How to evaluate the post-appeal claim

• Author: Scott M. Riemer/Jennifer L. Hess
• Pages: 137-140

8-119

Chapter 8

HOW TO EVALUATE

THE POST-APPEAL CLAIM

§8.0 INTRODUCTION

If the insurer denies your client’s appeal, you must now request and

evaluate the post-appeal claim to determine the merits of ling a lawsuit

and/or a second appeal. orough evaluation of the post-appeal claim

le will help you determine the best course of action for both you and

your client.

§8.1 HOW TO REQUEST THE POST-APPEAL CLAIM FILE

To request the post-appeal claim le, send a written request to the

insurer. To fully evaluate your client’s claim for litigation, you will need

the insurer’s internal notes as well as the reports of their peer review doc

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tors. You also will want to see any internal guidelines, rules, procedures,

or protocols the insurer may have relied on, not limited to the policy. Be

sure your request demands these items.

Forms & Samples: See the following in the Appendix:

 :  -   

e insurer has an armative legal and duciary duty to provide the

requested information. Pursuant to ERISA 502(c), 29 U.S.C. 1132(c),

documents required to be disclosed under Title I of ERISA must be

furnished within thirty (30) days after the request or the administrator

can be held personally liable for a failure or refusal to comply with this

regulation with a maximum penalty of $110 per day.