Finding out that your disability insurance provider has denied your claim can be frustrating, confusing and frightening. You and your family were likely counting on those benefits to help make up for your lost wages and allow you to pay household expenses despite being unable to work.
Fortunately, a denial does not have to be the last word. With a good Appeal, it may be possible to get the benefits you deserve without having to file a lawsuit or go to trial.
The Importance of the Administrative Appeal
Your long-term disability (LTD) insurance policy is a contract between you or your employer and the insurance company. Though disability insurance policies may vary, they generally allow claimants to appeal a denied claim through an internal appeals process. The Appeals process provides a claimant with the opportunity to supplement their file and respond to the stated reasons for the denial as well as the medical and/or vocational analysis used by the insurer as the basis for their denial. Once filed, a different claims representative reviews the entire file and can determine that the information provided with the Appeal confirms disability and therefore the denial should be overturned. At that point, all back benefits owed to date are payable and ongoing monthly benefits will commence.
Many initial claims fail because the claimant did not provide sufficient information to adequately prove that their medical condition is debilitating to the point that they cannot perform their job duties. Additionally, because most people are unfamiliar with what is needed to prove a claim and thus provide too little information or vague responses on the claim form or to an adjuster’s questions, they give the insurance company an excuse to deny the claim. For example, it is a common error to omit relevant medical records and details and employment information which are important evidence of disability and that the claimant is entitled to payment under their policy’s terms. An appeal is your chance to supplement your claim with additional evidence and clarify any misstatements or misunderstandings.
Finally, if your LTD insurance is provided through your employer, the federal Employment Retirement Income Security Act (ERISA) requires you to “exhaust all administrative appeals” before you have the right to sue in federal court. So even if you expect to file a lawsuit, you must file an administrative appeal within the 180-day appeal deadline. Failure to do so may waive any chance you have of further pursuing benefits and filing a lawsuit. Just as importantly, a successful appeal could save you a great deal of time and money.
However, you should always be prepared for the possibility that a lawsuit may be necessary. Insurance companies know the system and often do what they can to avoid paying valid claims. They also understand that the average insured does not understand the law and proof of claim requirements needed to overcome a denial of benefits.
How can DI Law Group help?
The attorneys at Disability Insurance Law Group know that a delay or denial of a disability claim can be financially devastating. DI Law Group represents disability insurance claimants at every stage of the insurance process – from filing the application for benefits through trial. If you have any questions regarding your disability insurance claim, our team of attorneys would be happy to provide you with a free consultation. Please contact us at 888-644-2644 or visit our website at www.dilawgroup.com.