Appealing an Individual Disability Insurance Benefit Denial

If your disability policy is an individual policy and not governed by the Employee Retirement Income Security Act (an ERISA policy), then you may have the right to bring a civil lawsuit and may not be obligated to first file an appeal with the insurance company. As a general rule (although there are exceptions) policies procured by the Insured, and not an employer or large group, managed by the Insured and paid directly by the Insured are not governed by ERISA. However, before proceeding, it may be wise to consult with an attorney to fully understand the policy's procedures on internal appeals and make sure the steps that you have contractually agreed to have been performed.

In many instances, it is wise to file an appeal, i.e., a written response to the insurance company's denial of benefits, before proceeding with a lawsuit. In addition to procuring benefits more quickly (a lawsuit may take anywhere from 1 to 2 years), preparing an appeal will make sure the claim is litigation-ready if the filing of a lawsuit is necessary. Because insurance companies utilize attorneys with extensive knowledge about the legal issues relevant to disability insurance claims and the litigation process, a pre-litigation appeal allows the insured to make sure his/her claim is litigation ready, should the insurance company uphold its denial. Finally, some polices do require arbitration or further review steps prior to the commencement of a civil action.

Most disability insurance cases involve complicated medical, vocational and legal issues. Because insurance companies have ample resources, they often retain physicians, medical experts and vocational experts to support their denial of benefits. Unfortunately, most claimants lack the resources or are unaware of how to gather the information necessary to challenge the insurance company.

The attorneys at Disability Insurance Law Group prepare each appeal as if it is going to trial. Because of our experience in preparing these appeals and litigating these claims, we understand what information is needed to prepare an effective appeal and the complicated legal issues that must be considered. We work closely with our clients' treating physicians in an effort to make sure the insurance company is provided with evidence and a thorough explanation of our clients' medical condition, restrictions and limitations. Additionally, we will not hesitate to employ the vocational and medical experts necessary to support our insureds' claims for benefits.

Should an appeal prove to be unsuccessful or not warranted, then it may be necessary to file a lawsuit. The attorneys at Disability Insurance Law Group will not hesitate to expend the time and resources necessary to aggressively advocate on our clients behalf during the appeals process or at trial.

To speak with one of our attorneys at this time or to set up an appointment to discuss your disability insurance case, please contact Disability Insurance Law Group through our toll free number 888-644-2644 or email us at any time. We handle cases nationwide and our attorneys would be happy to provide you with a free initial consultation.