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We get many individuals asking whether or not insurance can deny coverage, such as “can I be denied health insurance?” or, “what can I do if insurance denied my claim”? If your health insurance company has denied coverage, this article will answer most of your questions and, most of all, provide a solution so you can make the most educated choice about your future.

  • Health Insurance Rejected My Claim
  • Insurance Claim Dispute: Disability Insurance Lawyers can help.
  • Insurance Claim Dispute
  • Insurance Claim Letter / Insurance Appeal Letter:

Health Insurance Rejected My Claim

Your health insurance company can deny coverage for a variety of reasons.

There are a few possibilities in regards to next steps for a denied health insurance claim. Disability Insurance Lawyers will seek to appeal a claim which may go through 3 stages (illustrated here in the case of Sun Life Disability Complaints) before being seen by a board, and ultimately, judged upon via ordained tribunal in most cases. If you choose working with a disability lawyer, here are a few obligations and ethical considerations which you will need to consider when hiring a lawyer - and when you work with your long term disability insurance attorney

Ideally, before you seek a free consultation from any lawyer, you should keep documentation of all of your records - including the insurance company’s reasons for not continuing your benefits, (or your denied claim). Most cases require thorough paperwork as objective evidence through your claim. These can be records such as Doctors’ Visits, Imaging Results, Consultations, Medical Reports, etc. They can be helpful in your denied health insurance claim.

Reasons for Insurance Claim Denial

Because there is no federal standard for long term disability benefits, unfortunately, contracts and terms are subject to change. This poses a problem for claimants who have subscribed to an insurance policy - only to find out it will not support them anymore. If your health insurance is not paying claims, and your insurance provider has refused to pay insurance claim funds, you run the risk of deteriorating health. If a third party insurance claim denied its obligations to pay, you should immediately seek retribution in a disability dispute. These options fall under a Disability Claim Denial case.

Some reasons for denied health insurance & claim denial, when creating a denied health insurance claim, are as follows. These are also common reasons for rejections of pharmacy insurance claims.

  • Required documentation was not submitted (denied health insurance due to negligence)
  • Fail to report for a medical examination
  • You are the age of 65 or attain the age of 65
  • You are in prison
  • You are retired or retire during the duration of the claim
  • You recover fully
  • Refuse to participate in treatment program
  • Start a new job
  • Refuse to continue application process
  • Death (in some cases your estate can receive a lump sum of your benefits)

Insurance Claim Dispute: Disability Insurance Lawyers will help.

Disability Claims are complex, especially when your insurance declined a claim you have made. If your disability claim was denied the first time and you are looking for an alternative solution, seek a lawyer immediately. If you need to appeal an insurance claim on your own, you risk the chance of having to put forth a second insurance claim appeal. Your waiting period for receiving your DENIED insurance claim letter may occur between 4 and 52 weeks. This can be much too long for some individuals to wait for a DENIED insurance appeal letter. A denied health insurance claim will go for another round of inspection, and a twice-denied claim may be in order for an insurance company who does not think you have a legitimate claim. In some cases, you may have a chance of appealing insurance denial. Many people simple give up fighting insurance claim denials.

Can you sue an insurance company?

If you wish to do so, you may pursue a lawsuit in court. Unless you are an expert in law, or, are a lawyer, we do not recommend you do so. Disability Insurance Lawyers have experienced many cases and will provide a wide variety of angles for the insurance company to have to deal with. In many cases, lawyers will advise you before a claim in case they do not believe you have a case, such as when insurance claims are rejected. But when a lawyer takes on a case, they will:

  • Maintain a professional relationship
  • Protect and act in the clients’ own interests
  • Reveal information for a long term claim client only when truly necessary

Please refer to our helpful page on Disability Insurance Lawyers’ Long Term Claims & Obligations in order to learn more about what a disability insurance claim attorney can do for you - and how they work.

Fighting insurance claim denials takes time, energy, and financing. That’s why the team at PW lawyers, as Disability Insurance Lawyers, are always there for you. Contact us today for more details in regards to any Long Term Claims.

Insurance Claim Letter / Insurance Appeal Letter

Crafting one yourself? This is not your best option.

In case you were wondering how to write an appeal letter for medical insurance, our advice is to stop and retain a lawyer. Learning how to fight insurance claim denial takes years of experience and hard work. An insurance dispute lawyer such as ours will help you gain the maximum amount possible for your claim. PW Lawyers represents a wide range of clients that have been denied benefits under their group benefits packages. Every long term disability policy is different, however, many policy applications contain time limits, mandatory medical records, and updates on treatment.?Often, these policies are subject to a change of definition in which the insurer’s interpretation of disability changes or the time limit is disputed. Any of these circumstances can happen to you during your claim. We are here to help.

If your application was denied, your benefits have been terminated or need legal advice on your long term disability claim, contact us today for your free consultation: (905) 940-5554. If you need to appeal an insurance claim on your own, you risk the chance of having to put forth a second insurance claim appeal. A denied health insurance claim will go for another round of inspection, and a twice-denied claim may be in order for an insurance company who does not think you have a legitimate claim.

Getting injured is stressful, you can incur physical and financial loss. We can assist you to make your recovery a smooth transition.


Paul Wilkins

Principal Partner

Paul is a member of the Ontario Trial Lawyer’s Association and the Advocates Society. Frequently involved in pursuing his clients’ claims, his areas of focus include statutory accident benefits, short term and long term disability benefits, disability claims and Canada Pension Plan disability benefits.

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