Question
Can the Standard claim I am only entitled to one independent review?
The Standard has denied my partial disability claim resulting from open heart surgery and a complication. The period that I’m claiming is only five months and yet they refuse to pay. I had one independent review of the decision on my claim. I submitted an additional medical report on appeal. They are now stating that I was only entitled to the one independent review and that they do not intend to conduct any further reviews of the claim decision. Can they do this?
Answer
Julie, Is your policy an ERISA governed employer provided policy or privately purchased? If it is the former then the law only requires one level appeal and Standard would not be required to provide another level of appeal. If it is a private policy, then Standard again would not be required to give you another review, but your legal rights would be much different than under an ERISA policy.
