Applying for Insurance Benefits

By the attorneys of DI Law Group

Contents:

Filing a Claim for Disability Benefits Under Your Individual or Group Disability Insurance Policy

One of the most important aspects of a claim for disability benefits is completing the application and submitting it to the insurance carrier. While the application typically looks straight forward and easy to complete, the information you provide can mean the difference between proving your claim and foreclosing on your right to benefits.

Because your disability insurance policy governs any claim for benefits, it is very important that you obtain a complete copy of your disability insurance policy prior to filing a claim for benefits. Many applicants unknowingly damage their claims by providing incomplete answers and/or mistakenly misinterpreting the questions posed. A successful application for benefits will contain sufficient proof of loss, including proper documentation. This involves collaboration between the applicant, the treating physician(s), the applicant's accountant and his/her employer.

Most group policies that you obtain as a result of your employment, including those that provide coverage for eating disorders, are governed by the Employees Retirement Income Security Act of 1974 ("ERISA"). ERISA is a federal statute that provides extremely strict deadlines and guidelines that claimants and insurance companies must abide by in the processing of a claim, submission of an appeal, and ultimately the determination of eligibility for benefits under a disability insurance policy.

In addition to obtaining a copy of the employer's disability policy in effect at the time of your disability, it is important to acquire a copy of your employer's Summary Plan Description. Applying for benefits under an ERISA policy poses unique and difficult challenges for claimants. If you are denied benefits at the application stage, you must appeal directly to your insurance carrier. If the insurance carrier upholds its denial on appeal, you can file a lawsuit. However, your trial will most likely be based on your application and appeal. Accordingly, what you say and how you say it on your application is extremely important. Too often, these claims are denied and the claimant is forced into the long and difficult process of an ERISA appeal to pursue their benefits. The wait can be financially devastating for many claimants. However, many of these claims can be won at the application stage.

The attorneys at DI Law Group carefully review our clients' policies, speak to their physicians, review the medical documentation with our experts, and thoughtfully prepare our clients' applications with them. Accordingly, we are often able to avoid needless delay in processing these claims, as well as the typical pitfalls created by insurance companies. - Top-

Treating Physician and Attending Physician Forms

Often an insurance company will require the applicant's treating physicians to complete an Attending Physician Statement. The treating physician is required to determine whether the patient can perform the duties of his/her occupation or in some instances, of any occupation, among other things. Many times, the insurance company will even call the treating doctor in order to discuss the claimant's medical condition. We regularly consult with our client's treating doctors, so that they are able to properly evaluate and effectively communicate their patient's restrictions and limitations and are prepared to respond to the insurance carrier's questions. - Top-

Field Interviews

Insurance companies often require an in-person or telephone interview with a claimant early on in the process. This frequently provides insurance carriers with the ammunition needed to deny or delay payment of a claim. We do not allow our clients to attend an in-person or telephone interview without us present. We fully prepare our clients for what they will face prior to the interview and limit the interviewer's ability to ask ambiguous and unfair questions. - Top-

Independent Medical Examination

Insurance carriers often require claimants to attend Independent Medical Examinations (IME). The "independent" examiners are chosen and paid for by the insurance companies. The attorneys at DI Law Group only allow our clients to attend Independent Medical Examinations after careful negotiations about the appropriate physician, the physician's specialty, the tests to be conducted, and the scope of the examination. Typically, we will attend the examination with our client or have it videotaped to ensure an unbiased account. - Top-

Video Surveillance

In most cases, without the claimant's knowledge, insurance companies hire private investigators to follow the claimant and conduct video surveillance over a period of several days. This video is often used in attempt to create the illusion that the claimant is less than truthful based on answers provided during the claims process. Insurance carriers will use the surveillance videotape to terminate disability benefits or deny an application for disability benefits. Although the surveillance video is often unreliable and misleading, insurance carriers often get away with this tactic used to deny or terminate a claim. The attorneys at DI Law Group typically request a copy of the surveillance video to address these issues and allow our client's treating physicians an opportunity to review and comment before any decision to terminate or deny benefits is made. - Top-

Relevant Information

While claimants do have an obligation to provide sufficient evidence to prove their claim, claimants must be aware that insurance companies are not entitled to everything that they request. Insurance carriers are only entitled to information relevant to the claim of disability. Without understanding the legal implications of the documents requested by the insurance carrier, claimants often needlessly provide irrelevant information that can be unjustly used to confuse the issues at hand or delay payment of the claim. - Top-

Filing a Claim for Long-Term Care Benefits Under your Policy

Your long-term care insurance policy governs your claim for benefits. Thus, it is crucial that you obtain a complete copy of your long-term care policy and understand what your insurance contract requires prior to filing a claim for benefits. Where possible, our long-term care insurance attorneys become involved prior to the filing of a claim for benefits in order to prevent problems with your long-term care insurance claim before they begin.

It is important to be aware that long-term care policies require that you provide the insurance company with notice and proof of claim within strict time periods. It is your responsibility as the claimant to provide adequate proof of your entitlement to insurance benefits within the required time periods. Your failure to do so will likely result in a denial of your claim. Thus, it is necessary that you act quickly when your need for long-term care benefits arises.

Your application for benefits can be one of the most important documents in filing your insurance claim. It can help or haunt you throughout the entire claim. The applications are written by insurance companies, to benefit insurance companies. While it may look like a simple form, it is often created to illicit certain information and to discourage a full description of your situation. An application for benefits should never be taken lightly. Insurance companies often misconstrue and take information contained on these forms out of context to deny claims. Our long-term care insurance attorneys have the experience necessary to recognize problems before they begin. We guide our clients through the process and thoroughly review all documents before they are submitted to the insurance company. - Top-

Filing a Claim for Life Insurance Benefits

When filing an application for life insurance benefits, it is crucial that you obtain a complete copy of the life insurance policy governing your claim and that you understand what your insurance contract requires prior to filing a claim.

It is important to be aware that many life insurance policies require that you provide the insurance company with notice and proof of claim within strict time periods. It is your responsibility as the claimant to provide adequate proof of your entitlement to insurance benefits within the required time periods. Your failure to do so will likely result in a denial of your claim. Thus, it is necessary that you act quickly when your entitlement to life insurance benefits arises.

Many times with a life insurance claim, it is difficult to ascertain whether the claim forms (otherwise known as the application for benefits) and policy must be requested from the insurance company or from the loved one's former employer. If the life insurance policy was provided to your loved one through his or her employer, then you may need to request the application and policy directly from the employer.

A problem faced by many families seeking to obtain information from the insured's employer is the employer's refusal to provide an application for benefits or a copy of the policy because the insured was no longer an employee at the time of his or her death. The employer mistakenly believes that the employee's coverage automatically lapsed immediately following his or her termination from employment. This is a fairly common misunderstanding and has been the reason many families and individuals have been unable to obtain the life insurance benefits secured for them by a loved one. Our attorneys at DI Law Group have successfully dealt with this issue on numerous occasions and facilitated denied claims being paid to our clients. We have also been featured on Good Morning America for our work in one particular case where this was precisely what the employer/life insurance company was arguing to deny our client's life insurance benefits.

At DI Law Group, we have helped hundreds of beneficiaries and loved ones successfully obtain the benefits that they are entitled to under the terms of their insurance policy. We have devoted our practice to exclusively representing claimants in insurance matters and disputes. If you have questions regarding your rights under an existing life insurance policy, let our 25 years of combined experience work for you. Our goal is to help you expeditiously resolve your claim. - Top-

Tactics Used to Deny Claims

One of the most common tactics insurance companies use to deny a claim is accusing you, or your loved ones, of making a "material misrepresentation" on the application for the insurance policy. This is commonly done if your loved one passed away during the "contestability period," the time period in which the life insurance company is supposed to be reviewing the application to decide if they want to provide insurance coverage. Often, insurance companies will base their denial of benefits on allegations that there were material misrepresentations on the insurance application regarding the proposed insured's occupation, prior health, age, income, etc. If the insurance company believes they found any material misrepresentation, they will use that as the basis to deny the insurance claim. - Top-

Get Experienced Legal Help

Our attorneys get involved as early as prior to our clients even filing their application for benefits with the insurance company. While the application may look like a simple form, it is often created to illicit certain information and to discourage a full description of your limitations and restrictions.

An application for benefits should never be taken lightly. Insurance companies often misconstrue and take information contained on these forms out of context to deny claims. Our experienced lawyers guide clients through the process and thoroughly review all documents before they are submitted to the insurance company.

Many wrongful denials of insurance benefit claims can be overturned without the cost, frustration, and delay of filing a lawsuit, simply by supplying the right information and knowing how to respond to your insurance companies accusations. Understanding the common tactics utilized by insurance companies and recognizing their deceptive behavior is essential in securing your rights and preparing an effective response.

Before you proceed, it is vital that you understand your rights and obligations under your insurance policy and the law that governs your claim. If you fail to meet your obligations, you may unknowingly be fatally destroying your claim. Your response to your insurance company's wrongful denial of your life insurance claim depends on the law that governs your claim.

To discuss your case with an experienced insurance lawyer, please