Skilled DMS Disability Claims Attorneys Representing Clients Throughout the U.S.
At Disability Insurance Law Group, our nationwide claims attorneys represent policyholders throughout the U.S. who are having their benefits disputed or denied by Disability Management Services (DMS).
DMS is a third-party administrator (TPA) that administers claims on behalf of long-term disability insurance companies. It is important to note that TPAs often administer claims on behalf of insurance companies or employers.
AXA Equitable is one of DMS’ largest clients and a company our skilled disability claims attorneys have pursued for years to ensure our clients get the benefits they are entitled to — whether we had to fight against a DMS dispute or denial, or those coming directly from AXA.
For many U.S. workers, their employers offer disability benefits as part of their employment packages. This is especially true for most group policies governed by the Employee Retirement Income Security Act of 1974 (ERISA), millions of which DMS underwrite. ERISA policies have stringent filing requirements that can leave their policyholders struggling to get the benefits they are counting on. That is why we are here.
Our national disability insurance attorneys represent DMS policyholders nationwide — no matter where they live or work in the U.S. — with their best interests and true success in mind so our clients can pursue the benefits they are entitled to from their employer-provided coverage or personal policies. Contact us today to lean more.
Why Are DMS Disability Claims Frequently Disputed or Denied?
Whether you have purchased private DMS disability insurance or if your coverage is provided directly through your employment, the only crucial factor you may be concerned with is if you are left disabled and unable to return to work on a short-term or long-term basis; it will pay the benefits that are outlined in your policy.
Here are some reasons why DMS may dispute or deny disability claims:
- Policy Terms and Conditions
Denials can occur if the policyholder’s disability does not meet the specific terms and conditions outlined in the insurance policy. Failure to meet the policy’s definition of disability is a common reason for denial.
- Insufficient Medical Evidence
Disability claims typically require comprehensive medical evidence to support the inability to work. If the provided medical documentation is deemed insufficient or does not align with the policy’s requirements, DMS may deny the claim.
Some policies have exclusions or limitations related to pre-existing conditions. If the disability is attributed to a pre-existing condition not disclosed during the application process, the claim may be denied.
- Failure to Meet Waiting Periods
Disability policies often have waiting periods before benefits become payable. If the policyholder becomes disabled during this waiting period, the claim may be denied.
- Coordination of Benefits Issues
Since DMS is a TPA, it may administer disability claims that involve coordination with other insurance policies or employee benefits. Issues related to coordinating benefits can lead to denials or delays in processing claims.
- Claimant’s Failure to Comply
Policyholders are typically required to comply with the claims process, which includes providing necessary documentation and cooperating with medical examinations. The claim may be denied if the claimant fails to comply with these requirements. This is especially true for ERISA-governed claims.
- Misrepresentation or Fraud
The claim may be denied if DMS discovers that the policyholder provided false information or engaged in fraudulent activities to obtain coverage. Honest and accurate disclosure during the application process is crucial.
Policies often contain exclusions for certain conditions, activities, or events. If the disability is related to an excluded item specified in the policy, the claim may be denied.
- Change in Medical Condition
A claim that was initially approved may be subject to periodic review. If DMS determines that the policyholder’s medical condition has improved or no longer meets the criteria for disability, benefits may be terminated.
Errors in the claims administration process, such as data entry mistakes or misinterpreting policy provisions, can lead to erroneous denials. Administrative errors should be addressed through the appeals process.
It is essential for policyholders to carefully review their insurance policies, understand the terms and conditions, and provide accurate and timely information during the claims process. In the event of a denial, policyholders have the right to appeal the decision. We can help.
Whether you are considering applying for benefits, are waiting for a claim’s decision, or have been denied, we can assist you with your DMS disability claim anywhere in the country, starting with a free consultation.
We are fully dedicated to providing transparent legal services that allow us to pursue real results for real people who need our help — no matter where they live or work in the U.S.
Contact Our Dedicated Disability Insurance Attorneys Nationwide
If you are receiving resistance from DMS for your U.S. disability claim, or if your claim has already been denied, contact our dedicated disability insurance attorneys nationwide at 954-989-9000 or online to schedule a free, confidential case assessment without delay.