Soft tissue injury claim

Insurance company claims that ulnar nerve neuropathy is a soft tissue injury. No where in their policy book does it list this condition. Soft tissue injuries are defined as Sprain, strain, or contusion. Carpal tunnel is listed as a soft tissue injury and the insurance company says the ulnar nerve falls under this category. They are deny my claim. Have wrote to them asking for my claim file and now they tell me there is a $25.00 charge to get MY file. Can they do this? I have to pay to get my own file , can"t believe it. I am working on appealing there ruling as now I need surgery to repair my ulnar nerve. I have surgery on May 11 but must file appeal before May17 and not sure if I will be able to get surgeons post-op report to send in before my appeal deadline. Is the appeal date flexible or are they usually hard and fast on these dates? Really do not understand how they can deny claim as soft tissue injury when it has nothing to do with soft tissue its a nerve. I read there policy booklet front to back to make sure I would be covered on this and now get turned down. Just at a loss on what to do

Are “soft tissue” injuries not covered by ltd?

No they will only pay 40 days on a soft tissue injury

Sorry to hear about your struggles with this. To your first question, yes they are allowed to charge a reasonable fee for providing you with a copy of your claim file. $25-$50 is the common charge we see. For your second question, some insurance policies do have specific exclusions or limits based on medical conditions (sounds exactly like what is going on with you). In those situations, it boils down to how a judge would interpret the policy. It will turn on how the policy defines “soft tissue injury” and whether doctors will say that fits with your disabling condition.

David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.