Legal Definitions - supplemental claim

A supplemental claim is a request made to an administrative body or agency to reconsider a previous decision on an existing claim, based on new and relevant evidence that was not available or considered during the initial review process. It allows an individual to present additional information or arguments to support their original request, aiming for a different outcome than the one previously rendered.

• Example 1: Disability Benefits

  After a serious car accident, Maria applied for long-term disability benefits from her insurance company. Her initial claim was denied because the medical reports submitted at the time did not fully detail the extent of her chronic pain and neurological issues. Several months later, Maria underwent specialized diagnostic tests that revealed significant, previously undiagnosed nerve damage directly related to the accident. She then submitted a supplemental claim to the disability insurer, including these new test results and an updated report from her neurologist, asking them to reconsider her eligibility for benefits.

  This illustrates a supplemental claim because Maria is providing new and relevant medical evidence (the specialized test results and updated neurologist's report) that was not available during the initial review, to challenge a previous denial of her original claim and seek a different decision.

• Example 2: Property Insurance

  A homeowner, Mr. Henderson, filed an insurance claim for damage to his roof and exterior siding after a severe windstorm. The initial insurance adjuster estimated repairs for the visible damage. However, once the contractors began the repair work, they discovered extensive structural damage to the underlying roof trusses and wall framing that was not visible from the exterior and therefore not included in the original estimate. Mr. Henderson's contractor documented this additional damage with photos and a detailed report, and Mr. Henderson filed a supplemental claim with his insurance company to cover these newly discovered, necessary repair costs.

  This is a supplemental claim because Mr. Henderson is presenting newly discovered damage (the structural issues) that was not part of the original claim assessment, seeking an adjustment to the payout for the same incident.

• Example 3: Veterans' Benefits

  A veteran, Sergeant Miller, filed a claim with the Department of Veterans Affairs (VA) for service-connected hearing loss, which was initially denied due to insufficient evidence linking it directly to his military service. Years later, Sergeant Miller located a former squadmate who provided a sworn affidavit detailing specific instances of unmitigated noise exposure during combat operations that were not previously documented in Sergeant Miller's service record. Sergeant Miller also obtained a new medical opinion from an audiologist explicitly connecting his current hearing loss to those service incidents. He then filed a supplemental claim with the VA, including this new affidavit and medical opinion, requesting reconsideration of his service connection for hearing loss.

  This demonstrates a supplemental claim as Sergeant Miller is submitting new and relevant evidence (the squadmate's affidavit and new medical opinion) to support his previously denied claim for service-connected disability, aiming for a favorable decision.