Dealing with insurance issues after a spinal cord injury-Part I

Wednesday March 11, 2015

Residents of New Haven, Connecticut, would agree that treatment and rehabilitation after a spinal cord injury can cause financial challenges for the spinal cord injury victim, as well as for the victim’s family. To address those problems, most victims and their families rely on insurance coverage. However, negotiating an adequate claim with the insurance company is often difficult because, for insurance companies, a lesser payout means greater profits, which can be even more difficult for victims and their families.

However, if victims and their families follow certain steps, dealing with insurance companies after a spinal cord injury may not be so challenging. The first step requires a victim to understand the benefits offered by the insurance policy. In addition to the benefits, the insured person must also be aware of the exclusions, definitions and any other relevant information that may be listed in the fine print. If the spinal cord injury qualifies for workers’ compensation, the victim and the victim’s family must understand the benefits following a trauma.

The next step is to find out who is the case manager for a particular claim. If the insurance company has not appointed a case manager, the victim should ask for an immediate appointment. At this stage, it is important for the family members of a spinal cord injury victim to explain the case to the case manager or benefits advisor who has been appointed by the insurance company, in order to highlight what is essential to the victim.

Another important task is determining the rehabilitation benefits offered by the insurance policy. Victims and family members may wish to seek clarification regarding the number of days that are covered for inpatient acute and sub-acute rehabilitation, and outpatient and home rehabilitation. The points that may need to be clarified include the maximum number of days covered by the insurance policy in a year, and the maximum number of days that are covered over the lifetime of the spinal cord injury victim.

If a spinal cord injury victim and the victim’s family members can understand and address these issues from the beginning, they may have a good chance that the claim process will go smoothly. However, that may not be the case every time for a number of reasons. Therefore, it may help if an attorney is at the victim’s side to help navigate the often-complicated and time-consuming insurance maze.

Source: SpinalInjury101.org, “Steps to Negotiate the Insurance Maze,” accessed on March 11, 2015

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