The first step you should take is to read your denial letter and determine whether it satisfies the above requirements. If it does not, a letter should be sent to the plan or insurance company complaining of the deficiency. You should also note the date that an appeal must be sent to them (usually within 180 days). Because many courts enforce these deadlines, you must be very careful to submit a timely appeal. A NY disability lawyer will explain that any delay in submitting these appeals could jeopardize your ability to obtain benefits.
If the denial letter specifies that your records were reviewed by a specific doctor on behalf of the plan or insurance company, you should include in your letter a demand for that doctor’s report and any other information that they relied on in denying your benefits, including any rule, guideline or protocol. In addition, if you have not already done so, you should also request copies of the Plan and/or policy.
Very early on you should also show the denial letter to your doctor. It is important that your doctor prepare a report addressing every concern raised by the Plan in your denial letter. Because doctors are very busy, often the best way to do this is to bring the letter with you during your next appointment. Have your doctor dictate a response at that visit.
Another helpful step is to gather all medical evidence that supports your claim and addresses the concerns raised in the denial letter. Sometimes this will include your doctor’s office visit notes or other medical records. It may also be helpful to gather professional literature that supports your case.