An unsettling truth is that there are many disability claims that are initially rejected. Claims are rejected for many reasons, but often, the insurer will not fully provide the reasoning for the rejections or they do not explain the reasons in such a way that the claimant can understand.

If you believe your claim was wrongfully rejected, ACG can help. We will uncover the reasons why your claim was rejected, and if there is no valid contractual basis for the rejection of your claim, we will objectively present our arguments and provide the insurer with compelling information to support the validity of your claim.
The insurer will never specify what information they require from you in order to pay your claim, but if you are truly disabled and eligible for disability benefits, ACG has the expertise to source out the relevant information required to get your claim approved and paid.

When insurers terminate a previously accepted disability claim, there must be strong evidence to support the termination decision. The insurer must be able to prove that the claimant’s condition has sufficiently improved to the point that they are no longer deemed disabled based on the terms of the policy. But what exactly is that evidence and how has this information been interpreted? This is a very grey area and subject to diverse interpretation.

For over-worked claims adjudicators with typically high caseloads, it is not uncommon for information to be interpreted in such a way that supports claim closures, or for other information to be overlooked. If you believe that your claim has been terminated prematurely, and your doctor supports that you are still unfit to return to work, ACG will work to reinstate your benefits so that you can continue on your path to recovery.

Eliminate the burden, the stress, and the anxiety of having to deal with your claim. ACG will file a full and proper appeal on your behalf so that you don’t have to deal with the insurer yourself. Not only will we work to reinstate your benefits, our consultant will ensure that your insurer’s ongoing case management plan for you will be fair and reasonable, taking your interests into consideration.

If you have already attempted to handle the appeal on your own and it was denied, the insurer has re-iterated their position and it would take a lot more convincing to make them change their mind. Most insurance policies stipulate that it is the claimant’s responsibility to provide proof of disability, but what exactly is that “proof”? You could be spending up to $300 or more to obtain medical reports from your doctor(s), but is this really the “proof” that will get your insurer to change their mind?

Without knowing the insurer’s decision-making process and claims assessment criteria, and lacking the technical know-how to effectively argue for the approval of your claim, you may ultimately exhaust all of your appeals after much angst – wasting time, money, and effort. Not to mention having to endure the financial stress of not getting your benefits paid! Trust ACG to handle your appeal.

We have the expertise to get your benefits approved or reinstated quickly and efficiently. There is no need to jump through hoops or navigate through bureaucracy with ACG as your guide.

A safe and timely return to work is considered part of a healthy recovery program, but this does not apply 100% of the time.  If the insurer is putting pressure on you to return to work, even if on light modified duties, or on a graduated return to work program, and this is against your doctor’s medical recommendations, or it contradicts or hinders your medical treatment in some way, then please contact ACG to discuss your options.

There are times when returning to work too soon may actually impede the individual’s recovery or lead to regression. Talk to ACG if you have concerns about this and we will help you evaluate your options. If appropriate, we will discuss your concerns directly with your claims adjudicator and propose an alternate mutually agreeable case management plan.

It is critical that you feel positively about any type of rehab or recovery program that you are participating in, because if not, it will likely result in failure. This is counter-productive for both you and your insurer. As there is usually only so much rehab funding allotted to each individual’s disability claim, once the rehab funding is spent, the insurer will be very reluctant to spend further rehab expenditures on your file.

In order to maximize your chance of a successful recovery, an effective rehab program must be developed collaboratively with input from your health providers, claims adjudicator and/or rehab consultant, and most importantly, from YOU. Today’s busy adjudicators often overlook this critical piece in their case management practices, often unilaterally imposing what they believe to be an appropriate rehab program on claimants, resulting in less than desirable outcomes causing much grieve and angst amongst all parties involved.

If you have concerns or reservations about the rehab program that your insurer has recommended for you, and your insurer has chosen to ignore your concerns, please talk to ACG. We will advocate on your behalf to ensure that your concerns are addressed by your insurer, and if appropriate, we will make recommendations for an alternate rehab program that involves a collaborative approach, or for an alternate case management plan altogether.

If you have any problems with your claim or you just have some questions about how to handle a particular claim situation, contact ACG to discuss your concerns. We’re here to help!