Medical Reasons That Individual And Group Disability Insurance Companies Use To Deny Valid Claims
Many wrongful denials are predicated on your medical condition and how you document it.
You can submit all of the medical evidence in the world proving you permanently injured your back, but if the insurance company claims it was a work-related injury or otherwise excluded from coverage, your attorney will need to submit legally sufficient counter-arguments. Hiring the right disability insurance attorney is crucial because the reasons for your bad-faith denial dont always make sense when youre clearly injured and cant work.
Your individual or group disability insurance company may base your denial on a failure to submit proper medical evidence or comply with insurance company requirements. Individual and group long-term disability insurance companies may require you to submit a monthly disability statement. They may also mandate that you attend so-called independent medical exams with insurance company-hired doctors. An insurance physician who may lack the proper specialization or training to evaluate your condition could declare youve sufficiently recovered or are no longer disabled after a cursory IME.
Applying For Ltd Benefits
When applying for LTD benefits, you will have to fill out an application form created by the insurance provider. You can find this form on the insurers website, or you can ask your employer for it.
The application form will consist of a section for you to complete, as well as a section for your doctor to complete.
You will be required to provide information, including when your disability started, what your symptoms are and what your job duties include.
Your doctor will complete their portion and include your specific limitations and restrictions, how these restrictions affect your ability to work, and your prognosis and treatment plan.
The insurance company may require additional medical documents to support your claim and will receive them directly from your doctor.
In order to receive LTD benefits, you must be disabled from working in your own occupation. This does not mean that you must be completely physically disabled from performing all aspects of your job. Rather, it means that you must be unable to perform the substantial and important functions of your job.
Note that, after two years, in order to continue to receive disability benefits, you must be disabled from working in any occupation. You may also receive a phone call from someone from the insurance company to ask you questions.
The insurance company will then use all of this information to assess whether or not you will be approved for LTD benefits.
Were 30 Years Strong And Were Just Getting Started
We want to help you through this difficult time. We can offer guidance, insight, and legal representation related to long-term disability claims.Whether your employer provides the insurance coverage, or you are responsible for paying the premiums yourself, our long-term disability attorneys can help by:
Helping you understand your rights
Reviewing your policy to understand fully its terms and how they may apply to your current situation
Gathering evidence of your medical condition to prove your disability
Filing your long-term disability claim with your insurance provider.
Handling all communication with the insurance company and
Appealing your claim if you have been denied benefits for any reason.
We represent workers in long-term disability claims nationwide. We offer a free, confidential consultation so you can learn more about your claim and your rights to benefits.
If you are ready to get started, please give us a call at.
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Allegations Of Wrongful Denial Of Disability Benefits Under Erisa
Our client was covered under the policy by virtue of being an employee of Delta Airlines Inc.
Originally, Aetna Life had notified our client that they had granted his request for disability benefits under the Plan based on the Own Occupation standard of disability.
The Social Security Administration had also issued a fully favorable decision on our clients claim for Social Security disability benefits under Title II and Title XVI of the Social Security Act, finding that he was disabled during the relevant time period .
Subsequently, however, Aetna Life denied further long term disability benefits under the Plan.
Our client appealed Aetnas decision within the allotted time frame.
Six months after denying our clients claim, Aetna Life notified him that all administrative remedies had been exhausted and the insurer would consider no further claims or evidence. In its final denial, Aetna discounted the opinions of our clients treating physicians, among others, and the documented limitations from which our client suffers, including the effects of our clients impairments on his ability to engage in work activities.
Our client, who had now exhausted all available administrative remedies, decided to file a lawsuit against Aetna to obtain his rightfully owed disability benefits.
A Lawyer Can Help Gather Evidence For Your Claim
Claimants may rely on their insurance company to obtain medical records documenting their disability as evidence for their claim. It can be a good idea to make sure this process is not only handled correctly but also to submit additional forms of evidence, as medical records may not fully or accurately document your disability. A long-term disability attorney can help you determine what other forms of evidence may be best for your claim, such as reports from your doctor, statements from friends or coworkers, or additional evaluations from outside experts. The long-term disability attorneys at Chisholm Chisholm & Kilpatrick have connections to vocational experts who can evaluate the functions of your occupation as well as medical professionals who can perform additional physical or cognitive evaluations.
An attorney can also help assist your doctor in understanding your definition of disability so that they can complete your claim forms accurately. A lawyer may be able to bridge the gap between the insurance company and your doctor to clarify exactly what is required so all documentation is submitted correctly.
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Disability Insurance Claims Process
Disability insurance companies may deny claims based on technicalities. The insurance companies will use their own paid medical consultants to provide input despite never having met you. These insurance company medical consultants will often even disagree with your own treating physician who sees you on a regular basis. Then the insurance company will often accept its own medical consultants opinion regarding disability and disregard the opinion of your treating physician completely.
The insurance company will also ask you to sign forms authorizing the collection of personal information. They will even hire private investigators to investigate, follow, and take video of you to destroy your disability claim. The disability insurers will often use your signed authorization forms to collect medical and other personal records dating back years and years prior to your disability to support any conceivable argument to deny your claim, invading your personal privacy and exposing background information that is absolutely unrelated to your disability. Hire an ERISA attorney as soon as possible.
When Should I Apply For Long
While you arent eligible to receive long-term disability benefits until after your policys elimination or waiting period, you can and should begin the application process as soon as you anticipate that your disability will continue to prevent you from being able to work.LTD claims can take weeks to prepare and submit. You will also likely be asked by the insurance company to provide further information, medical records and reports which add to the delay in processing your application.Most long-term disability policies also have a limit for the length of time after becoming disabled that you are allowed to make a claim. If you do not apply for benefits before the deadline set out in your policy, your insurance company will deny your claim.
Insurance Companies Can Deny Valid Disability Insurance Claims
It has become common practice for insurance companies to systematically deny valid disability insurance claims as a means of containing costs and increasing profits.
Insurance companies that commonly issue disability policies are:
Our attorneys represent disabled claimants in all 50 states against providers of group and private long term disability insurance. Learn more about how to fight these specific insurance companies.
We understand how LTD insurance works, and why insurers deny benefits. Our goal as disability claim attorneys is to protect you from abusive tactics by the insurance companies and recover all long term disability pay you are entitled to receive. If you were denied disability benefits, contact us right away. Becoming disabled can have a devastating financial impact by stripping you of your ability to make a living. When you file a claim to receive long term disability benefits and your insurance company denies your claim you need strong legal representation when appealing these claims.
What Are My Options If My Long Term Disability Claim Is Denied Or Cancelled
So often, the battle isnt over the merits of the case, the battle is with the insurance companys unwillingness to fairly pay claims. To that end, the insurance company has a team of attorneys working on their behalf.
To greatly improve the chances of winning your appeal or even later in litigation, you need the same. It is critical that you have an experienced disability lawyer on your side who has fought and won long term disability claim cases many times.
A disabled claimant is naturally the ideal victim. When youre too sick to work, you are also too sick to fight the insurance company. Long term disability lawyer Marc Whitehead is dedicated to fighting these cases, changing lives for the better, and making justice a reality for each client.
If your claim for disability benefits is denied, there are deadlines and requirements that you must comply with. Therefore, time is of the essence.
To speak with us about your disability claim, call or ask a disability lawyer about your LTD claim online.
About Marc Whitehead
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Short & Long Term Disability Benefits
Employer provided disability insurance benefits, which are governed by the Employee Retirement Income Security Act , pays a portion of a claimants earnings if they cannot work because of illness or injury. Typically, the first six months of disability insurance benefits are paid by what is referred to as short term disability insurance. Typically, the benefits paid thereafter until the age of 65 are paid by long term disability insurance.
The ERISA claim regulations apply to both STD and LTD insurance benefits. While STD insurance and LTD insurance pay benefits, the terms under which such benefits are paid and calculated differ significantly.
The STD insurance benefits claim may or may not be subject to a pre-existing condition clause. The LTD insurance benefits claim is always subject to a pre-existing condition clause which may be avoided in certain circumstances.
The LTD insurance benefits are subject to more defenses to the obligation to pay than STD insurance benefits. One such defense is the limitation of benefits to 24 months for disability based on a mental or nervous condition and/or alcohol/drug abuse. Some insurance policies also have a similar limitation for subjective symptoms which cause disability.
How Disabled Do I Have To Be In Order To Get Long
You must be totally disabled from your current occupation.However, this does not necessarily mean that you have to be completely physically incapable of performing all aspects of your job.The test is whether your injuries prevent you from performing the substantial and important duties of your job.
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What Your Disability Lawyer Will Do
The immediate goal is to remove the stress you and your family are experiencing due to a denial by the insurance company. Whether you are suffering from a long-term disability or from a partial disability, we specialize in cases involving Short Term Disability and Long Term Disability Insurance Policies and Canada Pension Plan Disability Claims. Himelfarb Proszanski also has an employment law group that ensures your employment rights are protected with your employer. No other personal injury law firm can provide this added service. Thats part of the HimPro Advantage.
What They Say About Us
“I had a client who got in an accident and was severely injured. Mr. David Himelfarb took her case and he not only provide her many health services throughout two years from the insurance company but his team was always there for client to support her with all kind of information related to her case. They took all the stress of dealing with the insurance company away so she could focus on healing physically and emotionally. With the good experience and two years of hard work of Mr. Proszanski and his team, my client finally got a fair settlement from the at-fault driver. I highly recommend everyone to Mr. David Himelfrab and his law firm.”
“My mother had hired this firm after struggling for her disability claim. Mena Brar and Silene were really helpful and brought us the best. I would recommend hiring based on my mother’s experience.”
“First and foremost David believed me ie that I was mentally unfit to work. It is not an easy concept. He made it clear to RBC. David supported me throughout mediation and I received much more than anticipated. Thank you so much.”
Compassionate during stressful times, and performance focused. My outcome was far better than expected and has allowed me to get on with my life. David is a very sharp lawyer and obviously very experienced. Hopefully I don’t have another accident, but if I did, I’d use them again.
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Why Did My Insurance Company Stop My Benefits After Two Years
Under most long-term disability plans, the insured will receive benefits if they are totally disabled from performing their “own occupation”.After two years, the policy will only pay out benefits if the person is totally disabled from performing “any occupation”.This is called a “change in definition”.
Long Term Disability Client California
We as a society are not prepared to deal with catastrophic illness, and although I was smart enough to have taken out a Long-term Disability policy in my thirties, the third-party administrator for the policy has a reputation for being unethical. After my fourth case manager in four years, it became evident that the firmRead MoreLong Term Disability Client California
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How The Long Term Disability Process Works
The application process for long term disability insurance benefits can be challenging, requiring endless paperwork, doctor forms, and medical records being. We can help.
Once denied, the appeal process may be your only chance to submit evidence to protect your benefits. You truly need a lawyer to appeal, before a lawsuit is your only option.
Applications and appeals proving disability are denied. If so, there may come a time when your only remaining option is to file a lawsuit. We sue insurance companies to recover the benefits you are owed.
Lump sum settlements can occur at various stages of the disability claim process. We can negotiate with the insurance company on your behalf to recover the most money possible.
What Can A Long
Employer-provided group LTD insurance is governed by ERISA, the Employee Retirement Income Security Act, a federal law that provides for very specific procedures and time limits for filing LTD claims. A lawyer experienced with long-term disability claims will know how to abide by the ERISA rules and help you succeed, especially in the following areas.
Plain English Guide To Long
Long-term disability insurance is a form of financial protection when you lose your income because you cannot work. Instead, you receive monthly insurance payments. But many insurance companies find reasons to deny your LTD claim, which is why you need an LTD lawyer at Verkhovets Law. With monthly insurance payments, you have money to pay bills and maintain a lifestyle similar to what you had while working. LTD payments do not replace 100 per cent of your salary, however.According to a 2019 Group Long-Term Disability Termination Study published by the Canadian Institute Actuaries, each year 53,000 Canadians get approved for group long-term disability benefits. One in six Canadians will be disabled for three months or longer by the age of 60. It is helpful to retain an LTD lawyer at Verkhovets Law who is experienced at handing LTD claimsand dealing with insurance companies.The reasons for disability may include mental illness , chronic medical conditions and injuries , and many other health conditions.
There Are Typically A Few Steps In The Appeals Process At Each Stage It Is Possible For Your Claim To Be Approved The Possible Stages Include:
- Internal appeals Employees at the insurance company will take another look at your application and will reconsider the denial decision. Most companies allow for two or three rounds of internal appeals before the appeal must move on to the next stage.
- Appeal by lawsuit If internal appeals prove unsuccessful, you could file a lawsuit to challenge the companys decision. This will put your claim in front of a judge or jury to decide whether you qualify for benefits. The decision will be enforced on both you and your LTD insurer. If your lawsuit is successful, you could also be eligible to collect compensation for additional damages, including mental distress caused by the denial and financial losses, like your legal costs.
- Out-of-court settlement At any time during the appeal by lawsuit, the insurer could offer you a one-time, lump-sum settlement. This is usually offered in exchange for dropping the lawsuit and agreeing not to seek benefits under the plan. These lump-sum settlements will usually include payment for past and future benefits but might be limited to a specific years worth of payments, which might not be the actual amount that youre entitled to.
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