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Perhaps you have been struggling at work with multiple sclerosis, HIV, myasthenia gravis or another chronic disease,
and are feeling that it is time to consider going on a disability leave. Or perhaps you're already on a short term
disability leave, and are considering whether to file a claim for long term disability benefits. Or perhaps a
family member is in the hospital, recuperating from an accident, and the treating physician believes he or she would
benefit from a transfer to a rehabilitation facility. Or perhaps you have exhausted standard cancer chemotherapy,
and your oncologist is recommending a new drug, or a treatment that is part of a clinical trial.
In each of these types of cases, we can help by reviewing your employee benefit or insurance policy documents, calling
your attention to applicable benefit provisions and limitations, and alerting you to key issues that should be addressed as
you prepare to submit a claim or request for pre-authorization. It may be imperative to get updated medical records,
supporting letters from treating physicians, occupational descriptions, published medical literature addressing your illness
or treatment, or other sorts of evidence to substantiate your claim. We can draw on our legal understanding of your
insurance coverage and our experience dealing with claim administrators, to help you make your best case for coverage right
from the start.
Many of our clients rightly feel that after working many years and paying for their medical or disability insurance, getting
coverage for their disability or medical care shouldn't be a struggle. The reality of the modern "managed care" environment,
however, means that no claim is presumed valid and each one is carefully scrutinized to determine that coverage
is appropriate and fully substantiated. If a claim is incompletely documented, or if the evidence suggests that
a particular policy exception or limitation should apply (even if remotely), the claim administrator may deny the claim or
delay its approval, pending further investigation. This can leave you in a difficult position, awaiting the outcome
of an extended investigation (while your benefits are delayed or withheld) or forcing you to pursue an appeal to obtain coverage.
We believe that careful preparation can help to speed the processing of your claim and to avoid improper
claim denials. By sitting down with you, reviewing your plan or insurance policy documents, and discussing some of your
medical and occupational history, we can help guide you towards making a strong and persuasive claim right from the start.
Remember, the best defense is a good offence.
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