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Appealing Your Disability Denial

After an employee has dedicated their work-life to their employer, they expect to be treated fairly in a time of need. For many workers, disability insurance is compensation that they have earned through years of hard work. In return, they expect disability insurance to help them provide for their family in a time of need. Unfortunately, many people who are unable to work find their disability claim denied by the insurance company and do not know where to turn.

Disability Claim Benefits

Long-term and short-term disability insurance provides benefits to individuals who are unable to work due to an illness, disability, or other conditions. These benefits provide payments to supplement the loss of regular work income for the covered period of time. For short-term disability, this may provide benefits for up to 3 to 6 months, depending on the plan. For long-term disability, coverage may provide benefits for as long as the condition lasts, generally to the age of retirement.

Disability benefits may allow workers to take care of themselves and their families when they cannot earn an income from working. Without disability benefits, an individual may have to rely on government benefits, such as Social Security. For many disabled workers, it is difficult to get by on Social Security alone. This is why having a disability claim denied can be so tragic for disabled workers.

Denial of Disability Claim

The disability claim process generally begins with submitting forms to the insurance company. This has portions to be filled out by the employer, employee, and attending physician. The form also includes a release of medical records for the insurance company to review.

The insurance company must decide a disability claim within a reasonable period of time, but not later than 45 days. The insurance company can request an additional 30 days to review the claim, explaining why additional information is needed. Within that time, the company will inform the applicant whether the claim was approved or denied.

If your claim is denied, the insurance company must send a notice with a detailed explanation of why your disability claim was denied and detail the application process. Additional information should also be described in the disability insurance Summary Plan Description (SPD) or Summary of Benefits and Coverage (SBC). This includes a description of the appeals process, guidelines, and exclusions.

Why Claims are Denied

Disability claims can be denied for any number of reasons. Some disability claims are denied for valid reasons, including where the claimant was not covered by the insurance plan, the cause of the disability is excluded from coverage, or the injury or illness is not sufficiently limiting to be considered disabling.

However, many valid disability claims end up denied because of incorrect information, improper evaluation of the application, the insurance company not understanding developing medical science, or simply for administrative errors.

A number of disabling illnesses do not have specific tests that can evaluate the disease. Many illnesses that result in chronic pain or disability are difficult to diagnose, treat, or evaluate. While the pain may be real, debilitating, and even diagnosed by an attending physician, there may be no empirical proof that the individual is disabled.

Other claims may be denied by the insurance company attempting to “catch” the individual in a situation that may contradict their claim. The insurance company may try and use private investigators or social media posts to deny the claim, even if there is nothing to contradict your attending physician's experienced prognosis.

Some applications may contain inaccurate or mistaken information. An insurance company may deny the claim based on these misstatements, even if they were simple typographical errors that could easily be explained or corrected. It is important to understand the terms and questions contained in the disability claim forms, and if necessary, talk to an attorney to understand what signing the document may mean.

Appealing Your Disability Denial

If your claim is denied, you must take necessary steps to appeal that decision to ensure you receive the disability benefits that you deserve. The simplest way to appeal a denial is to contact an experienced disability benefits attorney. Your attorney will represent only you, and not the insurance company. They will identify any potential problems with the application, and fight to make sure you get the benefits you have earned.

Appeals have a timeline that should be followed, or you may be left with no recourse to dispute the insurance company's decision. You should also review all available information, including the denial letter, your initial application, and description of plan benefits. This will allow you to identify what may have potentially caused the denial.

You have 180 days to file an appeal; however, some plans may provide additional time. Before filing an appeal, you may seek a copy of any documents, records, relative information, medical expert advice, or vocational expert advice used by the plan in evaluating your claim.

On filing an appeal, your appeal should be reviewed to include any additional information submitted. If the appeal is denied, again, the insurance company should provide an explanation of the decision to deny the appeal, indicate the rules and regulations relied upon, and provide information about any additional appeals process.

If your appeal is denied, you may be able to file a legal claim to seek disability benefits. Contact your disability benefits attorney if you claims are denied to determine what rights you have and how you can seek benefits for your disability, including an award for past interest and attorney's fees.

Disability insurance enables workers to care for their families when they are no longer able to work. Do not rely on the final decision of the insurance company to dictate whether you are disabled or not and whether you will receive the disability payments you have earned. Contact an experienced ERISA disability benefits attorney.

ERISA Disability Benefits Attorney

Greg Paul has 16 years of experience fighting for short- and long-term disability benefits against the insurance companies. We represent individuals and families who have been denied benefits by their insurance company or plan administrator. You have a limited time to appeal your disability denial, so do not delay. If you have been denied short-term or long-term disability benefits, contact our office for a free consultation.

Free Consultation

Please contact us for a free consultation with Greg concerning the denial of short-term or long-term disability benefits. Most clients prefer to have a contingency fee agreement, which means attorney fees are are payable if we are successful.

ERISA Experience

Greg Paul has 18 years experience fighting for long-term disability benefits against insurance companies such as Aetna, CIGNA, Guardian, Hartford, Liberty Mutual, Mutual of Omaha, Principal, Prudential, Reliance Standard, Standard, Sun Life, and Unum.