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What a denial letter is really asking
How to read the reason, count the days you have to answer, and gather what is missing.
Lowell Drummond, Lawyer5 min read
A denial letter feels like a closed door. It is closer to a question: here is what we think is missing. Often, you can answer it.
Find three things on the page
- The reason the insurer gives
- The date on the letter, and the date you received it
- The deadline to respond or ask for a hearing
Write the deadline on your calendar before you do anything else. It is the one date that rarely moves.
Common reasons, and what answers them
- Not work-related: medical notes, witnesses and a clear timeline
- Reported too late: proof of when you told someone, and why there was a delay
- Pre-existing condition: a doctor's opinion that work made it worse
- Treatment not necessary: a second opinion, or the treating doctor's reasons
What to do this week
Make a copy of the letter. Gather your folder. Then call us, or any lawyer you trust, before the deadline. Do not wait to see whether the insurer changes its mind.
If the insurer still says no, you can usually ask a judge to decide. We prepare you for that hearing, and you do not have to face it alone.