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Your insurance company should communicate with you and your physicians before denying your claim.The “meaningful dialogue” rule is a very general guideline, which means that insurance companies rarely follow it, but it also gives us a broad basis on which to attack the insurance companies. Requiring insurance companies to participate in a “meaningful dialogue” means that they need to communicate with the claimant or treating physicians in order to clarify any questions they have. It is inappropriate to deny a claim simply because some information is confusing or conflicting. The insurance company must make a serious attempt to talk with the claimant or physicians to fully understand the claim.

“This office visit note, which features prominently in the claim handling notes and is cited in the denial letter as justification for denying our client’s disability benefits, does not belong to her. It is for a patient named Jane Doe, and every single Lincoln reviewer missed this vitally important piece of information, despite the fact that 1) Jane Doe’s medical condition is nothing like our client’s, 2) the wrong treating provider signed the note, and 3) Jane Doe’s name is printed no less than FIVE times in the office visit note, along with her date of birth, age, address and other identifying characteristics – all of which should have been BIG CLUES that this office visit note was NOT about our client."

This is a real excerpt (names changed) from one of the appeals we filed. Lincoln—the insurance company—denied our client benefits because her doctor’s office accidentally faxed another patient’s notes along with hers. Despite the fact that the wrong patient’s name was written on the paper FIVE times and her diagnosis was unrelated to our client’s claim, no one at Lincoln bothered to ask any questions—either of the physician’s office or our client. Instead, they took the wrong info and used it to deny her claim. This is NOT meaningful dialogue. It’s not even dialogue!

Ben Glass
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Ben Glass is a nationally recognized ERISA disability & life insurance attorney in Fairfax, VA.