You were examined by a doctor that the insurance company provided. In this instance, an internal appeal is useless since the insurance company won’t reverse its initial decision since it has the necessary evidence to support its initial denial.
You missed a deadline or had a pre-existing condition
Your insurance company believes that you’re not under proper medical care.
Deadlines are Important
You may be limited in the types of appeals you can file because of one or more looming deadlines. You generally have two years from the date on your denial letter to appeal.
Watch what you say with the plan administrator when having your questions answered
Any statements that you give to the plan administrator can and will be used upon you at a later date. When in doubt, it’s better to talk to a personal injury lawyer
What You Should do When Your Claim is Denied
Your claim was assigned to a case manager when you initially filed it. The case manager will check your initial claim to see what your abilities to function are and the medical treatment you will need now and in the future. These two factors will play an important part in determining if you’re eligible for benefits.
You generally have 60 days from the date on the denial letter to appeal. Make sure to submit an appeal that’s in writing. Make sure that your appeal contains new information about your case. Just keep in mind that all expenses for tests and medical reports will come out of your pocket. Most people don’t go this route since they generally aren’t working and just don’t have the money to pay the doctor for a paid written report.
Appeals Process
Most insurance companies are huge that many Canadian companies use to offer employer-sponsored insurance. You’ll get a denial letter which you can appeal. You’ll also get a list of information that you can include in your appeal to help you win your case. You can file an internal appeal but that will cut down on the amount of time you have to file a more successful external appeal.
Your personal injury lawyer in Guelph must do the following if you want to submit an appeal through the insurance. You submit an appeal which will be reviewed by two case managers. You have to wait for the denial letter to come in before you can appeal again if your appeal is denied.
The management unit will review the second appeal.You can write to the Secretary of the Plan Board of Management for an independent review if your second appeal is denied.Since the internal appeals process can take a while and doesn’t give you guaranteed results, it may make more sense to file an external appeal.
