In today’s current state of turmoil, even attorneys are recommending that claimants and insureds take special care to continuously support their claims in ways that encourage continued payment of benefit.
Opportunities for fair litigation may not exist in the future. No one really wants to go to court with a denied ERISA or IDI claim. Therefore, it’s important to know what to do, what to say, and what to put into the record so that claims are not placed in vulnerable positions for denial.
It should make sense to you that insurers will be looking to recapture COVID financial losses, and they will do this by pulling in the reins on proper medical review, IMEs and surveillance. Consultants as a general rule across state lines are prohibited from processing appeals, but even if I WERE able to assist, I would not. The appeal procedures, particularly for ERISA, are now so involved and complicated that a referral to an attorney would definitely be in my client’s best interests.
However, I am an expert in managing successful claims and making sure we are doing everything we can to support continued benefits, thus avoiding denials. Attorneys do not have these skills. Therefore, please consider not waiting until your claims are denied because there is a good chance you will not win in a litigation battle.
The best thing insureds can do is to ensure that all actions, language, requests, file additions etc. are taken making it very difficult for insurers to “target” claims for red flag vulnerabilities.
I cannot help you if your claim is already denied, and your options for success become very limited.
