A Disability Insurance Claim Denial Need Not Be The Last Word

Having insurance coverage can provide peace of mind. The hope, of course, is to never have reason to file a claim, but the expectation is that if a loss occurs, the insurance company will respond in a timely manner, address the issue professionally and pay an appropriate settlement amount to cover the damages incurred. However, when it comes to disability insurance claims, many Florida claimants find that the reality of how the insurance company handles the matter is far different from their expectations.

Although there are three different types of disability insurance an individual can have, legal experts report a high incidence of denial of benefits from all three. For both Social Security disability and employer-provided disability insurance, which is governed by federal ERISA laws, the right to appeal a denial is guaranteed. Where private disability insurance is involved, most allow some form of appeal, but it will be necessary to verify this by reviewing the specific language and terms of the contract.

In any case, the denied claimant must follow the relevant procedure for filing an appeal, paying special attention to time deadlines so as not to lose the right to have the appeal heard. An SSD claim allows three levels of appeal within the Social Security Administration system and a final appeal in federal court. An employer-provided insurance denial claim can go to court after the initial denial, but typically, only evidence used in the underlying denial can be heard. Private insurance appeals are again based on contract terms.

A seminal issue in insurance denials is that it is the insurer itself who initially determines its own responsibility for paying on a claim. An experienced insurance lawyer may evaluate a disability denial and explain the rights and responsibilities of the parties.