Has an Insurance Company Denied Your Long-Term Disability Benefits?
If you are medically unable to return to work and an insurance company has denied your long-term disability benefits, you should call an attorney. Most disability insurance plans are provided by employers. Employer-based plans usually fall subject to a Federal law known as ERISA, which means that you must note and exhaust various levels of administrative appeals.
While you may be eager to proceed directly to Court, administrative appeals present an additional and valuable opportunity to reverse denial decisions. You have time limits for filing these appeals – but you also do not want to submit an appeal without new information. An experienced benefits attorney will understand why your claim was denied and what type of new information is needed to prevail in the case. If you still have to proceed in Court, the Court’s review is based on the administrative record developed through these appeals. You do not receive a traditional trial with the opportunity to present new witness testimony to prove your case.
Most long-term disability policies will evaluate your ability to perform your employment position for the first 24 months. However, many policies change the standard to “your ability to perform any position” following 24 months. This distinction is significant and frequently results in the premature and unexpected termination of benefits. Your case manager might assert that you can perform lesser positions, even though your doctor has not cleared you to return to work. Decisions to terminate benefits in this circumstance also can be appealed under ERISA plans. Act promptly to avoid a disruption in your benefit payments.
Your insurance company’s formal “denial decision” will describe your appeal process and time limits. If you just have received this letter, you should contact us immediately to discuss a comprehensive strategy to secure your benefits.
Here are a few basic rules to proceed by:
DO NOT GIVE UP AFTER AN INITIAL DENIAL IF YOU KNOW THAT YOU ARE MEDICALLY UNABLE TO RETURN TO WORK!
SCHEDULE AN INITIAL CONSULTATION WITH A QUALIFIED ATTORNEY!
CONTINUE TO SEE YOUR TREATING PHYSICIANS REGULARLY!
DO NOT WAIT UNTIL AFTER YOU HAVE FILED YOUR ADMINISTRATIVE APPEAL TO CALL AN ATTORNEY!
DO NOT ASSUME THAT THE INSURANCE COMPANY WILL ACT AS A NEUTRAL EVALUATOR OF YOUR CLAIM!
REQUEST A COPY OF YOUR ADMINISTRATIVE FILE FROM THE INSURANCE COMPANY!
DO NOT AUTOMATICALLY SIGN OVER A PERCENTAGE OF ALL OF YOUR FUTURE BENEFITS FOR LEGAL ASSISTANCE!
DO NOT SETTLE YOUR CLAIM WITH OUT A LEGAL REVIEW OF THE TERMS!
DO NOT HIRE AN OUT-OF-STATE ATTORNEY OFF THE INTERNET THAT YOU CANNOT MEET WITH DIRECTLY TO DEVELOP YOUR CASE!