Disability Insurance Denials
Long-term disability (LTD) insurance provides beneficiaries with a portion of their income if they become ill or injured and cannot work for extended periods (usually more than 90 days).
To receive disability benefits, policyholders must file a timely proof of loss and disability claim that insurers approve. Often, disability claims are wrongfully delayed or denied, and policyholders do not receive the benefits they paid for and deserve. If you experienced a disability insurance claim denial, you should appeal—and hire a top-rated, national disability insurance lawyer at DarrasLaw to help guide you through the complicated process (as outlined below).
The Basics of Claim Appeals
Appeals essentially provide everything that disables you from your occupation including supporting objective and subjective medical evidence, tests, pharmacy documentation, job descriptions, vocational analysis and a review of the applicable ERISA law from the Federal circuit you live in. Typically appeals first go through the insurer’s internal process. Your appeals options will vary based on who administers your plan and the appeals options outlined in your plan.
If your group disability insurance company denies your claim they must state:
- The reason your disability claim or coverage was denied
- Appeals options and instructions on filing appeals
- Any applicable deadlines regarding your appeal
Is Your Long-Term Disability Insurance Provided by Your Employer?
If your plan is provided or paid for by your employer, it is likely governed by the Employee Retirement Income Security Act of 1974 (ERISA)—which is a wide-ranging federal statute that applies to U.S. employee benefit plans.
ERISA—along with other policy provisions and limitations specific to various private and group insurers—requires that claimants timely file administrative appeals before they can bring an ERISA federal lawsuit against the insurer.
This means you are required to undergo an administrative appeal or appeals before you are able to file an ERISA federal lawsuit in court. This process through the administrative appeal along with extensions can easily span more than a year, so brace yourself.
If your disability insurance policy is not subject to ERISA guidelines and your private disability policy does not require a preliminary administrative appeal like the one described above, contact a bad faith disability litigation lawyer before making any fatal appeal or filing mistakes.
Wrongful Insurance Claim Denials Are Not Necessarily the End of the Line
If your individual or long-term disability insurance company has wrongfully denied your disability claim for any of these or other bad-faith reasons, the top-rated, experienced attorneys and ERISA lawyers at DarrasLaw may be able to help:
- A false or mistaken assertion that your disabling condition was pre-existing and does not qualify for disability benefits under your policy
- Duplicative, endless requests for additional claim documentation
- A refusal to supplement Social Security Disability Insurance (SSDI) as required when the disability benefits promised by the policy exceed those received from SSDI
- An insurer-hired doctor, who lacks the proper training or specialization, reviews your file and determines that you are not disabled, or talks to your treating doctor and determines that you are ready to return to work before that is actually possible
- You were surveilled by a private investigator that provided photos or videotape. The insurance company suggests your activities are inconsistent with your alleged restrictions/limitations.
Tips for Filing a Long-Term Disability Insurance Group Claim Appeal
Receiving the news that your long-term disability claim was wrongfully denied can feel devastating. Fortunately, a wrongful denial does not end the claim—you can successfully, administratively appeal and you should.
These tips will help you understand the process and file a strong long-term disability claim appeal:
What is an appeal letter? An appeal typically begins with a written response to the disability insurance company’s wrongful claim denial that addresses legal, medical, and vocational issues identified by the insurer. The goal of the appeal letter is to clearly demonstrate to the insurance company that you are entitled to the disability benefits outlined in your long-term disability policy.
Can I file an appeal? Your specific appeal options may differ based on the kind of disability insurance coverage you have and who provides it.
Policyholders with coverage subject to ERISA must timely and thoroughly exhaust all administrative appeals laid out in the policy when appealing a wrongful denial. If the policy requires two or three appeals, you must follow all these administrative steps before you may file a federal ERISA lawsuit.
If you purchased a private, individual long-term disability insurance policy, you may not need to appeal. Your appeal options will depend on your specific policy language. Read it, and consult an experienced disability-insurance lawyer at DarrasLaw, we have seen and resolved more individual and long-term disability cases than any other firm in America.
Should I file an appeal for my Group Long-Term Denial? The short answer is absolutely, with attorney help! An appeal is the most common type of action taken to address a wrongful disability insurance denial.
For example, individual disability insurance policyholders may choose to skip appeals (where allowed) and file a lawsuit in court, but seek bad faith counsels’ advice before making any fatal mistakes.
Individual disability policyholders may consider filing suit if the insurer subjected them to bad faith tactics—such as using improper or hidden denial strategies to wrongfully deny disability claims, or intimidating or misinforming policyholders about their rights under their policies.
Claimants with group ERISA disability insurance policies should note that, you cannot seek damages for emotional distress, extra damages for repossession or stained credit, or punishment damages. Instead, you may only sue for your past-due disability benefits, interest and your attorney fees.
If you are uncertain about whether you should file an appeal or a lawsuit, a top-rated, experienced disability insurance attorney or ERISA lawyer at DarrasLaw may help you determine your best course of action to recover your disability benefits.
What to Consider Before Filing an Administrative Appeal
Note the strict timeframe. In many cases, you only have 180 days, or less, to gather all your evidence and timely file an appeal. Missing the appeal deadline is a fatal mistake, and it may preclude your ability to go further.
Don’t ignore claim details in the denial letter. Pay close attention to the details in your denial letter, as it should explain why your disability claim was denied and how to file an appeal.
The reason for denial will inform how you should proceed with your appeal and what additional information you will need to gather.
The denial letter will also outline the deadlines and specific requirements for filing your appeal.
Request your administrative file. Before you timely file your appeal, obtain your administrative file from your disability insurance company, as it will contain even more detailed information about your disability claim than the denial letter does.
The seasoned, top-rated disability insurance attorneys and ERISA lawyers at DarrasLaw will make sure you hit those deadlines and obtain all of the information you need to present the strongest possible administrative appeal.
Your Insurance Company Is Required by Law to Provide You a Free Copy of Your Administrative Record
The administrative record will include reports from the insurer’s reviewing doctors. The record will possibly include surveillance photos and videos and functional capacity evaluations. In addition, independent medical exam results or insurance company nurse and hired doctors reviews from any field visits you underwent, and any other information the insurer used to deny your disability claim.
The experienced, compassionate disability insurance lawyers and ERISA attorneys at DarrasLaw can help you examine those documents for any incomplete or incorrect information that could have contributed to your wrongful denial. Your appeal is an opportunity to strengthen your disability benefit claim by “stacking” the record with favorable information and filling in any missing information in your claim file.
For example, make sure your file already contains all of your relevant medical records, which may include treating physician’s chart notes, surgical reports, medication history, objective test results, pharmacy documentation, vocational reports, financial proof, declarations from before and after witnesses, and finding friends and family.
If you find missing or incomplete information in your file, promptly request it from your treating physician and include it in your appeal. Ensure that your treating physician clearly and accurately evaluated your limitations and restrictions as they relate to your ability to work and refutes every word of insurance companies reviewing nurses and doctors.
In some cases, third-party videotape information from friends and family may help. These reports should focus on first-hand observations of you, rather than opinions about your disabling condition. Such observations could include whether you need help completing tasks like walking, standing, showering, also, sitting and carrying tolerances.
When to Ask an Experienced, Top-Rated Attorney at DarrasLaw for Help
Insurance companies count on the lengthy, convoluted long-term disability insurance appeal process to discourage you from filing an appeal—or to trick you into making a fatal appeal mistake, like under-documenting your appeal or even missing crucial deadlines.
An experienced long-term disability insurance lawyer from the top-rated firm of DarrasLaw can help you determine the appropriate appeal steps, gather the necessary medical evidence, and craft a persuasive appeal letter.
Hold on to Your Disability Papers!
Keep (or retrieve) copies of all correspondence between you and your disability insurance company. Such documents can include, but are not limited to:
- Any documents providing additional information that your insurance company requested or that you voluntarily sent to the insurance company (like medical documents provided by your treating doctor that support your disability claim).
- An Explanation of Benefits (an EOB) letter—some form or document showing your disability benefits.
- Notes and dates from as many phone and email conversations as you had with your disability insurance company—or any other relevant information relating to your delay, wrongful denial, or appeal. Always try to include things like the day, time, name, and title of the person you talked to, as well as any important information shared or discussed in the conversation.
Find what you can, make note of the documents you remember submitting but can’t locate, save everything else moving forward, and give copies to your lawyer.
What to Include in Your Long-Term Disability Appeal?
In any appeal—you want to clearly and thoroughly state why you feel your denial is wrongful based on:
(1) The reasons you were denied
(2) Your specific coverage or policy’s language that you feel goes against your denial
When writing your appeal letter, consider including the following:
- Your medical condition and its disabling impact on you. The tone should not convey anger but factual information supported by objective and subjective evidence.
- Specific reasons, with references to your policy where possible, why you believe your disability claim is covered and, therefore, your denial is wrongful.
- Contact information for both you and your treating doctor, as well as any other relevant people with supporting claim information.
Keep a copy of all of the information related to your appeals filing: your appeals letter, your appended documents, and any confirmation receipts you receive.
If Your Individual or Long-Term Disability Claim Was Wrongfully Denied, Please Contact America’s Top-Rated Disability Insurance Law Firm, DarrasLaw, Today!
If you are preparing to file an appeal for your wrongfully denied individual or long-term disability claim, contact DarrasLaw’s top-rated long-term disability insurance attorneys and ERISA lawyers.
Insurance companies act in bad faith more often than one might imagine. The seasoned disability insurance lawyers at DarrasLaw know how to spot red flags that may indicate wrongful disability claims denials or delays.
The experienced, top-rated legal team at DarrasLaw has taken on long-term disability appeals of all kinds and at all stages—and won. There is no risk involved in contacting DarrasLaw—if you have questions about your individual or long-term disability insurance appeal, our legal team is here to help you fight back! Reach out to us at (800) 458-4577 or contact us online today for a free policy analysis or claim consultation.