One of the benefits to employment is not only compensation, but for many, it’s also being offered insurance. The idea of having insurance tends to give people a sense of ease. Sadly, though, just because someone has insurance, it does not mean all claims are going to be initially approved.
Time and time again, people find themselves wondering what to do after a health or disability claim is denied. This is where the attorneys of Willeford & Toledano can step in. For close to 40 years they have been helping people navigate the world of the Employee Retirement Income Security Act, known as ERISA, and the process of appealing a denied claim.
Here are a few things you should know beforehand:
No. 1: Insurance companies must stick to decision-making timeframes
There are a number of different types of claims, including urgent care claims and disability claims. Each type of claim has its own rules around the maximum amount of time a plan has before either approving or denying a claim.
No. 2: The reason for a claim denial cannot be a mystery
There must be a reason for a denial, and according to the U.S. Department of Labor, this reason must be shared with you, in writing. When you learn of a denial, you will also be given some basic information on how to appeal. An attorney with experience handling these types of cases will be able to speak to the specifics of your case.
No. 3: Keep your eye on the timeline
After a claim is initially denied, you have 180 days to appeal. Do not wait until the last minute to take action.
No. 4: Gather all your evidence in a timely manner
Submit all evidence tied to your claim during the process of appeal. A judge will not be able to look at any evidence that is submitted after a final denial. By having everything together beforehand, your attorney will be better suited to perfect your claim.
No. 5: Federal court action can be taken after a claim is denied on appeal
If your claim is still denied after a review, this is not necessarily the end of the road. Rather, this is the time to seek out legal advice in order to bring an action in federal court to challenge the denial.