having strong legal representation in both arbitration and mediation is a definite must as the insurance company will have legal representatives at these meetings in most situations.

If you have received a disability denial it is essential to continue on with the appeal process. Private insurance companies can and do overturn denials on a regular basis, providing the supporting documentation outlining your disability and its impact on your work can be provided.