Insurers Claims of Insuffient Proof

New York Disability Benefits Denial Attorney Representing NY Clients Denied a Benefits Claim Based 0n Insufficient Proof

Making a disability claim can be a frustrating process.  While you are going to medical appointments and trying to find medications that work, you are asked to complete paperwork, have your physician complete paperwork and submit it all within short deadlines identified by your disability insurer.  Then you must deal with the disability insurance company claim that they did not receive your medical records from your medical providers even though the medical offices confirm that they already sent all of your records in.  Sometimes, physicians complete forms but they are not detailed enough. When your insurance company denies your claim because of “insufficient proof,” they are just taking the first of many steps to limit or dismiss their obligation to support you when you need them most. If you have been impacted by unfair insurance tactics, you need an attorney who is ready to fight for you. Contact Gisonni Law Firm for a consultation today.

Insurance Companies Who Deny Claims Based on Insufficient Proof

Disability insurers take advantage of the confusing process of filing a claim and often deny your claim because you submitted proof that was insufficient.  That message arrives in a letter from the insurance company that offers you an opportunity to appeal the adverse decision.

Now you find yourself in a situation in which you are already appealing the decision before the claim ever got off the ground, and you have no idea what the company means by “insufficient proof.”  If the claim is governed by the Employee Retirement Security Act (“ERISA”), insurers are required to tell the insured what they need to reverse the determination.  But all too frequently, what is needed is either not communicated to the disabled insured so that it is understandable or not communicated at all.  To compound these problems, you are generally in the dark concerning what the insurance company actually received from the physician’s office.

What You Can Do

So what do you do to avoid this problem? Before your claim is submitted, make sure you understand what the disability insurer needs from you and from your physicians.  Don’t depend on your physician or her office to send in documentation.  Be proactive and obtain the medical records and completed claim forms from your physician.  Make copies, and send in those records in a manner to obtain a delivery receipt.  If your disability prevents you from advocating for yourself, ask your spouse, close friend or family member for help.

If your claim is denied, ask for a copy of your claim file.  Look at the file, and find out if the insurer actually received the records your physicians sent in.  When you feel overwhelmed by this process, call a qualified disability insurance attorney to guide you through the process.

Contact Gisonni Law Firm

If you have been denied a claim because you or your doctors did not provide sufficient proof, it may just be another devious tactic employed by your insurance company to save money. Unfortunately, people are taken advantage of every day by companies that claim to be the answer when needed most. If your claim has been denied and you need quality legal representation, contact Gisonni Law Firm for a consultation.