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Insurance appeals

Which criterion was I actually being measured against

Started 11 December 2024 · 24 replies · 287 hearts · read 4.5k times

ZebAustin, TX · 11 December 2024
1.6 years ago

Which criterion was I actually being measured against Writing it down partly to work out what I actually think.

I have a letter in front of me and I do not know what it actually says.

What I cannot find anywhere is the criterion I am being assessed against, and I suspect that is the whole of my problem.

I have been refused and I would like to appeal properly rather than emotionally, because the emotional version is what I sent last time.

I would rather hear from somebody whose appeal failed as well as from somebody whose succeeded, because I want to know what I am walking into.

No judgement wanted and none expected in this circle, which is why I am asking here.

96

BrimHalifax, UK
#1

Something I would flag: ask whether there is an independent review stage, because there usually is and it is rarely advertised.

12

MoBradford, UK
#2

The deadline for appealing is often short and buried. Mine was twenty-eight days and I found that out on day twenty-three.

10me too 6

WinkleWeymouth, UK
#3

Mo, thank you for that. It gives me somewhere to start from.

What surprised me was how routine this is at their end. My refusal was not personal and treating it as procedural made it much easier to fight.

15

PetraFacilitatorMelbourne, Australia
#4

Speaking as a facilitator: deciding not to appeal is a legitimate decision and this circle has never treated it as giving up. An appeal costs hours and attention that some weeks simply do not have in them.

19

TheaBergen, NO
#5

Thank you for the update. Threads that stop are the worst kind.

9me too 1

ColNewquay, UK
#6

Petra said something I want to sit with for a second.

I would say get everything you have already been told in writing before you start, because verbal assurances evaporate.

11

GroverPortland, ME
#7

Something practical: I sent everything recorded delivery and referenced the previous letter by date in every new one.

7

FitzLimerick, IE
#8

My appeal succeeded on a technicality about how a criterion was measured, which I would never have spotted without reading their policy.

12

IdaRotterdam, NL
#9

What Col described happened to me too, in a slightly different order.

Mine took four months and three letters and was eventually granted, and I nearly gave up after the first one.

13

MarthaCork, IE
#10

What I would say is do not accept a phone refusal. Ask for it in writing, always, and the tone often changes when you do.

10

TiernanOmagh, NI
#11

Something that helped was a template somebody here shared, which I rewrote in my own words and which gave me the structure I was missing.

12

TarnKeswick, UK
#12

My employer's HR had a route I did not know existed and it went through in eleven days after four months of getting nowhere myself.

14

RayBarnsley, UK
#13

Picking up Tiernan’s point rather than starting a new one.

I found that quoting their own document back to them was far more effective than any argument of my own.

8

BodilÅlesund, NO
#14

The thing nobody tells you is that a refusal is often about missing information rather than a judgement, and supplying it is the whole job.

15me too 3

NkechiAbuja, NG
#15

Building on what Bodil wrote rather than answering the original question.

My prescriber's practice had done dozens of these and their administrator knew exactly what to write. Ask whether yours has somebody like that.

11me too 2

ZebAustin, TX
#16

The flowchart I drew of the process was genuinely useful and I have since sent it to four people in this circle.

6

BrimHalifax, UK
#17

What I got wrong was appealing emotionally. The letter that worked was boring, numbered and entirely factual.

14

MoBradford, UK
#18

Here, reading, and glad you posted.

9

WinkleWeymouth, UK
#19

What I learned is that the person reading it is following a policy document, and the policy document is usually available if you ask for it.

11

TasnimBradford, UK
#20

Brim, thank you for that. It gives me somewhere to start from.

I asked my prescriber for a supporting letter that addressed each criterion in order, and that was what made the difference.

11

TheaBergen, NO
#21

Building on what Mo wrote rather than answering the original question.

What helped was treating it as an administrative task with steps rather than as a judgement on me, which took me two refusals to manage.

13me too 3

ColNewquay, UK
#22

I found the process demoralising and the outcome good, and I want both halves of that on the record.

11

PetraFacilitatorMelbourne, Australia
#23

A standing note rather than a correction of anybody: deadlines are the part of an appeal that cannot be recovered afterwards. If you take one thing from a thread like this, take the date.

25

FitzLimerick, IE
#24

My honest advice is to ask somebody to read your letter before you send it. Mine cut a page and made it twice as effective.

9