The federal statutes that make your appeal your right — and why you don't need a lawyer to use them.

If your insurance comes through an employer, this is the federal statute that gives you the right to appeal a denial. Every employer plan has to let you do it — with an authorized representative if you want one. That representative doesn't have to be a lawyer. It can be us.

The federal regulation that names authorized representatives by name. Insurers are required to let someone else handle your appeal paperwork on your behalf. This is the clause ClaimKicker operates under.

Deemed exhaustion. If the insurer blows past the 30- or 60-day clock without a real decision, the law treats your appeal as exhausted — meaning you can skip to external review, or to federal court, without their permission.

If your insurance is through the ACA marketplace or a fully-insured group plan, this is the statute that gives you an internal appeal and then a free external review by an Independent Review Organization. The IRO's decision is binding on the insurer.

The prudent-layperson standard. If you went to the ER and the insurer later said it wasn't an emergency based on the final diagnosis, this regulation forbids that. What matters is whether a reasonable person would have thought the symptoms needed immediate care.

HIPAA authorization. The rule that lets you authorize us to request medical records from your providers for your appeal. You sign once; we handle the paperwork.