Attorneys: A History of Helpfulness

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Attorneys: A History of Helpfulness

Attorneys in our day are often called bottom feeders, ambulance chasers or worse. I am an attorney in private practice, and it is my mission to show you that the law is a calling filled with noble and enthusiastic people who are doing the job to help others. The law can be incredibly confusion, and it seems to change drastically day by day. Attorneys are there to help clients navigate the murky waters of legal issues and find the most appropriate solution to problems they face. So don't think of a lawyer as the bad guys. Lawyers help people, and this blog will teach you how.

How Can You Appeal An Insurance Claim Denial? Your Lawyer Can Help

One of the hardest things you may ever have to go through in life is getting injured on the job. Workplace injuries encompass a wide range of illnesses brought on due to exposure to chemicals at work, asbestos in the insulation, hearing loss due to noise, accidents using machinery, and more. 

You have a right to make a claim with your insurance company to be paid out benefits that you are paying for through your job's benefits package, or through a private company. You can claim workers' compensation benefits to help with any income loss but in some cases, you might get denied those benefits.

How can you appeal a workers' compensation claim denial? Your first step is to contact a workers' compensation attorney to help you, as they can lead you through the appeal claim process.

Internal Appeal Of The Denial

Once you have hired a workers' compensation attorney to help you, you have two choices regarding how to appeal your claim. Your first choice is to file an internal appeal of the denial with the insurance company. This is an internal review of your denied claim from the insurance company itself.

You must send all relevant documentation including the form requesting the appeal of your denial, your original claim, medical records, and records of treatment to the insurance company when you file your appeal.

It's possible they have denied you due to several reasons, including:

  • the injury you suffered isn't included in your health plan
  • the treatment you received wasn't deemed necessary by the insurance company
  • you received treatment from a provider not listed in the health care plan

The insurance company will then review your claim internally and make a decision on whether or not there was an error in denying your claim. This process must be started within several months of your denial, so make sure you know how much time you have to file your appeal.

External Appeal Of Your Claim

You also have the option of filing an external review of your claim. This means you are asking a third party to review your claim and hopefully reverse the decision the insurance company made. All relevant medical and claim documents are sent to either your state appeal board or the federal one. Your workers' compensation attorney can help you with this process.

All states are required to have an external review of all workers' compensation claims that have been denied by insurance companies.

In some cases, your appeal may be seen at the federal level if your state's review process doesn't meet the standards of the federal government. You can check with your workers' compensation attorney to see whether your claim will be sent to the state or federal level.

You have a shorter amount of time to file an external review than an internal one, so keep that in mind.