Friday, April 24, 2015

Traumatic Brain Injury: On Insurance Claim Denials

Traumatic brain injury (TBI) can lead to a debilitating condition that affects an individual’s language, memory, thinking, learning and behavior. It could result from anything that induce trauma to the head, such as a vehicular accident, slipping on a sleek surface, etc. Oftentimes, an individual primarily relies on his insurance while awaiting resolution on a claim against the person at-fault. Unfortunately, most claims for cognitive rehabilitation services as treatment for TBI result in a denial.
Typical denial arguments include: paperwork was not done properly, the treatment is not medically necessary, the victim has already plateaued, or the treatment is not covered by the policy. In such cases, the victim should ensure that the denial is valid, and is not just a ploy by the insurance company to escape liability.
Get a legal assistance
Request for a copy of the Master Insurance Policy/ Agreement and have a lawyer review it for you. Oftentimes, these are rife with jargons aimed to confuse an average individual, so it’s important for you to have someone by your side who’s just as knowledgeable as the lawyers that drafted the contract. A traumatic brain injury lawyer can assist you in reviewing the policy carefully and get the reason for denial in writing. If the denial is unsound, a lawyer can help you draft an appeal, which may pave the way for negotiations.

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