Case Review


What is a case review?

Occasionally a psychologist disagrees with a decision made by the insurance carrier. (Examples include denial of an application for a new policy, non-renewals, cancellations, and claims coverage disputes). The insured may request a case review from The Trust regarding the carrier's adverse decision. The Trust requests a release waiver from the insured (by sending the insured a waiver form), and may also request sufficient additional information from the insured to adequately review the case. After evaluating the material on which the carrier based its determination, supplemented by any information the psychologist provides, The Trust confers with the carrier.

Who is eligible for a case review?

Any policyholder who is affected by a decision made by a Trust-endorsed or sponsored carrier may use the case review process to appeal any action by the carrier.

How do I start the case review process?

Once you receive an unfavorable decision from the carrier, you can call the Trust. A representative will take your information and walk you through the case review process. The Trust will then send you a release.

Do the Trustees always recommend in favor of the appealing psychologist?

The Trustees make the best recommendation possible based on the facts they have obtained.

Is the Trustees' recommendation to the carrier binding?

No. The carrier will respect the Trustees' high level of experience when weighing their recommendation, but it is still only a recommendation.

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For more detailed answers, or if your question was not answered here, please call us at 1-800-477-1200.