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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