Question

What is the appeal process? How can I get a copy of my policy?

Asked on June 5th 2015 by Gail
Long story short, I am at the appeal process for a denied claim. Every thing that was said in prior references above has happened to me. My Therapist and Supervisor for Behavioral Health spoke to my claims manager over the phone and the Supervisor requested a form from Prudential that could possibly give them the information they need. I am financially destitute and severely depressed along with the PTSD already diagnosed. I also suffer from degenerative lumbar and disc disease. I do not believe that Prudential was given my neurology reports so I obtained those records and am overnighting them myself. However, this still may not be enough information. Prudential requested records from November 2014 up until June. The hospital provided information up until March 2015. My therapist sent a letter to Prudential via fax confirming the diagnosis was the same and that I am still being treated for such. But this was not enough for the Prudential clinicians. My therapist filled out a 24 page form of essay questions. What is the appeal process.? Is there a specific form I have to fill out? exactly what am I to provide with the appeal letter. Prudential already has the most updated medical records available. Since my original claim, I have been diagnosed with diabetes 2 and have been suffering from chronic pain due to my back and am still suffering from migraines which are dibilitating. There are days when I can not focus, or concentrate long on anything I am irritable can not walk stand or sit for any length of time, suffer from blurred vision and have very little range of motion. This all seems trivial to some of the complaints I have just read. However, I can not work. What else can I do. Is it possible to get a copy of my policy also?

Answer

Answered on July 6th 2015 by Attorney Stephen Jessup

Gail, Your employer (or former employer) is responsible for providing you with a copy of your policy. I recommend you request same in writing from your HR department. With respect to your appeal- please feel free to contact our office and discuss your claim and the steps available to you at this time as it relates to your pending appeal.